20 Cfr 725.701

§ 725.701

20 CFR Ch. VI (4–1–20 Edition)

Subpart J—Medical Benefits and
Vocational Rehabilitation

rmajette on DSKBCKNHB2PROD with CFR

SOURCE: 83 FR 27695, June 14, 2018, unless
otherwise noted.

§ 725.701 What medical benefits are
available?
(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. Medical
benefits may not be provided to the
survivor or dependent of a miner under
this part.
(b) A responsible operator, or where
there is none, the fund, must furnish a
miner entitled to benefits under this
part with such medical services and
treatments
(including
professional
medical services and medical equipment, prescription drugs, outpatient
medical services, inpatient medical
services, and any other medical service, treatment 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
include palliative measures useful only
to prevent pain or discomfort associated with the miner’s pneumoconiosis
or attendant disability.
(d) An operator or the fund must also
pay the miner’s 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 operator, carrier, or OWCP on
matters connected with medical benefits.
(e)(1) If a miner receives a medical
service or treatment, as described in
this section, for any pulmonary disorder, there will be a rebuttable presumption that the disorder is caused or
aggravated by the miner’s pneumoconiosis.
(2) The party liable for the payment
of benefits may rebut the presumption
by producing credible evidence that the
medical service or treatment 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.
(3) An operator or the fund, however,
cannot rely on evidence that the miner
does not have pneumoconiosis or is not
totally disabled by pneumoconiosis
arising out of coal mine employment to
defeat a request for coverage of any
medical service or treatment under
this subpart.
(4) 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) of this subchapter.
(5) A finding that a medical service
or treatment is not covered under this
subpart will not otherwise affect the
miner’s entitlement to benefits.
§ 725.702 Who is considered a physician?
The term ‘‘physician’’ includes only
doctors of medicine (MD) and doctors
of osteopathy (DO) 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 by
OWCP.
§ 725.703 How is treatment authorized?
(a) Upon notification to a miner of
such miner’s entitlement to benefits,
OWCP must 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 OWCP. Where emergency services
are necessary and appropriate, authorization by OWCP is not required.
(b) OWCP 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 change physicians or facilities subject to the approval of OWCP.

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