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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: 81-570 – 1985年4月29日
Board of Trustees: 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.
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 health benefits coverage for a disabled Employee by the 雇主 under the terms of the 雇主 Benefit Plan (雇主 Plan). They hereby render their opinion on this matter.
背景事实
The Complainant was performing classified work for the Respondent until November 19, 1982, when he was injured on the job. The Trustees’ records show that he worked more than 2000 hours in the 24 consecutive calendar month period immediately preceding the accident. Since the date of his accident, he has been receiving Workers’ Compensation benefits. On November 29, 1983, the Complainant underwent a physical examination requested by the Respondent. Based on the results of this exam, the Complainant was terminated on December 12, 1983, pursuant to 第二条I(J) of the Wage Agreement and his health benefits coverage was terminated on December 31, 1983. The Complainant has questioned the Respondent’s authority to terminate his benefits coverage while he continues to receive temporary total disability benefits under state Worker’s Compensation laws. The Respondent has stated that although the Complainant’s termination is presently being contested in arbitration, it severed his employment relationship. 不过, in the event an arbitrator overturns the discharge, the Respondent has stated it will provide benefits coverage to the extent required by applicable state law.
With respect to the Complainant’s entitlement to benefits coverage under the 雇主 Plan, 然而, the Respondent contends that by providing coverage to the Complainant through December 31, 1983, it more than fulfilled its maximum obligation which is limited to the balance of the month in which the Complainant last worked plus twelve months, in this case through November 30, 1983.
争端
For what period is the Respondent responsible for providing health benefits coverage for the Complainant?
Position of the Parties
Position of the 原告: The Respondent is responsible for provision of health benefits coverage for the Complainant while he is receiving Workers’ Compensation benefits.
Position of the 被申请人: The Respondent is responsible for health benefits coverage for the Complainant through November 30, 1983, under the terms of the 雇主 Plan.
相关的规定
第二条! Section (j)(1) and (2) of the National Bituminous Coal Wage Agreement of 1981 provides:
第二条I – Health and Safety
Section (j) – Physical Examination
(1) 体格检查, required as a condition of or in employment, shall not be used other than to determine the physical condition or to contribute to the health and well-being of the Employee or Employees. The retention or displacement of Employees because of physical conditions shall not be used for the purpose of effecting discrimination.
(2) When a physical examination of a recalled Employee on a panel is conducted, the Employee shall be allowed to return to work at that mine unless he has a physical impairment which constitutes a potential hazard to himself or others.
Article I (1), (2) and (4) of the 雇主 Benefit Plan provides:
Article I – Definitions
The following terms shall have the meanings herein set forth:
(1) “雇主” means (coal company).
(2) “Wage Agreement” means the National Bituminous Coal Wage Agreement of 1981, 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.
文章第三. D(1)(a) and (b), (d) and (g) of the 雇主 Benefit Plan provide:
第二条I – Benefits
D. 一般规定
(1) Continuation of Coverage
(a) 裁员
If an Employee ceases work because of a layoff, continuation of health, life and accidental death and dismemberment Insurance coverage is as follows:
Number of Hours Worked for
the 雇主 in the 24
Consecutive Calendar Month
Period Immediately Prior to Period of Coverage
雇员入职日期 继续
最后的工作 最近工作日期
2000小时以上 Balance of month plus 12 months
500 or more but less than Balance of month plus
2000小时 6个月
少于500小时 30天
(b) 残疾
Except as otherwise provided in 第二条, 部分C, if an Employee ceases work because of disability, the Employee will be eligible to continue health, life and accident death and dismemberment 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 (a) above.
(d) Maximum Continuation of Coverage
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.
(g) 第二条I(j) – Wage Agreement
An Employee terminated under the provisions of 第二条I (j) of the Wage Agreement shall not be treated as a quit or discharge for purposes of continuation of coverage. Such Employee shall be entitled to continuation of coverage on the same basis as provided for in paragraph (b) above; provided, 然而, hours worked and the period of continuation of coverage shall be determined as of the date last worked.
讨论
根据第三条. D (1) (b) of the 雇主 Plan, a disabled Employee is entitled to benefits coverage for the greater of a) his period of eligibility for sickness and accident benefits or b) a period based on his hours worked for his 雇主. 根据第三条. D. (1)(d), this period of coverage cannot extend beyond the balance of the month in which he last worked plus twelve months.
The Complainant was injured on November 19, 1982, while employed in a classified Job for the Respondent, and has since been receiving Workers’ Compensation benefits. He therefore qualified to receive continued benefits coverage as a disabled Employee under 第二条I D. (i) (b) of the 雇主 Benefit Plan. Because the Complainant worked more than 2000 hours In the 24 month period preceding his accident, the Complainant Is entitled to continued benefits coverage for the balance of November 1982, 加12个月, 或到11月30日, 1983, in accordance with the schedule provided in 第二条I. D. (1)(a).
12月12日, 1983, the Complainant was terminated pursuant to 第二条I (j) of the Wage Agreement. 第二条I D (1) (g) of the 雇主 Plan states that such Employees terminated under the provisions of 第二条I (j) of the Wage Agreement shall be entitled to the continuation of coverage calculated according to the same schedule as that provided in 第二条I D. (1) (a)计划. Hours worked and the period of continuation of coverage shall be determined as of the date last worked. Although the Respondent voluntarily provided coverage through December 1983, the Complainant last worked on November 19, 1982; therefore, his period of continuation of coverage under the 雇主 Plan ended on November 30, 1983. 因此, the Complainant received the maximum amount of time allowed under the 雇主 Plan for the continuation of benefits coverage.
This opinion should not be construed as addressing any other protections which may be available to the Complainant under state law pertaining to health insurance extensions for disabled Employees.
Opinion of the Trustees
The Respondent is not responsible for the provision of health benefits coverage under the 雇主 Benefit Plan for the Complainant beyond November 30, 1983.