受托人的意见
争议的解决
情况下没有. 84-538
第1页
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受托人的意见
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在再保险
信访人提出的:员工
被申请人:雇主
ROD案例编号:84-538 - 1988年2月9日
董事会:Joseph P. 康纳斯,老., Chairman; Paul R. Dean,受托人; William B. 约旦,
Trustee; 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 health benefits coverage under the terms of the Employer Benefit Plan.
背景事实
The Complainants are Employees of the Respondent. 答辩人在
National Bituminous Coal Wage Agreement (“Wage Agreement”) of 1984. 被申请人
provided health benefits coverage for the Complainants through the Bituminous Industry
Trust/Business Insurance Trust (“BIT”) and California Life Insurance until April 30, 1987, when
BIT终止了. Due to insolvency, the BIT and California Life Insurance have ceased
paying health benefits claims for services rendered prior to April 30, 1987. 代表
for the Complainants asks who is responsible for payment of the Complainants’ medical bills that
are unpaid due to the insolvency of BIT and California Life Insurance.
争端
Whether the Respondent is responsible for payment of the Complainants’s medical bills that are
unpaid due to the insolvency of BIT and California Life Insurance.
双方立场
Position of the Complainants: 代表 for the Complainants asks who is responsible
for payment of the covered medical charges incurred by the Complainants.
受托人的意见
争议的解决
情况下没有. 84-538
第二页
Position of the Respondent: 被申请人 has not responded to repeated correspondence from
Funds’ staff regarding its position in this dispute.
相关的规定
Article XX Section (c)(3)(i) of the National Bituminous Coal Wage Agreement of 1984 provides
在相关部分:
(c) 1974年计划和信托
(3)(i) Each signatory Employer shall establish and maintain an Employee benefit
计划提供, implemented through an 保险公司(s), health and other nonpension benefits for its Employees covered by this Agreement as well as pensioners,
under the 1974 Pension Plan and Trust, whose last signatory classified employment was
与该雇主. The benefits provided by the Employer to its eligible Participants
pursuant to such plans shall be guaranteed during the term of this Agreement by that
Employer at levels set forth in such plans.
Article I (1), (2) and (4) of the Employer Benefit Plan provide:
第一条-定义
The following terms shall have the meanings herein set forth:
(1)“雇主”指(雇主名称).
(2) “Wage Agreement” means the National Bituminous Coal Wage
Agreement of 1984, as amended from time to time and any successor
协议.
(4) “Employee” shall mean a person working in a classified job for the
Employer, eligible to receive benefits hereunder.
第二条A款. (1) and (4) of the Employer Benefit Plan provide:
第二条-资格
The persons eligible to receive the health benefits pursuant to 第二条I are as follows:
A. 积极的员工
Benefits under 第二条I shall be provided to any Employee who:
受托人的意见
争议的解决
情况下没有. 84-538
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(1) is actively at work* for the Employer on the effective date of the
Wage Agreement; or
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* Actively at work includes an Employee of the Employer who was actively at work on
September 30, 1984, and who returns to active work with the Employer two weeks after the
工资协议生效日期.
(4) A new Employee will be eligible for health benefits from the first
我为雇主工作了一天.
讨论
Article XX Section (c)(3)(i) of the 1984 Wage Agreement requires an Employer to provide an
Employer Benefit Plan… “implemented through an 保险公司(s), [for] health and other
non-pension benefits…” It further requires that “benefits provided by the Employer to its eligible
Participants pursuant to such plans shall be guaranteed during the term of this Agreement by that
Employer at levels set forth in such plans.”
第二条. A of the Employer Benefit Plan provides health benefits coverage to active employees
working in classified jobs for a signatory Employer. 本案的被告
implemented its Employer Benefit Plan until April 30, 1987 through an employer trust fund and
保险公司. The employer trust fund and the carrier subsequently became insolvent.
Implementation of a plan through a carrier, in and of itself, does not relieve the Respondent of its
primary obligation to provide benefits pursuant to the Wage Agreement. 因为
Complainants were eligible for health benefits coverage from the Respondent as active
Employees at the time their outstanding medical charges were incurred, the Respondent is
responsible for payment of those charges under the terms of the Employer Benefit Plan.
受托人的意见
被申请人 is responsible for payment of the covered medical charges incurred by the
Complainants during their eligibility for health benefits coverage as Employees under the terms
of the Wage Agreement and the Employer Benefit Plan.