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受托人的意见
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在再保险

原告: 养老金领取者
被申请人: 雇主
ROD案例编号: 88-149——1989年9月13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 health benefits coverage for a 养老金领取者 under the terms 雇主福利计划的成员.

背景事实

The Complainant was injured while working in a classified job for the Respondent until June 25, 1985. As a result of this injury, the Complainant was awarded Workers’ Compensation benefits. Funds’ records indicate that the Complainant was unable to return to work because of pain and back problems. 1986年3月, the Complainant applied for Social Security Disability Insurance (“SSDI”) benefits under Title II of the Social Security Act. His application was approved on appeal by an Administrative Law Judge on June 22, 1987, 残疾发病日期为6月25日, 1985.

1987年8月, the Complainant applied for disability pension benefits under the 1974年退休金计划. He was awarded a 1974 Pension Plan Minimum Disability pension, retroactive to July 1, 1985. 投诉人被建议与被投诉人联系, 他最后一个签字的雇主, 关于他是否有资格享受医疗福利. The Complainant states that the Respondent refuses to provide his health benefits coverage.

The Respondent has submitted company records and correspondence which indicate that it contested the Complainant’s award of Workers’ Compensation benefits. The Respondent contends that the Complainant is not totally disabled and is not eligible for health benefits coverage as a 养老金领取者.

争端

Is the Respondent responsible for providing health benefits coverage for the Complainant as a 养老金领取者?

双方立场

Position of the 原告: The Respondent is responsible for providing health benefits coverage for the Complainant as a 养老金领取者.

Position of the 被申请人: The Respondent is not responsible for providing health benefits coverage for the Complainant because the Complainant is not totally disabled, 有资格领取残疾养恤金.

相关的规定

Article I (1), (2) and (5) 雇主福利计划的成员 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, as amended from time to time and any successor agreement.

(5) “养老金领取者” 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, or (ii) a pension based in whole or in part on years of service credited under the terms of Article II G of the 1974 Pension Plan, 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 雇主, subject to the provisions of 第八条 of this Plan.

第八条. (1)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:

B. 养老金领取者

Health benefits and life insurance under Article III hereof shall be provided to 养老金领取者 as follows:

(1) Any 养老金领取者 who is not again employed in classified signatory employment subsequent to

(a) such 养老金领取者’s initial date of retirement under the 1974 Pension Plan, and

(b) 2月1日, 1988, 都有资格作为养老金领取者享受以下的保险, 并受本计划所有其他条款的约束. Notwithstanding (i) and (ii) of the definition of 养老金领取者 in Article I(S) of this Plan, any such 养老金领取者 who was eligible for benefits under the 1974 Benefit Plan as a 养老金领取者 on December 5, 1977, 都有资格享受这些福利, 受本计划所有其他条文规限.

讨论

第二条乙. 雇主福利计划的成员 establishes that an individual who is eligible for pension benefits under the 1974年退休金计划 is eligible for health benefits coverage under the 雇主 Benefit Plan with certain exceptions not relevant here.

The Complainant was awarded a 1974 Pension Plan Minimum Disability Pension, 7月1日生效, 1985. The evidence submitted by the Respondent and the evidence contained in the Complainant’s record has been reviewed, and the Funds’ original decision that the Complainant is entitled to a Minimum Disability Pension pursuant to Article II D. 1974年养恤金计划的规定已得到确认. Inasmuch as the Complainant receives a 1974 Pension Plan Minimum Disability pension, he is eligible for health benefits coverage as a 养老金领取者 under 第二条乙. 雇主福利计划的成员 established by his last signatory 雇主, the Respondent. 因此, the Respondent is responsible for providing health benefits coverage for the Complainant and his eligible dependents, 7月1日生效, 1985, for as long as he continues to satisfy the eligibility requirements of 第二条乙. 雇主福利计划的成员.

受托人的意见

The Respondent is responsible for providing health benefits coverage for the Complainant and his eligible dependents, 7月1日生效, 1985, for as long as the Complainant continues to satisfy the requirements of 第八条. 雇主福利计划的成员.