Arbitrator strikes down reasonable and customary limit on massage benefits
Arbitrator finds limits in benefit plan were superseded by the collective agreement
Background
AMAPCEO filed a dispute at the Grievance Settlement Board after discovering that the insurance carrier was applying a reasonable and customary (R&C) limit to massage benefit coverage. The R&C, which was not set out in the collective agreement, was applied by the carrier in addition to other limitations on the massage benefit that were explicitly set out in the collective agreement.
The benefit plan included language that allowed for R&C limits while the collective agreement did not. The collective agreement stated that the benefits and terms and conditions of the plan “may only be altered by mutual agreement of the parties” and that where a conflict exists between the provisions of the plan and the collective agreement, the provisions of the collective agreement prevail.
The Award
Arbitrator Herlich determined that, by negotiating collective agreement language that did not include R&C limits, the parties had effectively bargained that the R&C limit in the benefit plan would no longer apply.
Although the case turns on the particular language and structure of the AMAPCEO collective agreement, it is a significant win for unions attempting to push back on efforts to limit bargained benefits through restrictions and qualifiers such as reasonable and customary limits that were not agreed to at the bargaining table.