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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: 81-488 - 1984年10月29日

Board of Trustees: Harrison Combs, Chairman; John J. 奥康奈尔,受托人;
Paul R. 迪恩,受托人.

Pursuant to Article IX of the United Mine Workers of America 1950 Benefit Plan 和 Trust, 并根据美国劳工部授予的豁免授权, the Trustees have reviewed the facts 和 circumstances of this dispute concerning the provision of health benefits coverage for a disabled Employee by the 雇主 under the terms of the 雇主’s Benefit Plan 和 hereby render their opinion on the matter.

背景事实

投诉人自四月二十四日起受聘于被投诉人从事保密工作, 1973, 至十二月二十九日, 1982. The Respondent’s records indicate that the Complainant was absent from work due to illness from November 12, 1982, 至十一月二十八日, 1982. 投诉人于12月31日被解雇, 1982, 并在12月31日之前由被告提供福利保险, 1983, 基于多于2000小时 worked during the 24 consecutive calendar month period immediately prior to his date last worked.

The Complainant filed for Social Security Disability Insurance Benefits under Title II of the Social Security Act 和 his benefits were approved effective June 1983. He filed an application for pension benefits under the 1974年退休金计划 on January 11, 1984.

4月13日, 1984, the Complainant was advised by letter that the Funds had reviewed his work history 和 on the basis of his 20 1/4 years of credited service, 加上他的年龄(55岁以下), 以及他获得社会保障残疾保险金的证据, 已经确定，他可能有资格作为残疾矿工享受医疗福利. 有人建议他联系上一个签字的雇主, 被申请人, 谁也收到了那封信的副本.

The Respondent does not disagree that the Complainant has the required credited service in the coal industry to qualify for a pension at age 55 和 that he is receiving Social Security Disability Benefits. The Respondent contends the Complainant was physically able to perform his classified duties up to the date of layoff 和 that 被申请人’s obligation to provide him with the respondent’s benefits coverage relates to his status as of December 29, 1982, 他上次约会成功了.

The Respondent has not provided the Complainant with health benefits coverage since December 31, 1983.

争端

Is 被申请人 responsible for the provision of health benefits coverage for the Complainant 和 his eligible dependents?
双方立场

Position of the Complainant’s Representative: Is 被申请人 responsible for the provision of health benefits coverage for the Complainant?

Position of 被申请人: Any disability which ensued subsequent to the Complainant’s layoff has no bearing upon his present eligibility for continued health benefits coverage.

相关的参考文献

雇主福利计划第I、(1)、(2)、(4)和(9)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(煤炭公司).

(2) “工资协议”指1981年《官方网站》, 如不时修订及任何后续协议.

(4) “雇员”系指为雇主从事保密工作的人员, 有资格获得本协议项下的福利.

(9) “Signatory Service” shall have the meaning assigned to such term in the United Mine Workers of America 1974 Pension Plan (the “1974 Pension Plan) or any successor thereto.

第二条. C. 雇主福利计划的第(1)和(2)条规定:

第二条-资格

C. 残疾员工

In addition to disabled pensioners who are receiving pension benefits 和 are 因此 entitled to receive health benefits under paragraph B of this 第二条, 第3条规定的健康福利也应提供给下列任何雇员:

(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 Benefits under Title II of the Social Security Act or its successor;

雇主福利计划第III D(1) (a)和(b)条规定:

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, 人寿、意外死亡和肢解保险的保险范围如下:

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 继续
最后工作日期最后工作时间

2000小时以上 月余额加上12个月

500或更多，但少于 月余额加上6个月
2000小时

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 和 accidental death 和 dismemberment coverage while disabled for the greater of (i) the period of eligibility for Sickness 和 Accident benefits, 或(ii)上述(a)项附表所列期间.

讨论

根据第二条. C. (1)雇主的福利计划, a disabled Employee is eligible for benefits coverage if he has not attained age fifty-five; satisfies the twenty-year service pension Eligibility Requirement under the 1974年退休金计划; became disabled after December 6, 1974, while in classified employment with the 雇主; 和 is eligible for Social Security Disability Insurance (“SSDI”) benefits under Title II of the Social Security Act. The Complainant satisfies the service pension eligibility requirements of the 1974年退休金计划 和 is not yet age 55. 1983年6月，他获得了SSDI奖, which was five months after his date last worked but during his 12-month eligibility period for continuation of coverage. 这个奖项确定他是在1974年12月6日之后残疾的. The issue is whether the Complainant became disabled while in classified employment with the 雇主.

Article I (4) defines an “Employee” as a person working in a classified job for the 雇主, 有资格获得本协议项下的福利. Although the Complainant was not actively at work at the time of the onset of his disability, he was receiving benefits as an Employee on layoff pursuant to 第二条I D (1) 和 must, 因此, 被视为第I(4)条意义上的“雇员”. 因此, he also meets the requirement of having become disabled while in classified employment with the 雇主. Based on these facts the Complainant satisfies the benefits coverage eligibility requirements of 第二条. C. (1)雇主的福利计划.

相应的, the Complainant 和 his eligible dependents are eligible for benefits coverage under the 雇主’s Benefit Plan.

受托人的意见

The Respondent is responsible for the provision of health benefits coverage for the Complainant 和 his eligible dependents. Because the Complainant’s disability commenced during the period of continuation of benefits coverage as a laid-off miner, 被投诉人有责任从1月1日起提供这种覆盖, 1984, 报道结束后的第二天，被解雇的矿工, 和 continuing for as long as the Complainant continues to satisfy the above-referenced requirements.