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OPINION OF TRUSTEES
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In Re
Complainant: Employee
Respondent: Employer
ROD Case No: 84-690 – April 19, 1989
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 position with the Respondent from July 27, 1987
until December 1987. The Complainant states that the Respondent provided him with a health
insurance card on July 27, 1987; however, his coverage was effective for only one month,
September 1987, because the Respondent failed to pay the insurance premiums. The
Complainant states that, as a result, he incurred medical bills in August 1987 that have not been
paid. The Complainant asks whether the Respondent is responsible for payment of the unpaid
medical bills.
Dispute
Whether the Respondent is responsible for payment of the Complainant’s outstanding medical
bills for services rendered in August 1987.
Positions of the Parties
Position of the Complainant: The Respondent is responsible for payment of the covered medical
charges incurred by the Complainant and his eligible dependents during his employment with the
Respondent under the terms of the Employer Benefit Plan.
Opinion of Trustees
Resolution of Dispute
Case No. 84-690
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 (c)(3)(i) of the National Bituminous Coal Wage Agreement of 1984 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
1984, 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 Employee
(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. 84-690
Page 3
Discussion
Article XX Section (c)(3)(i) of the 1984 Wage Agreement requires an Employer to provide an
Employer Benefit Plan… “implemented through an insurance carrier(s), E for health and other
non-pension benefits…” It further requires that “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 II A. (4) of the Employer Benefit Plan provides that an Employee is eligible for health
benefits coverage from the first day worked with the Employer. Accordingly, the Complainant
became eligible for health benefits coverage from the Respondent on July 27, 1987, his first day
worked with the Respondent. Inasmuch as the Complainant was eligible for health benefits
coverage as an active Employee of the Respondent at the time the outstanding medical bills were
incurred, the Respondent is responsible for payment of the covered medical charges under the
terms of the Employer Benefit Plan.
Opinion of the Trustees
The Respondent is responsible for payment of the covered medical charges incurred by the
Complainant and his eligible dependents during his active employment with the Respondent
under the terms of the Employer Benefit Plan.
