Opinion of Trustees
Resolution of Dispute
Case No. 81-516
Page 1
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OPINION OF TRUSTEES
_____________________________________________________________________________
In Re
Complainant: Employee
Respondent: Employer
ROD Case No: 81-516 – February 25, 1985
Board of Trustees: Harrison Combs, Chairman; Joseph P. Brennan, Trustee; William Miller,
Trustee; Paul R. Dean, Trustee.
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
responsibility for the provision of benefits coverage for an Employee by the Employer under the
terms of the Employer’s Benefit Plan. The Trustees hereby render their opinion on the matter.
Background Facts
According to information reported to the Funds by the Respondent, the Complainant was
employed in a classified position in February 1980 and worked approximately 1700 hours before
being laid off in March 1981. He returned to work in the months of June and July 1981 and was
again laid off. The Complainant worked for a non-signatory employer from January 15, 1982
until February 10, 1982 when he was recalled to his job with the Respondent. He worked for the
Respondent from February 11, 1982 until his discharge in May 1982.
In June 1980 the Complainant began to incur medical bills. From the information submitted, it
appears that only some of these bills were paid by the various insurance carriers retained by the
Respondent over this period. On September 19, 1984, a judgment was entered against the
Complainant in the General District Court on behalf of a hospital in the total amount of $956.39.
This amount represents $803.50 of unpaid medical bills (including some individual copayments), $130.89 in interest charges, $10.00 judgment costs, and $12.00 for garnishment
costs. Although these charges were for benefits covered under the Employer Benefit Plan, to date
the Respondent has refused to provide the Complainant with health benefits coverage for these
charges. The Complainant contends that he did not receive the level of coverage that is required
under the Employer Benefit Plan. The Respondent has not submitted its position in this dispute.
Dispute
Is the Respondent responsible for provision of health benefits coverage and
Opinion of Trustees
Resolution of Dispute
Case No. 81-516
Page 2
related charges incurred for services provided from February 1980 to May 1982?
Position of Parties
Position of the Complainant: The Complainant maintains that as an Employee of the
Respondent, he was eligible for health benefits coverage from February 1980 to May 1982.
Position of the Respondent: The Respondent has failed to present its position to the Funds
despite repeated requests for information.
Pertinent Provisions
Article XX Section (c)(3)(i) of the National Bituminous Coal Wage Agreements of 1978 [1981]
provide:
(c) 1974 Plans and Trusts
(3)(i) …[E]ach signatory Employer shall establish [and maintain an
Employee benefit plan to provide, implemented through an
insurance carrier(s), health and other non-pension benefits for its
Employees covered by this Agreement as well as pensioners under
the 1974 Pension Plan and Trust, whose last [signatory] classified
employment was with such Employer. The benefits provided by
the Employer to its eligible Participants pursuant to such plans
shall be guaranteed during the term of this Agreement by that
Employer at levels set forth in such plans…..
Article I (1), (2), and (4) of the 1978 [1981] Employer Benefit Plans provides:
Article I – Definitions
The following terms shall have the meanings herein set forth:
(1) “Employer” means (coal company)
(2) “Wage Agreement” means the National Bituminous Coal Wage Agreement of
1978 [1981], as amended from time to time and any successor agreement.
(4) “Employee” shall mean a pensioner working in a classified job for the Employer,
eligible to receive benefits hereunder.
Opinion of Trustees
Resolution of Dispute
Case No. 81-516
Page 3
Article II A(1)(2) and (4) of the 1978 [1981] Employer Benefit Plans provide:
Article II – Eligibility
A. Active Employees
Benefits under Article III shall be provided to any Employee who:
(1) Is actively at work* for the Employer on the effective date of the [Wage
Agreement]; or…
(2) Is on layoff or disabled from the Employer and had continuing eligibility
as of the effective date of the [Wage Agreement] Plan for coverage under
the 1978 Employer’s Benefit Plan (“prior Plan”) as a laid off or disabled
employee. Coverage for such laid-off or disabled Employees shall not
continue beyond the date when they would no longer have been eligible
for such coverage under the provisions of the prior Plan.
(4) A new Employee will be eligible for health benefits from the first day
worked with the Employer.
Article III A (10) [(11)] (a) 18. and E [D] (1)(a) and (c) of the 1978 [1981] Employer Benefit
Plans provide:
Article III – Benefits
A. Health Benefits
(10) [(11)] General Exclusions
(a) In addition to the specific exclusions otherwise contained in the
Plan, benefits also are not provided for the following:
18. Finance charges in connection with a medical bill.
E. [D]. General Provisions
(1) Continuation of Coverage
(a) Layoff
If an Employee ceases work because of layoff, continuation of
health, life and accidental death and dismemberment insurance
coverage is as follows:
Opinion of Trustees
Resolution of Dispute
Case No. 81-516
Page 4
Number of Hours Worked for
the Employer in the 24
Consecutive Calendar Month
Period Immediately Prior to Period of Coverage
the Employee’s Date Continuation from the
Last Worked Date Last Worked
2,000 or more hours Balance of month plus
12 months
500 or more but less than Balance of month plus
2,000 hours 6 months
Less than 500 hours 30 days
(e) Quit or Discharge
If an Employee quits or is discharged, health, life and accident
death and dismemberment coverage will terminate as of the date last
worked.
Discussion
The Complainant has incurred medical bills during his period of employment with the
Respondent which he claims were not paid because the Respondent had a variety of insurance
carriers during his employment. He therefore claims he was not provided with the level of health
benefits coverage specified in the Employer Benefit Plan.
Article XX Section (c)(3)(i) of the Wage Agreement(s) states that each signatory Employer shall
establish and maintain an Employee benefit plan to provide, implemented through an insurance
carrier(s), health and other non-pension benefits for its Employees covered by the Agreement(s).
That provision also states that benefits provided by the Employer to its eligible Participants
pursuant to such plans shall be guaranteed during the term of the Agreement(s) by that Employer
at levels set forth in such plans.
During the twenty-four month period prior to his layoff in July, 1981 the Complainant worked
more than 500 but less than 2,000 hours. Under Article III E (1978) or D (1981) of the
Employer Benefit Plans, he was, therefore, entitled to benefits coverage until he accepted
employment with a non-signatory company January 15, 1982. His eligibility for coverage under
Article II A(1) and (4) resumed when he returned to work with the Respondent as an active
Employee February 11, 1982, and continued until his discharge in May 1982.
The Respondent, therefore, is responsible for providing benefit coverage to the Complainant and
his eligible dependents from the date of his employment in February 1980, through his date of
discharge in May 1982, exclusive of his period of other employment from January 15 through
February 10, 1982.
Opinion of Trustees
Resolution of Dispute
Case No. 81-516
Page 5
The Complainant has also raised a question regarding the Respondent’s responsibility for
payment of interest and related charges arising from the court action by a provider to obtain
payment.
Article III A of the 1978 and 1981 Employer’s Benefit Plans specifically excludes from coverage
finance charges in connection with medical services. This opinion by the Trustees, however, is
not intended to express any view regarding the availability to the Complainant of recourse to
other forums to recover the finance charges incurred.
Opinion of the Trustees
It is the opinion of the Trustees that the Respondent is responsible for providing health benefits
coverage to the Complainant from February 1980 to May 1982 (excluding the period January 15,
1982 to February 10, 1982), at the level specified in the Employer Benefit Plan.
