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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: 81-493——1986年4月29日

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

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, the Trustees have reviewed this Request for Resolution of 争端 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 miner who died as a result of a mine accident that occurred on June 12, 1979, while he was employed by the Respondent. The Respondent provided health benefits for the Complainant and her dependent children for 60 months and then terminated them, contending that it was not responsible for the provision of any further benefits. The Complainant claims that she is entitled to health benefits until remarriage under the terms of the 雇主 Benefit Plan.

争端

Is the Respondent responsible for the provision of health benefits coverage for the Complainant and her dependent children for more than 60 months after the death of the Complainant’s husband?

双方立场

原告: The Respondent is responsible for the provision of health benefits until remarriage under 第二条.E.(1) of the 雇主 Benefit Plan.

被申请人: The Complainant is entitled to only 60 months of benefits after her husband’s death.

相关的规定

第二条.E.(1) of the 1978 and 1981 雇主 Benefit Plans provides:

E. Surviving Spouse and Dependents of Deceased 员工s or Pensioners

Health benefits under 第二条I shall be provided to (i) any unmarried surviving spouse (who was living with or being supported by the 员工 or Pensioner immediately prior to the 员工’s or Pensioner’s death) and (ii) such spouse’s unmarried surviving dependent children as defined in subparagraphs (2) and (5) of paragraph D, of an 员工 or Pensioner who died:

(1) As a result of a mine accident occurring on or after the effective date of the Plan while the 员工 was working in a classified job for the 雇主;

第二条.E.(1) of the UMWA 1974 Benefit Plan and Trust, effective December 7, 1974, provides:

E. Surviving Spouse and Dependents of Deceased Miners

Health benefits under 第二条I shall be provided to (1) any unmarried surviving spouse and (2) her unmarried surviving dependent children as defined in subparagraphs (2) and (5) of paragraph D, 一个死去的矿工:

(1) As a result of a mine accident occurring on or after the effective date while the miner was working in a classified job for an 雇主;

第二条.E. (1) of the UMWA 1974 Benefit Plan and Trust, effective March 27, 1978, provides:

E. Surviving Spouse and Dependents of Deceased 员工s or Pensioners

Health benefits under 第二条I 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, of an 员工 or Pensioner whose last classified employment was with a Participating 雇主 and who died:

(1) As a result of a mine accident occurring on or after December 6, 1974, while the 员工 was working in a classified job for such an 雇主;

受托人的意见

For the reasons set forth in the Trustees’ decision in ROD Case No. 81-439(随函附上), a case involving essentially similar facts, the Trustees conclude that the Respondent is responsible for the provision of health benefits to the Complainant until her remarriage and to her dependent children under the terms of the 雇主 Benefit Plans.