[Congressional Bills 104th Congress]
[From the U.S. Government Publishing Office]
[H.R. 615 Introduced in House (IH)]







104th CONGRESS
  1st Session
                                H. R. 615

To amend the Black Lung Benefits Act to provide special procedures for 
     certain claims due to pneumoconiosis, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                            January 20, 1995

  Mr. Rahall introduced the following bill; which was referred to the 
          Committee on Economic and Educational Opportunities

_______________________________________________________________________

                                 A BILL


 
To amend the Black Lung Benefits Act to provide special procedures for 
     certain claims due to pneumoconiosis, and for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Black Lung Benefits Act Amendments 
of 1995''.

SEC. 2. CLAIMS PROCEDURE.

    The Black Lung Benefits Act is amended by adding at the end the 
following new part:

                      ``PART D--SPECIAL PROVISIONS

``SEC. 441. CLAIMS.

    ``(a) Standard.--If a claim is filed after the date of the 
enactment of this section under part C for death or total disability of 
a miner due to pneumoconiosis, such miner shall be presumed to have 
been totally disabled by pneumoconiosis or to have died because of 
pneumoconiosis if the conditions described in any one of the following 
paragraphs are met:
            ``(1) A single positive chest roentgenogram (x-ray), 
        biopsy, or autopsy of such miner indicates the existence of 
        pneumoconiosis.
            ``(2) A single set of ventilatory studies of such miner 
        indicates the presence of a chronic respiratory or pulmonary 
        disease that meets or exceeds the severity standards of 
        regulations of the Secretary of Health and Human Services 
        published at 20 C.F.R. 410.490(b)(1)(ii).
            ``(3) A single set of blood gas studies of such miner 
        indicates the presence of an impairment in the transfer of 
        oxygen from the lungs to the blood that meets or exceeds the 
        severity standards of regulations of the Secretary of Labor 
        published at 20 C.F.R. 727.203(a)(3).
            ``(4) Other medical evidence involving such miner, 
        including the documented opinion of a physician exercising 
        reasonable medical judgment, indicates the presence of a 
        respiratory disease or pulmonary impairment that would prevent 
        the miner from performing his usual coal mine work.
The person who submits such claim shall not be required to prove the 
matters described in paragraph (1), (2), (3), or (4) by a preponderance 
of the evidence or by any higher evidentiary standard.
    ``(b) Causation.--
            ``(1) If a claim is filed after the date of the enactment 
        of this section under part C for death or total disability due 
        to pneumoconiosis and if the miner with respect to whom the 
        claim was filed worked 10 or more years in a coal mine and 
        presents evidence which proves the evidence of the matter 
        described in any paragraph of subsection (a), there shall be a 
        rebuttable presumption that the miner's pneumoconiosis arose 
        out of the miner's coal mine employment. No evidence shall be 
        excluded in determining the length of a miner's coal mine 
        employment. In the absence of complete Social Security 
        Administration records, affidavits from the miner's co-workers 
        shall be accepted as sufficient proof of the coal miner's 
        period of employment.
            ``(2) If a miner is unable to prove 10 years of employment 
        in a coal mine, the miner may prove that the miner's 
        pneumoconiosis is due to the miner's coal mine employment 
        through other evidence.
    ``(c) Rebuttal of Presumption.--
            ``(1) The presumption under subsection (a) that a miner is 
        totally disabled by pneumoconiosis may be rebutted only if--
                    ``(A) there is evidence that establishes that the 
                claimant is in fact doing the claimant's usual coal 
                mine work, or
                    ``(B) in light of all relevant evidence, it is 
                established that the miner is able to do the miner's 
                usual coal mine work or comparable and gainful work.
        A physician's opinion that the miner is not totally disabled 
        shall not rebut such presumption when invoked by qualifying 
        ventilatory studies or arterial blood gas testing.
            ``(2) In connection with a rebuttal of a presumption under 
        subsection (a), the Secretary of Labor may submit not more than 
        1 opinion from an examining or consulting physician and not 
        more than 3 x-ray readings to supplement such evidence.
            ``(3) The presumption under subsection (b) may be rebutted 
        only by clear and convincing proof that the miner's 
        pneumoconiosis, established by a condition described in 
        subsection (a), did not arise, in whole or in part, out of the 
        miner's coal mine employment.

