C.F.R. » Title 20 » CHAPTER VI—OFFICE OF WORKERS' COMPENSATION PROGRAMS, DEPARTMENT OF LABOR › SUBCHAPTER B—FEDERAL COAL MINE HEALTH AND SAFETY ACT OF 1969, AS AMENDED › PART 725—CLAIMS FOR BENEFITS UNDER PART C OF TITLE IV OF THE FEDERAL MINE SAFETY AND HEALTH ACT, AS AMENDED › Subpart C—Filing of Claims

20 C.F.R. § 725.309

Additional claims; effect of prior denial of benefits

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(a) If a claimant files a claim under this part while another claim filed by the claimant under this part is still pending, the later claim must be merged with the earlier claim for all purposes. For purposes of this section, a claim must be considered pending if it has not yet been finally denied.

(b) If a claimant files a claim under this part within one year after the effective date of a final order denying a claim previously filed by the claimant under this part (see § 725.502(a)(2)), the later claim must be considered a request for modification of the prior denial and will be processed and adjudicated under § 725.310.

(c) If a claimant files a claim under this part more than one year after the effective date of a final order denying a claim previously filed by the claimant under this part (see § 725.502(a)(2)), the later claim must be considered a subsequent claim for benefits. A subsequent claim will be processed and adjudicated in accordance with the provisions of subparts E and F of this part. Except as provided in paragraph (1) below, a subsequent claim must be denied unless the claimant demonstrates that one of the applicable conditions of entitlement (see §§ 725.202(d) (miner), 725.212 (spouse), 725.218 (child), and 725.222 (parent, brother, or sister)) has changed since the date upon which the order denying the prior claim became final. The applicability of this paragraph may be waived by the operator or fund, as appropriate. The following additional rules apply to the adjudication of a subsequent claim:

(1) The requirement to establish a change in an applicable condition of entitlement does not apply to a survivor's claim if the requirements of §§ 725.212(a)(3)(ii), 725.218(a)(2), or 725.222(a)(5)(ii) are met, and the survivor's prior claim was filed—

(i) On or before January 1, 2005, or

(ii) After January 1, 2005 and was finally denied prior to March 23, 2010.

(2) Any evidence submitted in connection with any prior claim must be made a part of the record in the subsequent claim, provided that it was not excluded in the adjudication of the prior claim.

(3) For purposes of this section, the applicable conditions of entitlement are limited to those conditions upon which the prior denial was based. For example, if the claim was denied solely on the basis that the individual was not a miner, the subsequent claim must be denied unless the individual worked as a miner following the prior denial. Similarly, if the claim was denied because the miner did not meet one or more of the eligibility criteria contained in part 718 of this subchapter, the subsequent claim must be denied unless the miner meets at least one of the criteria that he or she did not meet previously.

(4) If the applicable condition(s) of entitlement relate to the miner's physical condition, the subsequent claim may be approved only if new evidence submitted in connection with the subsequent claim establishes at least one applicable condition of entitlement. A subsequent claim filed by a surviving spouse, child, parent, brother, or sister must be denied unless the applicable conditions of entitlement in such claim include at least one condition unrelated to the miner's physical condition at the time of his death.

(5) If the claimant demonstrates a change in one of the applicable conditions of entitlement, no findings made in connection with the prior claim, except those based on a party's failure to contest an issue (see § 725.463), will be binding on any party in the adjudication of the subsequent claim. However, any stipulation made by any party in connection with the prior claim will be binding on that party in the adjudication of the subsequent claim.

(6) In any case in which a subsequent claim is awarded, no benefits may be paid for any period prior to the date upon which the order denying the prior claim became final.

(d) In any case involving more than one claim filed by the same claimant, under no circumstances are duplicate benefits payable for concurrent periods of eligibility. Any duplicate benefits paid will be subject to collection or offset under subpart H of this part.

