Black Lung Benefits Research Articles

Causes of death among Federal Black Lung Benefits Program beneficiaries enrolled in Medicare, 1999-2016.

Coal miners with totally disabling pneumoconiosis are eligible for benefits through the Federal Black Lung Benefits Program (FBLP). We identify the causes of death among Medicare beneficiaries with a claim for which the FBLP was the primary payer and compare these causes of death to all deceased Medicare beneficiaries to better understand elevated death and disease among miners with occupational respiratory exposures. From 1999 to 2016 Medicare data, we extracted beneficiary and National Death Index data for 28,003 beneficiaries with an FBLP primary payer claim. We summarized the International Classification of Diseases, Clinical Modification 10th revision-coded underlying causes of death and entity-axis multiple causes of death for 22,242 deceased Medicare beneficiaries with an FBLP primary payer Medicare claim and compared their causes of death to the deceased Medicare beneficiary population. Among deceased FBLP beneficiaries, the three leading underlying causes of death were chronic obstructive pulmonary disease, unspecified (J44.9, 10.1%), atherosclerotic heart disease (I25.1, 9.3%), and coal workers' pneumoconiosis (CWP) (J60, 9.2%). All diseases of the respiratory system combined (J00-J99) were the underlying cause of death for 29.1% of all beneficiaries, with pneumoconioses (J60-J64) as the underlying cause for 11.0% of all beneficiaries. Coal miners enrolled in Medicare with an FBLP primary payer claim were more likely to have specific respiratory and cardiovascular diseases listed as a cause of death than deceased Medicare beneficiaries overall, and were also more likely to die from CWP or any pneumoconioses.

Medicare Claims Paid by the Federal Black Lung Benefits Program: US Medicare Beneficiaries, 1999 to 2016.

To establish the burden of totally disabling respiratory impairment among coal miners, we identified the healthcare utilization and cost for Medicare claims where the Federal Black Lung Program (FBLP) was the primary payer. We extracted FBLP claims from 1999 to 2016 institutional Medicare data along with beneficiary, comorbidity, and claim cost information. Healthcare utilization was evaluated and compared to the 2016 Medicare population. The FBLP was the primary payer on 75,690 claims from 19,700 beneficiaries and paid an increasing percentage of the total paid to providers annually. Claims decreased from 1999 to 2016 but cost per claim increased. Beneficiaries were hospitalized and visited the ER for respiratory and cardiovascular conditions. Medicare beneficiaries with FBLP primary payer claims have higher healthcare utilization and comorbidities compared with Medicare enrollees, indicative of increased financial and healthcare burden.

Progressive Massive Fibrosis Resurgence Identified in U.S. Coal Miners Filing for Black Lung Benefits, 1970-2016.

There has been a resurgence of progressive massive fibrosis (PMF) in the United States, particularly among central Appalachian miners. We characterized the proportion of PMF among former U.S. coal miners applying for Federal Black Lung Program benefits, 1970-2016. Data from the U.S. Department of Labor were used to characterize trends in proportion of PMF cases, defined as an approved black lung claim with a determination of PMF, among all miners who filed for federal benefits between January 1, 1970, and December 31, 2016. Joinpoint, logistic, and linear regression models were used to identify changes in the proportion of claimants with PMF over time. There were 4,679 unique PMF cases among claimants for federal black lung benefits between 1970 and 2016, with 2,474 miners determined to have PMF since 1996. The number of PMF cases among Federal Black Lung Program claimants fell from 404 (0.5% of claimants) in 1978 to a low of 18 cases (0.6%) in 1988, and then increased to 353 cases (8.3%) in 2014. The proportion of federal black lung benefits claimants with PMF has been increasing since 1978 (0.06% annual percent change [APC]; 95% confidence interval [CI], 0.05-0.07%; P < 0.0001), and began increasing at a significantly increased rate after 1996 (0.26% APC; 95% CI, 0.25-0.28%; P < 0.0001). Most miners with PMF (84%) last mined in West Virginia, Kentucky, Pennsylvania, or Virginia. Since 1970, the proportion of claimants with PMF has increased significantly among miners who last worked in Kentucky (16.6% APC; 95% CI, 16.5-16.7%), Pennsylvania (4.7% APC; 95% CI, 4.6-4.8%), Tennessee (16.1% APC; 95% CI, 15.7-16.4%), West Virginia (16.8% APC; 95% CI, 16.6-16.9%), and most sharply among miners last working in Virginia (31.5% APC; 95% CI, 31.2-31.7%), where in 2009, more than 17% of claimants received a PMF determination. The proportion of PMF determinations for the rest of the United States has not exceeded 4%. There has been a resurgence of PMF, particularly in central Appalachian miners. The resurgence of this preventable disease points to the need for improved primary and secondary prevention of dust-related lung disease in U.S. coal miners.

