file clerks, etc. The Investigative Staff was told by all of the claims examiners that many times it takes so long to get things typed that subsequent events have made their original letter obsolete. The Investigative Staff found that, many times, letters from claimants went unanswered because of the workload. This problem, along with the problem of the claims examiners not being able to adjudicate claims in a timely manner, caused problems in other areas within the Office of Coal Mine Workers' Compensation. For example, claimants were writing letters to their Congressmen since they were not getting adequate information from the Department. This created a backlog at the Inquiries Section. Since these letters had to be answered, time had to be taken by the claims examiners to research the claims, which further delayed claims adjudication.

The first black lung appeals to the Office of the Administrative Law Judge were in October 1974 when 12 cases were filed. The first decision was rendered in January 1975. As of December 1, 1975, a total of 389 cases had been filed and 195 decisions had been rendered, leaving a balance of 194 cases, or an average of 12 cases per hearing officer. The majority of the appeals that still remain were filed during fiscal year 1976 as follows:

An official of the Office of Administrative Law Judge advised the Investigative Staff that the older cases were delayed several months by the Turner-Elkhorn court case. (This is a Kentucky case in which a three-judge court declared a portion of the Act unconstitutional. However, on April 28, 1975, the Supreme Court granted the Secretary of Labor's motion for a stay pending a final decision on the merits of the case.) This official stated that the current workload is very manageable. He stated that their projected appeals have not materialized, and this accounts for their small backlog. Their greatest number of appeals are by the responsible mine operators.

The first appeals to the Benefits Review Board occurred in June 1975 when three were received. As of November 30, 1975,

a total of 51 cases had been filed, and 1 decision had been rendered, leaving a backlog of 50. Their backlog of longshoremen cases is 142.

V. CLAIMS PROCEDURES--DEPARTMENT OF LABOR

This section of the report describes the procedures used in processing black lung benefits claims that are submitted to the Department of Labor. The Department does not have a field staff to take claims since it was directed by the Office of Management and Budget to use the existing field staff of the Social Security Administration at the District Offices to take claims.

The Investigative Staff sampled a total of 150 black lung claims to determine the length of time it was taking to reach an initial determination as to whether or not the claimant was eligible for benefits. The claims were selected by the Department of Labor from a listing of cases it had used in a prior study. The results of the Investigative Staff's sample are shown in the following table:

The days shown in the District Offices of the Social Security Administration are from the date of the application until it is received by the Department of Labor. Current Social Security Administration instructions to the District Offices are to forward the application as soon as possible, but not later than 30 days after the date of the application.

The times shown at the Department of Labor start with the receipt of the claim until the claimant is notified that, unless additional information is provided, the claim will be

disapproved, or the claimant is notified that his claim is approved. The time that it takes to get the claimant paid is not included in the figures in the table.

The Investigative Staff did not attempt to segregate the times at the Department of Labor between delays in getting information from the claimant, medical doctor, etc., and delays within the Department.

A. District Offices--Social
Security Administration

The District Offices are responsible for completing the basic documents required to process a black lung claim-application and coal mine employment history. The District Offices also provide the claimant with a brief explanation of the requirements of the law; his rights in the adjudication process as well as the adjudication process itself; the evidence needed to support his claim; his responsibility for submitting to medical examinations requested by the Department of Labor, or the potentially responsible operator; and the Department of Labor's role in the claim process. The District Offices are to provide black lung applicants with the same degree of service which is afforded regular social security claimants.

At the time the black lung application for a living miner is taken, a preaddressed franked postcard is filled out by the interviewer and mailed to the Department of Labor. This card will alert the Department of Labor's Medical Advisory Staff that a claim has been filed and for them to initiate action to get the applicant to take the necessary medical tests. The scheduling of medical tests was initially made by the District Offices; however, in September 1974 this scheduling was taken over by the Department of Labor. The Investigative Staff was told by a Department of Labor official that the change was made because of delays in receiving the medical results. The Investigative Staff's review of approved and denied claims did not, however, support this position as instances of extensive delays were not detected.

Another problem with the current system is that the Department of Labor has to rely upon the District Office's promptness in sending in the postcard. If the postcard is not sent in, the Department of Labor has to wait until the claims file is received. The Investigative Staff's review of approved and denied claims showed that, on the average, the claims folders are held in the District Offices for 30 days. A July-August 1975 study by the Department of Labor showed, on the average, 44 percent of the postcards for claims filed during that

period were not received; therefore, scheduling of medical tests was delayed until the claims folder was received.

The six District Offices that the Investigative Staff visited appeared to be sending in their postcards and had effective internal controls to insure that the cards are being sent. The Investigative Staff found the current method of providing information back to the District Offices on their performance was not adequate since it did not identify deficiencies by District Offices. For example, on October 8, 1975, the Social Security Administration sent a memorandum to its District Offices stating that the postcards were not being sent to the Department of Labor. The memorandum, however, reported the results by State, not by District Office. The managers of the District Offices visited by the Investigative Staff all indicated that the manner in which the deficiency was reported did them no real good and the only effective way for these deficiencies to be corrected would be to identify them by District Office.

Current Social Security Administration regulations require the District Offices to retain the black lung application until all nonmedical development is complete or 30 days have elapsed since the application was taken. Before a claim is sent to the Department of Labor, a letter of transmittal is prepared and signed by a District Office official to signify that the claims file has been received and cleared for transmittal. These requirements apparently stemmed from deficiencies noted by representatives of the Department of Labor in their review of claims received during the week of November 22, 1974. The results of the review, however, were shown by State and not by District Office, which, in the Investigative Staff's opinion, reduces its effectiveness as a management tool.

All incoming mail relating to the black lung benefits program is received by the Mail and Classification Unit, is opened, and date stamped. Mail is separated into five categories and routed to various offices within the Office of Coal Mine Workers' Compensation. All claim files received from District Offices of the Social Security Administration are sent to the Coordination and Control Section.

2. Coordination and Control Section

This Section receives all claims from the Mail and