``SEC. 442. APPLICATION OF SECTION 441.

    ``(a) In General.--Section 441 shall apply to all claims filed 
under part C on and after the date of the enactment of this Act, except 
that the Secretary of Labor shall review any claim that--
            ``(1) was filed under part B or part C, and
            ``(2) is either pending on the date of enactment of this 
        Act or has been denied on or before such date,
to determine if the evidence establishes eligibility under the 
presumption of section 441(a). The Secretary shall review each such 
claim regardless of whether the claimant also filed any subsequent 
claim under part B or C or such claim resulted in an award of benefits. 
The Secretary's review of a claim which resulted in the award of 
benefits may not result in the reversal or forfeiture of such benefits. 
The Secretary shall promptly notify each claimant having a claim 
subject to review under this subsection that the claim shall be 
reviewed by the Secretary in accordance with this subsection.
    ``(b) Procedure.--
            ``(1) In carrying out the review of a claim under 
        subsection (a), the Secretary shall not allow the claimant or 
        any other party to submit additional medical or other evidence 
        if the Secretary determines that the evidence on file meets the 
        criteria of eligibility set forth in section 441(a). If the 
        Secretary determines that the evidence on file does not meet 
        the criteria of eligibility set forth in section 441(a), the 
        Secretary shall provide an opportunity for the claimant to 
        present additional medical or other evidence to substantiate 
        the claimant's claim under such criteria and shall notify the 
        claimant of that opportunity. The Secretary shall not be 
        permitted to supplement the evidence in any claim reviewed 
        under subsection (a). Each claim reviewed under this section 
        shall be afforded the administrative and judicial review that 
        is afforded claims that are not subject to this section.
            ``(2) If a claim is determined under subsection (a) to meet 
        the eligibility requirements of section 441(a), the individual 
        for which the claim was submitted shall be awarded benefits 
        prospectively (unless, at the time of such determination, the 
        individual is receiving black lung benefits prospectively 
        pursuant to an award made in connection with a separate claim) 
        and retroactively for any period beginning on or after January 
        1, 1974, for which the claimant (1) has not received benefits, 
        and (2) is eligible under the statutory and regulatory 
        provisions governing the retroactive payment of benefits for 
        claims that are not subject to the special review required by 
        subsection (a).

``SEC. 443. PAYMENT OF BENEFITS.

    Benefits payable under any claim which is determined under section 
441 or 442 to be eligible for benefits shall be paid from the fund.

``SEC. 444. JUDICIAL REVIEW.

    ``A claimant who files a claim after the date of enactment of this 
Act and whose claim is denied by the Department of Labor's Benefits 
Review Board pursuant to the procedure of section 21(b) of the 
Longshore and Harbor Workers' Compensation Act (33 U.S.C. 921(b)), may 
petition for review in the United States District Court for the 
district in which the claimant last worked as a coal miner or where the 
claimant resides at the time the appeal is filed, whichever the 
claimant chooses. Section 205(g) of the Social Security Act (42 U.S.C. 
405(g)) shall govern all such petitions for review, except that (1) 
each reference therein to the Secretary shall be interpreted as meaning 
the Secretary of Labor, and (2) if the claim was denied because of the 
application of a regulation which violates this Act or any other 
Federal law, the period in which a claimant may petition for review 
shall not apply. A petition for review under this section may not be 
denied because the claimant has not exhausted the administrative 
remedies available to the claimant.

``SEC. 445. SURVIVORS AND DEPENDENTS.

