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OPINION OF TRUSTEES
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In Re
Complainant: Employee
Respondent: Employer
ROD Case No: 267, July 27, 1982
Board of Trustees: Harrison Combs, Chairman; John J. O’Connell, Trustee; Paul R. Dean, Trustee.
Pursuant to Article IX of the United Mine Workers of America 1950 Benefit Plan and Trust, and under the authority of an exemption granted by the United States Department of Labor, 受托人审查了有关根据雇主福利计划条款向残疾雇员提供健康和其他非养老金福利的争议的事实和情况，并在此就此事发表意见.
Background Facts
The Employee worked for the Employer from October 29, 1980, until December 20, 1980. On December 20, 1980, he was injured in a mine accident and has not worked since that time as a result of the injury. By letter dated May 7, 1982, 雇员的医生指出，雇员在矿难后已完全残疾. 雇员领取了五个星期的工人补偿福利，直到他提出永久完全残疾福利的索赔. He has applied for Social Security Disability benefits, but has not yet received a decision.
The Employer provided him with benefits coverage from his last date worked until April 1, 1981. 雇主签署了1978年的全国烟煤工资协议，并签署了1981年的协议. Although the Employer closed the mine where the Employee last worked, he is currently operating other mines.
Dispute
Is the Employer responsible for the provision of benefits coverage to the Employee beyond April 1, 1981?
Positions of the Parties
雇员职位:他认为雇主应提供自最后一次工作之日起52周的福利.
雇主立场:雇主未回复信件，电话联系不上.
Pertinent Provisions
Article XI, 《皇冠搏彩中心》第(b)节有关部分规定:
因疾病或意外事故致残的在雇主处工作6个月或6个月以上的雇员, 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. 在担任雇主的分类雇员期间，因矿难而致残的雇员，自其分类受雇的第一天起，有资格领取疾病和事故津贴. 在雇员未接受执业医生治疗的任何期间内，不得支付福利.
Article XI, 《皇冠搏彩中心》第(c)节有关部分规定:
Benefits for disability resulting from an accident, either on or off the job, shall be payable for a maximum of 52 weeks, 无论事故发生时雇员在雇主的分类雇佣期有多长.
Article XI, 《皇冠搏彩中心》第(d)节有关部分规定:
雇员在残疾期间根据本协议领取工资津贴的任何日子不得支付疾病和事故福利, 但雇员有资格享受的疾病和事故福利的期限应延长同等天数.
Article III, Section E. (1) of the Employer’s Benefit Plan, as adopted in 1978, which provides:
E. General Provisions
(1) Continuation of Coverage
(a) Layoff
If an Employee ceases work because of layoff, continuation of health, vision care, life and accidental death and dismemberment insurance coverage is as follows:
Number of Hours Worked
for the Employer in the Period of Coverage
24 Calendar Month Period Continuation from the
Prior to the Date Last Worked Date Last Worked
2,000 or more hours Balance of month plus
12 months
500 or more but less than Balance of month plus
2,000 hours 6 months
Less than 500 hours 30 days
(b) Disability
Except as otherwise provided in Article II, Section C, if an Employee ceases work because of disability, the Employee will be eligible to continue health, vision care, 身残时的人寿、意外死亡和肢解保险，以(i)有资格领取疾病和意外福利金的期间较长者为准, or (ii) the period as set forth in the schedule in (a) above.
Article III, Section E. (2) of the Employer’s Benefit Plan, is adopted in 1973, which provides:
In the event of an economic strike at the expiration of the 1978 Bituminous Coal Wage Agreement, the Employer will advance the premiums for its health, vision care, 以及罢工头10天的人寿、意外死亡和肢解保险. 这些预付保险费应在这些雇员返回工作岗位时通过支票扣除的方式偿还给雇主. Should such a strike continue beyond 30 days, the Union or such Employees may elect to pay premiums themselves.
Question and Answer P-16, 由受托人根据1974年美国联合煤矿工人福利计划授权通过, which provides in pertinent part:
Introduction
NBCWA第11条规定了对收入损失的赔偿，以保护符合条件的雇员免受因工作中或工作外的疾病或事故造成的经济困难. 该条第(b)款包含员工获得补偿必须满足的资格要求. Other sections of that Article describe the procedures for filing claims and making payments.
1974年福利和养恤金计划还载有关于参与人领取疾病和意外津贴期间的特别规定&A Benefits),
The following issues arise under these Plan provisions;
(1) Q. May a participant receive pension credit and health benefits for periods he was eligible for S&因补偿或未及时向雇主提交残疾通知而未领取该等款项的?
A. Yes. 在参与者满足NBCWA第11条第(b)款的所有要求和限制并基于S索赔的期间内&A, he will be considered as “constructively receiving” S&A Benefits. Constructive receipt of S&A Benefits is the same as actual receipt of S&A Benefit payments for all purposes under the 1974 Benefit and Pension Plans.
Article II, Section A. (2) of the Employer’s Plan, as amended in 1981, which provides:
Benefits under Article III shall be provided to any employee who:
(2)被雇主解雇或残疾，并且在工资协议生效之日仍有资格享受1978年雇主福利计划(“先前计划”)的保险，是被解雇或残疾的雇员. 对这些下岗或残疾雇员的保险不得在他们根据先前计划的规定不再有资格获得此类保险的日期之后继续提供.
Discussion
Under Article III. Section E. (1) of the Employer’s Benefit Plan, as amended in 1978, 在残疾雇员有资格领取疾病和事故福利期间，向其提供健康和其他非养恤金福利. Under Article II, Section A. (2) of that Plan, as amended in 1981, 该等保险在雇员根据先前计划本应符合资格的期间内继续进行.
The Employee became disabled on December 20, 1980, as the result of an accident and has not returned to work. His disability has been certified by his physician. Therefore, he would be eligible to receive Sickness and Accident benefits under Article XI, Section (b) of the National Bituminous Coal Wage Agreement of 1978 from December 21, 1980 through December 31, 1981.
Consequently, under the Employer’s Benefit Plan, 雇员将有资格从12月21日起继续享受健康和其他非养老金福利, 1980, through December 31, 1981. However, during the period of the economic strike, which commenced on March 27, 1981, 雇主只负责预付雇员在罢工前30天的保险费, 但不负责支付员工在罢工期间的保险费用.
Opinion of the Trustees
受托人认为，雇主有责任在雇员最后工作日期之后提供福利, December 20, 1980, through December 31, 1981 (excluding the strike period).