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受托人的意见
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在再保险

原告: 员工
被申请人: 雇主
ROD案例编号: 1988年6月28日

董事会:Joseph P. 康纳斯,老., Chairman; Paul R. 院长,受托人;
威廉·B. Jordan,受托人; William Miller,受托人; Donald E. 皮尔斯,小.,受托人.

Pursuant to Article IX of the United Mine Workers of America (“UMWA”) 1950 Benefit Plan and Trust, and under the authority of an exemption granted by the United States Department of Labor, the Trustees have reviewed the facts and circumstances of this dispute concerning health benefits coverage for a disabled 员工 under the terms of the 雇主 Benefit Plan.

背景事实

原告, 谁的出生日期是11月20日, 1932, sustained a compensable injury while performing classified work for the Respondent on January 2, 1985. 是那次受伤的结果, the Complainant has been unable to return to work and is receiving Workers’ Compensation benefits. 投诉人现年55岁, 根据皇冠搏彩中心网站的记录, he has 10 3/4 years of credited coal industry service. The representative for the Complainant states that the Respondent terminated health benefits coverage for the Complainant as a disabled employee, 2月19日生效, 1988, because the Complainant had attained age 55 and is eligible for a pension. The representative further states that if the Complainant retired at age 55, he would receive a Deferred Vested pension based on less than 20 years of credited service and would not be eligible for health benefits coverage as a Pensioner. The representative for the Complainant contends that the Complainant is entitled to health benefits coverage as a disabled 员工 beyond his 55th birthday.

The Respondent states that the Complainant was eligible for health benefits coverage as a disabled employee until November 20, 1987, 他达到退休年龄的日期, but due to an oversight the Complainant received coverage until February 1988. The Respondent maintains that the Complainant is not entitled to any additional period of coverage under 第二条 C. of the 雇主 Benefit Plan because the Complainant is not between the ages of 51 and 55.

争端

Whether the Respondent is responsible for providing health benefits coverage for the Complainant as a disabled 员工 pursuant to 第二条 C. (2)雇主福利计划.

双方立场

Position of the 原告: The representative for the Complainant contends that the Complainant is entitled to health benefits coverage as a disabled 员工 under 第二条 C. (2)过了55岁生日.

Position of the 被申请人: 原告 is not entitled to any additional period of coverage under 第二条 C. (2) because the Complainant is no longer between the ages of 51 and 55.

相关的规定

Article I (1), (2) and (4) of the 雇主 Benefit Plan provide:

第一条-定义

The following terms shall have the meanings herein set forth:

(1) “雇主”指(雇主名称).

(2) “Wage Agreement” means the National Bituminous Coal Wage Agreement of 1988, as amended from time to time and any successor agreement.

(4) “员工” shall mean a person working in a classified job for the 雇主, 有资格获得本协议项下的福利.

第二条. C. (2)雇主福利计划规定:

第二条-资格

C. 残疾员工

In addition to disabled Pensioners who are receiving pension benefits and are therefore entitled to receive health benefits under paragraph B of this 第二条, health benefits under 第二条I shall also be provided to any 员工 who:

(2) Becomes totally disabled due to a compensable disability within four years of the date the 员工 would -be eligible to receive a pension under the 1974 Pension Plan or any successor thereto, as long as the 员工 continues to be so disabled during the period for which Workers’ Compensation payments (Worker’s Compensation does not include Federal Black Lung Benefits) are applicable;

讨论

第二条. C. (2)雇主福利计划 provides health benefits coverage for an 员工 who “becomes totally disabled due to a compensable disability within four years of the date the 员工 would be eligible to receive a pension under the 1974 Pension Plan.” The clause “within four years of the date the 员工 would be eligible to receive a pension ” (emphasis added) indicates that the 员工’s disability must occur within the four year period preceding the date the 员工 becomes eligible for a pension. 因此，第二条C款的措词. (2) limits coverage under that provision to certain disabled 员工s who are not yet eligible for a 1974 Pension Plan pension.

The 1974 Pension Plan provides that pension benefits are to be provided to “[a]ny participant who (a) has at least 10 years of signatory service… and (b) has attained the age of 55 years …” Inasmuch as the Complainant has 10 3/4 years of credited signatory service and attained age 55 on November 20, 1987, the Complainant is eligible for a 1974 Plan pension. 相应的, the Complainant is not entitled to any additional health benefits coverage as a disabled 员工 under 第二条 C. (2)雇主福利计划.

受托人的意见

The Respondent is not responsible for providing any additional health benefits coverage for the Complainant as a disabled 员工 pursuant to 第二条 C. (2)雇主福利计划.