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受托人的意见
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在再保险
投诉人:残疾雇员
被申请人:雇主
ROD案例编号:88-657 - 1993年6月1日
董事会:Michael H. Holland, Chairman; Thomas F. Connors, Trustee; Marty D. Hudson, Trustee; Robert T. 华莱士,受托人.
The Trustees have reviewed the facts and circumstances of this dispute concerning the provision of health benefits coverage for an Employee under the terms of the Employer Benefit Plan.
背景事实
The Complainant began working in a classified position for the Respondent in August 1985 and last worked in a classified position on November 1, 1991年，该矿被闲置. 申诉人于11月17日被召回工作, 1991年，但因病无法重返工作岗位. On November 18, 1991 原告 underwent surgery to have a pacemaker implant. Funds’ records indicate that 原告 worked more than 2,在11月1日之前的24个月期间，共工作了000小时, 1991. 答辩人提供了疾病和事故(S&A)从1991年11月18日到1992年5月17日. The Respondent laid off its Employees and ceased operations at the end of December 1991. 根据向各皇冠搏彩中心网站提供的资料, 原告’s health benefits coverage was cancelled effective February 1, 1992.
The Complainant contends that the Respondent is required to provide health benefits coverage beyond February 1, 1992 for the remainder of his period of eligibility under the terms of the Employer Benefit Plan. The Complainant has submitted copies of unpaid medical bills incurred from February 1992 through June 1992, 还有催收公司的到期付款通知.
争端
Is the Respondent required to provide continued health benefits coverage for 原告 beyond February 1, 1992?
各方立场
Position of 原告: The Respondent is required to provide health benefits coverage for 原告 beyond February 1, 1992.
Position of the Respondent: The Respondent has not responded to repeated correspondence from Funds’ staff requesting its position in this dispute.
相关的规定
Article XI Sections (b) and (c) of the National Bituminous Coal Wage Agreement of 1988 provide in pertinent part:
(b)资格
Any Employee with six (6) months or more of classified employment with the Employer who becomes disabled as a result of sickness or accident, so as to be prevented from performing his regular classified job, and whose disability is certified by a physician legally licensed to practice medicine, shall be eligible to receive Sickness and Accident Benefits under this Plan.
第(c)节福利的开始和期限
Benefits for disability resulting from sickness shall be payable according to the following schedule:
分类长度 最大
受雇于雇主 的数量
残疾开始日期 周
至少6个月但不超过1年............. 6
至少1年 .................................... 13
至少5年但不超过10年............ 26
至少10年但不超过15年........... 39
15年以上 ................................... 52
Article I (1), (2) and (4) of the Employer 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, 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 Employer, 有资格获得本协议项下的福利.
第二条丙. (3)雇主福利计划规定:
第二条-资格
The persons eligible to receive the health benefits pursuant to Article III are as follows:
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 Article II, health benefits under Article III shall also be provided to any Employee who:
(3) 是接收还是会接收?, 正确应用后, be eligible to receive Sickness and Accident Benefits pursuant to the Wage Agreement.
Life and accidental death and dismemberment insurance shall also be provided to Employees described in (3) above.
第三条D. 雇主福利的(1)(a)、(b)和(d)条款规定:
第三条-福利
D. 一般规定
(1) 续保
(a) 裁员
如果雇员因裁员而停止工作, 健康的延续, life and accidental death and dismemberment insurance coverage is as follows:
工作时数
24 .雇主
连续日历月
紧接前一时期 保险期限
雇员入职日期 Continuation from Last Worked Date Last Worked
2000小时或以上 月加余额
12个月
500或更多，但少于 月加余额
2000小时 6个月
少于500小时 30天
(b) 残疾
第二条另有规定的除外, 部分C, 雇员因残疾而停止工作, 雇员将有资格继续保持健康, life and accidental death and dismemberment coverage while disabled for the greater of (I) the period of eligibility for Sickness and Accident benefits, or (ii) the period as set forth in the schedule in (a) above.
(d) 最大续保范围
在任何情况下，(a)条款的任何组合均不得, (b), (c), (e) or (g) above result in continuation of coverage beyond the balance of the month plus 12个月 from the date last worked.
讨论
第二条丙. (3) of the Employer Benefit Plan provides health benefits coverage for a disabled Employee who is receiving or would be eligible to receive Sickness and Accident Benefits pursuant to the Wage Agreement. 此外，第三条D.(1) (b) provides that an Employee who ceases work because of disability will be eligible to continue health, life and accidental death and dismemberment coverage while disabled for the greater of (i) the period of eligibility for Sickness and Accident benefits, or (ii) the period based on the number of hours worked as set forth in 第三条D. (1) (a). 根据1988年工资协定第11条, 原告, who ceased work because of disability resulting from sickness and whose length of classified employment with the Respondent was 6 years, is eligible for Sickness and Accident Benefits for a maximum of 26 weeks. 根据第三条D款. (1) (a)雇主福利计划, 原告 is entitled to continued benefits coverage for the balance of November 1991 plus 12个月, 或到1992年11月. 根据第三条D款. (1) (a) provides continued benefits coverage for the greater of these two periods, 原告 qualifies for benefits coverage for up to 12个月 beyond November 1991, 第三条所允许的最长期限. D.，前提是投诉人仍然残疾.
受托人的意见
The Respondent is required to provide health benefits coverage for 原告 and his eligible dependents for the remainder of his period of eligibility beyond February 1, 1992年至11月31日, 1992, 符合雇主福利计划的条款.