20 CFR 410.501

SSR 71-30

Where the Federal Coal Mine Health and Safety Act of 1969 requires that a claim be filed but fails to prescribe a specific period for the payment of continuing benefits to miners and widows, or for the limitation on payment at the time a terminating event occurs, held, payment of black lung benefits on a monthly basis, upon the filing of a valid claim at any time within the month, is inferentially supported by sections 412(a), 412(b), and 422(d) of such Act and by section 223 of the Social Security Act, such claim entitling the individual to a full month's payment, regardless of filing date within the month. Further held, no payment is required for any month or part thereof in which a terminating event occurs.

The Federal Coal Mine Health and Safety Act of 1969 (Public Law 91-173) provides cash benefits for coal miners who are totally disabled due to pneumoconiosis (black lung disease), and for widows of coal miners who were receiving cash benefits under this Act or who died from the disease. The black lung benefit provisions in title IV, Part B of such Act have been held to constitute "periodic benefits" under a Federal workmen's compensation law within the meaning of section 224 (such as to require a reduction of the worker's disability insurance benefits of the Social Security Act. Social Security Ruling 70-39, C.B. 1970, p. 90.

Federal workmen's compensation statutes (after which Part B of P.L. 91-173 is modeled in some respects), are administered in such a way that the initial payments are computed on a weekly, daily, or even an hourly basis. However, there is nothing in the Federal Coal Mine Health and Safety Act or in its legislative history to indicate that such a construction is either necessary or intended for black lung benefit purposes.

Advice has been requested as to the periodic payment scheme for black lung payments and the rationale in support of such payment schedule, whether daily, weekly, or monthly.

Section 413(b) of the Federal Coal Mine Health and Safety Act of 2969 provides, in pertinent part, that:

In carrying out the provisions of this part, the Secretary shall to the maximum extent feasible (and consistent with the provisions of this part utilize the ... procedures he uses in determining entitlement to disability insurance benefit payments under section 223 of the Social Security Act.

Section 223 of the Social Security Act provides that qualified claimants "shall be entitled to a disability insurance benefit for each month beginning with the first month" in which all requirements are met. Therefore, section 413(b), supra, may be said at least inferentially to suggest monthly payments. However, to "utilize the ... procedures" used in "determining entitlement" under section 223 is one thing; to incorporate the entitlement factors and payment procedures contemplated by section 223 is quite another. Thus, an accurate construction of section 413(b) cannot be derived from the simple reading of its text, nor can the section be said to incorporate other sections of the Social Security Act merely because they deal with various kinds of "procedures." The procedures contemplated therein are those for "determining entitlement" to disability insurance benefits alone and do not provide a substantial legal foundation for monthly payments.

Nevertheless, the reference in section 413(b) to the "procedures" of section 223 of the Act is some evidence that the Congress contemplated (at least with respect to such factors as the right to, and duration of, benefit payments) a general scheme of administration like that of the Social Security Act. No provision of P.L. 91-173 specifically directs or requires payment on other than a monthly basis.

The following legal authority reasonably contemplates payment on a monthly basis. Section 412(a) of the Act states that:

Subject to the provisions of subsection (b) of this section, benefit payments shall be made by the Secretary under this part as follows:
(1) * * * the disabled miner shall be paid * * * at a rate equal to 50 per centum of the minimum monthly payment * * *. (Emphasis supplied.)

Similarly, section 412(b) provides that:

* * * benefit payments * * * shall be reduced, on a monthly or other appropriate basis * * * (Emphasis supplied.)

In addition, section 422(d), a provision concerning the payment of benefits under Part C of title IV of the Act (which is to be administered by the Department of Labor after 1972), provides that:

Benefits payable under this section shall be paid on a monthly basis and * * * such payments shall be equal to the amounts specified in section 412(a) of this title. (Emphasis supplied.)

Since section 412(a) authorizes payment of Part B benefits, section 422(d) raises an additional, and very strong, inference that coal miner's benefits were intended to be paid monthly.

