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受托人的意见
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在再保险

原告: 残疾员工
被申请人: 雇主
ROD案例编号: 88-251 - 1990年4月30日

董事会:Joseph P. 康纳斯,老., Chairman; Paul R. Dean, Trustee; William Miller, Trustee; Donald E. 皮尔斯,小., Trustee; Thomas H. Saggau,受托人.

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

背景事实

原告, 谁的生日是11月11日, 1941, 于四月二十六日起受雇于答辩人担任保密职位, 1988年至6月17日, 1988, 当他因为健康问题停止工作时, 包括呼吸急促, 关节炎和听力损失. 原告 applied for Social Security Disability Insurance (“SSDI”) benefits on August 1, 1988. 他的申请最初被拒绝了, 但在5月9日的上诉中被行政法法官批准, 1989, when the Complainant was awarded SSDI benefits for a period of disability commencing June 17, 1988. 7月27日, 1989, 肯塔基州联邦行政法法官, Department of Workers’ 索赔 determined that the Complainant is suffering an occupational disability of 100 percent due to pneumoconiosis; benefits for such disability were awarded with an effective date of June 17, 1988.

在8月22日的信中, 1989, the Funds notified the Complainant that he may be eligible for health benefits coverage as a disabled Employee because he is eligible for SSDI benefits 和 will be eligible upon attaining age 55 to receive a pension based on 22 3/4 years of credited signatory service. 原告 was advised by the Funds to contact his last signatory 雇主, 被申请人, 确定他的资格.

原告 states that 被申请人 has refused to provide health benefits coverage for him as a disabled Employee. 答辩人声明, because the Complainant was employed by 被申请人 for only a short period of time, it is not likely that he acquired his type of disability while so employed. The Respondent therefore contends that it is not responsible for providing health benefits coverage to the Complainant as a disabled Employee. 除了, 被申请人 states that it is financially unable to provide health benefits coverage for the Complainant at the present time.
争端

Is 被申请人 responsible for providing health benefits coverage for the Complainant as a disabled Employee?

双方立场

Position of the Complainants: The Respondent is responsible for providing health benefits coverage for the Complainant as a disabled Employee.

Position of 被申请人: The Respondent is not responsible for providing the Complainant’s health benefits coverage since the Complainant’s disability is not likely a result of his brief classified employment with 被申请人, 和 被申请人 is financially unable to provide health benefits coverage for the Complainant.

相关的规定

雇主福利计划第I(1)、(2)、(4)条规定:

第一条-定义

下列术语具有本协议规定的含义:

(1) “雇主”指(雇主名称).

(2) “Wage Agreement” means the National Bituminous Coal Wage Agreement of 1988, 如不时修订及任何后续协议.

(4) “Employee” 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.

第二条丙. (1)雇主福利计划规定:

第二条-资格

C. 残疾员工

除了 to disabled Pensioners who are receiving pension benefits 和 are therefore entitled to receive health benefits under paragraph B of this Article II, health benefits under Article III shall also be provided to any Employee who:

(1) (a) 已完成20年的信用服务, including the required number of years of signatory service pursuant to Article IV C(6) of the 1974 Pension Plan or any corresponding paragraph of any successor thereto, 和

(b) 没有达到55岁，并且

(c) became disabled after December 6, 1974 while in classified employment with the 雇主, 和

(d) is eligible for Social Security Disability Insurance r Benefits under Title II of the Social Security Act or its successor.

讨论

根据第二条. (1)雇主福利计划, an Employee is eligible for health benefits coverage as a disabled Employee if he meets the following requirements: (a) has completed 20 years of credited service, including the required number of years of signatory service; (b) has not attained age 55; (c) became disabled after December 6, 1974 while in classified employment with the 雇主; 和 (d) is eligible for Social Security Disability Insurance benefits. 投诉人显然符合第二条的要求. C. (1) (a)、(b)及(d). The issue here is whether the Complainant became disabled while in classified employment with 被申请人.

投诉人于六月十七日停止为被投诉人工作, 1988年因致残健康问题, 包括呼吸急促, 关节炎, 还有听力损失. 这一结论得到了肯塔基州联邦的支持, Department of Workers’ 索赔 determination that the Complainant was 100 percent disabled due to occupational pneumoconiosis as of June 17, 1988, 和 the Complainant’s award of SSDI benefits for a period of disability commencing June 17, 1988. 因此, the Complainant must be deemed to have been in the classified employment of 被申请人 when he became disabled. Therefore, the Complainant has met each of the eligibility requirements of 第二条丙.(1)雇主福利计划. The Respondent’s claim that it is financially unable to provide health benefits does not relieve it of its obligation to provide such benefits under the Wage Agreement. 相应的, 被申请人 is responsible for providing the Complainants health benefits coverage as a disabled Employee.

受托人的意见

The Respondent is responsible for providing health benefits coverage for the Complainant as a disabled Employee as of June 17, 1988.