Linking Compensation and Health Surveillance Data Sets to Improve Knowledge of US Coal Miners' Health.

Increase knowledge of US coal miners' respiratory health by linking data from the black lung benefits program (BLBP) and the coal workers' health surveillance program (CWHSP). BLBP claims data from 2000 through 2013 was linked to CWHSP data from 1970 through 2016. Overall, 273,644 miners participated in CWHSP, 37,548 in BLBP, and 22,903 in both programs. Median age of miners at their time of first/only participation in CWHSP was 28 and 32 years, respectively. BLBP claimants were older (median age 59). Thirty-nine percent of BLBP claimants had not participated in CWHSP. The relative contributions of states to participation differed between CWHSP and BLBP. For example, Kentucky miners accounted for 18% of CWHSP participants, but 36% of BLPB participants. Many BLBP claimants never appeared in CWHSP, indicating missed opportunities for secondary prevention.

Increasing Severity of Pneumoconiosis Among Younger Former US Coal Miners Working Exclusively Under Modern Dust-Control Regulations.

Coal workers' pneumoconiosis (CWP) steadily declined among US miners following dust control regulations in 1970. In 2000, severe forms of this disease reemerged among young miners, and are well described among working-but not former-miners. Black lung benefits program (BLBP) data (2001 to 2013) were used to estimate respiratory disease burden among former miners including: (1) CWP (simple; advanced CWP, and progressive massive fibrosis [CWP/PMF]); and (2) respiratory impairment (FEV1 percent reference: mild, moderate, ≥moderately-severe). Among 24,686 claimants, 8.5% had advanced CWP/PMF; prevalence was highest among younger (less than or equal to 56 years: 10.8%) and older (greater than 70 years: 8.4%) miners and those who began work after versus before 1970 (8.3% vs. 4.0%). BLBP claims provide potentially useful data for monitoring the burden and severity of coal mine dust lung disease, and assessing efficacy of protective regulations.

DOL: Guidance on Misclassification of Workers; Notice of Proposed Rule on White‐Collar FLSA Exemption; Interim and Final Rules Relating to the H2‐B Worker Program; Proposed Black Lung Benefits Act Rule; Proposed Rule to Help Retirement Investors • OSHA: Final Rule to Protect Construction Workers in Confined Spaces; Public Comment Sought on Hazards Facing Communication Tower Workers • EEOC: Regulatory Agenda

Employment Relations TodayVolume 42, Issue 3 p. 51-57 Federal Regulations Update DOL: Guidance on Misclassification of Workers; Notice of Proposed Rule on White-Collar FLSA Exemption; Interim and Final Rules Relating to the H2-B Worker Program; Proposed Black Lung Benefits Act Rule; Proposed Rule to Help Retirement Investors • OSHA: Final Rule to Protect Construction Workers in Confined Spaces; Public Comment Sought on Hazards Facing Communication Tower Workers • EEOC: Regulatory Agenda Gia F. Colunga, Gia F. Colunga Freeborn & Peters LLPSearch for more papers by this authorRachel E. A. Atterberry, Rachel E. A. Atterberry Freeborn & Peters LLPSearch for more papers by this author Gia F. Colunga, Gia F. Colunga Freeborn & Peters LLPSearch for more papers by this authorRachel E. A. Atterberry, Rachel E. A. Atterberry Freeborn & Peters LLPSearch for more papers by this author First published: 20 October 2015 https://doi.org/10.1002/ert.21525Citations: 1Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Citing Literature Volume42, Issue3Fall 2015Pages 51-57 RelatedInformation

Transforming Places: Lessons from Appalachia (review)

