The Coal Mine Health and Safety Act contains a somewhat similar provision with similar intent, but different method of application. The amount of Federal benefits payable is reduced if the miner or widow is receiving benefits under a State program based on the miner's disability. This is a dollar-for-dollar offset. For example, if a miner would be entitled to $144.50 a month from the Federal program, but is already receiving $100 a month under a State program, the Federal benefit is reduced to $44.50. While we have made significant progress in launching this new and important benefit program and the pace of claims processing is accelerating to peak levels, so that a very large number of claims are now moving rapidly through the pipeline to final decision, realistically we recognize of course that a great deal of effort still lies ahead, both from a program and operating viewpoint. And we would not want to underestimate the job that remains to be done. To mention one important area of challenge to us, we need to know more about pneumoconiosis itself, as a disease entity, its cause, techniques for diagnosis, its disabling effects, and its relationship to other diseases of the lung-so that we can refine our evaluation policies to advance the objectives of the program. Toward this end we will be closely analyzing our case experience and we will continue to seek out new medical knowledge and professional advice and guidance. We will be working closely with the Public Health Service to contribute to the planning and encouragement of medical research and studies to be carried out under title V of the act and the leadership of the Public Health Service, and we will be alert to opportunities for applying to the fullest extent possible the added knowledge gained from such studies to improving the administration of the benefit program. From the standpoint of our immediate task of processing the pending claims load, we will continue to do our utmost to give applicants their final decisions and the benefits to which they are entitled as promptly as possible, while naintaining the standard of service that is basic to all social security claims operations; namely, to provide every assistance we can to applicants in establishing their rights to benefits under the law and to give full and fair consideration to each claim. Thank you, Mr. Chairman. Senator WILLIAMS. Thank you very much, Mr. Popick. I will say that the law presented to you a job that could be compared to scaling Mount Everest. From where I sit, you are well toward the summit. You have done a magnificent job. Mr. POPICK. Thank you, Senator. We have had a lot of help in this. It is encouraging to have such remarks that acknowledge the progress we have made and the effort we are trying to carry out. Senator WILLIAMS. It comes from the heart with full knowledge of what you are doing. Now I have just one question, and then I will turn to counsel. The social security disability now can be established at age 50. Am I right or wrong? Mr. POPICK. At any age below age 65 for the disabled worker. Mr. POPICK. The disability program was first enacted in the early 1950's, yes. Later cash benefits became payable to disabled workers age 50 and over. Then the age limit was removed. Now widows, disabled widows and widowers may be entitled to benefits, but only at age 50 and over. Senator WILLIAMS. You do have an overlap on disability and black lung? Mr. POPICK. That is right. Of course we have taken advantage of this by using very extensively the records we have in our disability claims in order to expedite the handling of some of the black lung claims. But it does bring up other considerations that come into play, like the offset requirement where in a small portion of cases the social security disability benefits plus the black lung benefits exceed that 80-percent limitation. Mr. FEDER. The question of total disability in which you pointed out the President signed the legislation does not exactly give you carte blanche to provide less restrictive criteria in respect to 203 (d), but the language of the statute does suggest that there will be some liberalization criteria at some point in time. Has there been any projection made when this will be settled? Will this lead to more liberalization? Mr. POPICK. There are medical studies that are going now in many places and might be further sponsored and planned under the research provisions of the act, which could ultimately give us some guidance on this. But we will also be gathering a good deal of data and information out of our day-to-day case experience. We are hoping that before too long we will have enough experience in the handling of cases and the decision results that may provide us a basis for further consideration and refinement in our criteria. That is as definite a reply I can give to your question at this time. Mr. FEDER. Thank you. Senator WILLIAMS. Mr. Siegel? Mr. SIEGEL. Mr. Popick, both Senator Scott, the senior Senator from Pennsylvania, and Senator Schweiker have written to you regarding the processing of claims of Pennsylvania claimants under this program. It would seem to us that it would be rather easy and straightforward for you to service these Pennsylvania claims, because these people for the most part are already contained within the Pennsylvania benefit system and there is a class of some 25,000 to 30,000 beneficiaries in Pennsylvania. The