Federal Black Lung Program

Federal Black Lung Program or Division of Coal Mine Workers’ Compensation, administers claims filed under the Black Lung Benefits Act:

• This Act compensates those disabled from pneumoconiosis due to coal mine employment and their survivors. “Disabled” means the victim cannot perform the work they did as a coal miner due to breathing coal mine dust and has permanently impaired their ability to breathe normally.
• It also administers benefits issued from the Black Lung Disability Trust Fund and by liable coal mine operators under Part C of this Act, ensuring that benefits paid under Part B of the Act are accurate and timely. The Black Lung Disability Trust Fund caters to the federal Black Lung Program benefits if the responsible coal operator doesn’t meet its legal obligations to pay benefits.
• In addition to monthly compensation, it provides the miner with medical coverage for treating lung diseases or pneumoconiosis.
• They also identify and assist coal mine operators and insurers in ensuring liability for payment of benefits is assigned accordingly.

The Federal Black Lung Program standards of service are as follows:

• Prompt and courteous assistance on all claims, including timely response to all inquiries
• Accurate adjudication of claims
• Timely initiation of benefit payments following the issuance of awards
• Proper oral or written explanations to all questions
• Monitoring of benefits to ensure accurate and proper issuance of payments
• Fair claim decisions to all parties, including a right to appeal

What is black lung disease?

Black lung disease, or coal workers’ pneumoconiosis, occurs from exposure to coal dust. The disease type and severity depend on the level of exposure. Coal mine workers take time to develop signs of the disease. Thus, most of them are diagnosed in their retirement years. The common symptoms of black lung disease include:

• Coughing
• Difficulty breathing
• Shortness of breath
• Tightness of the chest
• Production of black mucus
• Inability to engage in physical activity

Black lung occurs from inhaling coal dust over prolonged periods. Thus, it hardly affects people not in close contact with coal dust. The dust contains carbon particles and sometimes silica particles that are harmful to the lungs when inhaled.

These particles settle in the lungs’ alveoli (small sacs that help uptake oxygen by blood). Over time, the lungs get inflamed and scarred as they fight to eliminate these external bodies. Depending on the severity, black lung disease is categorized as simple or complicated. There is no cure for coal workers’ pneumoconiosis, but it can be managed with medication to improve the quality of life.

Who qualifies for black lung program benefits?

Those qualified for black lung program benefits include present and former coal miners, construction and certain transportation workers affected by coal mine dust, and their surviving dependents, such as surviving spouses, orphaned children, and dependent parents, brothers, and sisters.

Who Pays Monetary Benefits

An affected miner can claim the payment of benefits from the last coal mine operator they worked for, and the miner should have worked for the operator for at least one year.

However, the Black Lung Disability Trust Fund can cater to these benefits in the following cases:

• Where a miner’s last coal mine employment was before January 1, 1970
• If the coal mine operator the victim worked for no longer exists
• If a miner’s most recent employment of at least one year ended while the operator was authorized to self-insure. In that case, the operator cannot make the benefit payments.

If the responsible operator is later identified, the trust fund has the legal authority to recover the total benefits paid from the trust fund from this operator and any interest earned on these amounts.

Black Lung Benefits Act links benefit rates to Federal employee salary rates, and benefit levels are usually adjusted annually to match changes in the Federal employee payment schedules.

As of 2023, the monthly benefits for a miner without dependents is $737.90. For miners with three or more dependents, their monthly benefits can be as much as $1,475.80. Medical benefits are taken care of separately from disability benefits. Benefit payments and related administrative expenses in cases where the responsible operators don’t pay are paid from the Black Lung Disability Trust Fund.

The Federal Black Lung program ensures recipients receive their benefits every month and responds to any concerns they may have. They also contact all beneficiaries through mail annually to make sure that their benefit payments and information are up-to-date.

The Program provides Access to Medical Treatment as follows:

• medical treatment for black lung disease-related respiratory conditions
• prescription drugs
• in-patient and out-patient services
• doctors’ visits
• medical equipment and home oxygen
• Pulmonary rehabilitation may also be covered with a doctor’s prescription
• home nursing services

Medical treatment bills are checked and verified to ensure that payments are accurate and the requested treatments are necessary.