Reviewed by: Transforming Places: Lessons from Appalachia Shaunna Scott Transforming Places: Lessons from Appalachia. Edited by Stephen L. Fisher and Barbara Ellen Smith. (Urbana: University of Illinois Press, 2012. pp. viii, 322.) Transforming Places provides several studies of place-based citizen activism in Appalachia, offering lessons to those who struggle for social justice around the world. Divided into three sections, the volume examines identity construction, alliance-building, and efforts to “scale up” resistance from the local to regional and global levels. Its essays cover a variety of issues from resistance to the military-industrial complex to community struggles with prescription drug abuse. What do such a diverse array of political struggles and social issues have in common? The editors answer that question by deftly uniting these case [End Page 101] studies into a framework which emphasizes the shifting opportunities and challenges of a neoliberal globalizing regime that has seriously weakened the labor union movement and nearly dismantled the welfare state. In so doing, Fisher and Smith continue a long legacy of Appalachian research demonstrating how Appalachia is connected to and relevant to the rest of the world. Before turning to the essays themselves, it is worth highlighting the editors’ contextualization of prescription drug abuse, an issue which appears to have no sociopolitical cause or recourse. Comparing contemporary prescription drug abuse to the struggle for Black Lung benefits in an earlier era, the editors point out: “What counts as a ‘social problem’ and what remedies exist to treat it have shifted in ways that render collective political action more elusive. . . . The contrast between a collective sensibility of a disease [Black Lung] as the product of class exploitation . . . and the highly individualistic, victim-blaming discourse associated with drug addiction, vividly exemplifies the self-fulfilling logic of neoliberalism: What is individually borne is no more or less than the fault of the individual and therefore should not be collectively redressed” (5–6). This volume encourages us to challenge this neoliberal logic. Because the essays in this volume are engaging and accessible, this book is appropriate for both academic and lay audiences. I will certainly assign it in undergraduate and graduate level courses on social inequalities, community development, politics, and Appalachian studies. The most useful to organizers are those which document grassroots organizing efforts: the now-defunct Southern Empowerment Project (133–43), the Center for Participatory Change (122–32), the Virginia Organizing Project (183–97), the Community Farm Alliance (210–25), and Mountain Justice (226–38). Though they do not provide identical blueprints for success–that would not be possible given the diversity of places in which they operate, their lessons nevertheless have common themes: the importance of staff-leadership relations, options for more decentralized, flexible organizational structures, issues accompanying foundation support, the need to confront racism, sexism, classism, and heterosexism, strategies to engage power at the most effective scalar level, and the centrality of coalition-building, alliance, and inclusion (see also the essay on international coalitions, 252–66). Academic audiences will appreciate the conclusion which draws and builds upon neo-Marxian, feminist theory from geography. The distinction between place and space, central to geography, deserve wider circulation. Popular and policy discussions about globalization too often cede causal priority to the “abstract, spatial” forces of capitalism while dismissing “local, place-based” forces as uniformly reactionary and insular. We could benefit from greater recognition that the wrongly imagined inevitable, abstracted, displaced [End Page 102] forces of neoliberal capitalism are in fact embodied, locally situated practices and logics which privilege some people and places over others. This volume succeeds in making that case and, therefore, will win a place on the shelves of scholars, practitioners and activists alike. Shaunna Scott University of Kentucky Copyright © 2012 West Virginia University Press

Brief of Amicus Curiae the Washington and Lee University School of Law Black Lung Clinic in Support of Amicus Curiae Counsel on Severability

The Black Lung Clinic (“Clinic”) is a legal clinic at the Washington and Lee University School of Law in Lexington, Virginia. The Clinic represents former coal miners and survivors who are pursuing federal black lung benefits. The Clinic’s clients are represented by a member of the law school faculty licensed to practice law who works closely with students in the Clinic. Students evaluate claims; develop evidence; conduct discovery, depositions, and hearings; and write motions, arguments, and appellate briefs. In attempting to collect benefits, miners and survivors face formidable teams of lawyers, paralegals, and doctors that the coal companies assemble to challenge these claims. The Clinic currently represents thirty-seven former coal miners and their spouses. Nineteen of these clients are receiving benefits as a direct result of the changes to the Black Lung Benefits Act made in the Affordable Care Act.Section 1556 of the Act makes two major changes to the Black Lung Benefits Act. These changes remove limiting language to make it simpler for disabled miners and their families to establish that they are entitled to federal benefits. First, § 1556(a) reinstates the fifteen-year rebuttable presumption, which presumptively entitles former fifteen years underground and have a totally disabling pulmonary disease. The second, § 1556(b), reinstates a continuation of benefits for surviving spouses whose coal-mining spouse was receiving benefits at the time of their death. The clients of the Clinic already have benefited from these amendments: nineteen clients who are currently receiving black lung benefits will stop receiving those benefits if the Act is invalidated. Thirteen widows and six former miners, all of whom are receiving benefits, will be left without income on which they rely if the Act is struck down in its entirety. The Clinic has a profound interest in the possibility of the invalidation of the Act. If the Act is totally struck down it would adversely affect our clients; not only the ones currently enjoying benefits under the amendments, but all coal miners or surviving spouses who will bring cases in the future.

