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OPINION OF TRUSTEES
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In Re
Complainant: Employee
Respondent: Employer
ROD Case No: 88-262 – 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 an Employee under the terms of the Employer Benefit
Plan.
Background Facts
The Complainant was employed in a classified job by the Respondent from the summer of 1988
until April 3, 1989, when he quit to accept employment with another signatory Employer. The
Respondent provided health benefits coverage for the Complainant through Blue Cross and Blue
Shield until March 1, 1989, when his coverage was terminated. The Complainant has submitted
copies of unpaid bills for medical services rendered in March 1989; The Complainant’s
representative contends that the Respondent is responsible for payment of these medical bills
that were incurred during the Complainant’s employment with the Respondent. The Respondent
is signatory to the National Bituminous Coal Wage Agreement (“Wage Agreement”) of 1988.
Dispute
Is the Respondent responsible for payment of the Complainant’s unpaid medical bills incurred
during March 1989?
Positions of the Parties
Position of the Complainant: The Respondent is responsible for payment of the Complainant’s
medical bills incurred during his employment with the Respondent.
Opinion of Trustees
Resolution of Dispute
Case No. 88-262
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 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) of the Employer Benefit Plan provides:
Article II – Eligibility
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.
Opinion of Trustees
Resolution of Dispute
Case No. 88-262
Page 3
Article III D. (1)(e) of the Employer Benefit Plan provides in pertinent part:
D. General Provisions
(1) Continuation of Coverage
(e) Quit or Discharge
If an 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.
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 active
Employees working in classified jobs for a signatory Employer. Article III D. (1)(e) states that,
if an Employee quits for any reason, health, life and accidental death and dismemberment
coverage will terminate as of the date last worked. Information provided in this case indicates
that the Respondent terminated the Complainant’s health benefits coverage on March 1, 1989.
The Complainant, however, was actively employed in a classified position by the Respondent
from the summer of 1988 until April 3, 1989, when he quit to accept other employment.
Accordingly, the Respondent is responsible for payment of the covered medical expenses
incurred by the Complainant and his eligible dependents during March 1989.
Opinion of the Trustees
The Respondent is required to pay the covered medical expenses incurred by the Complainant
and his eligible dependents during his employment with the Respondent in March 1989,
consistent with the terms of the Employer Benefit Plan.
