OPINION OF TRUSTEES
ROD Case No: 88-424 – August 26, 1991
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 a Pensioner under the terms of the Employer Benefit Plan.
The Complainant was injured while working in a classified job for the Respondent on August 10, 1987. As a result of this injury, the Complainant was awarded Workers’ Compensation benefits. The Complainant worked intermittently thereafter and ceased working for the Respondent on February 9, 1989, because of disability. The Complainant received Sickness and Accident Benefits from the Respondent for a period of 39 weeks from February 10, 1989 through November 10, 1989.
In February 1989, the Complainant applied’ for Social Security Disability Insurance (“SSDI”) benefits under Title II of the Social Security Act. His application was approved on appeal by an Administrative Law Judge on May 30, 1990, with a disability onset date of February 13, 1989.
On August 21, 1990, the Complainant applied for disability pension benefits from the UMWA 1974 Pension Plan. The Complainant was subsequently notified that he was eligible for a 1974 Pension Plan Minimum Disability pension, effective December 1, 1989. The Complainant was advised to contact the Respondent, his last signatory employer, regarding his eligibility for health benefits coverage as a Pensioner. The Complainant states that the Respondent has refused to provide him with health benefits coverage.
Is the Respondent responsible for providing health benefits coverage for the Complainant as a Pensioner?
Positions of the Parties
Position of the Complainant: The Respondent is responsible for providing health benefits coverage for the Complainant as a Pensioner.
Position of the Respondent: The Respondent is not responsible for providing health benefits coverage for the Complainant because the Complainant is not disabled as the result of a mine accident.
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 (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.
(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 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. B. (1) of the Employer Benefit Plan provides:
Article II – Eligibility
The persons eligible to receive the health benefits pursuant to Article III are as follows:
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 II B. of the Employer Benefit Plan establishes that an individual who is eligible for pension benefits under the 1974 Pension Plan is eligible for health benefits coverage under the Employer Benefit Plan, with certain exceptions not relevant here. Inasmuch as the Complainant is receiving a 1974 Pension Plan Minimum Disability pension, he is eligible for health benefits coverage as a Pensioner under Article II B. of the Employer Benefit Plan established by his last signatory Employer, the Respondent. Therefore, the Respondent is responsible for providing health benefits coverage for the Complainant and his eligible dependents, effective December 1, 1989.
The Respondent has asserted that the Complainant is not disabled as a result of a mine accident and, therefore, is not entitled to a disability pension from the 1974 Pension Plan. Any Employer challenge of a pension eligibility decision must be raised in a separate procedure authorized by Article XX (g) (3) of the Wage Agreement, and may not be addressed by the Trustees in the ROD process.
Opinion of the Trustees
The Respondent is responsible for providing health benefits coverage for the Complainant as a Pensioner, effective December 1, 1989.