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 J—Medical Benefits and Vocational Rehabilitation

20 C.F.R. § 725.701

What medical benefits are available?

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(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.

Notes of Decisions
Cited in 11 cases, 1988–2006 · leading case: Barbara Combs v. Commissioner of Social Security
Sort: Relevance Newest Treatment
Barbara Combs v. Commissioner of Social Security (2006) ca6 · cites it 2× “A specific example of a seemingly procedural change that the court struck down as impermissibly retroactive was 20 C.F.R. § 725.701 . The regulation created a rebuttable presumption that when a miner who is eligible for black lung benefits receives medical treatment for a…”
Glen Coal Co. v. Seals (1998) ca6 · cites it 9× “20 C.F.R. § 725.701 (b) requires that “[a] responsible operator .”
Glen Coal Co. v. Director, Office of Workers' Compensation Programs (2003) ca6 · cites it 5× “§ 907 (a); 20 C.F.R. § 725.701 (b). The ALJ’s decision applied a presumption articulated by the Fourth Circuit 3 that “[s]ince most pulmonary disorders are going to be related to or at least aggravated by the presence of pneumoconiosis, when a miner receives treat *882 ment for…”
National Mining Ass'n v. Department of Labor (2002) cadc · cites it 2× “20 C.F.R. § 725.701 : The rule embodied in § 725.”
Joseph P. Connors, Sr. v. Amax Coal Co., Inc. (1988) ca7 “See 20 C.F.R. § 725.701 (a)-(c) (1988). The trustees brought suit in federal district court as subrogees to the miners’ rights against Amax, alleging that the company had been unjustly enriched by the Plan’s payment of the black lung related expenses of the company’s former…”
National Mining Ass'n v. Chao (2001) dcd “701 is substantively the same as it was previously in 20 C.F.R. § 725.701 (b) (2000). The new rule simply provides that when a miner establishes total disability, due to pneumo-coniosis, and receives medical services for a pulmonary disorder, there is a rebuttable presumption…”
Reich v. Youghiogheny and Ohio Coal Co. (1994) ohsd · cites it 2× “§ 932 (a); 20 C.F.R. §§ 725.701 and 725.701A. The term “benefits” is defined in 20 C.”
Four L Coal Co. v. Director, Office of Workers' Compensation Programs (2005) ca4 “The medical benefits encompass “such medical, surgical, and other attendance and treatment, nursing and hospital services, medicine and apparatus, and any other medical service or supply, for such periods as the nature of the miner’s pneumoconiosis and disability requires.”
Gulf & Western Industries v. Ling (1999) ca4 “§ 907 (a)); 20 C.F.R. § 725.701 (a) (1998). These benefits are to be furnished by the responsible operator, see note 2, supra, and encompass "such medical, surgical, and other attendance and treatment, nursing and hospital services, medicine and apparatus, and any other medical…”
Doris Coal Co. v. Director, Office of Workers' Compensation Programs (1991) ca4 “See 20 C.F.R. § 725.701 (b). To qualify for these benefits, a claimant must prove (1) that the mine operator should be held generally responsible for the miner’s pneumoconiosis and (2) that the particular expense incurred was necessary to treat the miner’s pneumoconi-osis.”
Combs v. Comm Social Security (2006) ca6 · cites it 2× “A specific example of a seemingly procedural change that the court struck down as impermissibly retroactive was 20 C.F.R. § 725.701 . The regulation created a rebuttable presumption that when a miner who is eligible for black lung benefits receives medical treatment for a…”
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