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operator’s liability to the fund, as is
otherwise provided in this part. Interest
payments owed pursuant to this
paragraph shall be paid directly to the
fund.
(c) In any case in which an operator
is liable for the payment of an attorney’s
fee pursuant to § 725.367, and the
attorney’s fee is payable because the
award of benefits has become final, the
attorney shall also be entitled to simple
annual interest, computed from the date
on which the attorney’s fee was
awarded. The interest shall be
computed through the date on which
the operator paid the attorney’s fee.
(d) The rates of interest applicable to
paragraphs (a), (b), and (c) of this
section shall be computed as follows:
(1) For all amounts outstanding prior
to January 1, 1982, the rate shall be 6%
simple annual interest;
(2) For all amounts outstanding for
any period during calendar year 1982,
the rate shall be 15% simple annual
interest; and
(3) For all amounts outstanding
during any period after calendar year
1982, the rate shall be simple annual
interest at the rate established by section
6621 of the Internal Revenue Code (26
U.S.C.) which is in effect for such
period.
(e) The fund shall not be liable for the
payment of interest under any
circumstances, other than the payment
of interest on advances from the United
States Treasury as provided by section
9501(c) of the Internal Revenue Code
(26 U.S.C.).
§ 725.609
persons.

Enforcement against other

In any case in which an award of
benefits creates obligations on the part
of an operator or insurer that may be
enforced under the provisions of this
subpart, such obligations may also be
enforced, in the discretion of the
Secretary or district director, as follows:
(a) In a case in which the operator is
a sole proprietorship or partnership,
against any person who owned, or was
a partner in, such operator during any
period commencing on or after the date
on which the miner was last employed
by the operator;
(b) In a case in which the operator is
a corporation that failed to secure its
liability for benefits in accordance with
section 423 of the Act and § 726.4, and
the operator has not secured its liability
for the claim in accordance with
§ 725.606, against any person who
served as the president, secretary, or
treasurer of such corporation during any
period commencing on or after the date
on which the miner was last employed
by the operator;

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(c) In a case in which the operator is
no longer capable of assuming its
liability for the payment of benefits
(§ 725.494(e)), against any operator
which became a successor operator with
respect to the liable operator (§ 725.492)
after the date on which the claim was
filed, beginning with the most recent
such successor operator;
(d) In a case in which the operator is
no longer capable of assuming its
liability for the payment of benefits
(§ 725.494(e)), and such operator was a
subsidiary of a parent company or a
product of a joint venture, or was
substantially owned or controlled by
another business entity, against such
parent entity, any member of such joint
venture, or such controlling business
entity; or
(e) Against any other person who has
assumed or succeeded to the obligations
of the operator or insurer by operation
of any state or federal law, or by any
other means.
§ 725.620 Failure to secure benefits; other
penalties.

(a) If an operator fails to discharge its
insurance obligations under the Act, the
provisions of subpart D of part 726 of
this subchapter shall apply.
(b) Any employer who knowingly
transfers, sells, encumbers, assigns, or in
any manner disposes of, conceals,
secrets, or destroys any property
belonging to such employer, after one of
its employees has been injured within
the purview of the Act, and with intent
to avoid the payment of benefits under
the Act to such miner or his or her
dependents, shall be guilty of a
misdemeanor and, upon conviction
thereof, shall be punished by a fine of
not more than $1,000, or by
imprisonment for not more than one
year, or by both. In any case where such
employer is a corporation, the president,
secretary, and treasurer thereof shall be
also severally liable for such penalty or
imprisonment as well as jointly liable
with such corporation for such fine.
(c) No agreement by a miner to pay
any portion of a premium paid to a
carrier by such miner’s employer or to
contribute to a benefit fund or
department maintained by such
employer for the purpose of providing
benefits or medical services and
supplies as required by this part shall be
valid; and any employer who makes a
deduction for such purpose from the
pay of a miner entitled to benefits under
the Act shall be guilty of a misdemeanor
and upon conviction thereof shall be
punished by a fine of not more than
$1,000.
(d) No agreement by a miner to waive
his or her right to benefits under the Act

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and the provisions of this part shall be
valid.
(e) This section shall not affect any
other liability of the employer under
this part.
§ 725.621

Reports.