Mannington to Upper Big Branch: The Promise Betrayed

Mannington to Upper Big Branch:The Promise Betrayed John P. David (bio) and Jan Young (bio) "I told my wife, if anything happens to me, get a lawyer and sue the blankety-blank out of them. That place [Upper Big Branch] is a ticking time bomb." —Stanley Stewart, continuous miner operator and survivor of the April 5, 2010, explosion at Massey Energy's Upper Big Branch mine in Montcoal, West Virginia, speaking at a May 24, 2010, Congressional hearing of the House Education and Labor Committee in Beckley The coal mine explosion at Upper Big Branch (ubb) that killed twentynine miners and injured two was the most deadly mining disaster since Consolidation Coal's #9 mine at Farmington near Mannington, West Virginia, exploded in November 1968 killing seventy-eight miners. It was also no accident. Developments in recent years have left no question of whether there would be another disaster, but only of when and where it would be, and how many miners would be killed. Generally referred to as "Mannington," the 1968 disaster in fact serves as a point of reference for tracking the path to Upper Big Branch. Mannington caused rank-and-file outrage and was the impetus for extensive changes in the coal industry, including the passage of the Coal Mine Health and Safety Act of 1969. Broader legislation, the Occupational Safety and Health Act, was passed the following year. The United Mine Workers of America (umwa) saw the rise of the reform movement, Miners for Democracy, and the growth of the Black Lung Association. The industry itself began a realignment that resulted in a significant shift to non-union operations. The Mannington disaster along with then umwa President Tony Boyle's statement that "As long as we mine coal, there is always this inherent danger of explosion. … This happens to be one of the better companies as far as cooperation with our union and safety is concerned" clearly exposed the cozy relationship between the coal industry, its regulators, and the union hierarchy. Emboldened by growing rank-and-file discontent, umwa insider [End Page 49] Joseph "Jock" Yablonski stunned the union's establishment in May, 1969 by challenging Boyle for the union presidency. Yablonski had served as President and International Executive Board member from District 5, one of the few districts that still held elections and was not under an international union trusteeship. On December 8, 1969, Yablonski lost the election to Boyle amid accusations of extensive fraud. On New Year's Eve, Yablonski, along with his wife and daughter, was murdered at his home in Clarksville, Pennsylvania. Some years later, Tony Boyle was convicted of having arranged the murders. He died in prison in 1985. In the meantime, in the southern West Virginia counties, Robert Payne was mobilizing the Disabled Miners and Widows in strikes for Black Lung benefits. Chapters of a Black Lung Association sprang up all over the coal fields with Arnold Miller of the Montgomery, West Virginia, chapter emerging as a leader. There were massive demonstrations centering around black lung and mine health and safety in general, often featuring the three physicians, I. E. Buff, Hawey Wells, and Donald Rasmussen, who became spokespersons for the view that Black Lung was a preventable disease that had become an unchecked disaster in America. In northern West Virginia and Pennsylvania, Yablonski's sons and brother encouraged the formation of Miners for Democracy (mfd). In its first battle, mfd's Lou Antal unsuccessfully challenged incumbent Mike Budzanoski for the presidency of umwa District 5. However, by the end of 1971, the U.S. Department of Labor's investigation of the Boyle-Yablonski election had unearthed enough irregularities to overturn Boyle's election. The stage was set for another national umwa election. The forces from mfd and the Black Lung movement came together, and in May 1972 put forward a reform slate with Arnold Miller from the Black Lung movement at its head. Harry Patrick from northern West Virginia held the second slot, and Mike Trbovich from the original mfd District 5 was slotted as Secretary-Treasurer. With the rerun election supervised by 230 agents from the U.S. Department of Labor, the reform slate won, and the...

