______________________________________________________________________________
OPINION OF TRUSTEES
______________________________________________________________________________
In Re
Complainant: Employer
Respondent: Employee
ROD Case No: 64 – October 25, 1979
Board of Trustees: Harrison Combs, Chairman; John J. O’Connell, Trustee;
Paul R. Dean, Trustee.
Pursuant to Article IX of the United Mine Workers of America 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 for the Employee and hereby render their opinion on the matter.
Background Facts
The Employee began working for the Employer on June 3, 1974; he had no previous mining experience. On October 26, 1976, the Employee injured his back while performing classified work for the Employer. He worked 6 days during 1976 and 1977 and last work in July, 1977. He was awarded Workmen’s Compensation based on this injury with payments to continue for five more years unless he recovers sufficiently to return to work. The Employer has cancelled his insurance coverage.
The Employee states he has suffered other complications from the injury and has been advised by his physician that he will never be able to work in the mines. He has applied for Social Security Disability Benefits and for Disability Pension from the Funds. Both applications are pending.
Question or Dispute
Is the Employer responsible for providing coverage for the Employee under the Employer’s Benefit Plan? If so, for what period?
Positions of the Parties
Employee’s Position: The Employee feels that he is eligible for coverage, under the contract, for the period he is receiving Workmen’s Compensation benefits.
Employer’s Position: The Employer has raised the question of Employee’s eligibility, but has not stated a position.
Pertinent Provisions
Article II C of the Employer’s Plan
Discussion
Article II C provides that in addition to disabled miners receiving 1974 Plan pensions, there are three categories of disabled miners who qualify for benefit coverage: Sections (1) and (2) both provide that the disabled Employee must meet the service requirements for pension in addition to meeting other requirements and Section (3) provides that the disabled Employee must be receiving Sickness and Accident Benefits (as provided by Article XI of the NBCWA of 1978). There are no provisions in the Employer’s plan which state that an Employee is eligible for coverage based solely on receipt of Workmen’s Compensation payments.
It is undisputed that the Employee is not currently receiving a Funds Disability Pension, he does not meet the service requirements for pension as required by Article II C(1) or II C(2) and he is not currently receiving Sickness and Accident Benefits. Accordingly, he is not eligible for coverage under the Employer’s plan.
Opinion of the Trustees
In the opinion of the Trustees, the Employer is not responsible for providing benefit coverage for the Employee. If the Employee should later qualify for a Disability Pension under the 1974 Pension Plan, however, he would then be eligible for such coverage.