Page images

bility for providing the medical examinations, it would be unreasonable to require those who already had industrial physicians and X-ray facilities to duplicate their resources by having to contract with independent clinics or hospitals. Accordingly, the medical examination specifications now require that the plan submitted by the operators include a statement of the steps that have been taken to assure confidentiality of medical records and roentgenographic findings.

The Public Health Service will make spot checks of the medical records to make sure that confidentiality is not being compromised.

Senator WILLIAMS. There are problem areas in this that I have no idea how you are handling. Now some miners have been advised not to cooperate in the X-ray examinations, not to have their chest X-rayed. Are you familiar with that?

Dr. Key. I am not familiar with that.

Senator WILLIAMS. There is a bulletin containing such advice that has gone to a lot of miners.

Mr. Popick, are you familiar with it?

Mr. POPICK. I have seen it, mostly because the question that was raised with us is whether this call for a lack of cooperation was being directed at the medical examinations we were calling for in connection with processing disability claims.

It was our belief, as we read this bulletin, that it was not aimed at us, but it was more relevant to the question of the periodical examination. I am afraid I don't have any more information on that to submit.

Senator WILLIAMS. Periodic medical examinations by the operators?

Mr. POPICK. Well, I thought under the program that Mr. Key has. I am not a really reliable source of information on this particular point.

Mr. FEDER. Dr. Key, the bulletin that Mr. Popick was referring to that we saw on our last trip to West Virginia is a bulletin published by the Black Lung Association. On the back page in very bold type was a warning to men about taking the regular examination, “Your employer will find out the result of the medical examination and you wilĩ be fired.” These are not the exact words, but this was the warning. This is based on, I won't say the history of 19 years in West Virginia, but at least the belief of the miners in West Virginia that over the period of 19 years where they have developed some stage of silicosis they have been fired with impunity. There is a serious question whether that can be done under Federal law.

These miners in West Virginia are very worried about this. It is no surprise to me to see that half of the southern West Virginia coal miners will not take the medical examination until they know for a fact that their employer, even if the situation where it is an industrial physician gives the examination, that the employer will not find out the results of that X-ray unless the employee agrees to let him have it. Then, too, somehow the Public Health Service should broadcast that across the country, so that these miners have the assurance that the employer will not find out, or will know what protection they will get if the employer does find out.

This is the concern. There are allegations under West Virginia law they have been fired for 19 years. They certainly will not trust the Federal law.

Are there any proceedings that have been developed to insure this confidentiality, to make sure that he is acting as a physician and not as an employee of the operator?

Dr. Key. I have no other assurances, other than the information in the operators' plans and the checks that the Public Health Service will initiate on its own. I agree with you this is an important area of concern, because if the miners are fearful about the results of the test being revealed to the operators, they won't take the examinations and our whole preventive program will be compromised.

I was reading through the act this morning trying to pick out the exact references which protected the miners against discrimination based on revealing of results of this X-ray examination. The closest I could come to it was section 110(b)(1). But the X-ray examination was not specifically mentioned. It was implied, but not mentioned.

Mr. FEDER. I think you are right in the reading of 110(b) (1), it is implied and not mentioned. The only other reference which is probably the greater protection is the provision in the act which requires any miner who shows evidence of pneumoconiosis to be transferred to another job without a cut in pay. I read that as prohibiting his being discharged from any job. Of course, that would be a violation of the act.

Dr. Key. I think the Public Health Service would be well advised, in view of this information that you report, to review its confidentiality procedures and publicize what steps have been taken throughout the mining industry so that we can get a good response.

Senator WILLIAMS. That seems like a good solution on that.
Mr. Siegel?
Mr. SIEGEL. I have a question or two for Mr. Popick.
Senator WILLIAMS. Do you have a statement ?
Mr. Popick. I have some remarks.



Mr. Popick. I am the Director of the Bureau of Disability Insurance, which is the component of the Social Security Administration charged with the primary responsibility for the administration of the black lung benefit provisions of the act.

