OPINION OF TRUSTEES
Complainant: Disabled Employee
ROD Case No: 84-234 – September 30, 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 health benefits coverage for a disabled Employee under the terms of the Employer Benefit Plan.
The Complainant, 48 years of age, was employed in classified work by the Respondent from December 1976 through October 31, 1983. In February 1985 he applied for a disability pension under the UMWA 1974 Pension Plan. The Complainant’s application for a disability pension was denied by the Funds, but his application for Social Security Disability Insurance benefits was approved, effective April 1, 1984. He was notified by the Funds that, because he was working in a classified job for a signatory employer when he became disabled, is eligible to receive Social Security Disability Insurance benefits, and upon attaining age 55 will be eligible to receive a pension based on at least 20 years of credited service, including the required number of years of signatory service, he may be eligible for health benefits as a disabled employee. The Complainant was advised by the Funds to contact his last signatory employer, the Respondent, to determine his eligibility. The Complainant contends that the Respondent has not provided his health benefits as a disabled Employee. He asks whether the Respondent is responsible for providing his health benefits.
Whether the Respondent is responsible for the provision of the health benefits coverage for the Complainant and his eligible dependents.
Positions of the Parties
Position of the Complainant: The Respondent is responsible for providing health benefits to the Complainant as a disabled Employee and to his eligible dependents.
Position of the Respondent: The Respondent has not replied to repeated correspondence regarding its position in this dispute.
Article I (1), (2) and (4) of the Employer Benefit Plan provide:
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 1981, 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 C. (1) of the Employer Benefit Plan provides:
Article II – Eligibility
C. Disabled Employees
In addition to disabled Pensioners who are receiving pension benefits and are therefore entitled to receive health benefits under paragraph B of this Article II, health benefits under Article III shall also be provided to any Employee who:
(1)(a) Has completed 20 years of credited service, including the required number of years of signatory service pursuant to Article IV of the 1974 Pension Plan or any corresponding paragraph of any successor thereto, and
(b) has not attained age 55, and
(c) became disabled after December 6, 1974 while in classified employment with the Employer, and
(d) is eligible for Social Security Disability Insurance benefits under Title II of the Social Security Act or its successor.
Under Article II C. (1) of the Employer Benefit Plan, a disabled Employee is entitled to health benefits coverage if he has not attained age 55; satisfies the 20 year service pension eligibility requirement under the 1974 Pension Plan; became disabled after December 6, 1974, while in classified employment with the Employer; and is eligible for Social Security Disability Insurance benefits under Title II of the Social Security Act. Inasmuch as the Complainant meets the foregoing eligibility requirements of Article II C. (1) of the Employer Benefit Plan, he is entitled to health benefits coverage from the Respondent, effective April 1, 1984.
Opinion of the Trustees
The Respondent is responsible for providing the Complainant with health benefits as a disabled Employee.