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受托人的意见
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在再保险
Complainant: Pensioner
被申请人:雇主
ROD Case No: 93-030 – 1996年6月6日
受托人:Thomas F. 迈克尔·康纳斯. 霍兰德，唐纳德·E. 皮尔斯,小. 和艾略特A. 西格尔.
受托人审查了有关根据雇主福利计划条款提供福利的争议的事实和情况.
背景事实
申诉人于1985年1月7日在为答辩人从事机密工作时受伤. As a result of this injury, the Complainant was awarded Workers’ Compensation benefits. In settlement of this Workers’ Compensation claim, 投诉人于1月27日签署了俄亥俄州工业委员会批准的和解协议和解除协议, 1989.
The first paragraph under the Settlement Agreement and Release states in pertinent part:
“I, [Complainant’s name] . . . forever release and discharge said employer . . . from any and all claims, 要求, actions or causes of action incurred on or prior to the date of this agreement . . . which I now have or which I may hereafter claim to have, . . . growing out of my employment with said employer . . .”
Paragraph (2) of the Settlement Agreement and Release states that:
“The parties further agree that if the above claim or any other claim being settled, has been recognized or allowed then the cost of all medical services, 护理服务, 医疗费用, 药物, 在签订本协议之前向局或委员会提交的药品费用应由雇主负责，但如果此类费用在本协议日期之前发生，并且在本协议日期之前未向局或委员会提交，则此类服务的费用应由索赔人负责. 在本协议生效之日或之后向索赔人提供的所有医疗服务的费用由索赔人负责.”
The Complainant applied for benefits from the 1974年退休金计划 in July 1990. The Complainant was notified by letter dated September 15, 1993, that he was eligible for a 1974 Pension Plan Disability pension effective November 1, 1988. The Complainant was advised to contact the Respondent, his last signatory Employer, regarding his eligibility for health benefits coverage as a Pensioner. 申诉人说，被投诉人没有向他提供医疗保险.
争端
被投诉人是否必须为投诉人提供医疗保险?
Positions of the Parties
投诉人的立场:被投诉人必须为作为养恤金领取者的投诉人提供健康福利.
被投诉人的立场:投诉人无权享受雇主福利计划规定的健康福利，因为投诉人在解决其工人赔偿索赔时放弃了从被投诉人获得包括健康福利在内的所有福利的权利.
相关的规定
1988年和1993年《皇冠搏彩中心网站》第20条(c)(3)(i)款规定, 这两份工资协议的相关条款是相同的，除了我们在括号内加上1993年工资协议的部分.)
(3)(i) Each signatory Employer shall establish and maintain an Employee benefit plan to provide, implemented through an insurance carrier(s), 本协议所涵盖的雇员以及领取养老金者的健康和其他非养老金福利, under the 1974 Pension Plan and Trust, 其最后一个签署人的分类工作是在该雇主[并且没有资格从根据《官方网站》维持的计划中获得福利]. 在本协议有效期内，雇主根据该等计划向其合格参与人提供的福利应按该等计划中规定的水平予以保证。.
第一条第一款, 雇主福利计划第(2)和(5)条规定:(第(5)条下的括号部分表示1993年工资协议中增加的语言.)
第一条-定义
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 1988 [1993], as amended from time to time and any successor agreement.
(5) “Pensioner” shall mean any person who is receiving a pension, other than (i) a deferred vested pension based on less than 20 years of credited service, 或(ii)全部或部分根据1974年养恤金计划第ii G条的规定记入的服务年数的养恤金, or any corresponding paragraph of any successor thereto, under the 1974 Pension Plan (or any successor thereto), whose last classified signatory employment was with the Employer, subject to the provisions of 第二条乙 of this Plan. [“领取养老金者不指根据1986年《皇冠搏彩中心网站》第9711条享有福利的任何个人, as amended by the Coal Industry Retiree Health Benefit act of 1992].
第二条乙. (1) of the Employer Benefit Plan provides:
Article II – Eligibility
根据第三条有资格领取健康福利的人员如下:(括号内的部分为1993年《官方网站》中删除的文字.)
B. 养老金领取者
根据本办法第三条向养恤金领取人提供的健康津贴[和人寿保险]应如下:
(1) Any Pensioner who is not again employed in classified signatory employment subsequent to
(a) such Pensioner’s initial date of retirement under the 1974 Pension Plan, and
(b) (2月1日, 1988], 2月1日, 1993, shall be eligible for coverage as a Pensioner under, and subject to all other provisions of this Plan. Notwithstanding (i) and (ii) of the definition of Pensioner in Article I(5) of this Plan, 在12月5日符合1974年福利计划下领取养老金资格的任何此类养老金领取者, 1977, shall be eligible for such benefits, subject to all other provisions of this Plan.
讨论
第三条B. of the Employer Benefit Plan provides health benefits coverage for 养老金领取者. 本计划第I(5)条将此类养恤金领取者定义为其最后受雇于雇主的分类签署雇员, and who is receiving a pension, with certain exceptions not relevant here, under the 1974 Pension Plan. 鉴于投诉人根据1974年养恤金计划领取残疾养恤金，而他最后一次机密签署工作是在被投诉人, 他是答辩人设立的雇主福利计划第I(5)条所定义的领取退休金者, and would be eligible for health benefits coverage under 第二条乙. 其中.
被投诉人声称，工人赔偿和解协议构成对投诉人在雇主福利计划下的权利的完全放弃. 在ROD 88-527, 受托人认为，工人赔偿案件的和解协议"明确考虑解决投诉人因工伤而产生的医疗费用，并不意味着一般放弃投诉人根据雇主福利计划就与其受雇于被投诉人的工作无关的情况获得健康福利的权利."由于申诉人的工人赔偿和解协议是对他1月7日因工伤而产生的医疗费用的和解, 1985, the Respondent is required to provide health benefits coverage for the Complainant as a Pensioner.
受托人的意见
被投诉人必须向作为养恤金领取者的投诉人及其合资格的家属提供健康福利. 被投诉人不需要为1月27日俄亥俄州工业委员会批准的投诉人的工人赔偿和解协议和释放中所述的与事故有关的医疗费用提供保险, 1989.