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OPINION OF TRUSTEES
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In Re
Complainant: Employee
Respondent: Employer
ROD Case No: 88-079 – August 2, 1989
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, 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 for an active Employee under the terms of the Employer
Benefit Plan.
Background Facts
The Complainant was employed in a classified job by the Respondent from April 7, 1986 to
March 7, 1988. The Complainant states that the Respondent failed to provide health benefits
coverage for its Employees. The Complainant contends that the Respondent agreed to pay its
Employees’ medical expenses itself; however, the Respondent has paid only a portion of the
medical bills incurred by the Complainant and his dependents during his employment with the
Respondent. The Complainant has paid the remaining bills himself and asks that the Respondent
be required to reimburse him.
Dispute
Whether the Respondent is responsible for payment of the medical expenses incurred by the
Complainant and his eligible dependents during his employment with the Respondent.
Positions of the Parties
Position of the Complainant: The Respondent is responsible for payment of the covered medical
expenses incurred by the Complainant and his eligible dependents during his employment with
the Respondent.
Opinion of Trustees
Resolution of Dispute
Case No. 88-079
Page 2
Position of the Respondent: The Respondent has not replied 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 1984 and 1988
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 1984 and 1988 Employer Benefit Plans 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 [1988], 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 1984 and 1988 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:
Opinion of Trustees
Resolution of Dispute
Case No. 88-079
Page 3
(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
September 30, 1984 [January 31, 1988], and who returns to active work with the Employer two
weeks after the effective date of the Wage Agreement.
Discussion
Article XX (c)(3)(i) of the 1984 and 1988 Wage Agreements requires a signatory Employer to
establish and maintain an Employee benefit plan to provide health and other non-pension
benefits for its Employees. The Wage Agreement stipulates that benefits provided by the
Employer pursuant to such Plan shall be guaranteed during the term of the Agreement at levels
set forth in such Plan.
Article II A. of the Employer Benefit Plans established pursuant to the 1984 and 1988 Wage
Agreements provides health benefits coverage for active Employees working in classified jobs
for a signatory Employer. The record in this case indicates that the Complainant incurred
medical expenses during his employment with the Respondent when no health benefits coverage
was in effect. Inasmuch as the Complainant was an active Employee of the Respondent at the
time the medical bills were incurred, the Respondent is responsible for payment of the medical
expenses which are covered under the terms of the 1984 and 1988 Wage Agreements and
Employer Benefit Plans.
Opinion of the Trustees
The Respondent is responsible for payment of the covered medical expenses incurred by the
Complainant and his eligible dependents during his employment with the Respondent, consistent
with the terms of the Wage Agreements and the Employer Benefit Plans.
