In the state of California, injuries and illnesses caused by the working conditions of one’s employment are subject to fair compensation. Workers in and around coal mines are especially prone to pneumoconiosis, a lung disease that turns lungs black, with the job location being the major contributing factor. It is therefore essential that you seek the services of a professional attorney to get insights about the Black Lung Benefits Program and how it works. The Workers’ Compensation Attorney Group in Orange County is a reliable and experienced law firm providing professional attorneys who have built a solid reputation with their high success rate in handling workers’ compensation cases. You can trust our specialized attorneys to help you claim benefits for pneumoconiosis caused by toxic working conditions.
What is The Black Lung Benefits Program?
The US Department of Labor amended and published the final regulations for the implementation of the Black Lung Benefits Act on December 20th, 2000. This act explains the procedures and guidelines for filing black lung benefits claims that were made after January 19th, 2001. The Black Lung Benefits Act (BLBA) makes sure all employees working in and around any of the nation’s coal mines are provided with medical treatment and monthly payments for pneumoconiosis (black lung disease), which is associated mainly with such job conditions. A miner’s dependent survivors are also provided with monthly benefits as per the regulations of this act if the said miner suffered death as a result of their working environment. The BLBA covers the total costs for traveling to seek medical services and the actual medical costs for treating the black lung condition. Payment for medical expenses is, however, usually subject to the maximum permissible fee entitled to a victim. Travel costs are also limited to reasonable amounts.
What is Workers’ Compensation Under California Law?
Workers’ compensation is a system of laws that dictate the benefits to be awarded to a worker who has suffered a work-related injury and outlines the particular procedures for obtaining said benefits as well. These laws vary according to state and depend on the type of work the injured worker was performing. The compensation laws applicable to employees in the federal government and certain types of industries such as railroad companies are different from others. In California, the procedures and requirements for claiming workers' compensation benefits are numerous and confusing, which can be overwhelming for most people, hence the need for a lawyer.
According to the law, all employers in California are supposed to have a workers’ compensation insurance to provide compensation coverage to any of their employee that suffers health damages while on the job. Therefore, injured or ill employees are entitled to workers’ compensation, provided they file a claim as required by the law. The claim can only turn into a lawsuit under certain conditions and if the insurer does not authorize your benefits claim after a certain period. In this case, you must hire a lawyer who is familiar with the state laws to help you obtain your rightfully deserved compensation.
What Are the Effects and Purposes of Workers’ Compensation Laws?
- Workers’ compensation laws were designed to ensure that all workers who get injured in the course of their employment duties get fixed monetary benefits without having to sue their employers. Therefore, it provides employees with some safety net in case of any work-related injuries or illness.
- Workers’ compensation laws also protect the employers in a given case by limiting the amount of money that an injured employee can obtain from them. To some extent, it also prevents the injured employee from suing their co-workers for work-related injuries.
- The workers’ compensation law provides an injured worker with an “exclusive remedy” for obtaining their benefits. This is unless the workers’ injury was started by a third party, for instance, technical failure of the machinery in use, in which case, the employee is supposed to seek compensation from the manufacturer of the product. Thus, the employer is not directly involved in third party claims. This case can only be solved by civil action and not workers’ compensation.
What Type of Workers’ Compensation Benefits are Covered by The Black Lung Benefits Program?
- Medical care
Any employee who is injured as a result of work-related conditions is entitled to proper medical treatment to relieve the effects of their injury. They are also entitled to the provision of appropriate medication until they make a full recovery. All medical bills, round-trips to and from the hospital, as well as prescriptions, are covered under medical treatment compensation. On some workers' compensation plans, the injured employee can also enjoy the company's doctor for a period not exceeding thirty (30) days.
- Vocational rehabilitation
If an employee sustained a work-related injury which prevents them from resuming the job, they should either get assistance in seeking another employment or occupational rehabilitation. Vocational rehabilitation has typically a maximum limit of money which an employee should be compensated and can otherwise be substituted by a different job offer by the same employer.
- Returning to work
If the injured employee returns to their job and gets an increment in their salary or receives the equal amount they were used to, the workers’ compensation benefits may be stopped at that point. However, if the employee is not done receiving their wage loss benefits, they might continue to enjoy the benefits but most probably in lesser amounts.
- Benefits for wage loss
Most states, including California, have two different types of wage loss benefit plans. They include:
- Temporary partial benefits
These types of benefits are only payable to workers who have suffered a temporary work-related disability but are still earning some salary despite their injury. The benefits that an injured employee receives are calculated based on the total difference between their post and pre-injury earnings.
