Part 41- FCMHS Act of 1969, Title IV BL Benefits

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CFR Title Page

PART 410—FEDERAL COAL MINE HEALTH
AND SAFETY ACT OF 1969, TITLE IV—
BLACK LUNG BENEFITS (1969- )
Table of Contents
Subpart A—Introduction, General Provisions, and Definitions
Sec.
410.101
410.110
410.120
410.130

Introduction.
General definitions and use of terms.
Disclosure of program information.
Periods of limitation ending on nonworkdays.

Subpart B—Requirements for Entitlement; Duration of Entitlement;
Filing of Claims and Evidence
410.200
410.201
410.202
410.210
410.211
410.212
410.213
410.214
410.215
410.216
410.219
410.220
410.221

Types of benefits; general.
Conditions of entitlement; miner.
Duration of entitlement; miner.
Conditions of entitlement; widow or surviving divorced wife.
Duration of entitlement; widow or surviving divorced wife.
Conditions of entitlement; child.
Duration of entitlement; child.
Conditions of entitlement; parent, brother, or sister.
Duration of entitlement; parent, brother, or sister.
"Good cause" for delayed filing of proof of support.
Filing a claim under State workmen's compensation law; when filing
such claim shall be considered futile.
Claim for benefits; definitions.
Prescribed application and request forms.

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410.222
410.223
410.224
410.226
410.227
410.228
410.229
410.230
410.231
410.232
410.233
410.234
410.240
410.250

Execution of a claim.
Evidence of authority to execute a claim on behalf of another.
Claimant must be alive when claim is filed.
Periods for which claims are effective.
When a claim is considered to have been filed; time and place of
filing.
Requests and notices to be in writing.
When written statement is considered a claim; general.
Written statement filed by or for a miner on behalf of a member of
his family.
Time limits for filing claims.
Withdrawal of a claim.
Cancellation of a request for withdrawal.
Interim provisions.
Evidence.
Effect of conviction of felonious and intentional homicide on
entitlement to benefits.

Subpart C—Relationship and Dependency
410.300
410.310
410.311
410.320
410.321
410.330
410.340
410.350
410.351
410.360
410.361
410.370
410.380
410.390
410.391

Relationship and dependency; general.
Determination of relationship; wife.
Determination of relationship; divorced wife.
Determination of relationship; widow.
Determination of relationship; surviving divorced wife.
Determination of relationship; child.
Determination of relationship; parent, brother, or sister.
Determination of dependency; wife.
Determination of dependency; divorced wife.
Determination of dependency; widow.
Determination of dependency; surviving divorced wife.
Determination of dependency; child.
Determination of dependency; parent, brother, or sister.
Time of determinations.
Legal impediment.

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410.392
410.393
410.394
410.395

Domicile.
"Member of the same household"; "living with"; "living in the same
household"; and "living in the miner's household".
[Reserved]
Contributions and support.

Subpart D—Total Disability or Death Due to Pneumoconiosis
410.401
410.410
410.412
410.414
410.416
410.418
410.422
410.424
410.426
410.428
410.430
410.432
410.450
410.454
410.456
410.458
410.462
410.470
410.471
410.472
410.473

Scope of subpart D.
Total disability due to pneumoconiosis, including statutory
presumption.
"Total disability" defined.
Determining the existence of pneumoconiosis, including statutory
presumption.
Determining origin of pneumoconiosis, including statutory
presumption.
Irrebuttable presumption of total disability due to pneumoconiosis.
Determining total disability: General criteria.
Determining total disability: Medical criteria only.
Determining total disability: Age, education, and work experience
criteria.
X-ray, biopsy, and autopsy evidence of pneumoconiosis.
Ventilatory studies.
Cessation of disability.
Death due to pneumoconiosis, including statutory presumption.
Determining the existence of pneumoconiosis, including statutory
presumption—survivor's claim.
Determining origin of pneumoconiosis, including statutory
presumption—survivor's claim.
Irrebuttable presumption of death due to pneumoconiosis—survivor's
claim.
Presumption relating to respirable disease.
Determination by nongovernmental organization or other
governmental agency.
Conclusion by physician regarding miner's disability or death.
Consultative examinations.
Evidence of continuation of disability.

