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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: 84-239——1987年1月27日

董事会: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, 并根据美国劳工部授予的豁免授权, the Trustees have reviewed the facts and circumstances of this dispute concerning the provision of health benefits coverage for an 员工 under the terms 雇主福利计划的成员.

背景事实

The Complainant was employed with the Respondent in a classified job when he was injured in a non-work-related accident on November 8, 1984. 他无法返回工作岗位，并收到疾病和事故(“S”)&A) 1985年11月18日之前的福利. 被投诉人为申诉人提供了持续的医疗保险，直至11月30日, 1985, 投诉人在雇主福利计划下的福利被终止.

2月24日, 1986, 投诉人向被投诉人提供了其主治医生的许可，允许其返回工作岗位. 申诉人说，他认为他的身体能够重返工作岗位. 申诉人同日参加了一个再培训班. 在课程结束时, the Respondent challenged the Complainant’s physical ability to perform his regular work and informed him that he could not return to work until he was examined pursuant to Article III Section (j) of the Wage Agreement.

申诉人随后于2月25日由一名医生进行了检查, 1986, 另一位医生于3月7日进行了检查, 1986. Both examiners reported that the Complainant’s physical condition prevented him from performing his regular work. 因为他们的发现, 被投诉人认定投诉人仍不能履行其正常职责.

申诉人声称，他参加了2月24日的再培训课程, 1986 constitutes a return to work; therefore, his health benefits coverage should have been reinstated on that date and should be continued beyond that date based on the number of hours he worked in the 24-month period prior to February 24, 1986. 皇冠搏彩中心网站的记录表明投诉人工作了1年,在2月24日之前的连续24个日历月期间，答辩人的工作时间为492小时, 1986.

被投诉人拒绝为投诉人提供医疗保险, claiming that the Complainant’s attendance at a retraining class does not constitute a return to active employment.

争端

Is the Complainant entitled to health benefits coverage on the date he attended a retraining class and to continued health benefits coverage beyond that date?

双方立场

Position of the 原告: The Complainant returned to work by attending a retraining class or one day before he was terminated for medical reasons. He is therefore entitled to health benefits coverage for that day and for continued benefits coverage based on his hours worked for the Respondent in the preceding 24-month period.

Position of the 被申请人: The Complainant’s attendance at a retraining class does not constitute a return to active employment for purposes of health benefits coverage.

相关的规定

雇主福利计划第I(1)、(2)、(4)条规定:

第一条-定义

下列术语具有本协议规定的含义:

(1) “雇主”指(煤炭公司名称).

(2) “工资协议”指1984年《皇冠搏彩中心网站》, 如不时修订及任何后续协议.

(4) “雇员”系指为雇主从事保密工作的人员, 有资格获得本协议项下的福利.

第二条A款. 雇主福利计划第(1)及(4)条规定:

第二条-资格

根据第3条有资格领取健康津贴的人员如下:

A. 积极的员工

第III条规定的福利应提供给下列任何员工:
(1) is actively at work* for the 雇主 on the effective date of the Wage Agreement; or

(4) 新雇员从为雇主工作的第一天起就有资格享受健康福利.

第三条D. 雇主福利计划的(1)(a)、(b)、(d)及(g)条款规定:

第三条-福利

D. 一般规定

(1) 续保

(a) 裁员

如果雇员因裁员而停止工作, 健康的延续, 人寿、意外死亡和肢解保险的保险范围如下:

工作时数
24 .雇主
连续日历月
紧接前一时期 保险期限
雇员日期 继续
最后的工作 最近工作日期

2000小时以上 月余额加上12个月

500或更多，但少于 月余额加上6个月
2000小时

少于500小时 30天

(b) 残疾

第二条另有规定的除外, 部分C, 雇员因残疾而停止工作, 雇员将有资格继续保持健康, life and accidental death and dismemberment coverage while disabled for the greater of (i) the period of eligibility for Sickness and Accident benefits, 或(ii)上述(a)项附表所列期间.

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*积极工作的雇员包括在9月30日积极工作的雇主雇员, 1984, and who returns to active work with the 雇主 two weeks after the effective date of the Wage Agreement.

(d) 最大续保范围

在任何情况下，(a)条款的任何组合均不得, (b), (c), (e) or (g) above result in continuation of coverage beyond the balance of the month plus 12 months from the date last worked.

(g) 第III (j)条-工资协议

An 员工 terminated under the provisions of Article III(j) of the Wage Agreement shall not be treated as a quit or discharge for purposes of continuation of coverage. Such an 员工 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

第三条D.(1)(b)为“因残疾而停止工作”的雇员提供持续的福利保障.” The period of continued benefits coverage shall extend from the date last worked for the greater of the 员工’s period of eligibility for Sickness and Accident Benefits, 或第三条D款规定的期限. (1)(a). 根据第三条D款. (1)(a), the period of continued coverage is based upon the number of hours worked for 24 .雇主-month period prior to the 员工’s date last worked. 第三条D款规定的持续承保的最长期限. (1)为雇员最后工作当月的余额加上12个月.

申诉人因残疾于1984年11月停止工作. Inasmuch as the Respondent provided continued benefits coverage for the Complainant through November 30, 1985, 被申请人履行了第三条规定的义务. (1)(b)雇主福利计划. The Complainant remained unable to work after his eligibility for continued benefits coverage terminated.

根据第二条A款. 雇主福利计划的成员, health benefits coverage is provided to an 员工 either from the first day worked or when the 员工 returns to active employment with the 雇主. 第二条A款的文字. does not qualify the terms “first day worked” or “active employment” by differentiating between time spent in retraining versus time spent in a regular job classification. 根据工资协议的条款, every classified 员工 is required to participate in an orientation program when employed and a general retraining program at least once during each calendar year. The 员工 is paid for time spent in such programs at the regular rate applicable to his job classification. 雇主s are required by the Wage Agreement and by ERISA to report employee hours to the Funds; hours spent by an 员工 in retraining are reported as hours worked. 用于再培训的时间也记入养恤金信贷的工作时间. 鉴于《官方网站》的再培训要求, 雇主福利计划的语言, 以及上面提到的注意事项, the Trustees conclude that active employment must be considered to include certain periods of safety training and retraining.

Inasmuch as the Respondent accepted the Complainant’s medical release and sent him to a retraining class on February 24, 1986, 投诉人可被视为在该日已恢复正常工作. 因此, 按照第二条A款的规定,, 他有权享受医疗保险, 2月24日生效, 1986.

在再培训课程结束时, the mine superintendent challenged the Complainant’s physical ability to perform his regular work by invoking Article III (j) (3) of the Wage Agreement. Two examiners concurred that the Complainant’s physical condition prevented him from performing his regular work.

根据第三条D款. (I) (g)的雇主福利计划, 援引《皇冠搏彩中心》第III (j)条的规定时, an 员工 is entitled to continuation of coverage for a period based upon the number of hours the 员工 worked for 24 .雇主-month period prior to his last date worked, 第三条D款规定. (1) (a)计划. 由于申诉人工作1,在2月24日之前的24个月期间内，答辩人的工作时间为492小时, 1986, 他有权在1986年8月之前继续享受医疗福利.

受托人的意见

The Respondent is responsible for providing health benefits coverage for the Complainant on February 24, 1986年，并在8月31日之前继续提供这种保险, 1986.