- Temporary total benefits
If a workplace injury was severe to the extent of a worker being unable to work normally again, they are entitled to temporary total benefits. These benefits are thus, only payable to workers who are temporarily restricted from resuming their work duties due to an injury. In some jurisdictions, these benefits are payable on a percentage, which is calculated depending on the employees’ pre-injury salary.
- Permanent disability benefits
If an employee’s injury is severe to the extent that they cannot fully recover from the condition, they are entitled to monetary benefits for their permanent disability. Having a permanent disability means that the said worker has lost their ability to return to the competitive open job market due to the injury. The rate and amount of benefits an injured worker receives, in this case, are dependent on the extent of the permanent disability their injury has caused them.
- Temporary disability benefits
If an injury sustained at the workplace forces an employee to take a leave or break from work, they are eligible for temporary disability benefits. Temporary disability payment is supposed to provide partial compensation to the employee for the lost salary when they are on break due to the injury sustained at work.
How Do I File My Workers’ Compensation Claim Under Black Lung Benefits Program?
It is important to note that the compensation claim for black lung benefits program can be filed by any present and former coal mine workers who were exposed to the toxic coal dust from the mines. This includes workers who were involved in the construction and transportation in and around the coal mine. Their surviving family dependents such as spouses, siblings, parents, disabled adults, and orphaned children can also file this claim on behalf of their deceased provider who worked in the coal mine environment.
An application to receive these benefits should be sent to the district office of the Division of Coal Mine Workers’ Compensation (DCMWC) in the California Department of labor. DCMWC processes and adjudicates claims that are filed by miners working in coal mines.
After sending the papers, the affected miner must undergo a pulmonary evaluation conducted by a qualified physician to determine the extent of the black lung disease infection (pneumoconiosis). As per the California law, the department of labor is supposed to provide the infected miner with some free examination and diagnosis to determine if they are eligible for black lung benefits. Below are examples of medical tests done on a claimant.
- Arterial blood gas test,
- Chest X-ray,
- Physical examination and,
- Inspection on the pulmonary function.
All expenses for this medical evaluation are paid for by the black lung Disability Trust Fund (BLDTF). The affected miner must choose a medical facility or a physician to conduct these tests from a list of medical facilities authorized by the district office to conduct pulmonary evaluations within the state of California. If all the supporting evidence from the medical examination proved that the claimant deserves black lung compensation benefits, the DCMWC at the California Department of labor would be required to propose a decision immediately. They will also need to order payment of the benefits awarded to the victim by the black lung Disability Trust Fund.
Additionally, if the district director finds out that the evidence does not support the black lung benefits claim and there is no responsible operator to pay the benefits, they will have to issue a schedule for submission of more evidence to support the claim. In such a situation, the district director will have to play the role of the responsible operator under certain subject limitations. If the coal mine operator is liable for payments of the claimant’s black lung benefits, the district director will issue them with a notice of claim.
Notice of the Claim
After the district director put together enough evidence on the history of a miner’s employment and finds out that there are more linked coal mine operators to the miner's illness, a notice of claim is given to them and their insurers. These related mine operators are regarded as "potentially liable operators.” This notice of claim is meant to notify them of this existing workers’ black lung benefits claim that has made them parties of the claim as well. The district director will also attach the claimant’s application for black lung benefits together with the evidence that supports the claim on the notice claim sent to these operators.
Upon receiving the claim, the operators are supposed to respond to it within thirty (30) days and indicate their intentions of contesting as the liable operator for this claim. They are also supposed to send the claimant a copy of a letter showing acceptance of the charges in the filed claim. The mine operator who accepts the liability of the claim must state the nature of their disagreement as per their designation by agreeing to or denying the following statements:
- The miner was employed for a period of less than a year.
- The miner was employed for at least one (1) day after December 31st, 1969.
- The mine operators are capable of assuming payment of benefits liability.
- The claimant was working with the operator when they got exposed to dust from the mine.
- The operator can accept or deny that they were the operator for the period after June 30th, 1973.
Therefore, the operator must respond to this incident within thirty (30) days after notice of the claim, failure to that, the said operator will not be allowed to contest the payment of claim benefits during later proceedings based on the above five grounds. However, they will still have the right to argue that another operator is responsible for that particular claim.
For you to negotiate all these complicated procedures and guidelines, you will require the services of a professional workers’ compensation attorney operating within your state. Orange County Workers’ Compensation Attorney Group has a team of expert lawyers who are conversant with the operations in this field. You can trust our attorneys with your Black Lung Benefits Claim anytime for a smooth and painless process of getting your deserved benefits.
What Kind of Benefits Does the Black Lung Benefits Act Typically Cover?
