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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:331 - 1983年9月20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 篇文章中,我X 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 the payment of a dismemberment benefit to an Employee by the 雇主 under the terms of the 雇主’s Benefit Plan, 在此发表他们对此事的看法.

背景事实

12月17日, 1979, the Complainant sustained a compensable injury while employed in classified work for the Respondent. The Complainant was involved in an automobile accident on December 19, 1980, while recuperating from his mining injury and during his period of continuation of coverage under the 雇主’s Benefit Plan. He sustained a spinal injury in the automobile accident which resulted in the paralysis of his legs.

争端

Is the Respondent responsible for the payment of a dismemberment benefit to the Complainant?

双方立场

Position of Complainant’s Representative: He asked whether or not the Complainant is entitled to a dismemberment benefit as outlined in the 1978 Wage Agreement, 因为他的腿已经不能用了.

Position of 被申请人: The Complainant has not suffered a severance of his feet at or above the ankle. 因此, he has not suffered a dismemberment under the 雇主’s Benefit Plan.

相关的规定

Article XX of the National Bituminous Coal Wage Agreement of 1978 provides:

General Description of the Health and Retirement Benefits

The following is a general description of certain information contained in the UMWA 1950 Pension and Benefit Plans and Trusts, 1974年UMWA养老金计划和信托皇冠搏彩中心网站, 个人健康和福利计划. The description is intended merely to highlight certain information; it is not a complete statement of all of the provisions of the Plans and Trusts, nor is it intended to be a Summary Plan Description as defined in the Employee Retirement Income Security Act of 1974, 而且完全是由, and subject to the more detailed information contained in the Plans and Trusts, copies of which are on file and available for inspection at the offices of the United Mine Workers of America Health and Retirement Funds, K街2021号, N.W.华盛顿特区.C. 20006.

Paragraph (8)(c) of the General Description of the Health and Retirement Benefits provides:

(8) Life and Accidental Death and Dismemberment Benefits:

第一次, effective immediately under the terms of this Agreement, Life and Accidental Death and Dismemberment Insurance benefits will be provided by the 雇主 for working miners 按照以下时间表:

(c) If a working miner should lose two or more members due to violent, 外部和偶然的手段, 矿工将得到12美元,肢解津贴. If a working miner shall lose one member due solely to violent, 外部和偶然的手段, 矿工将得到6美元,肢解津贴. A member for the purpose of the above is (i) a hand at or above the wrist, (ii) a foot at or above the ankle or (iii) total loss of vision in one eye.

篇文章中,我. (1), (2) and (4) of the 雇主’s Benefit Plan provides:

第一条-定义

The following terms shall have the meanings herein set forth:

(1) “雇主”指(煤炭公司)

(2) “Wage Agreement” means the National Bituminous Coal Agreement of 1978, as amended from time to time and any successor agreement.

(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. 雇主福利计划C(3)规定:

第二条-资格

The persons eligible to receive the health benefits pursuant to 第三条 are as follows:

C. 残疾员工
In addition to disabled Pensioners who are receiving pension benefits and are 因此 entitled to receive health benefits under paragraph B of this 第二条, health benefits under 第三条 shall also be provided to any Employee who:

(3) Is receiving 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. B.(1)(c)雇主福利计划规定:

第三条-福利

B. Life and Accidental Death and Dismemberment Insurance

(1) 积极的员工

Life and accidental death and dismemberment insurance will be provided for Employees, 如第二条所述, A和C部分(3), 按照以下时间表:

(c) If an Employee shall lose two or more members due to violent, 外部和偶然的手段, 该员工将获得12美元,肢解津贴. If an Employee shall lose one member due solely to violent, 外部和偶然的手段, 该员工将获得6美元,肢解津贴. A member for the purpose of the above is (i) a hand at or above the wrist, (ii) a foot at or above the ankle or (iii) total loss of vision of one eye.

讨论

The Complainant sustained a spinal injury in an automobile accident on December 19, 1980, 导致他失去了双腿的功能. The Complainant’s continuation of benefits coverage expired on December 31, 1980. 因此, the injury occurred during his period of eligibility for benefits coverage under the 雇主’s Benefit Plan.

第三条. 雇主福利计划B (1)(c)项, 3月27日生效, 1978, provides a dismemberment benefit for the loss of a “foot at or above the ankle.” The loss of a member, as defined in the Plan, includes the loss of use of a member. 申诉人失去了两名成员, 因此, 有权根据本计划领取肢解津贴.

受托人的意见

The Trustees are of the opinion that the 雇主 is responsible for payment of a dismemberment benefit.