_____________________________________________________________________________
OPINION OF TRUSTEES
_____________________________________________________________________________
In Re
Complainants: Disabled Employees
Respondent: Employer
ROD Case No: 88-244 – June 8, 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 for disabled Employees under the terms of the Employer
Benefit Plan.
Background Facts
The Complainants are two disabled Employees who sustained compensable injuries while
performing classified work for the Respondent. One of the Complainants began working for the
Respondent on August 3, 1988 and ceased work because of his injury in March 1989. The other
Complainant, began working for the Respondent in March 1989, and ceased work because of his
injury on October 24, 1989. As a result of their injuries, the Complainants have been unable to
return to work and are receiving Workers’ Compensation benefits.
The Complainants state that the Respondent has failed to pay the insurance premiums for their
health benefits coverage. According to information provided to the Funds, the Complainants’
health benefits coverage was cancel led July 31, 1989. The Complainants have submitted
information indicating that medical expenses incurred by them and their dependents after July
31, 1989 have not been paid. The Complainants contend that the Respondent is required to pay
their outstanding medical bills and to provide coverage for the remainder of their periods of
eligibility under the terms of the Employer Benefit Plan.
Dispute
Whether the Respondent is responsible for providing health benefits coverage for the
Complainants beyond July 31, 1989.
Positions of the Parties
Opinion of Trustees
Resolution of Dispute
Case No. 88-244
Page 2
Position of the Complainants: The Respondent is responsible for providing health benefits
coverage for the Complainants beyond July 31, 1989 pursuant to the terms of the Employer
Benefit Plan.
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 Section (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
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 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. (4) and C. (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
Opinion of Trustees
Resolution of Dispute
Case No. 88-244
Page 3
(4) A new Employee will be eligible for health benefits from the first day
worked with the Employer.
C. Disabled Employees
In addition to disabled Pensioners who are receiving pension benefits and are
therefore entitled to receive health benefits under paragraph 8 of this Article II,
health benefits under Article III shall be provided to any Employee who:
(3) Is receiving or would, upon proper application, be eligible to receive
Sickness and Accident Benefits pursuant to the Wage Agreement.
Article III D. (1) (a) and (b) of the Employer Benefit Plan provide:
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
(b) Disability
Except as otherwise provided in Article II, section C, if an Employee
ceases work because of disability, the Employee will be eligible to continue
health, life and accidental death and dismemberment coverage while disabled for
Opinion of Trustees
Resolution of Dispute
Case No. 88-244
Page 4
the greater of (i) the period of eligibility for Sickness and Accident benefits, or
(ii) the period as set forth in the schedule in (a) above.
Discussion
Article XX Section (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. 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 an active
Employee working in a classified job for a signatory Employer. Article II C. (3) provides health
benefits coverage for a disabled Employee who is receiving or would be eligible to receive
Sickness and Accident Benefits pursuant to the Wage Agreement. In addition, Article III D. (1)
(b) provides continued benefits coverage for an Employee who ceases work because of disability
for the greater of (i) the period of eligibility for Sickness and Accident benefits, or (ii) the period
based on the number of hours worked as set forth in Article III D. (1)(a).
One of the Complainants was employed by the Respondent from August 3, 1988 until March
1989 when he ceased work because of disability; the other Complainant was employed by the
Respondent from March 1989 until October 24, 1989, when he ceased work because of
disability. Information submitted in this case indicates that the Complainants’ health benefits
coverage was terminated on July 31, 1989. Inasmuch as the Complainants were actively
employed in classified positions by the Respondent until they ceased work because of disability,
the Respondent is responsible for providing health benefits coverage during their employment
and during their individual periods of eligibility for continued coverage as determined under
Article III D. (1) (b) of the Employer Benefit Plan.
Opinion of the Trustees
The Respondent is responsible for providing health benefits coverage for the Complainants and
for payment of the covered medical expenses incurred by the Complainants and their eligible
dependents during their individual periods of eligibility beyond July 31, 1989, as determined
under the terms of the Employer Benefit Plan.
