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Code of Federal Regulations Pertaining to U.S. Department of Labor |
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Employees' Benefits |
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Employment Standards Administration, Department of Labor |
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Claims for Benefits Under Part C of Title IV of the Federal Mine Safety and Health Act, As Amended |
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General |
20 CFR 725.1 - Statutory provisions.
- Section Number: 725.1
- Section Name: Statutory provisions.
(a) General. Title IV of the Federal Mine Safety and Health Act of
1977, as amended by the Black Lung Benefits Reform Act of 1977, the
Black Lung Benefits Revenue Act of 1977, the Black Lung Benefits
Revenue Act of 1981 and the Black Lung Benefits Amendments of 1981,
provides for the payment of benefits to a coal miner who is totally
disabled due to pneumoconiosis (black lung disease) and to certain
survivors of a miner who dies due to pneumoconiosis. For claims filed
prior to January 1, 1982, certain survivors could receive benefits if
the miner was totally (or for claims filed prior to June 30, 1982, in
accordance with section 411(c)(5) of the Act, partially) disabled due
to pneumoconiosis, or if the miner died due to pneumoconiosis.
(b) Part B. Part B of title IV of the Act provided that all claims
filed between December 30, 1969, and June 30, 1973, are to be filed
with, processed, and paid by the Secretary of Health, Education, and
Welfare through the Social Security Administration; claims filed by the
survivor of a miner before January 1, 1974, or within 6 months of the
miner's death if death occurred before January 1, 1974, and claims
filed by the survivor of a miner who was receiving benefits under part
B of title IV of the Act at the time of death, if filed within 6 months
of the miner's death, are also adjudicated and paid by the Social
Security Administration.
(c) Section 415. Claims filed by a miner between July 1 and
December 31, 1973, are adjudicated and paid under section 415. Section
415 provides that a claim filed between the appropriate dates shall be
filed with and adjudicated by the Secretary of Labor under certain
incorporated provisions of the Longshoremen's and Harbor Workers'
Compensation Act (33 U.S.C. 901 et seq.). A claim approved under
section 415 is paid under part B of title IV of the Act for periods of
eligibility occurring between July 1 and December 31, 1973, by the
Secretary of Labor and for periods of eligibility thereafter, is paid
by a coal mine operator which is determined liable for the claim or the
Black Lung Disability Trust Fund if no operator is identified or if the
miner's last coal mine employment terminated prior to January 1, 1970.
An operator which may be found liable for a section 415 claim is
notified of the claim and allowed to participate fully in the
adjudication of such claim. A claim filed under section 415 is for all
purposes considered as if it were a part C claim (see paragraph (d) of
this section) and the provisions of part C of title IV of the Act are
fully applicable to a section 415 claim except as is otherwise provided
in section 415.
(d) Part C. Claims filed by a miner or survivor on or after January
1, 1974, are filed, adjudicated, and paid under the provisions of part
C of title IV of the Act. Part C requires that a claim filed on or
after January 1, 1974, shall be filed under an applicable approved
State workers' compensation law, or if no such law has been approved by
the Secretary of Labor, the claim may be filed with the Secretary of
Labor under section 422 of the Act. Claims filed with the Secretary of
Labor under part C are processed and adjudicated by the Secretary and
paid by a coal mine operator. If the miner's last coal mine employment
terminated before January 1, 1970, or if no responsible operator can be
identified, benefits are paid by the Black Lung Disability Trust Fund.
Claims adjudicated under part C are subject to certain incorporated
provisions of the Longshoremen's and Harbor Workers' Compensation Act.
(e) Section 435. Section 435 of the Act affords each person who
filed a claim for benefits under part B, section 415, or part C, and
whose claim had been denied or was still pending as of March 1, 1978,
the effective date of the Black Lung Benefits Reform Act of 1977, the
right to have his or her claim reviewed on the basis of the 1977
amendments to the Act, and under certain circumstances to submit new
evidence in support of the claim.
(f) Changes made by the Black Lung Benefits Reform Act of 1977. In
addition to those changes which are reflected in paragraphs (a) through
(e) of this section, the Black Lung Benefits Reform Act of 1977
contains a number of significant amendments to the Act's standards for
determining eligibility for benefits. Among these are:
(1) A provision which clarifies the definition of
``pneumoconiosis'' to include any ``chronic dust disease of the lung
and its sequelae, including respiratory and pulmonary impairments,
arising out of coal mine employment'';
(2) A provision which defines ``miner'' to include any person who
works or has worked in or around a coal mine or coal preparation
facility, and in coal mine construction or coal transportation under
certain circumstances;
(3) A provision which limits the denial of a claim solely on the
basis of employment in a coal mine;
(4) A provision which authorizes the Secretary of Labor to
establish standards and develop criteria for determining total
disability or death due to pneumoconiosis with respect to a part C
claim;
(5) A new presumption which requires the payment of benefits to the
survivors of a miner who was employed for 25 or more years in the mines
under certain conditions;
(6) Provisions relating to the treatment to be accorded a
survivor's affidavit, certain X-ray interpretations, and certain
autopsy reports in the development of a claim; and
(7) Other clarifying, procedural, and technical amendments.
(g) Changes made by the Black Lung Benefits Revenue Act of 1977.
