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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: 84-120——1986年4月21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.
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, 和 under the authority of an exemption granted by the United States Department of Labor, 受托人审查了有关根据雇主福利计划条款为雇员的未亡配偶提供人寿保险福利的争议的事实和情况.
背景事实
投诉人的丈夫是一名由九月九日起为答辩人工作的机密雇员, 1980年至2月3日, 1984, 当时他因为生病而停止了工作，最终他获得了社会安全残疾保险福利. He never was able to return to work 和 died on August 20, 1985. During the twenty-four consecutive calendar month period immediately prior to February 3, 1984, he had worked in excess of 2000小时. 投诉人询问她是否有权根据雇主福利计划获得人寿保险福利. 申诉人声称，她的丈夫从事了二十(20)多年的机密服务, 然而, 向各皇冠搏彩中心网站提供的证据足以确定最多十(10)年的记帐服务.
争端
Is the Complainant entitled to life insurance benefits under 用人单位 Benefit Plan?
各方立场
投诉人的立场:作为一名在其死亡时正在领取社会保障残疾保险福利的具有20年以上分类服务的雇员的未亡配偶, the Complainant is entitled to receive life insurance benefits.
答辩人的立场:雇员在其疾病和事故福利资格终止后死亡, thus his surviving spouse is not entitled to life insurance benefits.
相关的规定
1984年《皇冠搏彩中心网站》第11 (c)条有关部分规定:
Section (c) Commencement 和 Duration of Benefits
疾病和事故津贴从因事故致残的第一天起计算, 和 with the eighth day of disability resulting from sickness, 除非雇员因致残疾病而住院，需要手术治疗或重症监护, benefits shall begin with the first full day of hospitalization…
因病致残的津贴应按下列规定支付:
的长度
分类 最大
就业与 的数量
用人单位 周
At least 6个月 but less than 1 year……………… 6
At least 1 year but less than 5 years……………….13
At least 5 years but less than 10 years……………..26
At least 10 years but less than 15 years…………….39
15 years or more………………………………….52
Article I (I), (2) 和 (4) of 用人单位 Benefit Plan provide:
第一条-定义
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 1984, as amended from time to time 和 any successor agreement.
(4) “Employee” shall mean a person working in a classified job for 用人单位, eligible to receive benefits hereunder.
Article II A (2) 和 C(3) of the Employee Benefit Plan provide:
Article II – Eligibility
根据第三条有资格领取健康津贴的人员如下:
A. 积极的员工
Benefits under Article III shall be provided to any Employee who:
2. 被雇主解雇或伤残，并在《皇冠搏彩中心网站》生效之日作为被解雇或伤残雇员继续有资格享受1981年雇主福利计划(“先前计划”)的保障. 对这些下岗或残疾雇员的保险不得在其根据先前计划的规定不再有资格获得此类保险的日期之后继续提供.
C. 残疾员工
除了领取养恤金福利并因此有权根据本条B款领取健康福利的残疾养恤金领取人之外, health benefits under Article Ill shall also be provided to any Employee who:
(1) (a) Has completed 20 years of credited service, 包括根据1974年养恤金计划第IV C(6)条或其任何后继条款的任何相应条款规定的签署人服务年数, 和
(b) has not attained age 55, 和
(c) 1974年12月6日以后在雇主分类雇佣期间致残，并且
(d)符合《皇冠搏彩中心》第二章或其后续章节规定的领取社会保障残疾保险金的资格;,
(2) 由于可补偿的残疾而在四年内完全残疾，雇员将有资格根据1974年养老金计划或其任何后续计划获得养老金, as long as the Employee continues to be so disabled during the period for which Workers’ Compensation payments (Workers’ Compensation does not include Federal Black Lung Benefits) are applicable; or
(3) 是接收还是会接收?, 正确应用后, be eligible to receive Sickness 和 Accident benefits pursuant to the Wage Agreement.
还应向上述第(3)项所述的员工提供人寿、意外死亡和伤残保险.
Article III B (I) (a) 和 D (1) (a) 和 (b) of 用人单位 Benefit Plan provide:
第三条-福利
B. Life 和 Accidental Death 和 Dismemberment Insurance
1. 积极的员工
Life 和 accidental death 和 dismemberment insurance will be provided for Employees, as described in Article Il, A和C部分(3), in accordance with the following schedule:
(a) Upon the death of an Employee due to other than violent, external 和 accidental means, life insurance in the amount of $30,000 will be paid to the Employee’s named beneficiary.
D. 一般规定
(1) Continuation of Coverage
(一)裁员
If an Employee ceases work because of layoff, 健康的延续, life 和 accidental death 和 dismemberment insurance coverage is as follows:
的数量 Hours Worked for the
雇主 in the 24 Consecutive
Calendar Month Period Immedi-
ately Prior to the Employee’s Period of Coverage Continuation
最近工作日期 from the 最近工作日期
2000小时以上 月加余额 12 months
500 or more but less than 月加余额
2000小时 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, 残疾时的人寿、意外死亡和肢解保险，以(i)有资格领取疾病和意外福利金的期间较长者为准, or (ii) the period as set forth in the schedule in (a) above.
讨论
申诉人声称，她有权获得人寿保险福利，因为她的丈夫有20多年的分类服务经验，并获得了社会保障残疾保险福利. 虽然在某些情况下可以向这种残疾雇员提供健康津贴, 根据第三D条第(1)款(c)项计算的保险期限或雇员有资格领取疾病和意外福利金的期限中较长的部分，向残疾雇员提供人寿和意外死亡福利金.
As an Employee with more than one but less than five years of service with 用人单位, 雇员因病致残，有权享受最多十三(13)周的疾病和事故福利. 在这个例子中, 自2月6日起，雇员有资格领取疾病和意外事故福利, 1984年至5月6日, 1984. 在最后一天工作前的24个月内工作超过2000小时, 根据雇主福利计划第III条D款，他的最长续保期为12个月加上他最后工作月份的剩余时间, 或截止到2月28日, 1985. 因此, 申诉人的前配偶在雇员于8月20日死亡之前已停止享有人寿保险福利的资格, 1985.
受托人的意见
被投诉人不负责为投诉人提供人寿保险福利.