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410.474
410.475
410.476

Place and manner of submitting evidence.
Failure to submit evidence.
Responsibility to give notice of event which may affect a change in
disability status.
410.490
Interim adjudicatory rules for certain part B claims filed by a miner
before July 1, 1973, or by a survivor where the miner died before
January 1, 1974.
Appendix to Subpart D

Subpart E—Payment of Benefits
410.501
410.505
410.510
410.511
410.515
410.520
410.530
410.535
410.536
410.540
410.550
410.560
410.561
410.561a
410.561b
410.561c
410.561d
410.561e
410.561f
410.561g
410.561h
410.563
410.565
410.570

Payment periods.
Payees.
Computation of benefits.
Certification to dependent of augmentation portion of benefit.
Modification of benefit amounts; general.
Reductions; receipt of State benefit.
Reductions; excess earnings.
Reductions; effect of an additional claim for benefits.
Reductions; effect of augmentation of benefits based on subsequent
qualification of individual.
Reductions; more than one reduction event.
Nonpayment of benefits to residents of certain States.
Overpayments.
Notice of right to waiver consideration.
When waiver may be applied and how to process the request.
Fault.
Defeat the purpose of title IV.
Against equity and good conscience; defined.
When an individual is "without fault" in a reduction-overpayment.
When an individual is "without fault" in an entitlement overpayment.
When an individual is at "fault" in a reduction-overpayment.
When adjustment or recovery of an overpayment will be waived.
Liability of a certifying officer.
Collection and compromise of claims for overpayment.
Underpayments.

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410.580
410.581
410.582
410.583
410.584
410.585
410.586
410.587
410.588
410.589
410.590
410.591

Relation to provisions for reductions or increases.
Payments on behalf of an individual.
Submission of evidence by representative payee.
Responsibility of representative payee.
Use of benefits for current maintenance.
Conservation and investment of payments.
Use of benefits for beneficiary in institution.
Support of legally dependent spouse, child, or parent.
Claims of creditors.
Accountability.
Transfer of accumulated benefit payments.
Eligibility for services and supplies under part C of title IV of the act.

Subpart F—Determinations of Disability, Other Determinations,
Administrative Review, Finality of Decisions, and Representation of
Parties
410.601
410.610
410.615
410.620
410.621
410.622
410.623
410.624
410.625
410.626
410.627
410.628
410.629
410.629a
410.629b
410.629c
410.629d
410.629e

Determinations of disability.
Administrative actions that are initial determinations.
Administrative actions that are not initial determinations.
Notice of initial determination.
Effect of initial determination.
Reconsideration and hearing.
Reconsideration; right to reconsideration.
Time and place of filing request.
Parties to the reconsideration.
Notice of reconsideration.
Reconsidered determination.
Notice of reconsidered determination.
Effect of a reconsidered determination.
Expedited appeals process; conditions for use of such process.
Expedited appeals process; place and time of filing request.
Expedited appeals process; parties.
Expedited appeals process; agreement requirements.
Expedited appeals process; effect of agreement.

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410.629f
410.630
410.631
410.632
410.633
410.634
410.635
410.636
410.637
410.638
410.639
410.640
410.641
410.642
410.643
410.644
410.645
410.646
410.647
410.648
410.649
410.650
410.651
410.652
410.653
410.654
410.655
410.656
410.657

