Your Entitlement to Medical Benefits
As a miner who has been awarded benefits under the federal Black Lung Benefits Act, you are entitled to medical benefits for treatment of your black lung disease and related disability. Your medical benefits cover payments to medical providers such as doctor appointments, hospitalizations, home and residential health care services, medical appliances, supplies, and prescription medications. Your medical benefits are paid by the same entity that is paying your compensation—the Black Lung Disability Trust Fund, a coal-mine employer, or an employer’s insurance carrier.
General Information about State Workers’ Compensation and Federal Black Lung Benefits
You have also received an award from a state workers’ compensation program for your black lung condition. If that award includes coverage of your related medical expenses, the state will have first responsibility for paying your medical bills. If a state denies these bills, then you may be entitled to have them paid under your federal black lung benefits award.
Similarly, if you have reached a settlement agreement with a coal mine employer or their insurance carrier in your state workers’ compensation claim, and that settlement agreement includes coverage of medical expenses related to your black lung disease, that agreement may impact whether you are entitled to payment of your medical expenses under your federal black lung benefits award.
It is very important for you to notify DCMWC when you receive any award of state benefits related to your black lung condition or when there is any change to a previous state award. If you did not receive information about medical benefits from the state workers’ compensation program, you should contact the state directly to request information.
Medical Benefits Paid by the Black Lung Disability Trust Fund
If the Black Lung Disability Trust Fund is paying your federal compensation and you are also entitled to state compensation for your black lung condition, you or your provider must submit any bills for black lung related medical treatment, services, or medical supplies through the state program first. If payment is denied under the state program, you or your provider should send a copy of the bill and the state program’s denial notice (often called an explanation of benefits) to the Federal Black Lung Program. You will need to give your federal black Lung claim number to the medical provider for billing purposes. Your medical provider can get assistance with billing questions by calling 1-800-638-7072. Please share the information in this announcement with your provider.
Providers may send bills electronically to DCMWC if they enroll with our bill processing agent (BPA). For questions and information about enrollment and billing, providers should contact our BPA at: 1-800-638-7072. Our agent can explain the program to your provider(s) and supply them with the necessary forms required for submitting bills for reimbursement. Billing information is also available through the OWCP Medical Bill Processing Portal.
If you paid for medical treatment or services out of pocket, you can ask for reimbursement by completing form OWCP-915 Claim for Medical Reimbursement. You may also use form OWCP-957 Medical Travel Refund Request to obtain reimbursement of travel costs associated with care for your lung condition. These forms are available on the Black Lung Forms page. Each form includes instructions for completion and identifies additional documentation required for reimbursement, if applicable.
Please mail your completed forms to:
U.S. Department of Labor
P.O. Box 8302
London, KY 40742-8302
Medical Benefits Paid by a Coal Mine Operator or Insurance Carrier
If a coal mine operator or an insurance carrier is paying your federal compensation and you are also entitled to state compensation for your black lung condition, you will need to work with the operator or carrier to pay for or be reimbursed for your treatment expenses. The operator or carrier should have sent you information about the procedures you should follow and a contact person or group (sometimes called a “third party administrator” or “TPA”) to help you with medical billing questions. DCMWC can help resolve any issues or disputes you may have with an operator or carrier over medical-bill payments. Please contact 1-800-347-2502 for assistance.
If you have questions about the submission or payment of bills, or require any other medical bill program assistance, contact a representative with our bill processing agent, toll free, at 1-800-638-7072.
You can find additional information about your benefits on the Black Lung homepage.