[78 FR 59118, Sept. 25, 2013]
Notes of Decisions
Cited in 133 cases (9 in the last 5 years), 1988–2026 · leading case: Cumberland River Coal Co. v. Billie Banks, 690 F.3d 477 (6th Cir. 2012).
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Cumberland River Coal Co. v. Billie Banks, 690 F.3d 477 (6th Cir. 2012). · cites it 16× “Cumberland River Coal Company appeals this determination, arguing that Banks failed to establish a change in his condition under 20 C.F.R. § 725.309 (d). Additionally, it argues that Banks failed to establish that he suffers from pneumoconiosis or that he is disabled due to this…”
Union Carbide Corp. v. Virginia Richards, 721 F.3d 307 (4th Cir. 2013). · cites it 8× “” 2 20 C.F.R. § 725.309 (d). The regulations provide: *311 A subsequent claim shall be processed and adjudicated in accordance with the provisions [that govern original claims], except that the claim shall be denied unless the claimant demonstrates that one of the applicable…”
U.S. Steel Mining Co. v. Dir., OWCP, 386 F.3d 977 (11th Cir. 2004). · cites it 8× “20 C.F.R. § 725.309 (d). Indeed, duplicate claims are feasible under the BLBA precisely because pneumoconiosis is a latent and progressive disease, from which a miner’s condition may deteriorate over time.”
Buck Creek Coal Co. v. Gay Sexton, 706 F.3d 756 (6th Cir. 2013). · cites it 11× “Buck Creek Coal Company appeals this determination, arguing that its application of 20 C.F.R. § 725.309 is invalid and that it violates due process because it contravenes the principles of finality and res judicata by permitting the re-adjudication of the cause of black lung…”
Arkansas Coals, Inc. v. Albert Lawson, 739 F.3d 309 (6th Cir. 2014). · cites it 8× “As the claimant was entitled to bring a second claim under 20 C.F.R. § 725.309 (d)(4) 1 and as the determination that Arkansas Coals was the responsible operator was not “necessary” to the resolution of the initial claim, we reject the finality and collateral estoppel arguments.”
Marmon Coal Co. v. Dir., Off. of Workers' Comp. Programs, 726 F.3d 387 (3rd Cir. 2013). · cites it 3× “20 C.F.R. § 725.309 (d). A “subsequent” claim is a claim filed “more than one year after the effective date of a final order denying a claim previously filed by the claimant.”
Energy West Mining Co. v. Oliver, 555 F.3d 1211 (10th Cir. 2009). · cites it 5× “” 20 C.F.R. § 725.309 (d) (citations omitted).”
Westmoreland Coal Co. v. Cox, 602 F.3d 276 (4th Cir. 2010). · cites it 5× “” 20 C.F.R. § 725.309 (d). The Act provides a statutory presumption of total disability resulting from pneumoconiosis where the coal miner suffers from: a chronic dust disease of the lung which (A) when diagnosed by chest [x-ray], yields one or more large opacities (greater than…”
Nat'l Mining Ass'n v. Dep't of Labor, 292 F.3d 849 (D.C. Cir. 2002). · cites it 6× “See 20 C.F.R. § 725.309 (d). As we explain in more detail below, a claimant bringing such a claim still bears the burden of demonstrating that he meets all of the relevant conditions.”
E. Associated Coal Corp. v. Dir., Off. of Workers' Comp. Programs, 805 F.3d 502 (4th Cir. 2015). · cites it 6× “” See 20 C.F.R. § 725.309 (c). The regulations limit the “applicable conditions of entitlement” to “those conditions upon which the-prior denial was based.”
B & G Constr. Co. v. Dir., Off. of Workers' Comp. Programs, 662 F.3d 233 (3rd Cir. 2011). · cites it 2× “Section 1556 applies immediately to all pending claims, including claims that were finally awarded or denied prior to the date of enactment of the Patient Protection and Affordable Care Act, for which the claimant seeks to modify a denial, or for which other actions are taken in…”
Coleman v. Dir., OWCP, 345 F.3d 861 (11th Cir. 2003). · cites it 7× “” 20 C.F.R. § 725.309 (d) (1999). Section 725.”
Show all 133 citing cases →
— 20 C.F.R. § 725.309(c) — 4 cases
Marmon Coal Co. v. Dir., Off. of Workers' Comp. Programs, 726 F.3d 387 (3rd Cir. 2013). “20 C.F.R. § 725.309 (d). A “subsequent” claim is a claim filed “more than one year after the effective date of a final order denying a claim previously filed by the claimant.”
B & G Constr. Co. v. Dir., Off. of Workers' Comp. Programs, 662 F.3d 233 (3rd Cir. 2011). “Section 1556 applies immediately to all pending claims, including claims that were finally awarded or denied prior to the date of enactment of the Patient Protection and Affordable Care Act, for which the claimant seeks to modify a denial, or for which other actions are taken in…”
Peabody Coal Co. v. Spese, 94 F.3d 369 (7th Cir. 1996).
Peabody Coal Co. v. Spese, 94 F.3d 369 (7th Cir. 1996).
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