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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: 81-668 – 1986年2月24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 员工’s eligibility for dismemberment benefits under the 雇主 Benefit Plan.

背景事实

7月28日, 1981, the 员工 sustained an injury that contributed to a corneal ulcer of the left eye. 9月30日, 1981, permanent adhesions were made between the left eyelid margins to keep the lids closed over the cornea for protection. 从那时起, the central portions of the eyelid margins have been opened approximately 5 millimeters, and there is limited vision in the eye. The 员工 filed a claim for dismemberment benefits under the 雇主 Benefit Plan based on a loss of vision in the left eye. Although the loss of vision is not total, the 员工 contends that it satisfies the legal definition of blindness under West Virginia law as contained in the White Cane Law 5-15-3 and in the Human Rights Act at 5-11-3.

The 雇主 denied the claim because the 员工 did not suffer total loss of vision in the eye.

争端

Is the 雇主 responsible for paying dismemberment benefits based on a loss of vision which, 虽然不是全部, meets some legal definitions of blindness?

Positions of the Parties

Position of the 员工: The 雇主 is responsible for paying the dismemberment benefit under the 雇主 Benefit Plan based on a loss of vision in the left eye which meets the definition for legal blindness according to West Virginia state law.
Position of the 雇主: The 雇主 is not responsible for paying the Dismemberment Benefit because the loss of vision is not total, the criterion for blindness under 雇主 Benefit Plan.

相关的规定

第三条. B. (1) (c) of the 雇主 Plan states in part:

If an 员工 shall lose one member due solely to violent, external and accidental means as the result of an injury occurring while insured and on or after June 7, 1981, such 员工 shall receive a $12,500 dismemberment benefit. A member for the purpose of the above is… total loss of vision of one eye.

讨论

The principal issue in this case is whether or not the 员工’s loss of vision in the left eye satisfies the “total loss of vision” requirement of 第三条. B. (1) (c). The 员工’s vision in the left eye is markedly impaired, but not total. Although the loss of vision in the left eye is not total, the 员工 argues that it meets the West Virginia legal definition of blindness. 然而, the 雇主 Benefit Plan provides dismemberment benefits only for total loss of vision in an eye without regard to definitions of blindness under state law.

Opinion of the Trustees

The 雇主 is not responsible for payment of dismemberment benefits for vision loss which is not total.