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Office of Workers' Compensation Programs

Division of Coal Mine Workers' Compensation (DCMWC)

Guide to Filing for Black Lung Benefits: Survivor's Claim

The Black Lung Benefits Act provides monthly benefits to eligible surviving family members of coal miners who died due to black lung disease, or “pneumoconiosis,” arising out of coal mine employment. You may also receive additional benefits for family members who are dependent on you. A coal mining company which employed the deceased coal miner (usually the last company that employed the miner for a year or more) may be required to pay your benefits if it meets certain requirements under the law. Otherwise, the Black Lung Disability Trust Fund will pay your benefits. The fact that the deceased miner filed a claim which was approved does not automatically entitle you to benefits.

The first step in the process of applying for Black Lung benefits is to complete an application form. You will be asked to provide important basic information about the miner, yourself and your family. The form is called the “Survivor’s Claim for Benefits Under the Black Lung Act” (Form CM-912). You will also complete an “Employment History” (Form CM-911a). This form requests information about the miner’s work as a miner, the number of years (s)he worked, the names of the coal companies which employed him or her, and any work outside the coal mining industry. We need this information to determine whether the individual was a coal miner and whether a specific coal mining company will pay your benefits. A representative from the U. S. Department of Labor’s Division of Coal Mine Workers’ Compensation or the Social Security Administration can assist you in completing the application forms. You may also file the forms by mail.

Based on the information in your benefits application and Employment History form, we may ask you to provide additional information, including copies of official documents. This information may include copies of marriage certificates, children’s birth certificates, death certificates, proof of enrollment in schools for dependent children, etc. This information is necessary to establish basic facts about your entitlement to benefits or the entitlement of members of your family.

We will need proof of the miner’s coal mine employment. We will usually ask for a detailed earnings record from the Social Security Administration, but any proof of employment that you may have will be helpful. Such proof could include W-2 forms, tax records, and letters from employers, among others.

We will also ask you to identify all sources of medical information about the miner. This information should include the names of hospitals where the miner received treatment, the names of physicians who treated the miner during his or her life, and any other sources of information about the miner’s health or death (including any state or federal award for the miner’s disability or death). If you obtained an autopsy of the miner, we will need to know the name of the physician who performed it. We will request copies from you or the medical facility of all the information that appears relevant to determining whether black lung disease caused the miner’s death. If necessary, we may ask a physician of our choosing to review the medical evidence and provide an opinion on the cause(s) of the miner’s death.

After we receive all of the relevant information, we will conduct a preliminary review and determine whether the information supports an award or a denial of your claim. This review is not final. You will receive a letter describing the information we received and the reasons for our opinion about your entitlement. This letter is the “Schedule for the Submission of Additional Evidence.” The “Schedule” will inform you about your opportunity to submit additional evidence, your right to obtain medical evidence from a physician of your own choosing, and the time limits for submitting evidence. If we find that a coal company is liable for your claim, that company has the right to submit evidence from a physician of its choice.

The most important part of applying for Black Lung benefits is obtaining medical evidence about the miner’s physical condition. The Black Lung benefits program has limitations on the amount of medical evidence which you or the coal company can give us for determining whether your claim should be approved or denied. We encourage you to get advice from an attorney or other qualified representative before obtaining any additional medical evidence. Ordinarily, attorney’s fees which must be paid if your claim is approved will be paid by the coal company liable for your claim or the Black Lung Disability Trust Fund. We will explain to you the situations in which you may be liable for payment of the attorney’s fees. You are not liable for any attorney’s fees if your claim is denied.

When we have received all of the evidence in your claim, we will decide whether your claim must be approved or denied. In some cases, we may ask you to attend an “informal conference” to discuss your claim before we make this decision. If we decide that an informal conference is necessary, we will inform you of your rights and obligations in writing when we schedule the conference. After we have reviewed your claim and all of the evidence (and the results of the conference if one is held) we will issue a “Proposed Decision and Order.” This decision will approve or deny your claim and explain the reasons for our decision. We will also inform you (and the coal company if one is liable for your claim) of the options for challenging our decision and the time limits for taking any further action. These options include asking the Department to reconsider its decision or asking for a hearing before an administrative law judge.

If you have any questions about the benefits application process, we are available to give you answers. You should contact the district office that has jurisdiction of your state of residence. The list of district offices and their toll-free numbers may be found online.