Black Lung Benefits Program: Administrative and Structural Changes Could Improve Miners' Ability to Pursue Claims
GAO-10-7
Published: Oct 30, 2009. Publicly Released: Oct 30, 2009.
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Highlights
The Department of Labor (DOL) Black Lung Benefits Program provides medical and income assistance to coal miners who suffer total disability or death due to lung disease caused by coal dust. To provide insight into DOL's administration of the Black Lung Benefits Program, GAO is reporting on (1) how long it takes to process and resolve black lung benefits claims; (2) at what rate and for what reasons black lung claims and appeals are denied by DOL; and (3) what barriers, if any, confront miners or their survivors in pursuing their claims. GAO collected and analyzed black lung claims and appeals data and interviewed officials at relevant federal agencies, national organizations, and selected local organizations at two sites.
Recommendations
Recommendations for Executive Action
| Agency Affected | Recommendation | Status |
|---|---|---|
| Department of Labor | To improve the effectiveness of the Black Lung Benefits Program, the Secretary of Labor should take steps to reduce the number of black lung cases remanded from Benefits Review Board (BRB) to Office of Administrative Law Judges (OALJ) by convening a group to determine the causes of these remands and develop solutions for reducing their incidence. |
DOL conducted data analyses in February 2010 and March 2011 on the subsequent history of cases remanded by the Benefits Review Board (BRB). The data will be used as a starting point for internal DOL discussions to examine the causes and results of remands and to identify potential measures for reducing their number and the delay they generate, without compromising the integrity and fairness of the claims process.
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| Department of Labor | To improve the effectiveness of the Black Lung Benefits Program, the Secretary of Labor should obtain summary information on how long it takes to resolve claims using its current automated system to routinely track cases through the entire adjudication process and develop associated performance measures. | The Office of Workers' Compensation Programs (OWCP) is using its Automated Support Package to produce ad hoc reports on the approximately twenty percent of claims that are disputed and proceed beyond its jurisdiction, and is perfecting the parameters of those reports to measure timeliness and outcomes. These reports track the claims that proceed to the Office of Administrative Law Judges (OALJ), the Benefits Review Board (BRB) and the Courts of Appeals; identify the parties who requested further review; and specify the additional time that elapses at each stage of the process. This reporting system enables OWCP to track the amount of time it takes claims to proceed through the entire...
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| Department of Labor | To improve the effectiveness of the Black Lung Benefits Program, the Secretary of Labor should consider shortening the time required to schedule hearings for black lung cases by examining the feasibility of using video teleconferencing technology to streamline the scheduling of hearings in remote areas. | In FY11, the Office of Administrative Law Judges (OALJ) purchased a videoconferencing monitor and related equipment, and appointed a Project Manager for its videoconferencing hearings. The Project Manager is charged with overseeing the technical aspects of OALJ's videoconferencing hearings and coordinating availability and utility of off-site videoconferencing facilities at remote hearing locations. On September 9, 2011, OALJ management and the Project Manager participated in videoconferencing training at the U.S. District Court for the District of Columbia. OALJ has conducted a few videoconferencing hearings in certain remote locations through use of facilities at United States District...
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| Department of Labor | To improve the effectiveness of the Black Lung Benefits Program, the Secretary of Labor should, based on feedback from relevant black lung medical stakeholders, including approved diagnostic providers and Black Lung Clinics, develop options for improving how doctors' opinions are documented on DOL's medical evaluation form. | In March, 2010, the Office of Workers' Compensation Programs (OWCP) requested feedback from a selected group of experienced diagnostic physicians and from experienced attorneys seeking to improve this reporting form. After receiving and analyzing that feedback, OWCP redesigned the physical examination reporting forms to focus more specifically on the nature and extent of a claimant's pulmonary disease and disability. The new reporting package was submitted to OMB for review and was approved on October 31, 2011 (OMB 1240-0023.) The forms were formatted and tested for use by the Division of Coal Mine Workers' Compensation (DCMWC) correspondence system and website. The form was posted on...
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| Department of Labor | To improve the effectiveness of the Black Lung Benefits Program, the Secretary of Labor should evaluate and report on claimant access to legal and lay representation by implementing changes to the data management systems of Office of Workers' Compensation Programs (OWCP), OALJ, and BRB that will permit accurate data about claimant representation throughout the claims and appeals process. | The Office of Workers' Compensation Programs (OWCP) instituted changes to its Automated Support Package that enables OWCP to track claims with either attorney or lay representation. OWCP can determine the starting and ending dates of representation, and whether the representative is an attorney or non-attorney. These changes are in effect for all claims in which a written declaration or notice of representation is received (and, in the case of a lay representative, representation is approved by the District Director). Instructions for data entry were provided to all claims personnel in December 2009. The Office of Administrative Law Judges (OALJ) records in its database those cases in...
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| Department of Labor | To improve the effectiveness of the Black Lung Benefits Program, the Secretary of Labor should evaluate and address blood gas testing practices that may contribute to inaccurate disability test readings by implementing a feedback mechanism to record and track complaints from federal black lung claims stakeholders about testing practices. |
OWCP has expanded its ability to collect, record and analyze complaints regarding medical evaluations, including blood gas testing. This improved complaint tracking system, initiated in June 2009, allows OWCP to identify individual providers who have generated complaints about blood gas testing and other testing practices. OWCP also sends a guide to black lung medical testing procedures to the miner with every test authorization. This guide, expanded and improved after our recommendation was issued, explains the test requirements and procedures in clear language, allowing miners to understand what they should expect when undergoing testing.
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| Department of Labor | To improve the effectiveness of the Black Lung Benefits Program, the Secretary of Labor should examine the following issues and evaluate the potential for proposing structural changes to the program to Congress: (1) options for enhancing incentives for attorneys and lay representatives to take claimants' cases; areas that could be explored include alternate pay structures for attorneys and an examination of federal support for lay representation; (2) the costs and benefits of allowing compensation for partial disability and settlement of claims; (3) the clinical limitations in documenting evidence to prove pneumoconiosis and total disability; and (4) new and previous proposals to reduce the amount of time it takes to resolve claims and appeals, including requiring complete evidentiary development at the primary claims processing phase and limiting the need for appeals. | The Department of Labor has made preliminary studies of the costs and benefits of allowing compensation for partial disability as suggested by GAO. OWCP would be willing to study the inclusion of settlements as part of a broad compensation scheme that would not preclude a miner from seeking additional compensation as his disease progressed and that would not preclude an eligible survivor from receiving benefits following the death of the miner. OWCP has found very little support for amending the Act to include either settlements or partial disability compensation. OWCP has instituted administrative measures to improve medical documentation of disability and disease. For example, OWCP has...
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Black lung diseaseClaims processingClaims settlementCoalCoal miningCoalminers benefitsDisabilitiesDisability benefitsDocumentationEmployee medical benefitsEmployeesExpense claimsRespiratory diseasesEvaluationTestingPolicies and procedures