that the medical evidence does not support his claim. The claimant is requested to provide, within 20 days, any medical evidence which may support his claim. If no additional evidence is provided, a final letter is sent to the claimant denying his claim. If no further word is received within 10 days from the date the claimant received the letter, the case will be administratively closed. The case can be reopened at any time during 1 year after the date of the last piece of correspondence. After the 1 year has elapsed, the claimant would have to submit a new claim.

Where medical evidence supports the claim of total disability due to pneumoconiosis, further nonmedical development is required. The eligibility of dependents and survivors has to be determined through such evidence as marriage, death, birth, and divorce certificates. In many instances the most difficult nonmedical evidence to obtain is the record of coal mine employment. The claims examiner does attempt to obtain primary evidence from information in the claimant's possession (tax returns, pay stubs, pension certificates), workmen's compensation records, employee's records, union records, and social security earnings records for employments since 1937. It takes about a month to obtain the earnings records from Social Security. If the primary evidence is not sufficient, then secondary sources would be searched, such as the employment history recorded by the miner, public documents and records, and, if all these fail to substantiate coal mine employment, they would obtain affidavits from fellow workers or persons with personal knowledge of the applicant's coal mine employment. They attempt to document 15 years of coal mine employment because the Act provides that there is "rebuttable presumption" that the miner is totally disabled due to pneumoconiosis if he worked in underground mines for 15 or more years and there is evidence of the existence of a totally disabling respiratory or pulmonary impairment even though the chest X-rays are negative.

Another aspect of nonmedical development that can be time consuming is determining if there is a responsible coal mine operator. From the evidence presented in the miner's employment history, the identity of the coal mine operator or operators with whom the miner had the most recent periods of cumulative employment of not less than 1 year is determined. However, no period of employment occurring more than 15 years prior to the miner's last date of coal mine employment shall be accumulated for the purposes of establishing the 1-year period. The situation can become complicated if the operator transferred his assets in the mine. In most instances where the claim has been approved, no responsible operator was found.

In those instances where no responsible operator was identified, a letter was sent to the claimant indicating that the claim was approved and showing the amount of backpayment (to the date of the application) and the recurring monthly payment. The payments section would be notified, and in 10 days the backpayment would be made to the claimant.

Where a responsible operator is identified, a letter is sent to him outlining his responsibilities. At the same time, a letter is sent to the claimant indicating that he has been approved and that the Department of Labor has found a responsible coal operator. The operator has 20 days to respond. If he agrees to his responsibility (only 3 percent have), arrangement is made for him to pay the claimant. If the operator does not agree with the Department of Labor's determination, he submits a letter of controversion. Upon receiving this letter, appeal procedures are initiated, and the Deputy Commissioner notifies the claimant that the Department of Labor will pay his benefits until a final decision is reached.

Another aspect of the claims adjudication process that delays the final determination is "conferences." The purposes of a conference are to (a) amicably dispose of controversies, (b) narrow the issues, and (c) simplify the subsequent methods of proof. They are presided over by a Deputy Commissioner and are to avoid, where possible, the need for formal hearings by the Office of the Administrative Law Judge. Since the inception of the program at the Department of Labor through November 1975, a total of 457 conferences have been held. The claims examiners and Deputy Commissioners that were interviewed by the Investigative Staff believed that the conferences were helpful and were well worth the time involved. They attempt to schedule several conferences together, which would justify the time and travel expenses. They stated that conferences can be beneficial in some cases, and they at least educate the claimant and his attorney; and the coal mine operator and his attorney in the Act and burdens of proof. This is beneficial because many of these attorneys will be handling subsequent cases and, as they become familiar with conference procedures and the Act, subsequent conferences are run more smoothly and in a more timely fashion. The next level of claims review is with the Office of the Administrative Law Judge.

