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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: 84-294——1987年4月30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 under the terms of the 雇主 Benefit Plan.
背景事实
申诉人为C公司工作 & 煤炭公司(C&L) in a classified position from February 1984 through on or about June 12, 1986. 在那个日期或前后，C & L ceased operations and laid off its 员工s, including the Complainant. 大约在6月17日, 1986, 蒙克煤炭公司, 被申请人, was established to sub-lease and operate the equipment and mine previously operated by C & L. C & L Coal Company and 被申请人 are separately incorporated and owned and operated by different individuals. 被申请人 signed the 1984 Wage Agreement effective June 26, 1986.
The Complainant claims to have worked for 被申请人 from on or about June 23, 1986年至7月18日前后, 1986. The Complainant claims that during that period he worked 142 hours for 被申请人. On Friday, 7月18日, 1986, the Complainant was injured in a non-work related accident. 第二天, he notified 被申请人 that due to his injury he was unable to return to work for approximately one week. 7月23日左右, 1986, 被申请人 gave the Complainant a permanent layoff slip dated 7月18日, 1986.
The Complainant contends that 被申请人 is responsible for providing continued 健康 benefits coverage for him as a laid-off 员工 based on his hours worked for C & L和Monk煤炭公司. 被申请人 claims that the Complainant was not laid-off, 但在7月21日自愿辞职, 1986. 被申请人 has submitted a statement signed by eight (8) of its 员工s indicating that the Complainant stated that he wanted a layoff slip in order to receive unemployment compensation. 被申请人 contends that under Article III (D)(1)(e) of the 雇主 Benefit Plan, the Complainant was entitled to 健康 benefits coverage only through his last day worked, 7月18日, 1986, but 被申请人 nonetheless provided coverage through August 31, 1986.
争端
Whether 被申请人 is responsible for providing the Complainant with 健康 benefits coverage after August 31, 1986.
双方立场
Position of the 原告: The Complainant was laid off and is entitled to continued 健康 benefits coverage after August 31, 1986.
Position of 被申请人: The Complainant quit and is not entitled to 健康 benefits coverage after August 31, 1986.
相关的规定
Article I (1), (2) and (4) 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”指(煤炭公司).
(2) “Wage Agreement” means the National Bituminous Coal Wage Agreement of 1984, as amended from time to time and any successor agreement.
(4) “员工” shall mean a person working in a classified job for the 雇主, 有资格获得本协议项下的福利.
第二条A款. (4)雇主福利计划规定:
第11条-资格
The persons eligible to receive the 健康 benefits pursuant to Article Ill are as follows:
A. 积极的员工
(4) A new 员工 will be eligible for 健康 benefits from the first day worked with the 雇主.
第三条D. 雇主福利计划的(1)(a)和(e)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, life and accidental death and dismemberment insurance coverage is as follows:
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 月加余额
12个月
500或更多，但少于 月加余额
2000小时 6个月
少于500小时 30天
(e) 辞职或解雇
如果员工辞职或被解雇, 健康, life and accidental death and dismemberment insurance coverage will terminate as of the date last worked.
讨论
第三条D.(1)(a) of the 雇主 Benefit Plan provides continued 健康 benefits coverage for a laid-off 员工 for a defined period based on the number of hours worked for the 雇主 during the 24-month period immediately prior to the date last worked. The issue of an 雇主’s responsibility to provide continued 健康 benefits coverage to a laid-off 员工 based on hours worked by such 员工 for a separate 雇主 has been previously addressed in Resolutions of 争端 81-338 and 81-621 (copies enclosed herein). The Trustees concluded in those respective opinions that an 雇主 is not responsible for providing continued coverage for a laid-off 员工 based on hours worked for a separate 雇主. 解析:选C & L and 被申请人 are separately incorporated and owned and operated by different individuals, they are separate 雇主s for purposes of calculating a period of continued benefits coverage.
作为自愿辞职的员工, the Complainant would be entitled to 健康 benefits coverage through his last day of work, 大约在7月18日, 1986. Inasmuch as the Complainant worked 142 hours for 被申请人, his period of continuation of coverage as a laid-off 员工 would be 30天, 到8月17日, 1986. 被告提供的保险覆盖至1986年8月31日. 因此, whether the Complainant quit or was laid off by 被申请人, 被申请人 has satisfied its obligations to provide 健康 benefits coverage for the Complainant.
受托人的意见
被申请人, who provided the Complainant’s 健康 benefits coverage through August 31, 1986, is not responsible for providing coverage beyond that date.