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Two appeals court rulings that upheld eased eligibility for federal black lung benefits for coal miners and their surviving families are likely to increase the number of claims paid by employers.
While the recent rulings are not the first to uphold black lung eligibility changes contained in the 2010 Patient Protection and Affordable Care Act, one apparently was the first to specifically uphold the reform law's return of what is known as the 15-year presumption.
The presumption is that coal miners working in the industry for 15 years who develop disabling pulmonary or respiratory impairment are presumed to have pneumoconiosis, or black lung disease, as the cause and not other factors, such as a lifelong smoking habit.
PPACA also reduced the burden of proof for dependent survivors seeking benefits.
Claimant and defense attorneys say the rulings will increase the number of claims against employers, which spiked after PPACA was signed into law. They say it also will affect the resolution of several still-pending claims.
Black lung disease was a factor in more than 8,000 deaths nationwide from 1998-2007, according to federal data (see related story).
In a late June decision, the Chicago-based 7th U.S. Circuit Court of Appeals ruled unanimously that a coal miner is entitled to black lung benefits because of the change in the health care reform law.
The ruling Consolidation Coal Co. v. Director, Office of Workers' Compensation Programs, United States Department of Labor, which upheld the 15-year presumption, involved a coal miner and smoker whose claims previously were denied.
“The problem we will have (now) is that more claims will be decided in favor of miners where the condition on which they base entitlement may well not have been caused by exposure to dust in the mines,” said Neil Richard Clement, a partner at RichardsonClement P.C. in Birmingham, Ala.
The ruling could lead to more claims, agreed Darrell Dunham, a black lung litigation expert at Darrell Dunham & Associates in Carbondale, Ill.
“If I were a coal miner that had a disabling pulmonary condition, even if I had filed a claim before and it had been rejected, (I would) think very seriously about going back and filing another claim,” Mr. Dunham said.
On the same day as the 7th Circuit ruling, the Atlanta-based 11th U.S. Circuit Court of Appeals upheld the constitutionality of a change in PPACA that eliminated the need for surviving dependents to prove that a miner died due to pneumoconiosis to continue receiving black lung benefits.
In U.S. Steel Mining Co. L.L.C. v. Director, OWCP et al., the company argued that the reform law's retroactive easing of black lung benefit requirements violated the Fifth Amendment of the U.S. Constitution.
However, the 11th Circuit ruled unanimously that Congress made a rational, legislative choice to improve survivors' opportunity to obtain benefits and that retroactive application does not does not violate Fifth Amendment rights.
The ruling is significant because other appeals courts overseeing states where coal mining is prevalent have ruled similarly, said Abigail P. van Alstyne, a partner at Quinn, Connor, Weaver, Davies & Rouco L.L.P. in Birmingham, Ala.
The ruling in U.S. Steel said the Philadelphia-based 3rd U.S. Circuit Court of Appeals and the Richmond, Va.-based 4th U.S. Circuit Court of Appeals also have ruled in favor of claimants in similar cases.
However, the Cincinnati-based 6th Circuit “concluded (somewhat summarily) that surviving spouses still must prove that the miner died of pneumoconiosis,” the 11th Circuit's ruling said.
U.S. Steel is now weighing whether to seek a rehearing before an en banc panel of the 11th Circuit, said Mr. Clement, who represents U.S. Steel.
The 1972 Black Lung Benefits Act instituted the 15-year presumption for coal miners. In 1978, Congress changed the law so that survivors did not have to file a new claim or revalidate an existing one to receive survivor benefits.
But in 1981, Congress removed the 15-year presumption and required survivors to file new claims and prove the miner died from pneumoconiosis.
Aside from overriding the 1981 changes, the 2010 health care reform law's reinstatement of black lung benefit rights also applied them retroactively to claims filed after Jan. 1, 2005, and still pending on or after March 23, 2010.
Neither of the recent appeals courts' decisions was surprising because the health care reform law intended to make the awarding of benefits easier, said Michelle C. Landers, executive vice president and general counsel for Kentucky Employers' Mutual Insurance in Lexington.
“Those amendments were out there to add another (potential) for the courts to award benefits and that is what happened,” Ms. Landers said.
Early-stage pneumoconiosis, commonly called black lung disease, can be asymptomatic, but advanced cases often lead to disability and premature death, according to the National Institute for Occupational Safety and Health.