Finally sections 426(a) and 508 both confer upon the Secretary of Health, Education, and Welfare broad power to promulgate regulations to implement the provisions of the Act and in the absence of express statutory provisions, this authority undoubtedly extends to prescribing payment periods.

Distinct, but related, issues concern payments in the first and last months of entitlement, i.e., months in which the factors of entitlement are met for only part of the month. Important administrative and policy considerations, in addition to the statutory foundations indicated above, favor paying a full month's benefit for the first month in which all factors of entitlement are met and no benefit for the month in which a pertinent factor of entitlement (e.g., disability of a miner, unremarried status of a widow) ceases to exist. This is so, especially with respect to nonpayment for the month in which a requirement for entitlement ceases to exist.

The concept of entitlement to payment beginning with the entire month of filing and ending with the month prior to the month in which the termination event occurs not only is actuarially sound and presents an equitable treatment of claimants' interest, but administratively is preferable to pro-rated initial payment, pro-rated months of adjustments in benefits, and pro-rated termination of payment.

This approach parallels that provided for payments under title II of the Social Security Act and utilizes the advantage of existing payment mechanisms and procedural economies which were anticipated by Congress in assigning the administration of the black lung benefit program to the Social Security Administration. Inferential support is also evident from section 413(b) in the reference of that section to the "procedures" of section 223 of the Social Security Act. For instance, section 223(a)(1)(D) of the Act provides that entitlement to disability insurance benefits shall end" . . . with the month preceding the month in which [the beneficiary] dies. . . ."

A further consideration in the payment of monthly benefits is the guidance derived from the absence in P.L. 91-173 of any provision with respect to the disposition of underpayments. If benefits were payable for all or part of the month in which the miner's or widow's death occurred, there would, in nearly all cases, be an underpayment for that month. With the absence of a provision (like that provided in section 204(d) of the Social Security Act) which would facilitate payment of such underpayments, the Administration could not receive "good acquittance" for an underpayment of benefits except by payment to the legal representative of the deceased beneficiary's estate.

Accordingly, the absence of any "facility of payment" provision with respect to underpayments, the absence of any clear direction in the statute to pay for the month of death, and the analogy drawn by the statute itself to section 223 of the Social Security Act, could, when taken together, be considered a statutory direction with respect to the issue of "nonentitlement" for the month of death. However, the most abrasive effects of such a policy are reduced by the payment of a full month's benefit for the first month of entitlement. Additionally, while a miner would receive no benefit for the month of death (any such benefit could be payable only to a legal representative), his widow could receive a full month's benefit for that month in her own right.

In addition to the foregoing considerations, the effective date of an application for the pertinent benefits must be established. Guidance for this requirement (section 414(c) of P.L. 91-173) appears somewhat ambiguous, in stating:

(c) No benefits under this part shall be payable for any period prior to the date a claim therefor is filed.

If the antecedent to "a claim therefor" is the word "benefits," i.e., a claim for benefits, no benefits could be paid prior to the date of filing. If, however, the antecedent of the words "a claim therefor" is the word "period," i.e., a claim for a period of entitlement, then, within the context of a program providing for monthly payments, with an application requirement but with no provision for retroactivity, a "claim" becomes a claim for a period of entitlement. Since the word "period" is not expressly defined by statute, its definition as a calendar month is not precluded. Thus, a claim filed by a qualified individual at any time within a monthly period would entitle that individual to the benefits for the full period, i.e., the entire calendar month.

As indicated above, the Federal Coal Mine Health and Safety Act of 1969 contains many indications that the Congress intended a monthly payment procedure. The Secretary of Health, Education, and Welfare has broad powers to administer the Act in a manner to make that administration as efficient as possible. This negates any inference that administratively onerous limitations should be implied where none are clearly expressed in the statute. Further, since the Act is remedial in nature, it should be given a liberal construction in order to effectuate its purpose.

Accordingly, it is held that black lung benefit payments may be made on a monthly basis upon the filing of a claim for payment by a qualified individual at any time within a payment period, such claim entitling the individual to a full month's payment, regardless of the date within the month on which the claim is filed; but no payment is required for any month or part thereof in which a terminating event occurs.

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