A proposed class action claims the U.S. Department of Labor has unlawfully failed to provide notice to disabled coal miners of their right to “extremely valuable” medical benefits.
The lawsuit more specifically claims it has been the Department of Labor’s practice to not provide notice of medical benefits available under a federal program to miners who have also received an award for black lung disease under a state workers’ compensation program. According to the suit, while awards under state programs may provide some medical benefits, many provide none at all and “leave a substantial unpaid portion that should be paid by the federal claim.”
“So, the Department’s practice leaves miners with substantial unpaid medical costs that should have been borne by the entity responsible for paying their federal benefits—usually a coal company,” the complaint summarizes.
Per the suit, when miners who qualify for medical benefits under the federal program are not given notice of such benefits, they often go without needed medical care for years or the costs of such care are shifted to “other parties that should not be liable for payment,” such as Medicare, union healthcare funds or the miners themselves.
The case, filed against the U.S. Department of Labor’s Office of Workers’ Compensation Programs and its current director, seeks an injunction requiring the defendants to, among other actions, issue medical cards to provide miners and their medical providers with “adequate, specific notice” about the process for obtaining medical treatment for black lung disease.
Black lung disease, the lawsuit explains, is a chronic lung disease that arises out of coal mine employment and includes coal workers’ pneumoconiosis, anthracosilicosis, anthracosis, anthrosilicosis, massive pulmonary fibrosis, silicosis or silicotuberculosis, and chronic obstructive pulmonary disease (COPD) or other pulmonary impairments. According to the suit, miners who are found to be totally disabled due to black lung disease are entitled under the federal Black Lung Benefits Act (BLBA) to lifetime disability compensation and medical benefits, including hospital services, medicine, equipment and medical supplies. The BLBA also requires the secretary of labor to supervise miners’ medical care and issue reports on such care, the suit relays.
The lawsuit goes on to explain that if a miner also receives an award under their state’s workers’ compensation statute for black lung disease, the federal benefits under the BLBA are subject to a reduction, or an “offset,” equal to the amounts of cash or benefits provided under the state program. In every case, however, the benefits provided under the federal program are greater than those provided under any state program, the suit attests. Thus, the complaint alleges, miners who receive a state workers’ compensation award are often also eligible to have the federal program “pick up the charges” not already covered.
The suit further explains that because of the progressive nature of black lung disease, miners who become totally disabled and thus eligible for federal benefits under the BLBA have often already received a state workers’ compensation award for partial impairment.
The case alleges, however, that even though these miners are entitled to know about their medical benefits under the federal program, the defendants have a policy and practice of refusing to provide medical cards to beneficiaries who have received a prior award of state workers’ compensation for black lung disease. These medical cards, according to the suit, contain valuable information such as the fact that minors covered by the program have no copay and no deductible. Moreover, the back of each card contains contact information for Department of Labor claims adjusters “who can handle any disputes about billing or the compensability of treatment,” the lawsuit alleges.
The plaintiff, a West Virginia resident, says that while the federal black lung program already determined that he is eligible to receive benefits, the entity responsible for paying his benefits requested a formal hearing on the decision, which has allegedly been pushed back for several years. In the meantime, the defendants have failed to issue a medical card to the plaintiff to provide notice to him and his medical providers about his medical benefits related to treatment of his black lung disease, the suit attests. The lawsuit claims that while the defendants are typically responsible to pay for such treatment while a minor is awaiting a final decision on their case and then seek reimbursement from the responsible operator in the event the case is decided in favor of the miner, the plaintiff’s medical providers have not received payment for such given the plaintiff was not provided with a medical card.
“[The plaintiff] has had to get by on free samples of breathing medicine because his medical providers have been unable to ascertain how to successfully remit the payments to the Defendants,” the complaint scathes. “That is because the providers lack the very type of specific notice regarding how to challenge non-payment and lack any document (such as a medical card) with reference to which they could seek reimbursement from the Defendants.”
Per the suit, the plaintiff has gone “for years” without adequate medical treatment for his black lung disease because the defendants have failed to provide an effective means by which he can secure access to the benefits he should have received.
The lawsuit looks to represent coal miners who are federal black lung beneficiaries and also received a state workers’ compensation award related to occupational pneumoconiosis.
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