5. Office of the Administrative Law Judge

Any party which has an interest in the claims procedures may, in writing or on the record at a conference, request a formal hearing as to any contested issue of fact or law. addition, a Deputy Commissioner may, on his own initiative,

In

refer a case for hearing when he determines a hearing necessary to protect the rights of any party in interest. If the Deputy Commissioner determines that a hearing is required or is necessary to the resolution of any issue, he shall refer the case to the Chief Administrative Law Judge who will assign it for a hearing. The Deputy Commissioner may not deny a request for a hearing if (a) the individual is a party in interest as defined in the regulations of the Department of Labor, and (b) no final disposition of the case has been achieved in prior proceedings.

The Office of Administrative Law Judge conducts Administrative Procedures Act hearings required by a variety of labor statutes. The judges are appointed from registers provided by the Civil Service Commission. The Office employs hearing officers who conduct hearings under the Black Lung Act. The Investigative Staff was told by the Deputy Chief Administrative Law Judge that the hearing officers can only hear black lung cases, while the law judges hired under the other programs can hear a case under any program. The Civil Service Commission would not allow them to hire judges for the black lung program.

The Investigative Staff was further informed that the cases are being assigned to a hearing officer within a week of their receipt from the Branch of Entitlement. The individuals involved in the hearing are given 30 days to prepare for the hearing. A hearing in a black lung case takes about 4 hours because a responsible operator is normally involved. A hearing under any one of Labor's other programs would last about 1 hour.

The hearings are officially terminated when all the evidence has been received, witnesses heard, pleadings and briefs submitted to the hearing officer, and the transcript of the proceedings printed and delivered to the hearing officer. The hearing officer is to make his decision within 20 days after the official termination of the hearing. Copies of the decisions shall be served personally or by certified mail upon the parties in interest.

6. Benefits Review Board

Any party in interest, adversely affected or aggrieved by a decision or order of the Administrative Law Judge, may, within 30 days from the filing of such decision or order, appeal such decision or order to the Benefits Review Board. The Board is composed of three members who are appointed by the Secretary of Labor.

The Board will issue a written decision as soon as

possible after completion of review proceedings. The decision will indicate that judicial review is available. An appeal of a Board decision has to be filed within 60 days of the issuance of that decision to the U.S. Court of Appeals.

VI.

CLAIMS ADJUDICATION--SOCIAL SECURITY ADMINISTRATION

The May 1972 amendments to the Federal Coal Mine Health and Safety Act of 1969 provided that the Social Security Administration had the responsibility for administering the black lung benefits program for miners' claims filed through June 30, 1973, and for survivors' claims filed through December 31, 1973. In addition, where the miner died after June 30, 1973, and before January 1, 1974, or is entitled to benefits at the time of his death, the Social Security Administration has jurisdiction over the survivor claim if it was filed within 6 months of the miner's death or the death of his widow who is entitled to black lung benefits.

There can be four levels of claims review within the Social Security Administration. The initial determination" is made by a claims examiner in the Bureau of Disability Insurance. As individuals are notified of the denial they can request that their claim be "reconsidered." The request for reconsideration has to be made in writing within 6 months from the date of mailing notice of the initial determination, unless such time is extended. The individual who performs the reconsideration is an examiner in the Bureau of Disability Insurance, but not the individual who performed the initial determination.

The next step in the appeals process is a "hearing" before an administrative law judge in the Bureau of Hearings and Appeals. The request for hearing has to be made in writing and filed within 6 months after the date of mailing of the reconsidered determination, except where the time is extended.

The decision of the administrative law judge is final and binding unless it is received by the next level, the Appeals Council of the Bureau of Hearings and Appeals. If the Appeals Council declines to hear a case or decides in favor of the Social Security Administration, the claimant can institute a civil action in the district courts.

The Investigative Staff was informed by a Social Security Administration official that there are no claims awaiting "initial determination"; however, there are about 400 claims awaiting "reconsideration." This individual could provide no estimate as to when these claims would complete the reconsideration process. The Investigative Staff believes that the Social Security Administration should make special efforts to clear these claims in an expeditious manner.