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Black Lung Program Services

Black Lung Program Services

The Stone Mountain Black Lung Program has several pieces. Below we provide brief descriptions of the services we offer. We quote from the federal guidelines and provide examples of how we meet the requirements. Because the Layperson Legal Representation program is a special service we offer, we have a separate section that goes into more detail about how we help miners and miners’ families who are trying to win their benefits cases.

 1.      Case Finding, Outreach, and Marketing

“Each program must make a substantial effort to locate and attract to the program as many people in the service area who may have Black Lung disease or other occupationally related respiratory diseases.”

 We have developed relationships with the United Mine Workers of America and other miner groups, developed good relationships with clinics and providers across the region, collaborated with local attorneys, created public service announcements, gone to local and regional health fairs, presented at conferences in Virginia and across the country, and regularly go to places where miners meet.

 2.      Screening, Diagnosis, and Treatment

a.     Screening: “All coal workers are candidates for screening for occupational lung disease. Other patients who are exposed to respiratory hazards in the workplace are also candidates for evaluation.”

 We take miners’ medical and work history and perform a physical evaluation, take x-rays or refer to other providers, perform pulmonary function testing, and perform other routine testing as needed by each miner.

b.     Advanced Testing: “Patients with abnormalities indicated on basic screening (history, physical, chest x-ray, and spirometry) should be referred for advanced testing…”

 If miners seem to have breathing problems, we can do more advanced testing and we refer to specialists for other tests.

 c.     Treatment of Occupational Lung Disease: “Each project is expected to develop treatment protocols based upon the degree of pulmonary impairment.”

 We prepare individualized treatment plans for miners based on accepted standards of care and that meet Department of Labor guidelines, often through collaboration with the miner’s regular medical provider. If miners do not have their own primary care provider, they can receive services at any of Stone Mountain’s 11 medical clinics.

 3.      Patient Education

“Education of patients with occupational lung disease is a major component of their treatment…. Each project must provide the patient and his [or her] family with information on pulmonary impairment, and specific preventive and self-care procedures…”

 We provide education to miners during individual meetings with the person and we also offer group education classes that cover a variety of topics including, but not limited to, medication, breathing exercises, relaxation techniques, smoking cessation, and relationship tips. These educational sessions include information, instruction, and demonstrations as well as opportunities to practice the skills discussed.

 4.      Pulmonary Rehabilitation

“Patients … should be strongly encouraged to participate in an outpatient pulmonary rehabilitation program.” The objectives of the program include:

  • “[A]ssist[ing] individuals with chronic lung diseases to attain their maximum potential in independence and selfcare.
  • Provid[ing] participants opportunities to learn more about lung disease, therapy, and coping strategies.
  • Control[ling] and alleviat[ing], to the extent possible symptoms of respiratory impairment.
  • Increas[ing] exercise capacity.
  • Optimiz[ing] nutritional status
  • Improv[ing] quality of life.

  

We provide miners with exercise training, as well as education and skills training in order to meet the objective listed above. Our Respiratory Therapists are experts at helping miners improve their quality of life. We also provide referrals for related services, including home health and transportation. Stone Mountain has behavioral health providers available in person or through technology at the Black Lung clinics and the primary care clinics.

5.      Benefits Counseling

“Each patient should have their health condition assessed to determine the likelihood of being eligible for State and/or Federal Benefits under a variety of programs.”

 We are well-known and respected across the country for the strength of our benefits counseling. Our counselors assist miners through the entire process, including explaining the claims process, deciding whether and when to file a claim, and completing application documents. We explain the claims process on a separate page. In addition, because we offer a unique Layperson Legal Representation program, we extend the basic Benefits Counseling process to include helping patients through the rest of the claims process, up to and including serving as their representative at hearings with the Administrative Law Judge and Benefits Review Board, if the decision is appealed. Please see the page on Layperson Legal Representation for more information about how we help miners win their claims.


Black Lung Benefits Claims Process 

The Black Lung benefits claims process can be confusing. There are many steps involved and each of them takes time, so it can be years before a miner or his widow receives benefits. There are state claims and federal claims. Stone Mountain assists miners with federal claims and refers miners and their families to attorneys for the state process. Below is a brief description of the federal claims process. Stone Mountain Benefits Counselors assist people through the process of submitting claims and then, if the miner chooses, our Layperson Legal Representatives can help with the hearing process. Miners’ widows also are eligible to file claims but the process is different for them so we suggest that widows contact our office directly.

 1.      Miner calls for appointment

2.      We mail paperwork, which the miner completes and brings in or we help to complete the paperwork

3.      When the miner comes in for the appointment, the paperwork is reviewed and insurance information is recorded – if the miner does not have insurance then our sliding scale option is explained

4.      After paperwork is done, the miner sees one of the Respiratory Therapists

a.      Vital signs are taken
b.      Medical history is reviewed
c.       Pulmonary Function Test (PFT) is completed
       i.      If the PFT indicates that the miner may have some breathing problems that may be because of their work as a miner, the miner is referred for a chest x-ray

       ii.      If the PFT does not show breathing problems, the Respiratory Therapist explains the progressive nature of Black Lung Disease and schedules the miner to come back in one year for a check-up to see if the person’s breathing is worse

       iii.      Test results are sent to the miner’s primary care provider

5.      As noted above, if the PFT shows breathing problems, the miner is referred for a chest x-ray, and the miner sends a disk of the x-ray image to us along with a check or money order so that an expert can review the x-ray to determine if the miner may have Black Lung Disease.