    ``(a) In General.--The Secretary shall award the survivor or 
dependent of a deceased miner benefits under a claim under part C if 
the conditions in any one of the following paragraphs are met:
            ``(1) The deceased miner worked 25 years or more in one or 
        more coal mines.
            ``(2) The miner's death was due in whole or in part to 
        pneumoconiosis.
            ``(3) The miner was receiving benefits for pneumoconiosis 
        at the time of the miner's death.
            ``(4) The miner had a claim for benefits for pneumoconiosis 
        pending at the time of the miner's death--
                    ``(A) in which the existing medical evidence or 
                such evidence combined with any additional medical 
                evidence submitted by survivors or dependents 
                demonstrates a level of impairment sufficient to 
                qualify for benefits under section 441(a), or
                    ``(B) in which the medical evidence was not 
                sufficient to qualify for benefits under section 441(a) 
                but lay evidence (i) demonstrates by a preponderance of 
                the evidence the existence of a respiatory disease or 
                pulmonary impairment that would prevent the miner from 
                performing the miner's usual coal mine work, and (ii) 
                such disease or impairment is established in accordance 
                with section 441(b)(2) as resulting from the miner's 
                coal mine work.
    ``(b) Definition.--For purposes of this section, survivors and 
dependents are those individuals who filed claims under part C after 
the date of enactment of this Act or whose claims under part B or C are 
eligible for review under section 442.

``SEC. 446. GENERAL PROVISIONS.

    ``(a) Multiple Claims.--If a claimant has had a claim denied under 
this Act, the Secretary shall permit the claimant to file an additional 
claim under this part without a showing of a material change in the 
claim. Such an additional claim shall be considered de novo on the 
merits.
    ``(b) Appeals by the Secretary.--The Secretary may not file an 
appeal from a decision of the Deputy Commissioner, the Office of 
Administrative Law Judges, the Benefits Review Board, or a district 
court of the United States with respect to a claim under this part 
which is adverse to the Secretary.
    ``(c) Reopening Claims.--No claim under this part under which the 
claimant was awarded benefits and with respect to which no appeal is 
pending may be reopened by the Secretary unless the Secretary offers 
reasonable evidence to suspect fraud in connection with the 
adjudication of the claim.''.

SEC. 3. CONFORMING AMENDMENT.

    Section 224(a)(2)(B) of the Social Security Act (42 U.S.C. 
424a(a)(2)(B)) is amended by striking out ``and (iv)'' and inserting in 
lieu thereof ``(iv)'' and by inserting at the end the following: ``and 
(v) benefits payable under the Black Lung Benefits Act,''.

SEC. 4. BENEFIT REPAYMENTS.

    Part C of the Black Lung Benefits Act is amended by adding at the 
end the following:
    ``Sec. 436. (a) In the administration of the benefits payable under 
this part, if a claimant receives benefits under this part under a 
claim but before final adjudication of the claim for benefits is made 
and if the final adjudication is that the claimant is ineligible for 
benefits, the payment of such benefits to the claimant shall not be 
considered an overpayment of benefits and the claimant shall not be 
legally responsible for the return of such benefits.
    ``(b) If, before the date of the enactment of this section, a 
claimant received benefits under this part under a claim but before a 
final adjudication of the claim for benefits was made, the claimant 
will not be required to repay such benefits. If, before the date of the 
enactment of this section, a claimant who received benefits under this 
part under a claim but before final adjudication of the claim for 
benefits was made was required under regulations of the Secretary to 
repay the benefits as an overpayment of benefits, the Secretary shall 
refund to the claimant the amount repaid by the claimant.''.

SEC. 5. WIDOW'S BENEFITS.

    (a) In General.--In the administration of the Black Lung Benefits 
Act--
            (1) a widow of a miner who received or is receiving 
        benefits under that Act shall not be disqualified to receive 
        such benefits if the widow remarries, and
            (2) a widow of a miner shall be entitled to receive such 
        benefits without regard to the length of time the widow was 
        married to the miner.
Any regulations of the Secretary of Labor which disqualify a widow 
described in paragraph (1) or impose a minimum marriage period as 
described in paragraph (2) shall on and after the date of the enactment 
of this Act have no legal effect.
    Applications.--Any widow who on the date of the enactment of this 
Act is entitled to receive benefits under the Black Lung Benefits Act 
because of subsection (a) shall file a claim for such benefits within 3 
years of the date of the enactment of this Act.
                                 <all>