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. § 725.707

At what rate will fees for medical services and treatments be paid?

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(a) All fees charged by providers for any medical service, treatment, drug or equipment authorized under this subpart will be paid at no more than the rate prevailing for the service, treatment, drug or equipment in the community in which the provider is located.

(b) When medical benefits are paid by the fund at OWCP's direction, either on an interim basis or because there is no liable operator, the prevailing community rate for various types of service will be determined as provided in §§ 725.708-725.711.

(c) The provisions of §§ 725.708-725.711 do not apply to charges for medical services or treatments furnished by medical facilities of the U.S. Public Health Service or the Departments of the Army, Navy, Air Force and Veterans Affairs.

(d) If the provisions of §§ 725.708-725.711 cannot be used to determine the prevailing community rate for a particular service or treatment or for a particular provider, OWCP may determine the prevailing community rate by reliance on other federal or state payment formulas or on other evidence, as appropriate.

(e) OWCP must review the payment formulas described in §§ 725.708-725.711 at least once a year, and may adjust, revise or replace any payment formula or its components when necessary or appropriate to ensure miners' access to care or for other reasons.

(f) Except as otherwise provided in this subpart, the provisions of §§ 725.707-725.711 apply to all medical services and treatments rendered after August 31, 2018.

Notes of Decisions
Cited in 5 cases, 1987–1998 · leading case: Robert B. Reich, Secretary, United States Department of Labor v. The Youghiogheny and Ohio Coal Company
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Robert B. Reich, Secretary, United States Department of Labor v. The Youghiogheny and Ohio Coal Company (1995) ca6 · cites it 5× “20 C.F.R. § 725.707 (a) and (b). “During the pendency of such adjudication, the [DOL] may order the payment of medical *115 benefits prior to final adjudication under the same conditions applicable to benefits awarded under § 725.”
Joseph P. Connors, Sr. v. Amax Coal Co., Inc. (1988) ca7 “" 20 C.F.R. § 725.707 (b), (c) (1988). 4 . The trustees also allude (in their appellate briefs, though not in their complaint) to the specific grant of subject matter jurisdiction contained in section 502(a)(3) of ERISA, 29 U.”
Glen Coal Co. v. Seals (1998) ca6 “The procedure for disputes concerning medical benefits is found in 20 C.F.R. § 725.707 . This section, unlike the section concerning the initial determination of liability, does not set out any statutory presumptions.”
Connors v. Amax Coal Co. (1987) insd “See also 20 C.F.R. § 725.707 . The jurisdiction of federal district courts with respect to black lung compensation awards is limited by statute as follows: If any employer or his officers or agents fails to comply with a compensation order making an award, that has become final,…”
Reich v. Consol Energy Inc. (1995) pawd “” 4 Also see 20 C.F.R. § 725.707 of the Secretary’s implementing regulations which provides the administrative procedure for resulting disputes over particular medical bills.”
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