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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: 84-272——1987年1月13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.
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 benefits coverage for the 未亡配偶 of an Employee under the terms of the 雇主 Benefit Plan.
背景事实
The Complainant is the surviving spouse of an Employee of the Respondent who was granted a leave of absence by the Respondent on September 2, 1981, for the purpose of accepting temporary employment with the United Mine Workers of America (UMWA). The Employee last worked for the Respondent on September 1, 1981
The Respondent has stated that it provided continuation of the Employee’s health, life and accidental death and dismemberment coverage through December 30, 1981. The Respondent has stated that 根据第三条D款. (I) (c) of the 雇主 Benefit Plan, the Employee was not eligible for such benefits beyond that date.
The Complainant has stated that the Employee did not return to active employment with the Respondent before he died on August 12, 1986. At that time, he was still employed with the UMWA. The Complainant asks whether she is entitled to a life insurance benefit from the Respondent.
争端
Is the Respondent responsible for the payment of a life insurance benefit to the Complainant?
双方立场
Position of the 原告: The Complainant asks whether she is entitled to a life insurance benefit from the Respondent.
Position of the 被申请人: The Employee was not eligible for benefits coverage on the date of his death. 因此, the Complainant is not eligible to receive a life insurance benefit under the 雇主 Benefit Plan.
相关的规定
Article I (1), (2), (4) and (7) of the 雇主 Benefit Plan provide:
第一条-定义
The following terms shall have the meanings herein set forth:
(1) “雇主” means (name of Coal Company).
(2) “Wage Agreement” means the National Bituminous Coal Wage Agreement of 1984, 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.
(7) “Dependent” shall mean any person described in Section D of Article II hereof.
第二条A款. (3) of the 雇主 Benefit Plan provides in pertinent part:
第二条-资格
The persons eligible to receive the health benefits pursuant to Article III are as follows:
A. 积极的员工
(3) …any Employee of the 雇主 who is not actively at work* for the 雇主 on the effective date of the Wage Agreement will not be eligible for coverage under the Plan until he returns to active employment with the 雇主.
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*Actively at work includes an Employee of the 雇主 who was actively at work on September 30, 1984, and who returns to active work with the 雇主 two weeks after the effective date of the Wage Agreement.
第三条D. (1) (c) 1. of the 雇主 Benefit Plan provides:
第三条-福利
D. 一般规定
(1) 续保
(c) 休假
1. During any period for which an employee is granted an approved leave of absence for the purpose of accepting temporary employment with the United Mine Workers of America (UMWA) such Employee shall be eligible to continue health, life and accidental death and dismemberment coverage for a period not to exceed 120 calendar days within any 12-month period.
讨论
第ii条D款. (1) (c) 1. of the 雇主 Benefit Plan provides continued benefits coverage for an Employee on leave of absence for the purpose of accepting UMWA employment. The provision stipulates that such coverage shall be provided for a period not to exceed 120 calendar days within any 12-month period.
The Employee began his leave of absence on September 2, 1981. The Respondent provided continued benefits coverage for the Employee and his dependents through December 30, 1981, 根据第三条D款. (1) (c) 1. Inasmuch as the Employee’s death on August 12, 1986 occurred after his eligibility for benefits had terminated, the Complainant is not eligible to receive a life insurance benefit under the 雇主 Benefit Plan.
受托人的意见
The Respondent is not responsible for the payment of a life insurance benefit to the Complainant.