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OPINION OF TRUSTEES
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In Re
Complainant: Disabled Employee
Respondent: Employer
ROD Case No: 84-507 – November 18, 1987
Board of Trustees: Joseph P. Connors, Sr., Chairman; Paul R. Dean, Trustee;
William B. Jordan, Trustee; William Miller, Trustee; Donald E. Pierce, Jr., Trustee.
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, 受托人审查了这一争议的事实和情况，该争议涉及雇主福利计划条款下残疾雇员的健康福利.
Background Facts
The Complainant, whose date of birth is June 16, 1927, 在10月17日为答辩人执行机密工作时受了可予赔偿的伤害, 1986. As a result of that injury, 投诉人无法重返工作岗位，正在领取工人补偿福利. The Complainant is 60 years of age and, according to Funds’ records, he has nineteen (19) years of credited coal industry service. 投诉人的代表指出，投诉人并不打算在近期退休. 该代表说，被投诉人拒绝了申诉人根据第二条丙款作为残疾雇员投保健康福利的请求. (2) of the Employer Benefit Plan. The representative asks whether this request was properly denied.
答辩人说，它为申诉人作为残疾雇员继续提供医疗保险，直至11月1日, 1987. 被投诉人坚持认为，投诉人无权根据第II条C项享有任何额外的保险期限. (2) of the Employer Benefit Plan. The Respondent contends that Article II C. 雇主福利计划(2)旨在为51至55岁的残疾雇员提供健康福利, 这样他们就可以从工作的最后一天开始不间断地获得保险，直到他们有资格作为养老金领取者获得保险. 答辩人说，申诉人在58岁(实际上是59岁)时残疾, and therefore, he is not entitled to health benefits coverage under Article II C. (2) of the Plan. 被投诉人指出，为了让申诉人继续享受医疗福利，他要么退休并作为养恤金领取者接受保险，要么重返工作岗位并作为在职雇员接受保险. 被投诉人还表示，投诉人可以选择改用其保险公司签发的个人保单，直到他能够重返工作岗位为止.
Dispute
被投诉人是否有责任根据第11条C款为投诉人作为残疾雇员提供医疗保险. (2) of the Employer Benefit Plan.
Positions of the Parties
投诉人的立场:投诉人的代表询问，被投诉人是否恰当地拒绝了投诉人根据第二条C款提出的医疗福利要求. (2) of the Employer Benefit Plan.
Position of the Respondent: Article II C. (2)雇主福利计划适用于在51至55岁之间(在符合领取退休金资格之日起四年内)成为残疾的雇员。. The Complainant was 59 years old when he became disabled on October 17, 1986; therefore, he is not entitled to health benefits coverage under Article II C. (2) of the Plan.
Pertinent Provisions
Article I (1), (2) and (4) of the Employer Benefit Plan provide:
Article I – Definitions
The following terms shall have the meanings herein set forth:
(1) “Employer” means (Employer’s Name).
(2) “Wage Agreement” means the National Bituminous Coal Wage Agreement of 1984, as amended from time to time and any successor agreement.
(4) “雇员”系指为雇主从事保密工作的人员, eligible to receive benefits hereunder.
Article II. C. (2) of the Employer Benefit Plan provides:
Article II – Eligibility
C. Disabled Employees
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, 第3条规定的健康福利也应提供给下列任何雇员:
(2) 在雇员有资格根据1974年养老金计划或其任何后续计划领取养老金之日起四年内，由于可补偿的残疾而完全残疾, as long as the Employee continues to be so disabled during the period for which Workers’ Compensation payments (Worker s Compensation does not include Federal Black Lung Benefits) are applicable; or
Discussion
Article II. C. 《皇冠搏彩中心网站》第(2)款为"在雇员根据1974年养恤金计划有资格领取养恤金之日起四年内因可补偿的残疾而完全丧失能力"的雇员提供健康福利.条款“在员工有资格领取养老金之日起四年内”(重点添加)表明，员工的残疾必须发生在员工有资格领取养老金之日之前的四年内. Thus, the language of Article II C. (2)将该条款的覆盖范围限制在某些尚未符合1974年养老金计划养老金资格的残疾雇员.
1974年养恤金计划规定，养恤金福利将提供给“[a]任何(a)至少有10年签署服务……和(b)年满55岁……”的参与者。申诉人于10月17日因可赔偿的残疾而完全丧失能力, 1986. The Complainant was fifty-nine (59) years old on October 17, 1986, and had established nineteen (19) years of credited signatory service. As such, 申诉人在10月17日残疾时有资格领取1974年计划养恤金, 1986. 因为申诉人在残疾时有资格领取1974年计划养恤金, 他无权享受第二条C款规定的残疾雇员的健康福利. (2) of the Employer Benefit Plan.
Opinion of the Trustees
被投诉人不负责根据第二条C款为投诉人作为残疾雇员提供医疗保险. (2) of the Employer Benefit Plan.