Steps for filing a claim for benefits under the Black Lung Benefits Act

1. Complete the “Miner’s Claim for Benefits under the Black Lung Act” (form CM-911) application form – it provides critical basic information about the individual and their family.
2. Complete the “Employment History” (form CM-911a)- This form includes information about the miner’s work, the number of years they worked, names of the coal companies they worked for, and their work outside the coal mining industry.
3. Complete two copies of “Authorization to Obtain Earnings Data from the Social Security Administration” (SSA-581) and review the SSA-581 instructions.
4. Review the guidelines on “Selection of Examining Provider” and complete the “Selection of Examining Provider” form. (Remember, you should select an approved provider in your home state or a contiguous state)

The victim may also be required to provide additional information, including copies of official documents such as marriage certificates, death certificates, children’s birth certificates, proof of dependent children’s enrollment in schools, etc.

Pulmonary evaluation by DOL

To win benefits, a miner must prove that he has Black Lung disease and is disabled due to a breathing impairment caused at least partially by Black Lung.

The Department of Labor (DOL) is legally obligated to offer you a free examination to prove that the victim is entitled to black lung benefits. Under this examination, they will determine whether the applicant is disabled to work due to black lung disease. As such, even when you have already contracted such, if you can still seek employment, your claim will be denied.

After filing a claim, DOL contacts victims to schedule a complete pulmonary evaluation (a medical examination to determine whether they are disabled by black lung disease.)

DOL will then provide the victim with a list of physicians in the state or a bordering state. The individual might be asked to select a physician they wish to use but within certain limitations.

The expected examinations consist of the following:

• A chest X-ray;
• A physical examination by a physician
• A pulmonary function test
• An arterial blood gas test, if necessary, which measures your ability to breathe

If the plaintiff refuses to be examined, their claim can be denied without further considering entitlement to the benefits. They also have the right to send this examination’s results to their physician.

Once they receive the pulmonary examination results, the DOL conducts a preliminary review of the results to determine if they support an award or a denial of the claim.

DOL then sends a “Schedule for the Submission of Additional Evidence” explaining the examination results and the reasons for their opinion about the entitlement. This letter also informs the victim about the opportunity to submit additional evidence, their right to obtain medical evidence from a physician of choice, and the time limits for submitting the evidence.

If they find that a coal company is liable for the victim’s claim, it has the right to have the victim examined by a physician of its choice. And if the victim refuses to be examined, their claim may be denied without further consideration of your entitlement to benefits.

The Black Lung Benefits program has certain limitations on the amount of medical evidence the victim and the liable company can give to determine entitlement to benefits.

Also, if the claim is approved, the coal company responsible for your claim or the Black Lung Disability Trust Fund should pay for the attorney fees.

Exchange of Medical Information

The parties involved should exchange any “medical information” in connection with a claim for benefits within 30 days of the party’s receipt. Additionally, you must send a complete copy of this information to the Department of Labor and other parties in the claim. It also includes any medical information from a prior claim that the victim did not put into the record or otherwise.

In this case, “Medical information” may include an examining physician’s report and related test results, a non-examining physician’s report addressing the victim’s respiratory condition, and any other procedures or tests related to the respiratory or pulmonary disease. However, medical records related to treatment or hospitalization by a primary care physician do not have to be included.

Medical information sent to DOL should be indicated as “evidence” or “information for exchange only.”  If identified as “evidence,” it should also be indicated whether it is “affirmative,” “rebuttal,” or “rehabilitative” evidence.

Medical information shared with the parties without being indicated as evidence will not be considered as such when deciding the claim.

Proposed Decision and Order

The DOL issues a “Proposed Decision and Order” once they arrive at a decision. This is a written decision explaining reasons for approving or denying your claim. They also inform the victim and the responsible coal company (where applicable) of the options for challenging such a decision and the legal time limits. These options include asking the DOL to reconsider its decision or requesting a hearing with an administrative law judge.

Filing For Black Lung Benefits by Survivors

Eligible surviving family members whose loved one died of black lung disease, or “pneumoconiosis,” coal miners can claim monthly benefits as provided in the Black Lung Benefits Act. The coal miner’s employer, usually the last company that employed the miner for at least a year, may be required to pay a victim’s benefits if it meets certain legal requirements. Otherwise, the Black Lung Disability Trust Fund may pay.