Reducing the Overburden: The Doris Coal Presumption and Administrative Efficiency under the Black Lung Benefits Act

Reducing the Overburden: The Doris Coal Presumption and Administrative Efficiency under the Black Lung Benefits Act

The National Vaccine Injury Compensation Program.

No-fault compensation is a popular solution to controversial problems. It has been proposed as an alternative to litigating medical malpractice, adverse reactions to future acquired immunodeficiency syndrome (AIDS) vaccines, and asbestos injuries. The idea is to reduce the expense and uncertainty of litigation and to ensure more equitable compensation to injured persons. Except for state-level workers’ compensation and auto accident insurance programs and the Black Lung Benefits Act, the United States has little experience with nofault compensation. For all of these reasons, the National Vaccine Injury Compensation Program is attracting attention. The federal vaccine program provides no-fault compensation to persons injured by vaccines used to prevent seven infectious childhood diseases. Because it awards compensation primarily for specific injuries occurring within a specified time after vaccination, it is the country’s simplest program of no-fault compensation. The number of adverse reactions to childhood vaccines is small relative to the number of injuries from other products, medical malpractice, or motor vehicle accidents. Also, the program is designed to operate expeditiously. In spite of its simplicity, the program has encountered surprises. At first, fewer petitions were received than expected, but deciding these few claims was more difficult than anticipated. The statute governing the

Lester's Progress , and: The Great Appalachian Sperm Bank and Other Writings (review)

bread." But things have changed. Now they have a cat named Garfield, cable tv and a microwave oven, Elsie works at the library and Harper builds houses in a subdivision. Harper Watts is no Appalachian totem when he takes a spill while cleaning gutters: "Three months short of his 70th birthday Harper Watts reached to clean a clogged section of guttering, leaned too far to the left, and groaned as his paint-spattered old aluminum ladder started sliding. Harper looked down and saw two clotheslines and a rose arbor coming up fast, bailed out and jumped. He landed left foot first, did a hopand -skip to miss the yellow cat Garfield, and collided head-on with two rows of wet sheets. "Harper took out forty pounds of wet bed linen and a dozen clothespins, hit the ground in a flapping, sopping tangle, and finally skidded to a stop just short of the pumpkins piled against the garden fence." Still Harper is no less "Appalachian" for coming down in a domestic disaster worthy of Dagwood. This change through time, as reflected in the Watts family (change which is certainly typical of what has gone on in the region in this century) might have been further highlighted by a slightly different arrangement of two of the stories. The man and woman in "Take Two" are referred to only as "he" and "she," but this story could fit well into the second rather than the first part of Mountain Passage; it feels like a story involving young Vernon Watts and his cheerleader girlfriend in the story "Merry Christmas." "Take Two" might be about Vernon (the poor boy from out in the county) and Sarah Collier (the pretty cheerleader with the well-to-do father) after two decades. "Little Lost Sheep," while one of the more recently written stories, according to the author's foreword, might also have been more appropriately positioned, say between "A Matter of Vision" and "River City Run," for it is a story about Vernon Watts at age eleven, after he feigns blindness in the second grade, to keep from going to school, and before he is introduced to the masculine world of the tobacco market in Maysville. But these are quibbles about arrangement , not about the intrinsic merit of these stories, all well worth reading. —Jim Wayne Miller Caudill, Harry. Lester's Progress. Berea, Kentucky: Kentucke Imprints, 1986. Paperback , $6.95. Best, Bill. 77ie Great Appalachian Sperm Bank and Other Writings. Berea, Kentucky: Kentucke Imprints, 1986. Paperback, $6.95. When two outspoken authors tackle the ills of Appalachia in biting satire, the results can be hilarious and hard to ignore. Harry Caudill's Lester's Progress and Bill Best's The Great Appalachian Sperm Bank are new from Kentucke Imprints, two tonguein -cheek volumes whose very presence—as George Brosi says—are a tribute to small press publishing. Lester's Progress is Harry Caudill's saga of welfare fraud, corruption, politics, and much more, set in fictional Fletcher County in the Quackgrass State. Hero Lester Warrick manipulates the system to collect black lung benefits, payments to the blind, low cost housing, and enough other fraudulent claims to fill a cedar chest with cash and drive a deliberately scuffed and muddied but brandnew Cadillac. Lester also collects, along the way, a colorful credibility as a squire of the county. Caudill lays it on too thick, but his chapter on "The Unreasonable Becomes Public Policy" is alone worth the price of the book. Caudill uses examples such as the unarmed Marines in Lebanon, university degrees freely conferred on those who cannot read or write, and the million dollar army tank which has to have its engine removed for an oil change to convince a jury that "what is crazy, what is deviant, what is in fact unreasonable is now publicly, socially, and legally accepted as reasonable behavior." The U.S. Supreme Court upholds the verdict: "In America, the justices said, norms have been turned around and upside down." Of course, says Bill Best in The Great Appalachian Sperm Bank, some of Harry Caudill's theories—specifically those regarding the genetic defects of the Appalachian people—are themselves "turned around and upside...

