The Black Lung Benefits Program provides medical and income assistance  to coal mine workers who suffer disability or death due to black lung  disease. DOL Issued Claims Decisions at Each Stage of the Process, on Average, in 1 Year or Less, but High Rates of Appeal and Remand, Among Other Factors, Delay Resolution of Many Claims

		DOL Issued Claims Decisions at Each Stage of the Claims Process, on Average, in 1 Year or Less

According to department data for fiscal year 2008, DOL decided claims at  each stage of the claims process, on average, in 1 year or less, meeting its  respective performance goals (see table 1). For the claims we examined, which were filed between 2001 and 2008,  mine companies agreed to pay benefits for the majority of claims within 3  years from the date of the initial claim, while a minority of claims  remained in the process for as many as 8 years before an RO agreed to  pay (see fig. For about 73 percent of the 763  examined claims filed between 2001 and 2008, ROs agreed to pay in less  than 3 years. According to DOL  officials, some miners extend appeals in an attempt to have interim  benefits reinstated or to maintain their payment of interim benefits. Some claimants have  difficulty proving that their lung disease is pneumoconiosis. In  addition, according to NIOSH scientists, some miners develop a form of  lung disease associated with long-term exposure to coal mine dust that  impairs lung function but frequently cannot be detected by X-ray. In such cases,  judges told us that they rely heavily on nonclinical evidence to determine  whether claimants are eligible for benefits. According to some  administrative law judges, mining company doctors are usually better  credentialed and produce lengthier, more sophisticated, and  comprehensive medical reports and evaluations than claimants’ doctors. Coal Miners Face a Number of Challenges in Pursuing Federal Black Lung Benefits, Including Finding Legal Representation and Developing Sound Medical Evidence

		Although the Program and DOL Recognize the Importance of Legal Representation for Miners, DOL Does Not Track, Evaluate, and Report on Claimants’ Access to Legal Representation

The importance of legal representation for black lung claimants is well  established. DOL judges told us that doctors’ medical opinions are a  key element of evidence in claims adjudication and indicated that most of  the opinions submitted by DOL’s approved doctors did not provide  claimants with sound evidentiary support for their cases. Although the cause for these  rates is not entirely clear, it is evident that the program’s structure can  create financial incentives for both miners and mine operators to continue  to file or extend appeals. While miners must be able to develop sound evidentiary  support for their black lung cases, the medical evidence prepared by DOL- approved doctors does not consistently provide this support, and blood  gas testing practices may contribute to inaccurate disability test readings. 4. 6. Appendix I: Objectives, Scope, and Methodology

To gain insight in to the administration of the Black Lung Benefits  Program, we examined (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 the Department of Labor (DOL); and (3)  what barriers, if any, confront miners or their survivors in pursuing their  claims. However, DOL does not track how long all claims remain  in the claims and appeals process. These states  and regions were selected because they have (1) high levels of miner death  related to black lung disease, (2) a large volume of federal black lung  claims, and (3) estimates of black lung-related resources and services.
Why GAO Did This Study

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.

What GAO Found

In fiscal year 2008, DOL issued decisions on claims in less than 1 year on average at each stage of adjudication, yet according to officials and experts, the appeals and remands (claims sent back to the prior stage of review for further consideration or development) that follow decisions can keep claims in the system for years. Although DOL does not track how long all claims remain in the claims and appeals process, we examined 763 miner claims filed between 2001 and 2008 that were ultimately awarded benefits by mine companies. We found that mine companies agreed to pay benefits for about 73 percent of these claims within 3 years from the date of the initial claim, roughly 24 percent of claims in 3 to 6 years, and the remaining 4 percent in 6 to 8 years. The program also contains financial incentives for both miners and mining companies to keep claims in the appeals process. For example, some miners may extend the appeals process to maintain their payment of interim benefits. Factors that add additional time to the appeals process also include allowing time for claimants to find legal representation and waiting until there are sufficient cases in rural areas before sending a judge to hold a hearing. In 2008, most claims (87 percent) were initially denied. Few claimants areable to prove they meet all of the program's eligibility requirements, and for certain cases, required conditions are difficult to prove. For example, some miners--those with a history of smoking--develop lung disease associated with long-term exposure to coal mine dust but which frequently cannot be detected by X-ray. Though current science does not allow a medical distinction between lung disease caused by smoking and by coal mine dust, regulations require that claimants establish that their lung disease is significantly related to or substantially aggravated by coal dust. In such cases, judges told us they rely heavily on nonclinical evidence, such as physician credentials, length of depositions, and level of sophistication of evidence presented by claimants and mine operators to determine claimant eligibility. According to some DOL administrative law judges, mining company doctors are usually better credentialed and produce lengthier and more sophisticated medical reports and evaluations. GAO found that coal miners face a number of challenges pursuing federal black lung claims, including finding legal representation and developing sound medical evidence to support their claims. DOL officials identified miners' lack of resources, the low probability of success, and high litigation costs for their cases as factors that contribute to the difficulties miners face in finding legal representatives. Miners also encounter challenges in developing sound medical evidence. DOL administrative law judges said medical evidence prepared by DOL-approved doctors for claimants does not always provide sound or thorough evidentiary support for their claims. Further, various practices of medical testing, a key measure of black lung-related disability, may contribute to inaccurate disability test readings.