(a) Upon making the first payment of
benefits and upon suspension,
reduction, or increase of payments, the
operator or other employer responsible
for making payments shall immediately
notify the district director of the action
taken, in accordance with a form
prescribed by the Office.
(b) Within 16 days after final payment
of benefits has been made by an
employer, such employer shall so notify
the district director, in accordance with
a form prescribed by the Office, stating
that such final payment, has been made,
the total amount of benefits paid, the
name of the beneficiary, and such other
information as the Office deems
pertinent.
(c) The Director may from time to
time prescribe such additional reports to
be made by operators, other employers,
or carriers as the Director may consider
necessary for the efficient
administration of the Act.
(d) Any employer who fails or refuses
to file any report required of such
employer under this section shall be
subject to a civil penalty not to exceed
$500 for each failure or refusal, which
penalty shall be determined in
accordance with the procedures set
forth in subpart D of part 726 of this
subchapter, as appropriate. The
maximum penalty applicable to any
violation of this paragraph that takes
place after January 19, 2001 shall be
$550.
(e) No request for information or
response to such request shall be
considered a report for purposes of this
section or the Act, unless it is so
designated by the Director or by this
section.
Subpart J—Medical Benefits and
Vocational Rehabilitation
§ 725.701

Availability of medical benefits.

(a) A miner who is determined to be
eligible for benefits under this part or
part 727 of this subchapter (see
§ 725.4(d)) is entitled to medical
benefits as set forth in this subpart as of
the date of his or her claim, but in no
event before January 1, 1974. No
medical benefits shall be provided to
the survivor or dependent of a miner
under this part.
(b) A responsible operator, other
employer, or where there is neither, the
fund, shall furnish a miner entitled to
benefits under this part with such

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medical, surgical, and other attendance
and treatment, nursing and hospital
services, medicine and apparatus, and
any other medical service or supply, for
such periods as the nature of the miner’s
pneumoconiosis and disability requires.
(c) The medical benefits referred to in
paragraphs (a) and (b) of this section
shall include palliative measures useful
only to prevent pain or discomfort
associated with the miner’s
pneumoconiosis or attendant disability.
(d) The costs recoverable under this
subpart shall include the reasonable
cost of travel necessary for medical
treatment (to be determined in
accordance with prevailing United
States government mileage rates) and
the reasonable documented cost to the
miner or medical provider incurred in
communicating with the employer,
carrier, or district director on matters
connected with medical benefits.
(e) If a miner receives a medical
service or supply, as described in this
section, for any pulmonary disorder,
there shall be a rebuttable presumption
that the disorder is caused or aggravated
by the miner’s pneumoconiosis. The
party liable for the payment of benefits
may rebut the presumption by
producing credible evidence that the
medical service or supply provided was
for a pulmonary disorder apart from
those previously associated with the
miner’s disability, or was beyond that
necessary to effectively treat a covered
disorder, or was not for a pulmonary
disorder at all.
(f) Evidence that the miner does not
have pneumoconiosis or is not totally
disabled by pneumoconiosis arising out
of coal mine employment is insufficient
to defeat a request for coverage of any
medical service or supply under this
subpart. In determining whether the
treatment is compensable, the opinion
of the miner’s treating physician may be
entitled to controlling weight pursuant
to § 718.104(d). A finding that a medical
service or supply is not covered under
this subpart shall not otherwise affect
the miner’s entitlement to benefits.
§ 725.702 Claims for medical benefits only
under section 11 of the Reform Act.

(a) Section 11 of the Reform Act
directs the Secretary of Health,
Education and Welfare to notify each
miner receiving benefits under part B of
title IV of the Act that he or she may file
a claim for medical treatment benefits
described in this subpart. Section
725.308(b) provides that a claim for
medical treatment benefits shall be filed
on or before December 31, 1980, unless
the period is enlarged for good cause
shown. This section sets forth the rules
governing the processing, adjudication,

