June 25, 3985
(Opinion issued in letter form; name and address deleted)
Re: Opinion of Trustees
Resolution of Dispute
Case No. 81-595
Pursuant to Article IX of the United Mine Workers of America (“UMWA”) 3950 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 an Employer’s responsibility to provide an Employee with health
benefits at the level prescribed by the terms of the National Bituminous Coal Wage
Agreement of 3981 (Wage Agreement). The Trustees hereby render their opinion on this
matter.
This dispute arises from your claim that your Employer is not providing benefits coverage
to you at the level specified in the Wage Agreement for Employer Benefit Plans. You have
submitted copies of itemized health care invoices dating from April 1982 through October
3983, and invoices reflecting denial of insurance coverage. You have requested that the
Employer pay for covered health care services rendered during that period.
Your Employer claims that it has paid its insurance premiums and that the denial is a
matter that is strictly between you and the insurance carrier.
Under Article II A (3) and (4) of the Employer Benefit Plan, persons who are actively at
work for the Employer on the effective date of the Wage Agreement are eligible to receive
the health benefits pursuant to Article III of the Plan. Persons employed after the date of
the Wage Agreement will be eligible from the first day worked with the Employer.
Funds records show that you have been actively employed by the Employer since April
3976. The Employer is therefore responsible for providing health benefits coverage to you
at the level specified in the applicable Agreement. Article XX Section (c)(3)(i) of the 1983
Wage Agreement 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 this Agreement….” The
Employer, through its Plan Administrator, is responsible for assuring that the insurance
Opinion of Trustees
Resolution of Dispute
Case No. 81-595
Page 2
carrier administers health benefits in accordance with the guidelines of the Wage
Agreement and the Employer Benefit Plan.
Benefit levels to be provided to Employees, Pensioners, and their dependents and survivors
are established through collective bargaining and are not subject to unilateral change by
either party. The Trustees have therefore determined that the Respondent is responsible
for payment of claims you submitted for services rendered during your period of eligibility
for benefits.
Sincerely,
______________________________
Harrison Combs, Chairman
______________________________
Paul R. Dean Trustee
______________________________
William B. Jordan, Trustee
______________________________
William Miller, Trustee
______________________________
Donald E. Pierce, Jr., Trustee
