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受托人的意见
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在再保险

投诉: 已故雇员的尚存配偶及儿子
被申请人: 雇主
ROD案例编号: 88-707 - 1995年6月8日

受托人: 托马斯·F. 迈克尔·康纳斯. 霍兰德，马蒂·D. 哈德逊和
罗伯特T. 华莱士.

的 Trustees have reviewed the facts and circumstances of this dispute concerning the provision of benefits for the survivors of an Employee under the terms 雇主福利计划的成员.

背景事实

申诉人与雇员于1969年结婚，并于1990年6月离婚. 的 Complainant claims that six months after their divorce she and her ex-husband began living together as a common-law couple and remained so until his death by suicide on December 2, 1992.

的 Complainant contends that the Respondent is required to provide a life insurance benefit to the Employee’s named beneficiary (the Employee’s son) and 健康 benefits coverage for the Complainant as the common-law surviving spouse. 的 Complainant has submitted the following documentation to support her claim as a common-law spouse: statements from relatives and acquaintances; bank statements; the Employee’s death notice; real estate sales contracts; tax assessments; and insurance policies.

被告说，1992年11月2日，雇员没有上班. 被告于12月2日致函雇员, 1992, 他因自10月31日起旷工而被停职, 1992年，未就被告缺席一事与他联系. 答辩人声称，在雇员死后，它发现, 1992年11月他不在时, 雇员申请了另一份工作.

的 Respondent states that it is not required to provide 健康 benefits to the Complainant or life insurance benefits to the Employee’s son because the Employee voluntarily terminated his employment or was suspended and would have been discharged but for his death. 的

Respondent also states that “[e]ven if one assumes [the Employee] was still an employee” the Complainant is not entitled to 健康 benefits coverage because she was divorced from the Employee and the Employee had not listed her as a dependent on his group insurance enrollment card.

争端

Is the Respondent required to provide a life insurance benefit to the Employee’s named beneficiary and 健康 benefits coverage for the Complainant as a common-law spouse of a deceased Employee?

双方立场

Position of the Complainant: 的 Respondent is required to provide a life insurance benefit to the Employee’s named beneficiary (the Employee’s son) and 健康 benefits coverage for the Complainant as a common-law spouse of a deceased Employee.

Position of the 被申请人: 的 Respondent is not required to provide a life insurance benefit to the named beneficiary or 健康 benefits coverage for the Complainant because the Employee had voluntarily terminated his employment with the Respondent prior to his death and there was just cause for the Employee’s discharge. 除了, 投诉人不符合雇员未亡配偶的资格，因为她已与雇员离婚.

相关的规定

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1988年全国烟煤工资协议, 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.

(7) “受抚养人”系指本协议第二条D节所述的任何人.

第二条A款. (一)、(四)、(五. (3)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:

A. 积极的员工

第III条规定的福利应提供给下列任何员工:
(1) is actively at work* for the 雇主 on the effective date of the Wage Agreement; or

(4) 新雇员从为雇主工作的第一天起就有资格享受健康福利.

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 of an Employee or Pensioner who died:

(3) 当该雇员或养恤金领取者有权根据a段领取健康福利时, B, (二)本条第(三)款, 但(i)该等雇员或领取退休金者在《皇冠搏彩中心》生效日期前死亡，且其配偶没有资格领取未亡配偶的福利, 只有在配偶有资格根据第三条C款分期领取死亡抚恤金的期间, or (ii) if such Employee or Pensioner died on or after the effective date of the Wage Agreement and the spouse is not eligible for a Surviving Spouse’s benefit and life insurance benefits or death benefits are payable in a lump sum, 则仅在该雇员死亡当月后的60个月内，或仅在该养恤金领取者死亡当月后的22个月内. 如果人寿保险赔偿金不支付, 健康福利只提供到雇员或养恤金领取人死亡的那个月的月底.

未亡配偶的健康津贴应继续发放，直至其再婚为止, 但如果此种配偶有权享受上述第(3)款规定的此种福利, 这种健康津贴的持续时间不得超过上文第(3)款规定的期限. 在未亡配偶按每月至少500美元的收入正常就业的任何月份，不得提供健康福利.

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*积极工作的雇员包括在1月31日积极工作的雇主雇员, 1988, 并在工资协议生效之日起两周后返回雇主的工作岗位.

第三条B. 雇主福利计划第(1)(a)条规定:

B. 人寿及意外死亡及伤残保险

(1) 积极的员工

公司将为员工提供人身、意外死亡和伤残保险, 如第二条所述, A和C部分(3), 按照以下时间表:

(a) 雇员因暴力以外的原因死亡, 外部和偶然的手段, 35美元的人寿保险,000美元将支付给雇员的指定受益人.

