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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 Case No: 81-445 – 1984年4月30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 (“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 provision of benefits coverage for a laid-off Employee by the 雇主 under the terms of the 雇主’s Benefit Plan. The Trustees hereby render their opinion on the matter.

背景事实

The Complainant’s classified employment for the Respondent began July 25, 1981. He continued his employment through December 3, 1982, when he became ill. He was absent from work through January 17, 1983. He worked until 1月21日, 1983, at which time he again became ill. 在这缺勤期间, the Respondent instituted a reduction in force and laid-off the Complainant effective 3月14日, 1983. The Complainant’s physician released him for work on April 25, 1983. During the Complainant’s period of employment with the Respondent, 7月22日起, 1981, 到1月21日, 1983, 他工作了两年多,000小时. The Respondent therefore provided continuation of coverage for the Complainant and his eligible dependents through January 31, 1984.

争端

Is the Respondent responsible for the provision of continuation of coverage for the Complainant and his eligible dependents after January 31, 1984?

双方立场

Position of the Complainant: The Respondent is responsible for the provision of continuation of coverage for 12 months after the date of lay-off, 3月14日, 1983.

Position of the 被申请人: The Complainant’s date last worked was 1月21日, 1983. The Respondent provided continuation of coverage for the Complainant through January 31, 1984年改编自他的2多部电影,000工作小时.

相关的参考文献

Article I (1), (2) and (4) of the 雇主’s Benefit Plan provide:

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, eligible to receive benefits hereunder.

第二条A款. (1) of the 雇主’s Benefit Plan provides:

第二条-资格

The persons eligible to receive the health benefits pursuant to Article III are as follows:

A. 积极的员工

Benefits under Article III shall be provided to any employee who:

(1) is actively at work for the 雇主 on the effective date of the Wage Agreement.

第三条D. (1) (a), (b) and (d) of the 雇主’s Benefit Plan provide:

第三条-福利

D. 一般规定

(1) 续保

(a) 裁员

If an Employee ceases work because of layoff, 健康的延续, life and accidental death and dismemberment insurance coverage is as follows:

工作时数
为雇主提供的表格
连续日历月 保险期限
紧接前一时期 继续从
雇员最后工作的日期 最后工作日期

2000小时以上 月结余
加12个月

500或更多但更少 月结余
2000小时以上 加6个月
少于500小时 30天

(b) 残疾

Except as otherwise provided in Article II, 部分C, if an Employee ceases work because of disability, the Employee will be eligible to continue health, life and accidental death and dismemberment insurance 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

In no event shall any combination of the provisions of (a), (b), (c) or (g) above result in continuation of coverage beyond the balance of the month 加12个月 from the date last worked.

讨论

Although the Complainant claims eligibility for continuation of coverage from the date he was laid-off, the schedule for the continuation of coverage under 第三条D.1. (a) provides that the period of coverage for a laid-off Employee is measured from the Employee’s date last worked.

The Complainant last worked on 1月21日, 1983, and ceased work because of disability. 根据第三条D款.1. (b) of the 雇主’s Benefit Plan, he was eligible for continued coverage for the balance of January 1983 加12个月. The Respondent correctly provided continuation of coverage for the Complainant from the Complainant’s date last worked, 1月21日, 1983, 第三条D款规定.1. (b). Therefore, it is not responsible for benefits coverage after January 31, 1984.

受托人的意见

The Respondent is not responsible for the provision of benefits coverage for the Complainant and his eligible dependents after January 31, 1984.