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OPINION OF TRUSTEES
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In Re
Complainant: Surviving Spouse
Respondent: Employer
ROD Case No: 84-387 – January 9, 1990
Board of Trustees: Joseph P. Connors, Sr., Chairman; Paul R. Dean, Trustee; William Miller, Trustee; Donald E. Pierce, Jr., Trustee; Thomas H. Saggau, Trustee.
Pursuant to Article IX of the United Mine Workers of America (“”UMWA”) 1950 Benefit Plan and Trust, ana 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 is the surviving spouse of an Employee who died on June 6, 1983, at the age of 27, as the result of an automobile accident. The Employee last worked for the Respondent on June 4, 1983. Following his death, the Respondent provided a life insurance benefit to the Complainant and health benefits coverage for the Complainant and her eligible dependents. The Complainant is not eligible for a Surviving Spouse benefit under the 1974 Pension Plan.
The Complainant claims that the Respondent has not provided health benefits coverage since early 1986. The Complainant indicated that she did not know her coverage had been terminated until July 1986, when she began receiving notices of unpaid medical bills. The Complainant has submitted unpaid medical bills which were incurred between July 1986 and January 1987. The Complainant states that when she telephoned the Respondent about the unpaid bills, she was told that the Respondent had ceased providing health benefits coverage.
The Respondent was signatory to the National Bituminous Coal Wage Agreements (“Wage Agreement”) of 1981 and 1984. The 1984 Wage Agreement expired on January 31, 1988. The Respondent ceased operations in July 1986 and did not sign the 1988 Wage Agreement.
Dispute
Whether the Respondent is responsible for providing health benefits coverage for the Complainant and her eligible dependents.
Positions of the Parties
Position of the Complainant: The Respondent is responsible for the provision of health benefits coverage for the Complainant and her eligible dependents.
Position of the Respondent: The Respondent has not responded to repeated correspondence from Funds’ staff requesting its position in this dispute.
Pertinent Provisions
Article XX(c)(3)(i) of the National Bituminous Coal Wage Agreements of 1981 and 1984 provides:
(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 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 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 E. (3) of the Employer Benefit Plan 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;
E. Surviving Spouse and Dependents of Deceased Employees or Pensioners
Health benefits under Article III shall be provided to (i) any unmarried surviving spouse (who was living with or being supported by the Employee or Pensioner immediately prior to the Employee’s or Pensioner’s death) and (ii) such spouse’s unmarried surviving dependent children as defined in subparagraphs (2) and (5) of Paragraph D, of an Employee or Pensioner who died:
(3) At a time when such Employee or Pensioner is entitled to receive health benefits pursuant to paragraph A, B, or C of this Article II, provided that (i) if such Employee or Pensioner died prior to the effective date of the Wage Agreement and the spouse is not eligible for a Surviving Spouse’s benefit, then only for the period that the spouse is eligible to receive death benefits in installment payments pursuant to paragraph C of Article III, or (ii) if such Employee or Pensioner died on or after the effective date of the Wage Agreement and the spouse is not eligible for a Surviving Spouse’s benefit and life insurance benefits or death benefits are payable in a lump sum, then only for 60 months following the month of the death of such Employee or only for 22 months following the month of death of such Pensioner. If life insurance benefits are not payable, health benefits shall be provided only to the end of the month in which the Employee or Pensioner died.
Any children who have not attained age 22 shall not be entitled to receive health benefits under this paragraph E if they are employed and living outside the household (residence) of the surviving spouse or the immediate family of the deceased Employee or Pensioner.
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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.
Health benefits shall continue for a surviving spouse until remarriage of such spouse, but if such spouse is entitled to such benefits under paragraph (3) above, such health benefits will continue not longer than for the period specified in paragraph (3) above. Health benefits shall not be provided during any month in which such surviving spouse is regularly employed at an earnings rate equivalent to at least $500 a month.
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 for its Employees. The Wage Agreements stipulate that benefits provided pursuant to such Plan shall be guaranteed during the term of the Agreements. Article II E. (3) of the Employer Benefit Plan provides health benefits for the unmarried surviving spouse and the eligible dependents of an Employee who died while entitled to receive health benefits pursuant to Article II A, B, or C of the Employer Benefit Plan. Inasmuch as the Complainant is the unmarried surviving spouse of an Employee who died while he was entitled to receive health benefits pursuant to Article II A. of the Plan, the Respondent is responsible for providing health benefits coverage for the Complainant and her eligible dependents during the terms of the 1981 and 1984 Wage Agreements.
The issue here is whether the Respondent is contractually obligated to provide such coverage beyond the expiration of the 1984 Wage Agreement when the Respondent did not sign the 1988 Wage Agreement. Under Article II E. of the Employer Benefit Plan, the surviving spouses and dependents of certain Employees and Pensioners are entitled to a specific period of health benefits coverage. The Trustees have previously decided in ROD 81-730 (copy enclosed herein) that the clear and unequivocal language of the Employer Benefit Plan requires an Employer to provide health benefits coverage for the period specified under Article II E. (3) of the Plan, even when that period extends beyond the expiration of a Wage Agreement.
Under Article II E. (3) (ii), the unmarried surviving spouse of an active Employee who died while eligible to receive health benefits pursuant to Article II A., is eligible to receive health benefits for 60 months following the Employee’s death, if such spouse is not eligible to receive a Surviving Spouse benefit and life insurance benefits are payable in a lump sum. Inasmuch as the Complainant is the unmarried widow of an active Employee who was eligible to receive health benefits at the time of his death, is not eligible to receive a Surviving Spouse benefit, and was eligible for life insurance benefits in a lump sum, she and her eligible dependents are entitled to health benefits coverage from the Respondent for 60 months following the month of the death of her husband. Inasmuch as the Employee died on June 6, 1983, their period of eligibility extended through June 1988, provided they continued to meet the eligibility requirements of Article II E. of the Employer Benefit Plan.
Opinion of the Trustees
The Respondent is responsible for providing health benefits coverage for the Complainant and her eligible dependents through June 1988, in accordance with the provisions of Article II E. (3) of the Employer Benefit Plan.