I want to say that we, too, appreciate the opportunity to appear before the subcommittee and report on the progress that we have been able to make in administering the provisions of title IV of the act.

When the Federal Coal Mine Health and Safety Act of 1969 was signed last December 30, the Social Security Administration had been on notice for about 2 weeks that we might be involved in the administration of the benefit provisions. This statement is significant at the outset in viewing in perspective the task we faced in undertaking the implementation of these provisions, particularly since the law was made effective with the date of its signature by the President, with benefits to begin for eligible claimants in the month in which they filed application, and with no provision for payment of benefits in any case prior to that time.

With virtually no leadtime then to prepare for the administration of this legislation, we were immediately faced with the urgent need for quick action on several major fronts.

First, potentially eligible claimants needed to be told about the program and urged to file application as promptly as possible to avoid possible loss of benefits.

Second, we had to develop a body of administrative regulations and policy criteria for determining when a person should be considered disabled due to coal workers' pneumoconiosis and when death could be found to be due to that disease.

Third, we had to devise administrative procedures and other mechanisms for taking applications, developing necessary evidence, determining all necessary factors of entitlement, and establishing and continuing benefit payments.

It was necessary to gear up and take action on all of these fronts simultaneously if we hoped to process claims within a reasonable time and help claimants avoid loss of benefits. As an example of our response to these needs, on the day the act was signed, every Social Security district office in the Nation was provided by teletype with informational material for release to the press, television, and radio, and given emergency instructions on the acceptance of applications under the new law.

As a result of this action and other publicity given to the new program, 18,000 applications for benefits were filed in the first week after enactment. And in the first month of enactment, almost 100,000 applications had been filed by coal miners and widows. I do want to acknowledge, however, the valuable assistance and cooperation we received in this informational effort from Members of Congress, the United States Mine Workers of America, the United Mine Workers Retirement Welfare Fund, and many others.

Senator WILLIAMS. We accept your statement of appreciation.

Mr. POPICK. We also immediately began to develop the necessary substantative rules for determining who would be eligible for benefits under the program, including the medical criteria for determining when a miner is totally disabled due to pneumoconiosis, or when his death could be attributed to this disease.

This was done in very close consultation with a number of groups and individuals whose experience and interest we found to be most relevant and helpful, starting primarily with our colleagues in the Public Health Service, Dr. Key and his staff, as well as representatives of the UMWA and the fund, workman's compensation agencies, our own Social Security Medical Advisory Committee, coal mine operators, and a wide range of professional and technical specialists in the field.

To date, over 180,000 miners' and widows' claims for benefits have been filed, with over 80 percent of these from Pennsylvania, Kentucky, and West Virginia. New claims are being filed at the rate of about 3,000 per week. The first benefit awards were made at the end of April, 4 months after enactment, and we have now progressed to the point of having approved a total of 30,000 claims for payment.

While we were limited at the start in what we could do by way of processing claims before we had time to catch up on the many legal and policy issues that needed to be resolved, we did use the time while we were working on these problems to good advantage. We did a tremendous amount of work in gathering evidence pertinent to these claims that was available from existing sources.

Because 80 percent of these claimants for black lung benefits had previously filed claims for social security benefits, we were able to utilize a good deal of evidence in our own files. In addition, we worked out arrangements to tap other valuable sources of evidence. For example, we sent social security personnel to Pennsylvania to screen and excerpt pertinent records in over 30,000 claims in the files of the Pennsylvania occupational disease program. Workmen's compensation files in other States were also screened.

Arrangements were made to receive death certificates en masse from the larger coal mine States at our expense, as well as to tap UMWA and Retirement and Welfare Fund reports. As a result of this type of activity, in a large number of the claims thus far allowed, we did not have to go back to the applicant at all for any additional information or evidence after he had filed his application.

At the present time we are working with the greatest speed and vigor on the big backlog of cases remaining to be processed. We have placed additional temporary staff in our district offices in the coal mining areas to provide maximum assistance to applicants in filing claims and securing necessary evidence. Our offices with peak claims loads are remaining open on evenings and Saturdays, and a considerable amount of overtime is being worked by the staff throughout the operation as part of a massive effort to expedite the completion of the heavy volume of claims.

