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受托人的意见
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在再保险

原告: 未亡配偶
被申请人: 雇主
ROD案例编号: 81-261——1986年4月29日

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

根据美国煤矿工人联合会(“UMWA”)1950年福利计划和信托的第九条, 并根据美国劳工部授予的豁免授权, the Trustees have reviewed the facts and circumstances of this dispute concerning eligibility for health benefits coverage for a surviving spouse under the terms of the 雇主 Benefit Plan.

背景事实

The Complainant is the surviving spouse of a classified Employee who worked for the 被调查者 from October 1978 until March 25, 1980年，他声称自己因工作受伤. 他没有回去工作，而且, 10月14日, 1980, 29岁时, 他死于一场车祸.

1982年6月, 州工人赔偿委员会驳回了申诉人基于工伤提出的索赔, 但, 关于职业病的索赔, 判给投诉人的利益, 作为雇员的遗孀, 追溯至3月24日, 1980.

被投诉人根据第三条向投诉人支付了人寿保险赔偿金.B.1. of the 1978 雇主 Benefit Plan and provided health benefits coverage for approximately one year following the Employee’s death. 被调查者, 独资企业, 是1981年工资协议的签署人吗, 但于1981年12月停止运营. Funds’ staff has determined that 被调查者 does not satisfy the no longer in business criteria of the UMWA 1974 Benefit Plan.

争端

Is the 被调查者 responsible for the provision of health benefits to Complainant and her dependent children?

双方立场

Position of the 原告: Either the 被调查者 or the UMWA 1974 Benefit Trust is responsible for additional health benefits coverage for Complainant and her dependent children.

Position of the 被申请人: 被调查者 ceased operating in December 1981 and is not able to provide health benefits to Complainant and her dependent children.

相关的规定

第二条.E.1978年雇主福利计划第(3)(ii)条规定:

E. 已故雇员或退休人员的尚存配偶及受养人

Health benefits under 第三条 shall be provided to (i) any unmarried surviving spouse and (ii) such spouse’s unmarried surviving dependent children as defined in subparagraphs (2) and (5) of paragraph D, 雇员或领取退休金人士的死亡∶

3. At a time when such Employee or Pensioner is entitled to receive health benefits pursuant to paragraph A, B, (二)本条第(三)款, provided that (ii) if such Employee or Pensioner died on or after the effective date of the Wage Agreement and the spouse is not eligible for a 未亡配偶’s benefit and life insurance benefits or death benefits are payable in a lump sum, then only for 60 months following the month of the death of such Employee or only for 22 months following the month of death of such Pensioner. 如果不支付人寿保险赔偿金或死亡赔偿金, health benefits shall be provided only to the end of the month in which the Employee or Pensioner died.

第二条.E.1981年雇主福利计划第(3)(i)及(ii)条规定:

E. 已故雇员或退休人员的尚存配偶及受养人

Health benefits under 第三条 shall be provided to (i) any unmarried surviving spouse (who was living with or being supported by the Employee or Pensioner immediately prior to the Employee’s or Pensioner’s death) and (ii) such spouse’s unmarried surviving dependent children as defined in subparagraphs (2) and (5) of paragraph D, 雇员或领取退休金人士的死亡∶

3. At a time when such Employee or Pensioner is entitled to receive health benefits pursuant to paragraph A, B, (二)本条第(三)款, provided that (i) if such Employee or Pensioner died prior to the effective date of the Wage Agreement and the spouse is not eligible for a 未亡配偶’s benefit, then only for the period that the spouse is eligible to receive death benefits in installment payments pursuant to paragraph C of 第三条, or (ii) if such Employee or Pensioner died on or after the effective date of the Wage Agreement and the spouse is not eligible for a 未亡配偶’s benefit and life insurance benefits or death benefits are payable in a lump sum, then only for 60 months following the month of the death of such Employee or only for 22 months following the month of death of such Pensioner. 如果不支付人寿保险赔偿金或死亡赔偿金, health benefits shall be provided only to the end of the month in which the Employee or Pensioner died.