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and payment of claims filed under
section 11.
(b)(1) A claim filed pursuant to the
notice described in paragraph (a) of this
section shall be considered a claim for
medical benefits only, and shall be filed,
processed, and adjudicated in
accordance with the provisions of this
part, except as provided in this section.
While a claim for medical benefits must
be treated as any other claim filed under
part C of title IV of the Act, the
Department shall accept the Social
Security Administration’s finding of
entitlement as its initial determination.
(2) In the case of a part B beneficiary
whose coal mine employment
terminated before January 1, 1970, the
Secretary shall make an immediate
award of medical benefits. Where the
part B beneficiary’s coal mine
employment terminated on or after
January 1, 1970, the Secretary shall
immediately authorize the payment of
medical benefits and thereafter inform
the responsible operator, if any, of the
operator’s right to contest the claimant’s
entitlement for medical benefits.
(c) A miner on whose behalf a claim
is filed under this section (see
§ 725.301) must have been alive on
March 1, 1978, in order for the claim to
be considered.
(d) The criteria contained in subpart
C of part 727 of this subchapter (see
§ 725.4(d)) are applicable to claims for
medical benefits filed under this
section.
(e) No determination made with
respect to a claim filed under this
section shall affect any determination
previously made by the Social Security
Administration. The Social Security
Administration may, however, reopen a
previously approved claim if the
conditions set forth in § 410.672(c) of
this chapter are present. These
conditions are generally limited to fraud
or concealment.
(f) If medical benefits are awarded
under this section, such benefits shall
be payable by a responsible coal mine
operator (see subpart G of this part), if
the miner’s last employment occurred
on or after January 1, 1970, and in all
other cases by the fund. An operator
which may be required to provide
medical treatment benefits to a miner
under this section shall have the right
to participate in the adjudication of the
claim as is otherwise provided in this
part.
(g) Any miner whose coal mine
employment terminated after January 1,
1970, may be required to submit to a
medical examination requested by an
identified operator. The unreasonable
refusal to submit to such an
examination shall have the same

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consequences as are provided under
§ 725.414.
(h) If a miner is determined eligible
for medical benefits in accordance with
this section, such benefits shall be
provided from the date of filing, except
that such benefits may also include
payments for any unreimbursed medical
treatment costs incurred personally by
such miner during the period from
January 1, 1974, to the date of filing
which are attributable to medical care
required as a result of the miner’s total
disability due to pneumoconiosis. No
reimbursement for health insurance
premiums, taxes attributable to any
public health insurance coverage, or
other deduction or payments made for
the purpose of securing third party
liability for medical care costs is
authorized by this section. If a miner
seeks reimbursement for medical care
costs personally incurred before the
filing of a claim under this section, the
district director shall require
documented proof of the nature of the
medical service provided, the identity of
the medical provider, the cost of the
service, and the fact that the cost was
paid by the miner, before
reimbursement for such cost may be
awarded.
§ 725.703

Physician defined.

The term ‘‘physician’’ includes only
doctors of medicine (MD) and
osteopathic practitioners within the
scope of their practices as defined by
State law. No treatment or medical
services performed by any other
practitioner of the healing arts is
authorized by this part, unless such
treatment or service is authorized and
supervised both by a physician as
defined in this section and the district
director.
§ 725.704 Notification of right to medical
benefits; authorization of treatment.

(a) Upon notification to a miner of
such miner’s entitlement to benefits, the
Office shall provide the miner with a
list of authorized treating physicians
and medical facilities in the area of the
miner’s residence. The miner may select
a physician from this list or may select
another physician with approval of the
Office. Where emergency services are
necessary and appropriate,
authorization by the Office shall not be
required.
(b) The Office may, on its own
initiative, or at the request of a
responsible operator, order a change of
physicians or facilities, but only where
it has been determined that the change
is desirable or necessary in the best
interest of the miner. The miner may

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change physicians or facilities subject to
the approval of the Office.
(c) If adequate treatment cannot be
obtained in the area of the claimant’s
residence, the Office may authorize the
use of physicians or medical facilities
outside such area as well as
reimbursement for travel expenses and
overnight accommodations.
§ 725.705

Arrangements for medical care.

(a) Operator liability. If an operator
has been determined liable for the
payment of benefits to a miner, the
Office shall notify such operator or
insurer of the names, addresses, and
telephone numbers of the authorized
providers of medical benefits chosen by
an entitled miner, and shall require the
operator or insurer to:
(1) Notify the miner and the providers
chosen that such operator will be
responsible for the cost of medical
services provided to the miner on
account of the miner’s total disability
due to pneumoconiosis;
(2) Designate a person or persons with
decisionmaking authority with whom
the Office, the miner and authorized
providers may communicate on matters
involving medical benefits provided
under this subpart and notify the Office,
miner and providers of such
designation;
(3) Make arrangements for the direct
reimbursement of providers for their
services.
(b) Fund liability. If there is no
operator found liable for the payment of
benefits, the Office shall make necessary
arrangements to provide medical care to
the miner, notify the miner and medical
care facility selected of the liability of
the fund, designate a person or persons
with whom the miner or provider may
communicate on matters relating to
medical care, and make arrangements
for the direct reimbursement of the
medical provider.
§ 725.706
services.