6.      We send the disk and check or money order to the “B-reader” who may take 4-6 weeks to review the x-ray and send us a report.

7.      If the B-reader’s report says that the miner may have Black Lung Disease, the miner is sent an application packet and is scheduled to meet with a Benefits Counselor.

8.    The Benefits Counselor reviews the paperwork and explains the process to the miner. The miner selects a physician to perform a Department of Labor examination.

9.      The miner is examined by a DOL physician and completes related testing. The physician has 120 days to complete the report.

10.  The Benefits Counselor works with the miner to complete the Schedule for Submission of Additional Evidence (SSAE).

a.      If the SSAE review determines that the miner would not be eligible for benefits, the Benefits Counselor and miner will review the reports and test results to determine whether to move forward or withdraw the claim and refile within the next year when more medical evidence is available.

b.      If the SSAE review indicates that the miner would be entitled to benefits, the miner and Benefits Counselor begin collecting more information and submitting evidence.

11.  The Department of Labor issues a Proposed Decision Order (PDO)

a.      If the PDO is a denial, the miner and Benefits Counselor will discuss options and determine if a request for modification is possible. If a modification is filed, it can be granted or denied

       i.  If the modification is denied, the miner can refile within a year

     ii.   If the modification is granted, new medical evidence must be submitted and then a hearing with the Administrative Law Judge is scheduled

b.      If the PDO is for an award, the miner and Benefits Counselor will collect evidence and schedule a hearing before an Administrative Law Judge (ALJ)

       i.      The ALJ may decide on an award, which may either be accepted or appealed by the coal company’s insurance carrier.

1.      If it is accepted, then the miner will begin receiving benefits in the future as well as back benefits from when the claim was filed.

2.      If it is appealed, the insurance company must show that an error was made.

       ii.      The ALJ may deny the claim, in which case the miner can accept the denial or appeal to the Benefits Review Board (BRB).

1.      The BRB can either “vacate” (overturn) or “affirm” (approve) the ALJ decision.

 


Layperson Legal Representation

As noted in the Program Services Section, the SMHS Black Lung Clinics offer benefits counseling and we have lay legal representation available for patients. We are recognized across the country for these services and the SMHS staff has trained the benefits counselors in Black Lung Clinics throughout the United States. Here we provide more information about the special services we offer in these areas.

One of the needs of miners with Black Lung Disease and who have total respiratory and/or pulmonary impairment is assistance with receiving the compensation they deserve for having contracted the disease and experienced disability through workplace exposure. SMHS believes that advocating for miners is a crucial part of providing holistic services. As a result, over 20 years ago SMHS developed a Lay Advocacy program to assist miners in benefits cases.

The entire Lay Advocacy Program is complex, so this is just a brief overview of the roles that Lay Advocates play with miners. A key part of the Program is that the Advocates are volunteers with no formal legal training. This is important because Administrative Law Judges (ALJs) cannot refer a claimant to an attorney when counsel does not represent a miner. As a result, many ALJs refer people who make claims to SMHS because the Lay Advocates are not lawyers. This acceptance and support by the Judges allows SMHS to help coal miners who have no representation or cannot find a lawyer.

Components of the SMHS Lay Advocacy Program:

  • Have a strong working knowledge of Federal Regulations pertaining to the Federal Black Lung Benefits Act;
    Have knowledge about the legal process;
  • Develop and submit medical evidence;
  • Prepare the miner for the upcoming hearing;
  • Review opposing side's medical evidence and prepare responses;
  • Represent client in Federal Court, without charging a fee;
  • Write briefs as well as opening and closing arguments;
  • Attend depositions, complete interviews;
  • Participate in prehearing phone conferences with the ALJ on issues.

 

The SMHS Lay Advocacy component has proven to be one of the leading sources in the nation for securing Federal Black Lung Benefits for coal miners and their widows. From July 1, 2016, to June 30, 2017, SMHS lay advocates were involved in a total of 317 awards from the Department of Labor District Director’s Offices and the Office of Administrative Law Judges from around the country. This generated $4,345,897.39 in backpay benefits monies to the miners and their families, in addition to $226,388.19 in monthly benefits. This does not include medical benefits. Over the course of four years (7/1/13 – 6/30/17), SMHS assisted with 1058 Federal Black Lung Claims that received favorable decisions for monetary awards. The total amount of backpay benefits monies to the miners and their families was $10,968,928.32. Even though we are allowed to collect a percentage of the money awarded to the miners, we do not do so.

The success of the SHS Lay Advocacy program has led to requests for training at other Black Lung clinics and for other concerned individuals. SMHS Black Lung Clinic staff members have developed a training program that has been presented across the country. Attendees at training sessions have included Black Lung Clinic peers, attorneys, medical professionals, Department of Labor Staff, and Administrative Law Judges from across the country.