第三条.C. 1981年雇主福利计划规定:

C. 死亡的好处

(1) 1977年12月6日前死亡

对于截至12月5日仍在领取抚恤金的案件，应继续支付死亡抚恤金, 1977, 根据1974年福利计划, 供已故雇员及退休人士使用, 谁的最后一次机密工作是在雇主那里, 以同样的方式和同样的数量, 如1974年福利计划所规定.

(2) 1977年12月5日以后和1978年3月27日以前的死亡人数

死亡抚恤金应支付给在12月6日及12月6日之间死亡的人, 1977, 在3月27日之前, 1978, 适用于最后受雇于雇主的雇员及退休人员, 以及截至12月5日参加1974年福利计划的人, 1977, 以同样的方式和同样的数量, 如1974年福利计划所规定.

第二条.D.1974年UMWA福利计划的(3)(c)(ii)项, 6月7日生效, 1981, provides health benefits to the surviving spouse of an Employee whose last signatory employer is no longer in business, 如下:

(ii) if such Employee or Pensioner died on or after 1978年工资协议的生效日期 and the spouse is not eligible for a 未亡配偶’s benefit and life insurance benefits or death benefits are payable in a lump sum, 然后仅在该养恤金领取者死亡当月之后的60个月内领取. 如果人寿保险赔偿金不支付, health benefits shall be provided only to the end of the month in which the Employee or Pensioner died.

讨论

第二条.E.(3)(ii) of the 1978 雇主 Benefit Plan provides that the surviving spouse of an Employee who died on or after the effective date of the [1978] Wage Agreement is entitled to health benefits from the 雇主 for 60 months. 答辩人仅在雇员死亡后提供了约12个月的养恤金.

1974年的福利计划和信托, 6月7日生效, 1981, provides health benefits for 60 months to the unmarried surviving spouse of an Employee who “died on or after 1978年工资协议的生效日期,” and who would have been eligible for health benefits because his last signatory employer is no longer in business after June 6, 1981. 1981年雇主福利计划第2条的相应部分.E.(3)(ii), also provides 60 months of health benefits to the surviving spouse of an Employee who “died on or after the effective date of the Wage Agreement,，但没有具体说明是哪一份工资协议. 鉴于1974年福利计划的平行规定, 然而, 看来这里指的是1978年的工资协定.

此外，第二条.E.1978年及1981年雇主福利计划的第(3)(i)款, 在《皇冠搏彩中心》生效日期前去世的雇员的遗孀有何关系, provides health benefits based upon the period death benefits are paid in installments pursuant to paragraph C of 第三条. 第三条.C. 具体指的是12月6日之前的死亡抚恤金, 1977年12月5日至12月5日期间死亡的死亡抚恤金, 1977年和3月27日, 1978, 1978年工资协议的生效日期. 根据1978年工资协议和1978年雇主福利计划, 代替死亡抚恤金, 人寿保险是一次性支付的, and the period of eligibility for health benefits depended only upon the receipt of life insurance benefits.

相应的, 受托人认为，第2条中提到的“工资协议”.E.1981年雇主福利计划的第(3)条与1978年工资协议相一致. 因此，根据第二条的规定.E.1978年和1981年雇主福利计划的第(3)(ii)款, 申诉人在其丈夫去世后有资格获得60个月的医疗福利.
The Complainant also asked whether the 1974 Benefit Plan and Trust is responsible for the provision of her health benefits. The 1974 Benefit Plan provides health benefits only to the surviving spouse of an Employee whose last signatory employer is no longer in business within the meaning of the Plan. Inasmuch as an audit by Funds’ staff revealed that the 被调查者 does not meet the no longer in business criteria, 投诉人没有资格获得1974年福利计划下的福利.

受托人的意见

The 被调查者 is responsible for providing health benefits to Complainant and her dependent children for 60 months following the death of Complainant’s husband.