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受托人的意见
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在再保险

原告: 雇员的尚存配偶
被申请人: 雇主
ROD案例编号: 88-264——1990年4月25日

董事会:Joseph P. 康纳斯,老., Chairman; Paul R. Dean, Trustee; William Miller, Trustee; Donald E. 皮尔斯,小., Trustee; Thomas H. Saggau,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 accidental death benefits under the terms of the 雇主 Benefit Plan.

背景事实

The Employee was employed in a classified position by the Respondent, a signatory employer. During the morning of November 12, 1988, the Employee died from a self-inflicted gunshot wound. Witnesses at the shooting provided statements to the police indicating that the Employee had pointed a gun at them and stated that the gun was not loaded; he then put the gun to his own head and pulled the trigger. The gun discharged and the Employee died shortly thereafter.

The Death Certificate indicates that the Employee’s immediate cause of death was “pending autopsy.” The Coroner’s Supplementary Medical Certification lists the major findings of the autopsy as (1) tight contact wound of head with perforation of skull and brain, (2) marked atherosclerotic narrowing of his left anterior descending arteries, (3)乙醇0.26%. 除了, where the coroner’s report indicates whether death was due to accident, 自杀, 或杀人, 验尸官写的是“意外”.” The coroner also described the Employee’s injury as a “self-inflicted gunshot to right forehead.”

The Complainant received a $35,000 life insurance benefit from the Respondent. The Complainant’s claim for a $70,000 accidental death benefit was denied by the Respondent.

争端

Is the Respondent required to pay an accidental death benefit of $70,向投诉人支付000英镑?

双方立场

Position of the 原告: The Respondent is required to pay an accidental death benefit of $70,向投诉人支付000英镑 because the Complainant’s husband’s death was accidental.
Position of the 被申请人: The Respondent is not required to pay an accidental death benefit of $70,向投诉人支付000英镑 because the Employee’s death was not the result of accidental means. 除了, 被告主张收回70美元,000是不合适的，因为雇员的死亡是到期的, 至少在某种程度上, 致他自己自愿的陶醉, and he was acting in violation of the law – using weapons while intoxicated – at the time of his death.

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(雇主名称).

(2) “Wage Agreement” means the National Bituminous Coal Wage Agreement of 1988, 如不时修订及任何后续协议.

(4) “Employee” 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. 雇主福利计划规定:

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

Benefits under Article III shall be provided to any Employee who:

(1) is actively at work* for the 雇主 on the effective date of the Wage Agreement; or
…

(4) A new Employee will be eligible for health benefits from the first day worked with the 雇主.

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*Actively at work includes an Employee of the 雇主 who was actively at work on January 31, 1988, and who returns to active work with the 雇主 two weeks after the effective date of the Wage Agreement.
第三条B. (1] (a], (b) and (d) of the 雇主 Benefit Plan provide:

第三条-福利

B. 人寿及意外死亡及伤残保险

(1) 积极的员工

Life and accidental death and dismemberment insurance will be provided for Employees, 如第二条所述, A和C部分(3), 按照以下时间表:

(a) 雇员因暴力以外的原因死亡, 外部和偶然的手段, 35美元的人寿保险,000美元将支付给雇员的指定受益人.

(b) 以下文(d)为准, 仅因暴力致死的雇员, 外部和偶然的手段 as the result of an injury occurring while insured and on or after February 1, 1988, 70美元的人寿保险,000美元将支付给雇员的指定受益人.

(d) Accidental death or dismemberment benefits are not payable if caused in whole or in part by disease, 身体或精神上的虚弱, 尿疹或细菌感染, 疝, 自杀, 故意自残, 起义, or acts of war or is caused by or results from committing a felony.

讨论

根据第三条. B. (1)(b)雇主福利计划, a $70,000 accidental death benefit is payable 仅因暴力致死的雇员, 外部和偶然的手段. There is no question that the Employee’s death was due to violent and external means; the issue here is whether the Employee’s death was due to accidental means.

据枪击现场的目击者称, the Employee said the gun was unloaded before he aimed it at his head and pulled the trigger. The information submitted in this case indicates that the Employee’s actions were voluntary and unnecessary. The Employee freely undertook a known risk when he aimed the gun at his head and pulled the trigger, 使枪开火. Although the Employee may have made an error in judgment by assuming that the gun was not loaded, the consequences of his actions were reasonably foreseeable and not out of the ordinary or accidental. When he pulled the trigger, the gun operated mechanically the way it was intended to operate. 因此，可以合理地得出结论, 根据他案子里的证据, that the Employee’s death was not due solely to accidental means. 相应的, the Respondent is not required to pay an accidental death benefit of $70,向投诉人支付000英镑. The additional issues raised by the Respondent regarding the Employee’s level of intoxication and use of a gun while intoxicated need not be addressed.

受托人的意见

根据第二条. B (1)(b), 被告不需要支付70美元,向投诉人赔偿意外死亡抚恤金.