20 C.F.R. Part 727, Subpart A

20 C.F.R. Part 727, Subpart A

PART 727-REVIEW OF PENDING AND DENIED CLAIMS UNDER THE BLACK LUNG BENEFITS REFORM ACT OF 1977

To return to the Table of Contents for 20 C.F.R. Part 727, click HERE .

Subpart A-General

§ 727.1 Statutory provisions, purpose of this part.

(a) Under title IV of the Federal Coal Mine Health and Safety Act of 1969, as amended by the Black Lung Benefits Act of 1972, benefits were provided to coal miners and certain survivors of coal miners on account of the miners' total disability or death due to pneumoconiosis. Part B of title IV of the act as amended provided that all claims for benefits filed between De- cember 30, 1969, and June 30, 1973, would be filed with, processed by, and paid from Federal funds by the Secretary of Health, Education, and Welfare, through the Social Security Ad- ministration. The survivor of a miner was permitted to file a claim with the Secretary of Health, Education, and Welfare under part B until January 1, 1974, or within 6 months of the miner's death, if death occurred before January 1, 1974, or in the case of a part B beneficiary, within 6 months of the beneficiary's death. Section 415 of part B of title IV of the act provides that a claim filed by a miner between July I and December 31, 1973, would be filed with and processed by the Secretary of Labor and paid, if appropriate, by the Secretary of Labor from Federal funds for all periods of eligibility between July 1 and December 31, 1973. For periods of eligibility after December 31, 1973, an approved section 415 claim was to be paid by a coal mine operator found liable pursuant to the act or the Secretary of Labor as appropriate. A claim filed after December 31, 1973, was to be filed under an approved State workers' compensation law or, if no such law was available in an appropriate State, the claim was to be filed with the Secretary of Labor under part C of title IV of the Act. Claims were to be adjudicated under certain provisions of the Longshoremen's and Harbor Workers' Compensation Act, as amended, 33 U.S.C. 901 et seq., and paid by a coal mine operator found liable pursuant to the act. If no such operator could be identified benefits were to be paid by the Secretary of Labor from Federal funds.

(b) The Black Lung Benefits Revenue Act of 1977 and the Black Lung Benefits Reform Act of 1977 significantly amend the provisions of title IV of the act to, among other things, establish the black lung disability trust fund (the fund) for the payment of all claims predicated upon coal mine employment which terminate prior to January 1, 1970, and for other claims for which no operator liability can be established. The fund is financed by individual coal mine operators. Other provisions of the act as amended modify the evidentiary requirements necessary to establish entitlement to benefits, eliminate certain restrictions on the filing of claims, establish penalties to be applied if a coal operator fails to meet its obligations under the act, and make technical, correcting, and other administrative or procedural and substantive changes.

(c) Section 435 of the act as amended directs the Secretary of Health, Education, and Welfare and the Secretary of Labor to undertake a review of all previously denied and pending claims in light of the amendments made by such act. The Secretary of Health, Education, and Welfare is directed to perform this review at the request of the claimant on all denied and pending claims filed under part B of title IV of the Act, exclusive of those claims filed under section 415. The Secretary of Labor is directed to perform this review automatically on all claims filed under section 415 and part C of title IV of the Act, which were denied or pending as of the effective date of the Black Lung Benefits Reform Act of 1977, and in addition is required to review certain claims originally filed with the Secretary of Health, Education, and Welfare.

(d) The new section 435 contains provisions setting forth the scope of the claims review, the procedures to be followed and the consequences which accrue depending upon the results of any particular review. It is the purpose of this part to set forth and implement the provisions of section 435 as those provisions apply to the Secretary of Labor, and inform all interested par- ties of the manner in which a right to review will be extended with respect to all denied and pending claims for black lung benefits under the act by the Secretary of Labor.

§ 727.2 Applicability and content of this part.

(a) This part is designed to apply to, and set forth the role of, the Secretary of Labor in carrying out the provisions of section 435 of the act. The action to be taken and the procedure to be followed by the Secretary of Health, Education, and Welfare and the Social Security Administration under section 435 is detailed elsewhere. This part will, however, describe what will be done by the Secretary of Health, Education, and Welfare and the Social Security Administration in general terms and will detail the responsibilities assigned to the Secretary of Labor with respect to a claim reviewed by the Secretary of Health, Education, and Welfare.

(b) This subpart A describes generally the statutory framework established to facilitate the review of all pending and denied black lung claims, the applicability and content of this part and other relevant parts contained in this title 20 of the Code of Federal Regulations, and sets forth applicable definitions and usages.

(c) Subpart B of this part sets forth the procedures to be followed in the review of various types of claims subject to review under this part.

(d) Subpart C of this part contains the criteria to be applied in determining a claimant's eligibility for benefits under this part. Such criteria shall also be applicable to all claims for medical services filed under section 11 of the Black Lung Benefits Reform Act of 1977 (see §725.308(b) of this subchapter), and shall also be applicable to all other claims filed under part 725 of this subpart until such time as the Secretary promulgates new criteria for determining total disability or death due to pneumoconiosis in accordance with section 402(f)(1) of the act.

(e) Subpart D of this part contains provisions relating to the liability for, and conditions governing, the payment of benefits under this part.

(f) Subpart E of this part sets forth special provisions relating to the processing of claims subject to review under this part which are within the jurisdiction of an admininstrative law judge or the Benefits Review Board.

§ 727.3 Definitions, use of terms.

Except as is otherwise provided by this part, the definitions and usages of terms contained in subpart A of part 725 of this title, as amended from time to time, shall be applicable to this part.

§727.4 Applicability of other parts in this subchapter.

(a) Part 725. Part 725 of this subchapter, which sets forth: (1) The procedure for filing a claim for black lung benefits under part C of title IV of the act, (2) the procedure to be followed in the adjudication of claims so filed, (3) standards for determining whether a particular individual is a miner, or a qualified dependent or survivor of a miner, (4) the criteria to be applied in determining the liability of a coal op- erator or the fund for the payment of approved claims so filed, and (5) the manner in which the payment of benefits shall be made with respect to part C claims, shall not be applicable to the processing, adjudication, or payment of claims under this part unless applicability is specifically provided by part 725 or this part.

(b) Part 718. Part 718 of this subchapter, which contains the criteria and standards to be applied in determining whether a miner is totally disabled due to pneumoconiosis or whether a miner died due to or while totally or partially disabled by pneumoconiosis, shall not be applicable to the determination of claims under this part unless applicability is provided by part 718 or this part. Until such time as part 718 of this subchapter is revised in accordance with the 1977 amendments to the act, the provisions of subpart D of part 410 of this title which are not inconsistent with the 1977 amendments to the act, shall be applicable to the adjudication of claims under this part, unless otherwise provided by this part (see subpart C of this part).

(c) Parts 715, 717, and 720. Parts 715, 717, and 720 of this subchapter, which parts established the procedures for the filing, processing, and payment of claims filed under section 415 of the act, are repealed and pertinent provisions of those parts which retain vitality are incorporated within part 725 of this subchapter as amended.

(d) Part 726. Part 726 of this subchapter, which contains provisions setting forth a coal operator's obligations to insure or self-insure its liability for the payment of benefits to certain eligible claimants, is applicable to this part insofar as it bears upon the responsibility of a coal operator to secure the payment of benefits to certain claimants who may be determined eligible for benefits under this part.