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受托人的意见
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在再保险
原告: 未亡配偶
被申请人: 雇主
ROD案例编号: 81-692 - 1987年9月21日
董事会:Joseph P. 康纳斯,老., Chairman; Paul R. Dean,受托人; William B. Jordan,受托人; William Miller,受托人; Donald E. 皮尔斯,小.,受托人.
根据美国煤矿工人联合会(“UMWA”)1950年福利计划和信托的第九条, 并根据美国劳工部授予的豁免授权, the Trustees have reviewed the facts and circumstances of this dispute concerning the provision of health benefits coverage under the terms of the 雇主 Benefit Plan.
背景事实
The Complainant is the surviving spouse of an Employee who died as the result of a mine accident while working in a classified job for the Respondent on November 23, 1981. 被告是1981年全国烟煤工资协议(“工资协议”)的签署人, 9月30日到期的, 1984, 但没有签署1984年的工资协议.
申诉人说，她收到的是9月22日的挂号信通知, 1984 that her health benefits coverage would be terminated at the expiration of the 1981 Wage Agreement on September 30, 1984. 该信指出，答辩人提供保险的义务将于该日终止. The Complainant has stated that following the termination of her coverage she contacted the Respondent and arranged to pay her own health insurance premiums to continue coverage. 从1984年11月开始, the Complainant paid such premiums directly to the Respondent who contracted with an 雇主 association to provide coverage for the Complainant as well as for other employees, 退休人员, 以及他们的家属. 雇主协会于2月28日终止了该保险, 1986, 随后根据《皇冠搏彩中心》第11章提交了救济申请.
The representative for the Complainant asks whether 被申请人对…负责 providing the Complainant with health benefits coverage after September 30, 一九八四年或继续有关的转换安排，该安排的有效期至二月二十八日, 1986. The Respondent contends that it has fulfilled its obligation to the Complainant under the 雇主 Benefit Plan by providing health benefits coverage through September 30, 1984. 被告说，当时雇主协会终止了集团计划, 它试图为申诉人和其他退休人员从另一家航空公司获得团体费率, 但没有成功.
争端
Whether 被申请人对…负责 providing health benefits coverage for the Complainant following the expiration of the 1981 Wage Agreement or for continuing the conversion arrangement which was in effect until February 28, 1986.
双方立场
Position of the 原告: The representative for the Complainant asks whether 被申请人对…负责 providing health benefits coverage after the expiration of the 1981 Wage Agreement on September 30, 一九八四年或继续有关的转换安排，该安排的有效期至二月二十八日, 1986.
Position of the 被申请人: The Respondent fulfilled its obligation to the Complainant under the 雇主 Benefit Plan by providing health benefits coverage through September 30, 1984.
相关的规定
1981年《皇冠搏彩中心》第20 (c)(3)(i)条有关部分规定:
(3)(i)各签署雇主应建立并维持员工福利计划，以提供, 通过保险公司实施, 本协议所涵盖的雇员以及领取养老金者的健康和其他非养老金福利, 1974年养恤金计划和信托皇冠搏彩中心网站, 谁的最后一个签署人曾受雇于该雇主. The benefits provided by the 雇主 to its eligible Participants pursuant to such plans shall be guaranteed during the term of this Agreement by that 雇主 at levels set forth in such plans.
雇主福利计划第I(1)、(2)、(4)条规定:
第一条-定义
下列术语具有本协议规定的含义:
(1) “雇主”指(雇主名称)
(2) “工资协议”指1981年《皇冠搏彩中心》, 如不时修订及任何后续协议.
(4) “雇员”系指为雇主从事保密工作的人员, 有资格获得本协议项下的福利.
第二条E. (1)雇主福利计划规定:
第二条-资格
根据第三条有资格领取健康津贴的人员如下:
E. 已故雇员或退休人员的尚存配偶及受养人
Health benefits under Article III shall be provided to (i) any unmarried surviving spouse (who was living with or being supported by the Employee or Pensioner immediately prior to the Employee’s or Pensioner’s death) and (ii) such spouse’s unmarried surviving dependent children as defined in subparagraphs (2) and (5) of paragraph D, 雇员或领取退休金人士的死亡∶
(1) As a result of a mine accident occurring on or after the effective date of the Plan while the Employee was working in a classified job for the 雇主;
第三条D. (3)(b)雇主福利计划规定:
第三条-福利
D. 一般规定
(3) 转换特权
(b) 健康的好处
当医疗保险终止时, 受益人可以, 在应用程序, 转换, 未经体检, to a policy issued by the insurance carrier provided such application is made to the insurance carrier within 31 days after the coverage terminates. 保单类型, coverage and premiums therefor are subject to the terms and conditions set forth by the insurance carrier.
讨论
Article XX(c)(3)(i) of the 1981 Wage Agreement requires a signatory 雇主 to establish and maintain an 雇主 Benefit Plan to provide health and other non-pension benefits for its Employees and Pensioners whose last classified employment was with such 雇主. The Wage Agreement stipulates that the benefits provided by the 雇主 pursuant to such Plan shall be guaranteed during the term of the Agreement. 第二条E. (1) of the 雇主 Benefit Plan provides health benefits for the unmarried surviving spouse of an Employee who died as the result of a mine accident while working in a classified job for the 雇主. Inasmuch as the Complainant is the unmarried surviving spouse of an Employee who died as the result of a mine accident, 被申请人对…负责, 确实提供了, 申诉人在1981年《皇冠搏彩中心网站》期间的医疗福利保险.
The issue here is whether the Respondent is contractually obligated to provide the benefits set forth in the 雇主 Benefit Plan beyond the expiration of the 1981 Wage Agreement when the Respondent did not sign the 1984 Wage Agreement. 美国联邦第四巡回上诉法院，位于华盛顿特区. 美国煤矿工人联合会，等. v. 皇家煤炭公司., 768 F.2d 588, 592(第4卷. 1985年)及Dist. 17、美国煤矿工人联合会，等. v. 联合公司.等., 765 F. 412,417(第4章. 1985)(全体会议), has ruled that an 雇主’s contractual obligation to provide health benefits and other non-pension benefits to its Pensioners does not extend beyond the expiration of the Wage Agreement. Inasmuch as the surviving spouse of an Employee who died as the result of a mine accident has the same eligibility period as a Pensioner, 在雇主福利计划下，这类未亡配偶应被视为领取退休金者. 相应的, the Respondent is not obligated to provide the Complainant’s health benefits coverage or to a conversion privilege after September 30, 1984.
受托人的意见
Under the controlling language of the applicable Wage Agreement and Plan documents and in light of the Fourth Circuit’s decisions, the Respondent is not responsible for providing health benefits to the Complainant or for offering the Complainant a conversion privilege following the expiration of the 1981 Wage Agreement.