Workers' Compensation: Benefit and Injury Claims Rates in the Seventies

A LTHOUGH public policy analysts are revaluating income maintenance and income support programs, economists have devoted little attention to empirical research on one such program. Workers' Compensation (WC), a program in search of quantitative researchers, is about the same size as the Unemployment Insurance (UI) and Social Security Disability Insurance (SSDI) programs, and WC may have stronger supply effects than the UI program.' The state and federal no-fault insurance programs which constitute America's WC insurance system cost over $25 billion in 1980, and they covered, approximately, 90% of all wage and salary workers.2 During the period 1972 to 1978, the cost of WC as a percentage of covered payroll doubled and was probably equal to 2% of covered payroll.3 The WC program has enjoyed the support of both labor and industry. Employers favor this form of no-fault insurance because it guarantees a limit on the liabilities that they will incur due to the work-related injuries and diseases of their employees, and employees value the guaranteed medical expenses and payments that they receive under the program.4 Labor can view Workers' Compensation as a vast improvement over either the common law, which seemed to be designed to provide employees with strong safety incentives rather than to replace their lost income, or the employer liability laws that prevailed in most states until the early part of this century. Perhaps another reason for the position that the Workers' Compensation program has held in American social insurance has been that it is specialized in nature, and has constituted a relatively small share of the employers' overall cost. However, in recent years as the claim frequency under Workers' Compensation has risen dramatically and as policymakers and practitioners alike have consistently underestimated the cost consequences of liberalized Workers' Compensation benefits, analysts are beginning to reevaluate this very important form of social insurance. In this paper we analyze the two classes of Workers' Compensation injuries which account for most of the Workers' Compensation costs in the United States: temporary total and permanent partial injuries. In the next section we briefly describe some of the rudiments of the program after which we sketch an economic model of injury rates and suggest how they interact with wages and hours of work as levels of benefit change. In the fourth section of the paper we present empirical results which indicate that recent changes in the Workers' Compensation laws have had subReceived for publication April 1, 1982. Revision accepted for publication December 1, 1982. * Brigham Young University and Rutgers University, respectively. We wish to thank Steve Zrebiec for competent research assistance, and Monroe Berkowitz, Tom Brown, John F. Burton, Jr., Jennifer Field, and Fred Siskind for comments on an earlier draft. The views expressed herein are our own, and do not necessarily reflect those of Brigham Young University. ' Danziger, Haveman, and Plotnick (1981) guesstimate the reduction of work hours by transfer recipients as a percentage of total work hours of all workers as 1.2%, 0.7%, and 0.3% for SSDI, WC, and UI, respectively. 2 Dan Price's estimate (1981) that the WC program cost $20 billion in 1979 is a conservative one. He correctly attributes the full premium paid to private insurers, $14.3 billion, and to state funds to that year's cost, but he attributes only the benefits paid in 1979 by federal programs and firms that were selfinsured plus a 5%-to-10% markup for administrative cost to 1979 costs. This is equivalent to assuming that the federal programs and the firms which self-insure incur all of their WC losses during a calendar year. Actually, 1979 losses may be paid over many years, and injury or illness claims may arise many years after the end of calendar year 1979. These incurred losses and future claims should be fully reflected in current costs, but are so only to the extent that the actuarial price (premium) paid to private carriers and state funds is fully reflected in premiums collected. In addition, Price did not include the federal black lung benefits program funded by general revenues. 3Elson and Burton (1981) have examined the increasing trend in Workers' Compensation insurance. They present evidence which indicates that costs have doubled, for homogeneous classes of employers, in most states over the 1972 to 1978 period. 4There has been erosion of the certainty aspect of benefit payments due to litigation of claims. Vroman (1978) pointed out that certain permanent partial disability claims would be litigated with probability one. The high incidence of controversion has played a prominent role in calls for reform of the WC system and certainly was a factor in the state of Florida's decision to institute a wage loss system on August 1, 1979.

