Division of Coal Mine Workers' Compensation (DCMWC)

Are you filing a claim as an active or retired miner?

If you are filing on your record of employment in the coal mining industry, you must complete a CM-911, Miner's Claim for Benefits, and related forms.

Are you filing a claim as the survivor of a miner?

If you are filing on the employment record of a deceased miner, you must complete a CM-912, Survivor's Claim for Benefits, and related forms.

Are you filing a claim on behalf of another person?

If you are filing a claim on behalf of a minor child or on behalf of someone under a legal or physical impairment, please consult 20 CFR 725.301 to make sure that you are eligible to file. Benefits are payable only to the beneficiary, his or her representative payee, or his or her legal guardian.

Are you assisting a claimant?

If you are acting as a lay representative for a miner or a survivor, you must submit a written statement to that effect and signed by the claimant in addition to the claim forms. Lay representatives may be benefits counselors, family members, or any other non-attorney approved by the appropriate adjudication official, usually the District Director at the time a claim is filed. If you are an attorney representing the claimant, your written declaration of representation must be submitted but the claimant's written appointment is not required. Please consult 20 CFR 725.362 for additional information for representatives.