Steps:

1. Complete an application form, ‘Survivor’s Claim for Benefits Under the Black Lung Act’ (Form CM-912), including important basic information about the miner, yourself, and your family.
2. Complete ‘Employment History’ (Supplemental Form CM-911a), requesting the miner’s work information as a miner, the number of years (they worked, the names of the coal companies that employed them, and any work outside the coal mining industry.
3. Other official documents required may include copies of children’s birth certificates, marriage certificates, death certificates, dependent children’s proof of school enrollment, etc.

Survivors entitled to benefits on the deceased’s lifetime claim may be automatically entitled to benefits.

Prove of claim: Survivors also need to prove that the miners died due to or their death was hastened by pneumoconiosis to be entitled to benefits. Thus, there is a need to identify all sources of medical information about the miner, such as the names of physicians who treated the miner during their life, names of hospitals where the miner received treatment, and any other information about the miner’s health and death (including any state or federal award for the miner’s disability or death).

Autopsy evidence: Where applicable, the victim should provide the name of the physician who obtained the autopsy of the miner and all the information relevant to determining if the miner died of black lung disease. The medical evidence may require verification from a physician.

Schedule for the Submission of Additional Evidence

Upon receiving all of the relevant information, the DOL conducts a preliminary review to determine whether it supports an award for the claim. They then issue a letter, ‘Schedule for the Submission of Additional Evidence,’ describing the information received and the reasons for their opinion about the entitlement.

This letter also informs of an opportunity to submit additional evidence, the victim’s right to obtain medical evidence from a physician of their choice, and the time limits for submitting evidence. If the coal company is found liable for the claim, it has the right to submit evidence from a physician of its choice.

Who receives black lung benefits?

• Black lung benefits can be paid only to a beneficiary, their legal guardian, or a representative payee authorized to receive the payment on their behalf.
• Representative payee- Where a beneficiary cannot handle their benefits, the District Director may order the appointment of a payee to ensure that payments are used only for the use and benefit of the beneficiary. It can be an agency or institution directed to receive and manage funds on behalf of an incapable beneficiary. It may include a parent receiving benefits for their minor child and nursing homes.

Representative Payees must sign a DOL form as power of attorney and complete a CM-910, Request To Be Selected As Payee. Where applicable, they must provide CM-787, the Physician’s/Medical Officer’s Statement. It is important to note that a power of attorney alone cannot authorize one to become a representative payee.

Responsibilities of a representative payee

A payee is not paid for their services and cannot claim any payment.

Black lung benefits are only for the use and benefit of the beneficiary. They should be used to cover the beneficiary’s expenses, such as food, clothing, shelter, personal comfort items, and medical care. 

If the beneficiary is in an institution, the funds should be used for the customary charges made by the institution and for those items for personal needs that will improve or maintain the beneficiary’s condition or general well-being.

Benefits may be used to support the beneficiary’s legal dependents as long as the beneficiary’s own needs are satisfied.

Representative payees must provide a yearly report of benefits received and spent. They should also complete form CM-929P, “Report of Changes That May Affect Your Black Lung Benefits.” Thus, an annual record of any unusual expenditure made with the beneficiary’s black lung benefits should be kept.

Do all coal miners get black lung?

Not all coal mine workers will develop black lung disease. Recent studies have shown that about 16% of coal miners in the U.S. contract the disease. Coal mining may involve drilling into silica-containing rock, and when miners are exposed to silica for prolonged periods, they may develop silicosis and lung cancer.

Does federal black lung affect Social Security?

Where a miner found to be disabled is employed or self-employed, his benefits are subject to reduction under the Social Security annual earnings retirement test. Earnings of widows, wives, and children do not require a reduction in the sum of black lung benefits payable.

Do you pay taxes on black lung benefits?

Black lung benefit trusts are subject to excise taxes on taxable expenditures, certain acts of self-dealing, excess contributions to these trusts, and self-dealing and taxable expenditures per Treas.

What is the life expectancy of a black lung patient?

In 2016, the Centers for Disease Control and Prevention (CDC) reported that black lung decreases life expectancy by 12.6 years. During the last 30 years, over 10,000 men and boys have died, and 25,000 have been injured in the coal mining industry. And the average age of those killed is 32.13.

What is the source of the black lung trust fund?

The purpose of the Black Lung Disability Trust Fund and associated BLET was to take up the burden associated with providing black lung benefits without relying on taxpayers’ money. The primary source of this pool for the trust fund is the excise tax on coal produced and sold domestically, including the black lung excise tax, BLET. The trust fund borrows from the treasury if the revenue is insufficient to finance Black Lung Program benefits.