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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: 88-547 - 1992年5月7日

Board of Trustees: Joseph P. 康纳斯,老., Chairman; Paul R. Dean, Trustee; William Miller, Trustee; Donald E. 皮尔斯,小., Trustee; Elliot A. 西格尔,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 dismemberment benefits under the terms of the 雇主 Benefit Plan.

背景事实

2月22日,1990 the Complainant sustained an injury while working in a classified job for the Respondent that contributed to the complete loss of hearing in the Complainant’s left ear. As a result of this injury, the Complainant was awarded Workers’ Compensation benefits. The representative for the Complainant contends that the Complainant is entitled to a dismemberment benefit of $17,500 due to the loss of hearing in his left ear.

争端

Is the Respondent required to pay a dismemberment benefit of $17,500 to the Complainant?

双方立场

Position of the 原告: The Respondent is required to pay a dismemberment benefit of $17,500 to the Complainant due to the total loss of hearing in the Complainant’s left ear.

Position of the 被申请人: The Respondent is not required to pay a dismemberment benefit of $17,500 to the Complainant because the loss of hearing is not included as a dismemberment under the 雇主 Benefit Plan.

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” means (雇主’s Name).

(2) “Wage Agreement” means the National Bituminous Coal Wage Agreement of 1978, as amended from time to time and any successor agreement.

(5) “员工” shall mean a person working in a classified job for the 雇主, eligible to receive benefits hereunder.

第三条B. (1)(c) of the 雇主 Benefit Plan provides:

第三条-福利

B. Life and Accidental Death and Dismemberment Insurance

(1) 积极的员工

Life and accidental death and dismemberment insurance will be provided for 员工s, as described in Article II, A和C部分(3), in accordance with the following schedule:

(c) If an 员工 shall lose two or more members due to violent, external and accidental means as the result of an injury occurring while insured and on or after February 1, 1988, such 员工 shall receive a $35,000 dismemberment benefit. If an 员工 shall lose one member due solely to violent, external and accidental means as the result of an injury occurring while insured and on or after February 1, 1988, such 员工 shall receive a $17,500美元的肢解津贴. A member for the purpose of the above is (I) a hand at or above the wrist, (ii) a foot at or above the ankle or (iii) total loss of vision of one eye.

讨论

第三条B. (1)(c) of the 雇主 Benefit Plan provides that an 员工 who loses one member due solely to violent, external and accidental means as the result of an injury occurring while insured shall receive a $17,500美元的肢解津贴. 根据第三条B款. (1)(c), a member is defined as (i) a hand at or above the wrist, (ii) a foot at or above the ankle, or (iii) total loss of vision of one eye. Because loss of hearing is not defined as a member for the purpose of the provision of dismemberment benefits, the Respondent is not required to pay a dismemberment benefit under the terms of the 雇主 Benefit Plan.

受托人的意见

The Respondent is not required to pay a $17,500美元的肢解津贴 to the Complainant.