第三条D. (1)雇主福利计划(e)的相关部分规定:

第三条-福利

D. 一般规定

(1) 续保

(e)辞职或解雇

如果员工辞职(任何原因)或被解雇, 健康, 人寿保险、意外死亡保险和肢解保险自上次工作日期起终止。.

讨论

在第84-111条和第88-181条(附本)中，受托人决定根据第II - A条. 雇主福利计划的成员, 健康福利提供给"在职雇员"，其中包括在《皇冠搏彩中心》生效之日为雇主积极工作的雇员. 因为在1988年《皇冠搏彩中心》生效之日，该雇员正在为答辩人积极工作, 他根据雇主福利计划获得健康福利的资格于该日开始. 第III条D款规定了终止雇员健康福利的唯一条件. (1) (c)及(e). 第三条D. (1) (e)规定，如果雇员辞职或被解雇, 健康和其他非养恤金福利将自上次工作之日起停止. 没有提交证据证明该雇员已辞去其在被申请人的工作. (见ROD 51).)此外，该雇员被停职，但在其死亡之日并未被解雇. 因此, 因为该雇员在工资协议生效日符合“在职雇员”的定义，并且没有辞职或被解雇, 雇员有资格享受第二条A款规定的健康福利. 在他死的时候.

第三条B. (1)雇主福利计划向雇员提供第二条A款所述的人寿保险. 计划的详情. 因为雇员有资格获得第二条A款规定的健康福利. 在其死亡时，雇员的指定受益人有权获得人寿保险赔偿金.

根据第II E条. (3) (ii)雇主福利计划中雇员的未婚未亡配偶，在符合第ii条A款规定的健康福利期间死亡., 是否有资格在雇员去世后的60个月内领取健康福利, 如果这样的配偶没有资格获得未亡配偶福利，那么人寿保险福利是一次性支付的.

申诉人声称，她有资格作为雇员的普通法未亡配偶享受医疗保险. 受托人以前已处理过普通法配偶享受健康福利的资格问题(见《皇冠搏彩中心网站》第156条), 81-685, 和88 - 245年). 的 Trustees stated that if there is no living spouse of either party in the background a valid common-law marriage exists if the relationship has been of substantial and continuous duration and the parties have been living together openly as married persons and are recognized as such in the community. 的 Trustees further stated that a common-law relationship of substantial and continuous duration is one which has or had continued for a period of not less than nine (9) months (see RODs 84-256 and 88-162). 如果一个有效的习惯法婚姻成立, 受抚养配偶将有资格享受雇主福利计划规定的健康福利.

为了支持她的说法，她和前夫在1990年离婚后建立了普通法婚姻, the Complainant has submitted documentation which includes the following: a life insurance policy issued in May 1991 which lists the Complainant as the Employee’s wife; statements from their joint credit union account dated June 1991 and June 1992; a statement for a joint renter’s insurance policy issued in July 1991; a statement for a joint mutual fund account established in August 1991; a statement for a joint auto insurance policy for a period beginning in August 1991; an application for a joint credit account dated in September 1991; a copy of a real estate sales contract dated June 15, 1992 which lists the Complainant and the Employee as buyers; and a copy of a receipt dated June 1992 for their daughter’s school tuition on which the Complainant and the Employee are listed as Mr. 和夫人. 的 Complainant also submitted notices from her local newspaper and church indicating that she was the wife of the deceased Employee and a notarized statement from the landlord of the Complainant and the Employee, 这表明他们俩在社区里被称为夫妻. 虽然投诉人没有被列为雇员团体登记保险卡的家属, 申诉人提交的证据足以证明存在Q中定义的有效普通法婚姻&A H-1 (81).

因为申诉人是一名在职雇员的未婚寡妇，该雇员在去世时有资格领取健康福利, 没有资格领取未亡配偶福利, 而且人寿保险的保险金是一次性支付的, 申诉人有权从她丈夫死亡当月起的60个月内获得答辩人提供的医疗保险. 因为雇员于12月2日死亡, 1992, 投诉人的资格期限至1997年12月, 除非她符合第II条E款的资格要求. (3)雇主福利计划.

受托人的意见

的 Respondent is required to provide a life insurance benefit to the Employee’s named beneficiary and to provide 健康 benefits coverage for the Complainant through December 1997, 除非她符合第II条E款的资格要求. (3)雇主福利计划.