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Division of Coal Mine Workers' Compensation (DCMWC)

SELECTION OF AN EXAMINING PROVIDER

For Your Black Lung Pulmonary Evaluation

The U.S. Department of Labor is required to provide you with a complete pulmonary evaluation in connection with your Black Lung benefits claim. In order to assure that you receive a high quality evaluation, the Department of Labor has made arrangements with qualified providers to perform the tests. You must select a provider from the Approved Diagnostic Provider list on our website, either in your state of residence or a surrounding state. WITHIN 15 DAYS SELECT YOUR PROVIDER FROM THE LIST AND RETURN THE 'SELECTION OF EXAMINING PROVIDER' FORM LETTING US KNOW YOUR SELECTION. Your signature on the form verifies that you have followed the requirements and restrictions listed below. DO NOT CONTACT THE PROVIDER UNTIL YOU GET AN AUTHORIZATION LETTER.You will receive another letter authorizing the specific tests needed with the provider that you selected. You will then be instructed to contact the provider to arrange for examination.

The Department of Labor will pay the cost of the examination, including round trip mileage. The evaluation consists of a chest X-ray, pulmonary function study, arterial blood gas study, and physical examination.

Certain requirements and restrictions apply:

  • You may not select any provider who has examined or treated you in the year prior to the filing of your application for benefits.
  • You may not select a close relative of yours or of your spouse. Excluded among others are: parents, children, grandchildren, brothers, sisters, nephews, nieces, aunts, uncles, and first cousins.
  • If your trip and return trip for the examination both occur on the same day, we will pay the actual round trip mileage.
  • If the trip involves staying overnight, we will not pay for overnight accommodations, unless there is no listed provider close enough for you to travel to and from the examination in a single day.
  • If you travel over 100 miles from your home for your examination for the Department of Labor, the responsible mine operator named in your claim has the right to send you for an examination up to the distance you travel for the Department of Labor's examination.

Once you have made your selection from the list, complete the enclosed form indicating your choice. Please send the complete form to:

Office of Workers' Compensation
Division of Coal Mine Workers' Compensation
Central Mail Room
PO Box 8307
London, KY 40742-8307