Guide to Filing for Black Lung Benefits

Division of Coal Mine Workers' Compensation (DCMWC)

GUIDE TO FILING FOR BLACK LUNG BENEFITS
(MINER)

The Black Lung Benefits Act provides monthly benefits to coal miners who are totally disabled by black lung disease caused by working in the coal mining industry. "Totally disabled" means you are unable to perform the work you did as a coal miner because breathing coal mine dust has permanently impaired your ability to breathe normally. You may also receive additional benefits for family members who are dependent on you and for the cost of your own medical treatment. A coal mining company which employed you (usually the last company that employed you 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 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 yourself and your family. The form is called the "Miner's Claim for Benefits under the Black Lung Act" (Form CM-911). You will also complete an “Employment History” (Supplemental Form CM-911a). This form requests information about your work as a miner, the number of years you worked, the names of the coal companies which employed you, and your work outside the coal mining industry. We need this information to determine whether you were a coal miner and whether a specific coal mining company will pay your benefits. A representative from the U.S. Department of Labor (Division of Coal Mine Workers' Compensation) or the Social Security Administration can assist you in completing the application forms.

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.

After we have begun processing your benefits application, we will contact you to schedule a complete pulmonary evaluation. A "pulmonary evaluation" is a medical examination to determine whether you are totally disabled by black lung disease. The Department of Labor (DOL) is required by law to offer you a free examination to prove that you may be entitled to black lung benefits. We will provide you with a list of physicians who can perform this examination. All of these physicians will be located in your state or a bordering state. You will be asked to select a physician you wish to use, within certain limitations. The examination consists of:

• a physical examination by a physician;
• a chest X-ray;
• a pulmonary function test and an arterial blood gas test (unless medically contraindicated), which measure your ability to breathe.

Additional information about choosing a physician and the pulmonary examination are contained in the form "Selection of an Examining Provider." Please review this information and instructions carefully. If you refuse to be examined, your claim may be denied without any further consideration of your entitlement to benefits. You also have the right to have the results of this examination sent to your personal physician.

After we receive the results of your pulmonary examination, we will conduct a preliminary review of those results and determine whether they support an award or a denial of your claim. This review is not final. You will receive a letter explaining the results of the examination and the reasons for our opinion about your entitlement. This letter is called 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 have you examined by a physician of its choice. If you refuse to be examined, your claim may be denied without any further consideration of your entitlement to benefits.

The most important part of applying for Black Lung benefits is obtaining medical evidence about your physical condition. The Black Lung benefits program has limitations on the amount of medical evidence which you and the coal company may give us for determining whether you are entitled to benefits. We encourage you to get advice from an attorney or other qualified representative before submitting any additional medical evidence to the Department of Labor. Ordinarily, attorney's fees (paid only 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.

NOTE: Recent changes to the regulations governing the Federal Black Lung Program require the parties to exchange – with all other parties – any "medical information" developed in connection with a claim for benefits, even if the submitting party does not intend to offer the information as evidence to be considered by the DOL's deciding official. This rule applies to your claim.

Generally, the exchange must be made within 30 days of the party's receipt of the information. You must send a complete copy of the information to the other parties in the claim, including the Department of Labor, within 30 days after either you or your agent receives it. If you have medical information from a prior claim that you did not put into the record or otherwise share with the other parties, you must also send this information to the other parties.

"Medical information" includes an examining physician's report and associated test results, a non-examining physician's report addressing your respiratory or pulmonary condition, and any other tests or procedures related to your respiratory or pulmonary condition. Medical records related to hospitalization or treatment—such as a visit to a primary care physician—do not have to be exchanged with the other parties under this rule. You also do not have to share any correspondence between your representative (either an attorney or a lay representative) and a medical expert.

When submitting medical information to DOL, please identify the information as medical "information for exchange only" or "evidence." (If you identify it as "evidence," you should also indicate whether it is "affirmative," "rebuttal" or "rehabilitative" evidence; we will explain this to you if you do not have an attorney or representative.) Unless you tell us that you want the medical information you shared with the parties to be considered as evidence, we will not consider it when deciding your claim.

When we have received and reviewed all of the evidence in your claim, we will decide whether your claim must be approved or denied and issue a "Proposed Decision and Order." This written decision will explain our reasons for approving or denying your claim. 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 can contact the district office at the telephone number listed on the enclosed letter.

Or, information can be submitted to your claim electronically at: https://coalmine.dol.gov/

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 here: https://www.dol.gov/owcp/dcmwc/districtoffices.htm.