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OPINION OF TRUSTEES
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In Re
Complainant: Employee
Respondent: Employer
ROD Case No: 88-706 – September 28, 1993
Board of Trustees: Michael H. Holland, Chairman; Thomas F. Connors, Trustee;
Marty D. Hudson, Trustee; Robert T. Wallace, Trustee.
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 injured on September 26, 1991, while working in a classified position for
a signatory Employer. He received Workers’ Compensation benefits and on November 5, 1991,
the Complainant was released by a physician to return to work but could only perform work with
restrictions. The Complainant ceased work on March 30, 1992, because his Employer no longer
had available work with restrictions.
In September 1992, the company that employed the Complainant was purchased by the
Respondent, a signatory Employer. The Complainant was examined by the Respondent’s
physician and was asked to report to work on October 1, 1992. The Complainant returned to
work on October 1, 1992. On October 2, 1992, the Complainant submitted a physician’s
statement regarding his work restrictions to the Respondent. Because there was no restricted
work available, the Complainant was sent home. The Complainant returned to work–without
restrictions–on December 1, 1992.
The Complainant received Sickness and Accident (S&A) benefits from October 2, 1992, through
November 29, 1992. The Respondent terminated health benefits coverage for the Complainant
from October 1, 1992, through November 30, 1992, and reinstated his coverage when he return
to work on December 1, 1992. In February 1993, the Complainant was awarded Workers’
Compensation benefits on appeal for the period from March 30, 1992, through November 29,
1992.
The Complainant contends that he is eligible for health benefits coverage during the period of
October 1, 1992, through November 30, 1992. The Respondent states that because the
Complainant failed to inform the Respondent of his restricted work status prior to being called
Opinion of Trustees
ROD Case No. 88-706
Page 2
back to work on October 1, 1993, the Complainant’s one day return to work did not reestablish his eligibility for health benefits coverage. The Complainant claims that he informed
the Respondent’s physician of his restricted work status prior to his recall to work.
Dispute
Is the Respondent required to provide health benefits coverage for the Complainant during the
period of October 1, 1992, through November 30, 1992?
Positions of the Parties
Position of the Complainant: The Respondent is required to provide health benefits coverage for
the Complainant from October 1, 1992, through November 30, 1992.
Position of the Respondent: The Respondent is not required to provide health benefits coverage
from October 1, 1992 through October 30, 1992 because the Complainant failed to notify the
Respondent of his work restriction; therefore, his return to work on October 1, 1992 did not reestablish his eligibility for health benefits coverage.
Pertinent Provisions
Article I (1), (2) and (4) of the Employer Benefit Plan provides:
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. (1) and (4) of the Employer Benefit Plan provides:
Opinion of Trustees
ROD Case No. 88-706
Page 3
Article II – Eligibility
The persons eligible to receive the health benefits pursuant to Article III are as follows:
A. Active Employees
Benefits under Article III shall be provided to any Employee who:
(1) is actively at work*
for the Employer on the effective date of the Wage
Agreement; or
(4) A new Employee will be eligible for health benefits from the first day
worked with the Employer.
________
*
Actively at work includes an Employee of the Employer who was actively at work on January
31, 1988, and who returns to active work with the Employer two weeks after the effective date of
the Wage Agreement.
Article II C. (3) of the Employer Benefit Plan provides:
Article II – Eligibility
The persons eligible to receive the health benefits pursuant to Article III are as follows:
C. Disabled Employees
In addition to disabled Pensioners who are receiving pension benefits and are therefore
entitled to receive health benefits under paragraph B of this Article II, health benefits
under Article III shall also 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.
Life and accidental death and dismemberment insurance shall also be provided to
Employees described in (3) above.

Discussion
Opinion of Trustees
ROD Case No. 88-706
Page 4
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. Inasmuch as the Complainant
reported to work on October 1, 1992 as scheduled and was paid wages, the Complainant was
eligible for health benefits coverage as an active Employee on October 1, 1992.
Article II C. (3) of the Employer Benefit Plan 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. Inasmuch as the Complainant was eligible for Sickness and
Accident benefits from October 2, 1992, through November 29, 1992, the Respondent is required
to provide health benefits coverage for the Complainant as a disabled Employee from October 2,
1992, through November 29, 1992.
Opinion of the Trustees
The Respondent is required to provide health benefits coverage for the Complainant as an Active
Employee on October 1, 1992. The Respondent is also required to provide health benefits
coverage for the Complainant as a Disabled Employee from October 2, 1992, through November
29, 1992.