Under this act, former and present coal miners who have been exposed to the dangerous coal dust are eligible to apply for monthly financial and medical benefits. Before a claimant receives benefits of any kind, the Black Lung Benefits Act program conducts some diagnostic testing on the claimant to confirm if there is a presence of pneumoconiosis and the extent of the associated infection disability. After determining this, the claimant will then receive a monthly stipend such as medical services, hospitalization coverage, outpatient therapy, and some durable medical equipment. Below are services covered by the Black Lung Benefits Program:
- Outpatient and inpatient hospital costs, including emergency room costs,
- Emergency services that involve ambulance transportation to the hospital,
- Transportation costs to the hospital, clinic, or doctor for distances of around two hundred (200 mi.) miles or less.
- Hospital visits, consultations, and calls to the doctor's office,
- Costs for approved prescription drugs with both brand name and generic as per the Federal Black Lung Benefits Program.
Services That Are Not Covered by the Black Lung Benefits Act
Below are examples of expenses that are not covered by the Federal Black Lung Program:
- Medical issues that are not related to pneumoconiosis, for instance: diabetes, arthritis or a heart condition,
- Other x-rays that were done by the physician besides chest x-ray.
- Home health issues.
- Medicine bought without the approved physician’s prescription.
- Private services at the hospital besides lung diagnosis; for example, telephone use.
- Travel expenses to and from your preferred drugstore,
- Non-authorized home medical equipment,
- Medicine for any other health issue that is not black lung condition,
- Home nursing care or services,
- Medical treatment for other family members or spouses’ health issues.
Black Lung Benefits Insurance
Every coal mine is required by law (as per the Black Lung Benefits Act) to insure itself or purchase a commercial insurance contract (which includes state agency contract or policy) to pay benefits liability to their sick mine workers. A coal mine operator who is supposed to pay these liability benefits to their employees and fails can face a civil penalty of not less than one thousand ($1,000) dollars each day of non-compliance to these rules. Additionally, if the treasurer, secretary, and the president of a coal mine run their operations without insurance coverage, they might be liable for payment of monetary awards to previous employees.
Frequently Asked Questions About The Black Lung Benefits Program
- What is the Black Lung Benefits Act?
Black Lung Benefits Act is a federal law that works to provide benefits to coal miners who get infected with pneumoconiosis and their surviving dependents if the disease causes the death of a miner. This act also makes, sure enough, benefits are given in the future to coal mine workers and their dependents in a situation where the disease causes total disability to the victim or death.
- Where do I find information about black lung benefits?
The Office of Workers’ Compensation (OWCP) in the US Department of Labor is the one that administers the federal Black Lung Benefits Program and not the Coal Mine’s Healthy and Safety Administration as many people tend to assume. People that are eligible for this program must be entirely or permanently affected by black lung (pneumoconiosis) which is somewhat a high standard to meet; thus, many mine workers do not qualify for these benefits.
- What medical costs are covered under the black lung benefits program?
The cost for all medical services provided by the approved physician and travel expenses: to and from, to treat your lung illness is authorized and covered by the Federal Black Lung Benefits Act. The costs are typically paid in full, and there are no deductibles in respect to all covered medical services and customary rates related to pneumoconiosis.
- If the Social Security Administration provides my black lung benefits at the beginning of every month, can I still get my medical benefits?
If Social Security provides your monthly black lung benefits, you are automatically disqualified from receiving medical benefits. This is unless you filed your workers’ compensation claim for black lung with the US Department of Labor before or on December 31st, 1980. This is the only way you can be considered to be a black lung medical beneficiary.
- If I was awarded benefits by the state where I was an employee in a coal mine after filing a claim, and the Federal Black Lung Program also awarded me benefits for my black lung issue, can I still qualify for medical benefits under Federal Black Lung Program?
The Federal Black Lung Program can also cover medical expenses that were not covered by the state for the filed workers’ compensation claim for black lung illness. However, reimbursement or bills for your awarded benefits should first of all be submitted to the state program which granted you the benefits.
Find a Workers’ Compensation Attorney Specializing in Black Lung Benefits Near Me
Every step of claiming workers’ compensation benefits for any work-related injury or illness requires an attorney to give you insight into the system requirements and help you claim your full benefits. The procedures involved can be very confusing and overwhelming, especially for work-related illnesses that fall under the Black Lung Benefits Act. If you need legal representation on matters related to Black Lung Benefits Program for a disease you contracted as a coal mine worker or for a deceased relative who worked as a mine worker, The Workers’ Compensation Attorney Group based in Orange County, CA can help you with the case. Our attorneys are well versed and experienced in matters relating to workers’ compensation. We have an excellent track record of helping coal mine workers successfully claim their black lung benefits for pneumoconiosis. Do not hesitate to contact us today at 562-485-9694. Our Orange County workers compensation lawyer will assist you and answer any question or clarification you may have regarding workers’ compensation in California.