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OPINION OF TRUSTEES
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In Re
Complainant: Employee
Respondent: Employer
ROD Case No: 84-364 – October 28, 1987
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
provision of health benefits coverage under the terms of the Employer Benefit Plan.
Background Facts
The Complainant worked for the Respondent in a classified position from April 1985 to June 16,
1986, when he was laid off. The Complainant has submitted copies of unpaid medical bills
incurred during his employment with the Respondent.
The Complainant states that the Respondent terminated his health benefits coverage on or about
June 16, 1986. The Complainant claims that he is entitled to 12 months of continued health
benefits coverage beyond June 1986, because he worked over 2,000 hours for the Respondent
during the 24-month period prior to June 16, 1986. The Complainant asks whether the
Respondent is responsible for payment of medical charges incurred during his employment and
during his period of eligibility for continued coverage as a laid-off Employee.
The Respondent is signatory to the National Bituminous Coal Wage Agreement (“Wage
Agreement”) of 1984.
Dispute
Whether the Respondent is responsible for payment of the Complainant’s outstanding medical
bills and for the provision of health benefits coverage for the Complainant as a laid-off Employee
under the terms of the Employer Benefit Plan.
Positions of the Parties
Position of the Complainant: The Respondent is responsible for payment of the covered medical
charges incurred by the Complainant during his employment and during his period of eligibility
for continued coverage as a laid-off Employee under the terms of the Employer Benefit Plan.
Opinion of Trustees
Resolution of Dispute
Case No. 84-364
Page 2
Position of the Respondent: The Respondent has not responded to repeated correspondence from
Fund’s staff regarding its position in this dispute.
Pertinent Provisions
Article XX Section (c)(3)(i) of the National Bituminous Coal Wage Agreement of 1984 provides
in pertinent part:
(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.
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 (Employer’s Name).
(2) “Wage Agreement” means the National Bituminous Coal Wage
Agreement of 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. (4) of the Employer Benefit Plan provides:
Article II – Eligibility
The persons eligible to receive health benefits pursuant to Article III are as follows:
A. Active Employees
(4) A new Employee will be eligible for health benefits from the first
day worked with the Employer.
Opinion of Trustees
Resolution of Dispute
Case No. 84-364
Page 3
Article III D. (1)(a) of the Employer Benefit Plan provides:
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:
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
Discussion
Article XX Section (c)(3)(i) of the 1984 Wage Agreement requires Employers to provide an
Employee benefit plan… “implemented through an insurance carrier(s), [for] health and other
non-pension benefits…” It further requires that “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.’ Inasmuch as the Complainant was eligible for health
benefits coverage as an active Employee of the Respondent at the time the outstanding medical
bills were incurred, the Respondent is responsible for payment of the covered medical charges
under the terms of the Employer Benefit Plan. Furthermore, inasmuch as the Complainant was
eligible for health benefits coverage beyond June 16, 1986 as a laid-off Employee, the
Respondent is responsible for the payment of any additional covered medical charges incurred
during the Complainant’s period of eligibility for continued health benefits coverage as
determined under the terms of the Employer Benefit Plan.
Opinion of the Trustees
Opinion of Trustees
Resolution of Dispute
Case No. 84-364
Page 4
The Respondent is responsible for payment of covered medical charges incurred by the
Complainant and his eligible dependents during his active employment and during his period of
eligibility for continued benefits coverage as a laid-off Employee as determined under the terms
of the Employer Benefit Plan.