DI 52115: Federal Workers' Compensation (WC) Payments

Effective Dates: 03/22/2012 - Present

BASIC (09-08)

The Black Lung Benefits (BLB) program under FMSHA provides monthly benefit payments to:

coal miners totally disabled as a result of pneumoconiosis, to
the widows of coal miners who died as a result of pneumoconiosis, and to
their dependents.

The Division of Coal Mine Workers’ Compensation (DCMWC) within the U.S Department of Labor Employment Standards Administration’s Office of Workers’ Compensation Programs (OWCP), adjudicates and processes claims filed by coal miners and their survivors under the BLB program.

A. Part B Black Lung Benefits (BLB)

Part B BLB is not workers’ compensation (WC) for offset purposes. However, a Part B benefit could be offset as a public disability benefit (PDB). See details in DI 52125.020 - Determining Public Disability Benefit (PDB) for Part B Black Lung.

B. Part C Black Lung Benefits (BLB)

Part C BLB is offsettable as WC. Offset the total amount paid to the miner and family, including any cost of living increases.

If a court order changes Part C BLB to Part B BLB payments, offset is no longer applicable. Offset should be removed retroactively to the month of offset upon effectuation of the court decision. Follow the guidelines shown in DI 52115.015A. in this section.

1. BL Part C payments

For some injured workers, the DOL has assigned responsibility for

monthly BL Part C payments to the coal company where the worker was last employed, known as a Responsible Mine Operator (RMO). RMO is considered the coal mine company found liable for the individual’s Black Lung disease. During appeals or other situations where the RMO cannot or will not pay, the DOL pays the claim out of the Black Lung Trust Fund. The payments are considered WC for offset purposes just as DOL BL payments are considered WC.

Benefits are paid monthly at predetermined rates described on DOL’s website at http://www.dol.gov/owcp/dcmwc/benefits_part_c.htm

NOTE: However, these predetermined rates may be reduced or not paid because of amounts received by the miner under another State or Federal WC law for disability due to black lung.

2. DOL Data Exchange Black Lung Part C Alerts

DOL provides SSA a monthly payment file that contains the records of all live miners entitled to Part C BLB. The payment file is a third-party report for offset purposes. For instructions, see DI 52115.020 - DOL Data Exchange Black Lung Part C Alerts.

C. Obtaining proof of BL Part C payments

Contact the disabled worker for any development. If the worker is unable to provide the necessary proof, verify the payments from the following outside resources:

If BL is paid by a WC carrier or RMO, contact the carrier or RMO directly for the proof. The DOL office has access to information regarding payments by the coal mine company.
If BL is paid by the BL Trust Fund, complete a Form SSA-1709, (Request for Workers’ Compensation/Public Disability Benefit Information). For instructions, see DI 52145.010 - Completion and Receipt of Form SSA-1709. Send to:

U.S. Department of Labor,

ESA/OWCP/DCMWC,

Room C-3520,

200 Constitution Ave. NW,

Washington, DC 20210; or
Telephone the DOL, OWCP Division of Coal Mine Workers Compensation. Refer to the DOL website to find the office that handles the State or county where the miner resides: http://www.dol.gov/owcp/dcmwc/blcontac.htm .

NOTE: For Pennsylvania or West Virginia, you need to know the county they live in. County information is available at: http://www.naco.org .

D. Processing initial claims involving BL Part C payments

The field offices (FOs) and processing centers (PCs) are responsible for adjudicating disability claims involving BL Part C.

1. Claims processed via MCS/EC

To process claims via MCS/EC, the FO or PC will:

Complete the MCS/EC WC Common Screens, listing the Source of Compensation as “BL”. For Common Screens, see MSOM Common 001.001 through MSOM Common 001.008.
Establish a 042 diary code by using the DECI and DIAR screens. See MSOM MCS 009.013 Decision Input (DECI) and MSOM MCS 009.015 Diary Screen (DIAR).
Retain documentations following the procedure in DI 52145.015 - Retention of Workers’ Compensation/Public Disability Benefit (WC/PDB) Proofs.

2. Claims processed via A101 or EF101

To process claims via A101 or EF 101, the FO or PC will:

Adjudicate the Interactive Computations Facilities (ICF) screens for the WC/PDB action before preparing the A101/EF101 screens. For instructions, see DI 52165.000 - Interactive Computations Facility (ICF) for Workers’ Compensation/Public Disability.
Establish a diary control for 35 days for return of proof.
The PC establishes the diary in Processing Center Action Center System (PCACS), only if MCS is not being used to process your action. Explain the reason for the diary. Follow procedures in MSOM PCACS 009.001 - Diaries and Development - Overview.
FO instructions may vary depending on whether there is a PCACS diary pending. For instructions, see DI 52140.001E. - Processing WC/PDB Offset and GN 01040.005 - Establishment of Diaries and Listings.
Retain documentations following the procedure in DI 52145.015 - Retention of Workers’ Compensation/Public Disability Benefit (WC/PDB) Proofs.

E. Processing post entitlement cases involving BL Part C

When proof is received, the FOs and PCs takes the following post entitlement actions:

Verify the validity of the documents. If necessary, contact DOL to confirm any questionable data. Follow the guidelines shown in DI 52115.015C. in this section.
Offset the Part C BLB amount plus any separate amounts to auxiliaries. For instructions, see DI 52165.000 - Interactive Computations Facility (ICF) for Workers’ Compensation/Public Disability.
Update the changes to the BL Part C via ICF WC, coding the offset type code as “BL”. For instructions, see DI 52165.000 - Interactive Computations Facility (ICF) for Workers’ Compensation/Public Disability.