410.658

Effect of a request that does not result in agreement.
Hearing; right to hearing.
Time and place of filing request.
Parties to a hearing.
Additional parties to the hearing.
Administrative Law Judge.
Disqualification of Administrative Law Judge.
Time and place of hearing.
Hearing on new issues.
Change of time and place for hearing.
Subpenas.
Conduct of hearing.
Evidence.
Witnesses.
Oral argument and written allegations.
Record of hearing.
Joint hearings.
Consolidated issues.
Waiver of right to appear and present evidence.
Dismissal of request for hearing; by application of party.
Dismissal by abandonment of party.
Dismissal for cause.
Notice of dismissal and right to request review thereon.
Effect of dismissal.
Vacation of dismissal of request for hearing.
Administrative Law Judge's decision or certification to Appeals
Council.
Effect of Administrative Law Judge's decision.
Removal of hearing to Appeals Council.
Appeals Council proceedings on certification and review; procedure
before Appeals Council on certification by the Administrative Law
Judge.
Evidence in proceeding before Appeals Council.

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410.659
410.660
410.661
410.662
410.663
410.664
410.665
410.666
410.667
410.668
410.669
410.670
410.670a
410.670b
410.670c
410.671
410.672

410.673
410.674
410.675
410.675a
410.676
410.677
410.678
410.679
410.680
410.681

Decision of Appeals Council.
Right to request review of Administrative Law Judge's decision or
dismissal.
Time and place of filing request.
Action by Appeals Council on review.
Procedure before Appeals Council on review.
Evidence admissible on review.
Decision by Appeals Council or remanding of case.
Effect of Appeals Council's decision or refusal to review.
Dismissal by Appeals Council.
Extension of time to request reconsideration.
Extension of time to request hearing or review or begin civil action.
Review by Appeals Council.
Judicial review.
Interim provision for the adjudication of certain claims filed prior to
May 19, 1972.
Application of circuit court law.
Revision for error or other reason; time limitation generally.
Reopening initial, revised or reconsidered determinations of the
Administration and decisions of an Administrative Law Judge or the
Appeals Council; finality of determinations and decisions.
Good cause for reopening a determination or decision.
Finality of suspension of benefit payments for entire taxable year
because of earnings.
Time limitation for revising finding suspending benefit payments for
entire taxable year because of earnings.
Late completion of timely investigation.
Notice of revision.
Effect of revised determination.
Time and place of requesting hearing on revised determination.
Finality of findings with respect to other claims for benefits based on
the disability or death of a miner.
Imposition of reductions.
Change of ruling or legal precedent.

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410.682
410.683
410.683a
410.683b
410.684
410.685
410.686
410.686a
410.686b
410.686c
410.686d
410.686e
410.687
410.687a
410.688
410.689
410.690
410.691
410.692
410.693
410.694
410.695
410.696
410.697
410.698
410.699
410.699a

General applicability.
Certification of payment; determination or decision providing for
payment.
[Reserved]
Transfer or assignment.
Representation of party; appointment of representative.
Qualifications of representative.
Authority of representative.
Proceedings before a State or Federal court.
Fee for services performed for an individual before the Social
Security Administration.
Petition for approval of fee.
Payment of fees.
Services rendered for an individual in a proceeding before the
Administration under part B of title IV of the Act.
Rules governing the representation and advising of claimants and
parties.
Effective date.
Disqualification or suspension of an individual from acting as a
representative in proceedings before SSA.
Notice of charges.
Withdrawal of charges.
Referral to the Deputy Commissioner for Programs and Policy, or his
or her designee, for hearing and decision.
Hearing on charges.
Decision by hearing officer.
Right to request review of the hearing officer's decision.
Procedure before Appeals Council on review of hearing officer's
decision.
Evidence admissible on review.
Decision by Appeals Council on review of hearing officer's decision.
Dismissal by Appeals Council.
Reinstatement after suspension or disqualification.
Penalties for fraud.

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Subpart G—Rules for the Review of Denied and Pending Claims
Under the Black Lung Benefits Reform Act (BLBRA) of 1977
410.700
410.701
410.702
410.703
410.704
410.705
410.706
410.707

Background.
Jurisdiction for determining entitlement under part B.
Definitions and terms.
Adjudicatory rules for determining entitlement to benefits.
Review procedures.
Duplicate claims.
Effect of Social Security Administration determination of
entitlement.
Hearings and appeals.

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