specific question has been raised, why is it necessary for additional medical examinations to be conducted in the case of these Pennsylvania recipients? I wonder if you would comment on it? Mr. POPICK. Yes. I am familiar with this question. We have been asked this several times. Of course, in response directly to your last point, a medical examination is not required in all of the Pennsylvania claims, far from it. As a matter of fact, I would say that of the 20,000, roughly, claims we have already paid in Pennsylvania, only a small portion of those that have been paid thus far actually required additional medical examinations. The large majority of those claims were handled on the basis of evidence that we got from existing sources. Primarily, in many in stances, right from the files of the Pennsylvania occupational disease program. Now, I might add in further answer to that question that actually the requirements for eligibility under the Pennsylvania occupational disease law are not exactly parallel or identical with those under this statute. There are significant differences. The Pennsylvania law pays benefits in cases other than pneumoconiosis. It has no requirement that I know of that the pneumoconiosis have arisen out of work in an underground coal mine. So we cannot automatically accept those decisions. In addition, of course, this law requires us to establish criteria for making evaluations of these claims and for having the evidence that is called for by the regulations to make those decisions, and we are using knowledge of the Pennsylvania decision, we are using all the records they have and we are using all the other records available. But we are required from a legal standpoint to make an independent decision under the existing regulations and the law, and cannot accept automatically the decision by another program. Mr. SIEGEL. Out of the 20,000 claims already approved for payment in Pennsylvania, what percentage or how many required additional medical examinations? Mr. POPICK. I am sorry that I am not in a position to give you that figure, but I would say it would be a very small percentage. Now in the Pennsylvania claims that will be approved from here on out, there will be a larger percentage of those that will require either an X-ray or some pulmonary function test. But the first large group, certainly much more than a half of those we have paid already, we had no need for medical examinations. We never would have been able to pay them as quickly as we did if we had had to have additional medical tests. Mr. SIEGEL. What do you estimate the remaining number of claims you can expect to have from Pennsylvania? Another 10,000? Mr. POPICK. We have over 185,000 claims already. Our actuarial estimate is that we will get a total of 220,000 claims by the end of the fiscal year. So, we have about 35,000 to go between now and the end of June. This is nationwide. But we are getting about 3,000 a week new claims, as I indicated before, and we are going to reach this margin of 35,000 new claims pretty fast if the new load does not begin to taper off. But if you want to look at the 35,000 more estimated, Pennsylvania's claims are about 40 percent of the total load. So, I would say about 15,000, something like that, on the basis of our actuarial estimates. I think my figures are right on that. Mr. SIEGEL. How long is the time cycle in your organization between the receipt of a claim application and the clearance for pay ment? Mr. POPICK. You mean in our regular program or black lung? Mr. POPICK. That is really difficult to answer at this time because at the moment we are in a very extraordinary situation. We have had a lot of catching up to do in establishing policies and procedures and handling the very large load of claims that we have pending as quickly as possible. Most of the claims we have processed thus far on the basis of existing records, as I indicated to you before. At the end of April we started to pay the first group of 7,000 claims. We are now at 30,000 claims paid. Those that did not need additional development, actually the working time on them, the elapsed time from the time we were able to move forward after the regulations were issued, was not very long. Your question is directed to what will be the processing time as we get into a more normal procedure. I would say that our regular claims are handled in a little over 2 months on an average. I would think that in many places we could ultimately, when we stabilize the operation and our work load, handle many of these claims more rapidly than that. Mr. SIEGEL. Then for me to sum up, what you have done in the initial months of this program is to go and process as fast as possible all the claims that you could process out of existing records without further investigation. Now you are getting down to the ones that are going to take a little more original work on your part. Mr. POPICK. You said "all." I would like to be clear that primarily they have been cases that we have been able to move along on the basis of existing records, although we are getting a growing number of those requiring special examination. But essentially that is the picture. Mr. SIEGEL. That is all I have. Senator WILLIAMS. Thank you very much, Mr. Popick. This concludes this phase of our hearings. (Whereupon, at 1:45 p.m., the committee adjourned, subject to the call of the Chair.) 47-135 O 71 51 |