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OPINION OF TRUSTEES
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In Re
Complainant: Laid-off Employees
Respondent: Employer
ROD Case No: 88-490 – December 17, 1992
Board of Trustees: Joseph P. Connors, Sr., Chairman; Paul R. Dean, Trustee;
Elliot A. Segal, 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 laid-off Employees under the terms of the Employer Benefit Plan.
Background Facts
The Complainants worked for the Respondent in classified positions until they were laid off in January 1992.
One of the Complainants has stated that the Respondent terminated health benefits coverage for its Employees in August 1991. The representative for the Complainants contends that the Respondent is responsible for payment of the covered medical charges incurred by the Complainants and their eligible dependents during their employment and during their period of eligibility for continued coverage as laid-off Employees.
The Respondent is signatory to the National Bituminous Coal Wage Agreement (“Wage Agreement”) of 1988.
Dispute
Whether the Respondent is responsible for payment of the Complainants’ unpaid medical bills and for the provision of health benefits coverage for the Complainants as laid-off Employees under the terms of the Employer Benefit Plan?
Positions of the Parties
Position of the Complainant: The Respondent is responsible for payment of the covered medical charges incurred by the Complainants during their employment and during their periods of eligibility for continued coverage as laid-off Employees under 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 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 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 person eligible to receive the health benefits pursuant to Article III are as follows:
A. Active Employee
(4) A new Employee will be eligible for health benefits from the first day worked with the Employer.
Article III D. (1)(a) of the Employer Benefit Plan provides:
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 of Coverage
Period Immediately Prior to Continuation from
the Employee’s Date Last Worked the Date Last Worked
2,000 or more hours Balance of month
plus 12 months
500 or more but less Balance of month
than 2,000 hours plus 6 months
Less than 500 hours 30 days
Discussion
Article XX (c)(3)(i) of the 1988 Wage Agreement requires each 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. (4) of the Employer Benefit Plan provides health benefit coverage for active Employees working in classified jobs for a signatory Employer. Article III D. (1)(a) of the Plan provides continued benefits coverage for laid-off Employees based upon the number of hours worked for the Employer during the 24-month period immediately prior to the date last worked. Inasmuch as the Complainants were actively employed in classified positions when they were laid off by the Respondent in January 1992, the Respondent is responsible for providing health benefits coverage to the Complainants and their eligible dependents during their employment and for the continuation of the Complainants’ health benefits coverage beyond January 1992, pursuant to Article III. D. (1)(a) of the Employer Benefit Plan. Accordingly, the Respondent is responsible for payment of the covered medical expenses incurred by the Complainants and their eligible dependents during their employment and during their individual periods of eligibility for coverage as laid-off Employees, as determined under the terms of the Employer Benefit Plan.
Opinion of the Trustees
The Respondent is responsible for payment of the covered medical expenses incurred by the Complainants and their eligible dependents during their employment and during their individual periods of eligibility for continued coverage as laid-off Employees, consistent with the terms of the Employer Benefit Plan.