_____________________________________________________________________________
OPINION OF TRUSTEES
_____________________________________________________________________________
In Re
Complainant: Pensioner
Respondent: Employer
ROD Case No: 88-206 – January 19, 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, 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 is a Pensioner whose last signatory classified employment in the coal industry
was with the Respondent from February 6, 1989 until August 10, 1989. The Complainant was
awarded a UMWA 1974 Pension Plan Age 55 retirement pension, effective September 1, 1989.
Information provided to the Funds indicates that the Complainant has not had health benefits
coverage since May 1, 1989 because the Respondent failed to pay the insurance premiums. As a
result, the Complainant incurred medical bills in June and July 1989 that have not been paid.
The Respondent is signatory to the National Bituminous Coal Wage Agreement (“Wage
Agreement”) of 1988.
Dispute
Is the Respondent responsible for providing health benefits coverage for the Complainant and for
payment of the unpaid medical bills incurred by the Complainant and his eligible dependents?
Positions of the Parties
Position of the Complainant: The Respondent is responsible for payment of the Complainant’s
unpaid medical bills and for providing health benefits coverage for the Complainant.
Position of the Respondent: The Respondent has not replied to repeated correspondence from
Funds’ staff requesting its position in this dispute.
Opinion of Trustees
Resolution of Dispute
Case No. 88-206
Page 2
Pertinent Provisions
Article XX(c)(3)(i) of the National Bituminous Coal Wage Agreement of 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 nonpension 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), (4) and (5) 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 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.
(5) “Pensioner” shall mean any person who is receiving a pension, other than
(I) a deferred vested pension based on less than 20 years of credited
service, or (ii) a pension based in whole or in part on years of service
credited under the terms of Article II G of the 1974 Pension Plan, or any
corresponding paragraph of any successor thereto, under the 1974 Pension
Plan (or any successor thereto), whose last classified signatory
employment was with the Employer, subject to the provisions of Article II
B of this Plan.
Article II A. (4) and B. (1) of the Employer Benefit Plan provide:
Article II – Eligibility
Opinion of Trustees
Resolution of Dispute
Case No. 88-206
Page 3
The persons eligible to receive the 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.
B. Pensioners
Health benefits and life insurance under Article III hereof shall be provided to
Pensioners as follows:
(1) Any Pensioner who is not again employed in classified signatory
employment subsequent to
(a) such Pensioner’s initial date of retirement under the 1974 Pension
Plan, and
(b) February 1, 1988, shall be eligible for coverage as a Pensioner
under, and subject to all other provisions of this Plan.
Notwithstanding (I) and (ii) of the definition of Pensioner in
Article I(S) of this Plan, any such Pensioner who was eligible for
benefits under the 1974 Benefit Plan as a Pensioner on December
5, 1977, shall be eligible for such benefits, subject to all other
provisions of this Plan.
Article III D. (1)(e) of the Employer Benefit Plan provides:
Article III–BenefIts
D. General Provisions
(1) Continuation of Coverage
(e) Quit or Discharge
If any Employee quits (for any reason) or is discharged, health, life and
accidental death and dismemberment insurance coverage will terminate as of the
date last worked. An Employee who ceases work and will be found to be eligible
for health benefits as a retiree on the first of the month subsequent to the date on
which he last worked shall be eligible for benefits without interruption as
provided by the Plan from the date he last worked.
Opinion of Trustees
Resolution of Dispute
Case No. 88-206
Page 4
Discussion
Article XX (c)(3)(i) of the 1988 Wage Agreement requires a signatory Employer to establish and
maintain an Employer Benefit Plan to provide health and other non-pension benefits for its
Employees and for Pensioners whose last signatory classified employment was with such
Employer. The Wage Agreement stipulates that benefits provided by the Employer pursuant to
such Plan shall be guaranteed during the term of the Agreement by that Employer at levels set
forth in such Plan.
Article II A. of the Employer Benefit Plan provides health benefits coverage for active
Employees working in classified jobs for a signatory Employer. Article II B. provides health
benefits coverage for individuals who are eligible for pension benefits under the UMWA 1974
Pension Plan with certain exceptions not relevant here. In addition, Article III 0. (1)(e) states
that an Employee who ceases work and is found to be eligible for health benefits as a Pensioner
on the first of the month subsequent to the date on which he last worked shall be eligible for
benefits without interruption from the date last worked. Inasmuch as the Complainant was an
active Employee of the Respondent from February 6, 1989 until August 10, 1989 and became a
1974 Plan Pensioner effective September 1, 1989, he is entitled to health benefits coverage
during his employment and continuing beyond his date last worked throughout his eligibility for
coverage as pensioner, consistent with the terms of the Wage Agreement and the Employer
Benefit Plan. The Respondent is therefore responsible for payment of the covered medical
expenses incurred by the Complainant and his eligible dependents in June and July 1989 during
the Complainant’s employment with the Respondent.
Opinion of the Trustees
The Respondent is responsible for payment of the covered medical expenses incurred by the
Complainant and his eligible dependents in June and July 1989, and for providing health benefits
coverage to the Complainant as an Employee and Pensioner, consistent with the term of the
Wage Agreement and the Employer Benefit Plan.
