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OPINION OF TRUSTEES
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In Re
Complainants: Employees
Respondent: Employer
ROD Case No: 81-682 – October 28, 1986
Board of Trustees: Joseph P. Connors, Sr., Chairman; Paul R. Dean, Trustee; William B. Jordan,
Trustee; William Miller, Trustee; Donald E. Pierce, Jr., 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
level of health benefits coverage for Employees under the terms of the Employer Benefit Plan.
Background Facts
According to information reported to the Funds by the Respondent, the Complainants began
working for the Respondent in classified positions in February and March of 1983. The
Complainants continued working for the Respondent until they were laid off in mid-April of
1985.
The Complainants have submitted copies of bills for medical services rendered during their
employment with the Respondent. From the information submitted, it appears that only some of
these bills were paid by the various insurance carriers retained by the Respondent during this
period. The Complainants have indicated that some of the unpaid bills are for services rendered
during periods when no coverage was provided by the Respondent. They have also indicated
that payment for some of the bills was denied by the various insurance carriers because the
Respondent was not providing the level of coverage that is required under the Employer Benefit
Plan.
The Respondent was signatory to the National Bituminous Coal Wage Agreement (“Wage
Agreement”) of 1981. Records maintained by the Funds indicate that on October 22, 1984, the
Respondent signed a Letter of Agreement wherein it agreed to be bound by and comply fully
with the terms and conditions of the successor agreement to the 1981 Wage.Agreement. The
Respondent has failed to respond to repeated correspondence from the Funds regarding its
position in this dispute.
Dispute
Is the Respondent responsible for the provision of health benefits coverage for the Complainants
at the level prescribed by the Employer Benefit Plan?
Opinion of Trustees
Resolution of Dispute
Case No. 81-682
Page 2
Positions of the Parties
Position of the Complainants: The Respondent is responsible for the provision of the
Complainants’ health benefits during their periods of eligibility at the level prescribed by the
Employer Benefit Plan.
Position of the Respondent: The Respondent has failed to present its position in this dispute.
Pertinent Provisions
Article XX Section (c)(3)(i) of the National Bituminous Coal Wage Agreements of 1981 and
1984 provide:
(c) 1974 Plans and Trusts
(3) (i) 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 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. Such plans shall also
include that each signatory Employer continue to make the death
benefit payments in pay status as of December 5, 1977, for
deceased Employees and Pensioners under the 1974 Pension Plan
whose last signatory classified employment was with such
Employer, in the same manner and in the same amounts as
previously provided for in the 1974 Benefit Plan and Trust. The
plans established pursuant to this subsection are incorporated by
reference and made a part of this Agreement, and the terms and
conditions under which the health and other non-pension benefits
will be provided under such plans are as to be set forth in such
plans.
Article I (1), (2) and (4) of the Employer Benefit Plans provide:
Article I – Definitions
The following terms shall have the meanings herein set forth:
Opinion of Trustees
Resolution of Dispute
Case No. 81-682
Page 3
(1) “Employer” means (Employer’s Name)
(2) “Wage Agreement” means the National Bituminous Coal Wage Agreement of
1981 [1984], as amended from time to time and any successor agreement.
(4) “Employee” shall mean a person working in a classified job for the Employer,
eligible to receive benefits hereunder.
Article II A. (1) and (4) of the Employer Benefit Plans provide:
Article II – Eligibility
The persons eligible to receive the health benefits pursuant to Article III are as follows:
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…
(4) A new Employee will be eligible for health benefits from the first day worked
with the Employer.
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*
“Actively at work” includes an Employee of the Employer who was actively at work on March
26, 1981 [September 30, 1984], and who returns to active work with the Employer within two
weeks after the effective date of the Wage Agreement.
Article III D. 1(a) and (f) of the Employer Benefit Plans provide in pertinent part:
Article III – Benefits
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. 81-682
Page 4
Number of Hours Worked for the
Employer in the 24 Consecutive
Calendar Month Period Immediately
Prior to the Employee’s Date Period of Coverage Continuation
Last Worked from the Date Last Worked
2,000 or more hours Balance of month plus 12 months
500 or more but less than
2,000 hours Balance of month plus 6 months
Less than 500 hours 30 days
(f) Other Employment
Notwithstanding the foregoing, in the event an Employee accepts employment
during a period of continued coverage under paragraph (a), health, life and accidental
death and dismemberment coverage will terminate as of the date of such employment.
Discussion
Article XX(c)(3)(i) of the 1981 and 1984 Wage Agreements requires a signatory Employer to
establish and maintain an Employer Benefit Plan to provide health and other non-pension
benefits to its employees. The Wage Agreements stipulate that benefits provided by the
Employer pursuant to such plans shall be guaranteed during the term of the Agreements by that
Employer at levels set forth in such plans. The Respondent was signatory to the 1981 Wage
Agreement, and as the Trustees established in ROD 84-115, by virtue of its executed Letter of
Agreement with the UMWA, the Respondent is signatory to the 1984 Wage Agreement.
Therefore, the Respondent is responsible to provide those benefits specified in the Agreements
and in the Plans incorporated by reference therein, during the terms of those Agreements at the
level set forth in such Plans.
Article II A. of the Employer Benefit Plan provides health benefits coverage to employees
working in classified jobs for signatory employers. Article III D.’ 1(a) provides continued
benefits coverage for laid-off employees for defined periods based upon the number of hours
worked for the employer during the 24-month period prior to layoff. Article III D. (1) (f)
stipulates that such period of continued benefits coverage will terminate as of the date a laid-off
employee accepts other employment. Inasmuch as the Complainants were active Employees of
the Respondent who were laid off in April 1985, the Respondent is responsible for providing
their health benefits coverage during their active employment and for the continuation of such
coverage during the Complainants’ layoff for their individual periods of eligibility, as determined
under the terms of the Employer Benefit Plan, until they accepted other employment.
Opinion of Trustees
Resolution of Dispute
Case No. 81-682
Page 5
Opinion of the Trustees
The Respondent is responsible for the provision of health benefits coverage for the Complainants
at the level specified in the Employer Benefit Plan during the Complainants periods of eligibility
as determined under the terms of the Employer Benefit Plan.