Many cases require medical evidence beyond that available from existing records in order to assure proper consideration of the applicant's benefit rights. To obtain this evidence, we have enlisted the assistance of the State agencies which work with us under special agreement in our regular disability program. These agencies are now very intensively engaged in arranging for necessary medical examinations in coal miners' claims involving primarily X-rays and pulmonary function studies as needed. These examinations are performed by qualified local physicians and medical facilities convenient to the applicant, and at no cost to him.

Of course, with the volume and concentration of these claims and the limitations on medical resources, securing the necessary medical evidence is posing a major challenge for some of these agencies and for the prompt handling of claims. We have been working very closely with the State agencies with major work loads to enlarge the avail ability of medical resources in their areas, and we have also deployed technical and specialist claims staff from our headquarters disability operation at key points throughout the States to reinforce this all-out effort to expedite these claims.

While we are providing every assistance we can to applicants in establishing their entitlement to these new benefits, a very substantial number of claims can be expected to be denied because we will find that one or more requirements of the law are not met. But denied applicants have a right to challenge the decision, as do applicants for social security benefits. They may request administrative reconsideration and, if still dissatisfied, may ask for a hearing before a hearing examiner. There are also further appeal rights to the appeals council and to the Federal courts.

As we notify individuals of the disallowance of their claims and many of them exercise their right to request reconsideration, we can expect a substantial workload to develop for us in taking the necessary action to thoroughly reconsider and, in some cases, supplement the evidence in their claim and make a new decision in each appealed case.

Title IV of the act provides two basic benefits. First, benefits to coal miners totally disabled due to pneumoconiosis arising out of employ. ment in underground coal mines; and, two, benefits to widows of coal miners who died due to pneumoconiosis arising out of employment in an underground coal mine. It is immaterial how long ago the disability began, when the miner died, or the age of the miner or the widow.

At present, the basic benefit for miners and widows in $144.50 per month. Benefits are not paid directly to wives and children. However, the amount of the benefits payable to a miner or widow is increased where there are qualified dependents. The maximum amount per family is $288.90 per month.

Since the basic benefit amounts are tied to the civil service benefits retirement levels, the benefit amount is increased as Federal salaries and retirement benefits are increased, and one such upward adjustment has already been made.

The payments to the 30,000 miners and widow's whose claims have already been approved include payments for additional 20,000 dependent wives and children, making a total of 50,000 beneficiaries thus far. The amount of cumulative benefits paid back to January 1970, now totals about $25 million.

It should be noted that our responsibility under this program is limited generally to claims filed through December 1972. For claims filed in 1970 and 1971, we will handle benefit payments as long as the beneficiary remains eligible during his or her lifetime. For claims filed in 1972, we handle them only to the end of that year. In 1973, administrative responsibility for new claims will shift to the Department of Labor and will be handled through workman's compensation agencies in States which have enacted appropriate legislation to provide comparable benefit payments.

It may be of interest to offer a comment on the difference in concepts underlying these coal workers' pneumoconiosis benefits and those provided under our regular disability program. Social security disability benefits are payable to insured workers who are disabled within the meaning of the law, regardless of the nature of the medically determinable impairment or disease that causes the disability and regardless of whether there was a causal connection with employment.

Under the Federal Coal Mine Health and Safety Act, benefits are payable to a miner who is totally disabled due to pneumoconiosis, provided the disease was caused by underground coal mine work. Thus, these two requirements-disability must be due to the specific disease, pneumoconiosis, and the requirement of causal connection with underground coal mine work—are quite different from anything in our regular program.

Fortunately, the problem of establishing causality is facilitated for us by the provision in the law which permits a presumption that pneumoconiosis was due to work in the mine when the miner worked 10 or more years in an underground mine. However, the problem remains if the applicant is disabled by pneumoconiosis and did not work in an underground coal mine for this length of time. On the basis of

« PreviousContinue »