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

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

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

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Subpart D-Payment of Benefits/Liability

§ 727.300 Conditions and duration of eligibility.

The provisions of subpart B of part 725 of this subchapter shall be applicable in determining the conditions and duration of eligibility applicable with respect to a claim approved under this part.

§ 727.301 Amounts payable, other pay- ment provisions.

Except as is otherwise provided in this part (see §727.302), provisions relating to the amount of benefits payable, the manner of payment and all other provisions contained in subpart G of part 725 and §725.309 of this subchapter, shall be applicable to a claim approved under this part. A miner whose claim is approved under this part shall be entitled to medical benefits to be determined and administered in accordance with the provisions of subpart I of part 725 of this subchapter.

§ 727.302 Date from which benefits are payable after review and approval.

(a) Section 435(c) of the act provides that any individual whose claim is approved after review shall be awarded benefits on a retroactive basis for a period which begins no earlier than January 1, 1974. This section implements section 435(c) of the act and sets forth provisions governing the date from which benefits shall be payable with respect to a claim reviewed under this part. (See also section 6(a) of the Longshoremen's Act as incorporated by section 422(a) of the act.)

(b) In the case of a claim reviewed and finally approved under §727.105, benefits shall be payable for all periods of eligibility occurring on or after January 1, 1974.

(c)(1) In the case of a miner whose claim is reviewed and finally approved under § 727.106, benefits shall be payable for all periods of eligibility beginning with the month of onset of total disability due to pneumoconiosis or January 1, 1974, whichever is later. Where the evidence does not establish the month of onset, benefits shall be payable from the month during which the miner elected review under §727.104.

(2) In the case of a survivor whose claim is reviewed and finally approved under §727.106, benefits shall be payable for all periods of eligibility occurring on or after the month of the miner's death or January 1, 1974, whichever is later.

(d)(1) In the case of a miner's claim which is reviewed and finally approved under § 727.107, benefits shall be payable for all periods of eligibility beginning with the month of onset of total disability due to pneumoconiosis or January 1, 1974, whichever is later. Where the evidence does not establish the month of onset, benefits shall be payable from the month during which the miner elected review under § 727.104.

(2) In the case of a survivor whose claim is reviewed and finally approved under §727.107, benefits shall be payable for all periods of eligibility occurring on or after the month of the miner's death or January 1, 1974, whichever is later.

(e) In the case of a claim reviewed and finally approved under §727.108, benefits shall be payable as provided in § 725.503 of this subchapter.

(f) For the purposes of this section, the term "finally approved" means that an award of benefits has been made or affirmed by a district director, administrative law judge, the Benefits Review Board, or a U.S. court of appeals, that no further hearing, appeal, or reconsideration is pending, and the time to request such hearing, appeal, or reconsideration has expired. (See part 725 of this subchapter generally.) Benefit payments shall be initiated prior to final approval in accordance with the provisions of §725.522 of this subchapter.

§ 727.303 Claims filed under section 415 of the act.

(a) A claim filed by a miner between July 1 and December 31, 1973, with the Secretary of Labor under section 415 of the act is subject to review under this section if it was pending or had been denied on or before March 1, 1978. Prior to the enactment of the Black Lung Benefits Reform Act of 1977, benefits with respect to a section 415 claim may have been payable by the Secretary of Labor from Federal funds for periods of eligibility between July 1 and December 31, 1973. However, under section 435 of the act, no benefits may be paid with respect to a claim reviewed under that section, including a section 415 claim, for any period of eligibility prior to January 1, 1974. Accordingly, in the case of any claim filed under section 415 of the act with respect to which no benefits have been awarded prior to March 1, 1978, for any period of eligibility between July 1 and December 31, 1973, no benefits which might have been awarded for this period shall be awarded in any adjudication of the claim taking place after the effective date of this part.

(b) A claim filed under section 415 of the act which is reviewed under this part shall for all purposes be considered as if it was filed on January 1, 1974, under part C of title IV of the Act.

§ 727.304 Liability for benefit payments.

A claim approved under this part shall be payable either by a coal mine employer (see subpart F of part 725 of this subchapter) or the black lung disability trust fund. Benefits shall be payable by a responsible coal mine employer if the miner's last date of coal mine employment occurred on or after January 1, 1970, and if the miner's last coal mine employer or a successor to such employer is found liable under the provisions of subpart F of part 725 of this subchapter. Where it is determined that the employer liable for the payment of such benefits has not commenced payment of benefits within 30 days after the date the claimant is initially determined eligible or within 30 days after a payment is due, the fund will make the required payments. The employer is required by section 424 of the act to reimburse the fund where its liability is finally determined. For the purposes of determining the liability of a coal mine employer or the fund for the payment of an approved claim, the provisions of subparts F and H of part 725 of this subchapter shall be applicable to a claim considered under this part, including any claim originally filed under part B of title IV of the Act with the Social Security Administration. In all other cases, benefits shall be payable by the fund. Nothing in this part shall be construed in derogation of the terms of part 725 of this subchapter insofar as part 725 affects the liability of a coal mine employer.