Authorization to provide medical

(a) Except as provided in paragraph
(b) of this section, medical services from
an authorized provider which are
payable under § 725.701 shall not
require prior approval of the Office or
the responsible operator.
(b) Except where emergency treatment
is required, prior approval of the Office
or the responsible operator shall be
obtained before any hospitalization or
surgery, or before ordering an apparatus
for treatment where the purchase price
exceeds $300. A request for approval of
non-emergency hospitalization or
surgery shall be acted upon
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if a written response cannot be given
within 7 days following the request. No
employee of the Department of Labor,
other than a district director or the
Chief, Branch of Medical Analysis and
Services, DCMWC, is authorized to
approve a request for hospitalization or
surgery by telephone.
(c) Payment for medical services,
treatment, or an apparatus shall be made
at no more than the rate prevailing in
the community in which the providing
physician, medical facility or supplier is
located.
§ 725.707 Reports of physicians and
supervision of medical care.

(a) Within 30 days following the first
medical or surgical treatment provided
under § 725.701, the treating physician
or facility shall furnish to the Office and
the responsible operator, if any, a report
of such treatment.
(b) In order to permit continuing
supervision of the medical care
provided to the miner with respect to
the necessity, character and sufficiency
of any medical care furnished or to be
furnished, the treating physician,
facility, employer or carrier shall
provide such reports in addition to
those required by paragraph (a) of this
section as the Office may from time to
time require. Within the discretion of
the district director, payment may be
refused to any medical provider who
fails to submit any report required by
this section.
§ 725.708
benefits.

Disputes concerning medical

(a) Whenever a dispute develops
concerning medical services under this
part, the district director shall attempt
to informally resolve such dispute. In
this regard the district director may, on
his or her own initiative or at the
request of the responsible operator order
the claimant to submit to an
examination by a physician selected by
the district director.
(b) If no informal resolution is
accomplished, the district director shall
refer the case to the Office of
Administrative Law Judges for hearing
in accordance with this part. Any such
hearing shall be scheduled at the
earliest possible time and shall take
precedence over all other requests for
hearing except for prior requests for
hearing arising under this section and as
provided by § 727.405 of this subchapter
(see § 725.4(d)). During the pendency of
such adjudication, the Director may
order the payment of medical benefits
prior to final adjudication under the
same conditions applicable to benefits
awarded under § 725.522.

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(c) In the development or adjudication
of a dispute over medical benefits, the
adjudication officer is authorized to take
whatever action may be necessary to
protect the health of a totally disabled
miner.
(d) Any interested medical provider
may, if appropriate, be made a party to
a dispute over medical benefits.
§ 725.710 Objective of vocational
rehabilitation.

The objective of vocational
rehabilitation is the return of a miner
who is totally disabled for work in or
around a coal mine and who is unable
to utilize those skills which were
employed in the miner’s coal mine
employment to gainful employment
commensurate with such miner’s
physical impairment. This objective
may be achieved through a program of
re-evaluation and redirection of the
miner’s abilities, or retraining in another
occupation, and selective job placement
assistance.
§ 725.711 Requests for referral to
vocational rehabilitation assistance.

Each miner who has been determined
entitled to receive benefits under part C
of title IV of the Act shall be informed
by the OWCP of the availability and
advisability of vocational rehabilitation
services. If such miner chooses to avail
himself or herself of vocational
rehabilitation, his or her request shall be
processed and referred by OWCP
vocational rehabilitation advisors
pursuant to the provisions of §§ 702.501
through 702.508 of this chapter as is
appropriate.
5. Part 726 is revised as follows:
PART 726—BLACK LUNG BENEFITS;
REQUIREMENTS FOR COAL MINE
OPERATOR’S INSURANCE
Subpart A—General
Sec.
726.1 Statutory insurance requirements for
coal mine operators.
726.2 Purpose and scope of this part.
726.3 Relationship of this part to other parts
in this subchapter.
726.4 Who must obtain insurance coverage.
726.5 Effective date of insurance coverage.
726.6 The Office of Workers’ Compensation
Programs.
726.7 Forms, submission of information.
726.8 Definitions.
Subpart B—Authorization of Self-Insurers
726.101 Who may be authorized to selfinsure.
726.102 Application for authority to
become a self-insurer; how filed;
information to be submitted.
726.103 Application for authority to selfinsure; effect of regulations contained in
this part.

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