The Black Lung Benefits Revenue Act of 1977 established the Black Lung
Disability Trust Fund which is financed by a specified tax imposed upon
each ton of coal (except lignite) produced and sold or used in the
United States after March 31, 1978. The Secretary of the Treasury is
the managing trustee of the fund and benefits are paid from the fund
upon the direction of the Secretary of Labor. The fund was made liable
for the payment of all claims approved under section 415, part C and
section 435 of the Act for all periods of eligibility occurring on or
after January 1, 1974, with respect to claims where the miner's last
coal mine employment terminated before January
1, 1970, or where individual liability can not be assessed against a
coal mine operator due to bankruptcy, insolvency, or the like. The fund
was also authorized to pay certain claims which a responsible operator
has refused to pay within a reasonable time, and to seek reimbursement
from such operator. The purpose of the fund and the Black Lung Benefits
Revenue Act of 1977 was to insure that coal mine operators, or the coal
industry, will fully bear the cost of black lung disease for the
present time and in the future. The Black Lung Benefits Revenue Act of
1977 also contained other provisions relating to the fund and
authorized a coal mine operator to establish its own trust fund for the
payment of certain claims.
(h) Changes made by the Black Lung Benefits Amendments of 1981. In
addition to the change reflected in paragraph (a) of this section, the
Black Lung Benefits Amendments of 1981 made a number of significant
changes in the Act's standards for determining eligibility for benefits
and concerning the payment of such benefits. The following changes are
all applicable to claims filed on or after January 1, 1982:
(1) The Secretary of Labor may re-read any X-ray submitted in
support of a claim and may rely upon a second opinion concerning such
an X-ray as a means of auditing the validity of the claim;
(2) The rebuttable presumption that the death of a miner with ten
or more years employment in the coal mines, who died of a respirable
disease, was due to pneumoconiosis is no longer applicable;
(3) The rebuttable presumption that the total disability of a miner
with fifteen or more years employment in the coal mines, who has
demonstrated a totally disabling respiratory or pulmonary impairment,
is due to pneumoconiosis is no longer applicable;
(4) In the case of deceased miners, where no medical or other
relevant evidence is available, only affidavits from persons not
eligible to receive benefits as a result of the adjudication of the
claim will be considered sufficient to establish entitlement to
benefits;
(5) Unless the miner was found entitled to benefits as a result of
a claim filed prior to January 1, 1982, benefits are payable on
survivors' claims filed on and after January 1, 1982, only when the
miner's death was due to pneumoconiosis;
(6) Benefits payable under this part are subject to an offset on
account of excess earnings by the miner; and
(7) Other technical amendments.
(i) Changes made by the Black Lung Benefits Revenue Act of 1981.
The Black Lung Benefits Revenue Act of 1981 temporarily doubles the
amount of the tax upon coal until the fund shall have repaid all
advances received from the United States Treasury and the interest on
all such advances. The fund is also made liable for the payment of
certain claims previously denied under the 1972 version of the Act and
subsequently approved under section 435 and for the reimbursement of
operators and insurers for benefits previously paid by them on such
claims. With respect to claims filed on or after January 1, 1982, the
fund's authorization for the payment of interim benefits is limited to
the payment of prospective benefits only. These changes also define the
rates of interest to be paid to and by the fund.
(j) Longshoremen's Act provisions. The adjudication of claims filed
under sections 415, 422 and 435 of the Act is governed by various
procedural and other provisions contained in the Longshoremen's and
Harbor Workers' Compensation Act (LHWCA), as amended from time to time,
which are incorporated within the Act by sections 415 and 422. The
incorporated LHWCA provisions are applicable under the Act except as is
otherwise provided by the Act or as provided by regulations of the
Secretary. Although occupational disease benefits are also payable
under the LHWCA, the primary focus of the procedures set forth in that
Act is upon a time definite of traumatic injury or death. Because of
this and other significant differences between a black lung and
longshore claim, it is determined, in accordance with the authority set
forth in section 422 of the Act, that certain of the incorporated
procedures prescribed by the LHWCA must be altered to fit the
circumstances ordinarily confronted in the adjudication of a black lung
claim. The changes made are based upon the Department's experience in
processing black lung claims since July 1, 1973, and all such changes
are specified in this part or part 727 of this subchapter (see
Sec. 725.4(d)). No other departure from the incorporated provisions of
the LHWCA is intended.
(k) Social Security Act provisions. Section 402 of Part A of the
Act incorporates certain definitional provisions from the Social
Security Act, 42 U.S.C. 301 et seq. Section 430 provides that the 1972,
1977 and 1981 amendments to part B of the Act shall also apply to part
C ``to the extent appropriate.'' Sections 412 and 413 incorporate
various provisions of the Social Security Act into part B of the Act.
To the extent appropriate, therefore, these provisions also apply to
part C. In certain cases, the Department has varied the terms of the
Social Security Act provisions to accommodate the unique needs of the
black lung benefits program. Parts of the Longshore and Harbor Workers'
Compensation Act are also incorporated into part C. Where the
incorporated provisions of the two acts are inconsistent, the
Department has exercised its broad regulatory powers to choose the
extent to which each incorporation is appropriate. Finally, Section
422(g), contained in part C of the Act, incorporates 42 U.S.C. 403(b)-
(l).
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