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受托人的意见
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在再保险
原告: 残疾员工
被申请人: 雇主
ROD案例编号: 88-419 - 1991年9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 continued benefits coverage for a disabled Employee under the terms of the 雇主 Benefit Plan.
背景事实
申诉人于3月15日受伤, 1990, 同时在被调查者的机密职位工作. He received Workers’ Compensation benefits and did not return to work for the Respondent until February 1991. The Complainant ceased working on March 7, 1991 due to a disability. The Complainant has stated that he was not eligible for Sickness and Accident benefits during the period of disability which began March 7, 1991 because the maximum number of weeks during which he was entitled to such benefits had elapsed during his original period of disability following the accident on March 15, 1990. The Complainant claims that he worked approximately 860 hours for the Respondent during the 24-month period prior to March 7, 1991年和, 因此, he should receive health benefits coverage as a disabled employee for six months beyond March 1991.
The Respondent states that the appropriate period for determining the Complainant’s health benefits coverage as a disabled employee is from March 8, 1989至3月7日, 1991. The Respondent states that the Complainant worked 499 1/2 hours during that period and is, 因此, eligible for continued health benefits coverage for only 30天 beyond March 7, 1991. The Respondent notified the Complainant that his health benefits coverage was terminated as of April 8, 1991.
争端
Whether the Respondent is required to provide continued health benefits coverage for the Complainant for six months beyond March 1991.
双方立场
Position of the 原告: The Respondent is required to provide health benefits coverage for the Complainant for 6个月 beyond March 1991 because the Complainant worked approximately 860 hours for the Respondent during the 24-month period prior to his date last worked.
Position of the 被申请人: The Respondent is required to provide health benefits coverage for the Complainant for only 30天 beyond his date last worked because the Complainant worked 499 1/2 hours during the period from March 8, 1989年至3月7日, 1991.
相关的规定
雇主福利计划第I(1)、(2)、(4)条规定:
第一条-定义
下列术语具有本协议规定的含义:
(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.
第三条D. 雇主福利计划的(1)(a)和(b)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
雇员入职日期 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
(b) 残疾
第二条另有规定的除外, 部分C, 雇员因残疾而停止工作, 雇员将有资格继续保持健康, life and accidental death and dismemberment coverage while disabled for the greater of (i) the period of eligibility for Sickness and Accident benefits, 或(ii)上述(a)项附表所列期间.
讨论
第三条D. (1) (b) of the 雇主 Benefit Plan provides that an Employee who ceases work because of disability will be eligible to continue health, life and accidental death and dismemberment coverage while disabled for the greater of (i) the period of eligibility for Sickness and Accident benefits, or (ii) the period based on the number of hours worked as set forth in 第三条D. (1) (a)计划. The Complainant states that he was not eligible for Sickness and Accident benefits when he ceased working on March 7, 1991. 因此, 他的保险期限将持续到3月7日以后, 1991 is based on the number of hours worked for 24 .雇主 consecutive calendar month period immediately prior to his date last worked in accordance with the schedule set forth in Article III. D. (1) (a).
The Respondent has interpreted the phrase “24 consecutive calendar month period immediately prior to the Employee’s date last worked” as the period between the Complainant’s date last worked and the corresponding date exactly 2 years earlier. While such period is equivalent to a period of 24 months and is “immediately prior to the … date last worked,它不是连续的24个“日历月”,” which literally refers to months as they are designated on the calendar. 此外, 在以前的rod中, the Trustees have held that the time period to be used in calculating hours worked pursuant to Article III. D. (1) (a) includes the portion of the month in which the Complainant last worked plus the full 24 calendar months prior to that. 参见rod 81-400和88-091(附件中的副本). 与这些决定一致, the time period to be used in calculating the Complainant’s hours worked 根据第三条D款. (1) (a) is the inclusive period of March 1989年至3月7日, 1991.
Funds’ records and information submitted by the Respondent in connection with this ROD indicate that the Complainant worked 547 1/2 hours for the Respondent during the inclusive period of March 1989年至3月7日, 1991. 相应的, the Respondent is responsible for providing health benefits coverage for the Complainant for the balance of March 1991 plus 6个月, 根据第三条D款. (1) (a)雇主福利计划.
受托人的意见
The Respondent is required to provide continued health benefits coverage for the Complainant and his eligible dependents through September 30, 1991, 符合雇主福利计划的条款.