Coal workers' pneumoconiosis and the compensation dilemma.

Coal workers' pneumoconiosis is a preventable occupational disorder of the respiratory system resulting from exposure to and retention of respirable coal dust. It exists in two distinguishable forms: simple, which is seldom if ever disabling, and complicated, also known as progressive massive fibrosis (PMF), which is sometimes totally disabling and is associated with a high mortality rate. The disease affects a small proportion of active U.S. miners, and only a very small number develop PMF. In its more advanced stages, the disorder is characterized by shortness of breath. Scientific criteria for diagnosis are well established but are not followed in the U.S. because of Federal law and regulation. However, an acceptable scheme for classification of chest radiographs exists. Black lung benefits payable to miners, their survivors and dependents are approaching $2 billion annually, and regulations concerning eligibility for such benefits are intentionally slanted to make it possible for claimants to receive benefits in a manner not consistent with regulations governing similar payments to other occupationally employed persons or in accordance with established medical criteria.

Respiratory Disability in Coal Miners

ABSTRACT To the Editor.— I found much in the article Respiratory Disability in Coal Miners to be incomplete or misleading. Unfortunately, the study, made more than two years ago by Morgan et al, overlooks certain pertinent and important considerations that are essential to reaching valid conclusions. Moreover, the sample of cases reported by Morgan and co-workers may not be representative of the universe of black lung claimants.Any valid conclusions must be based on an understanding of the criteria for establishing entitlement for benefits under the Black Lung Benefits Reform Act of 1977. These criteria involve legal as well as medical considerations. The medical considerations defined by the Act include not only massive fibrosis but also chronic obstructive pulmonary disease (COPD).For purposes of the Act, Congress adopted the definition of pneumoconiosis (black lung) as a chronic dust disease of the lung and its sequelae, including respiratory and pulmonary impairments arising

Black Lung Benefits

The Black Lung Benefits Reform Act of 1977 awards compensation for pulmonary disability incurred as a consequence of employment as a coal miner. The intent of Congress as expressed in this act is simple and clear, but unfortunately administration of the act is difficult and often results in an unfair and inequitable distribution of public funds. Assessing disability by symptoms and measures of pulmonary function is not easy and often results in erroneous judgments. Disability, even when it exists, is rarely caused by coal particles alone but is usually the result of other factors such as cigarette smoking, which results in emphysema. A man in whom emphysema develops and who has a history of being a coal miner can receive compensation, while another victim of the same disease, who never worked in a coal mine, receives no compensation. As might be expected the prospect of being awarded a government pension

Black lung benefits

Black lung benefits

Letter: Black Lung Benefits Reform Act.

To the Editor.— The House Sub-Committee on Labor has recently been holding hearings on a bill HR 8, which is also known as the Black Lung Benefits Reform Act of 1975.I wish to call attention to certain proposals in this bill that are grossly unfair to the non-coal-mining working population and to the consumer. Were this bill to become law, any respiratory impairment that develops in a man who has worked for 25 years in a coal mine would be assumed to be due to his occupation. Such a presumption could only be rebutted on the basis of a blood gas test. After 35 years, the presumption of disability would become irrebuttable, and every miner who had worked for this period would be able to retire on "disability." The fact that there is no medical basis whatsoever for such a presumption is well known to those who are familiar with

An Analysis of the Black Lung Compensation Program

Federal intervention into the state workmen's compensation system has taken place through the program for compensation of coal workers suffering from pneumoconiosis (black lung). Enacted as part of the Federal Coal Mine Health and Safety Act of 1969 and amended by the Black Lung Benefits Act of 1972, the program imposes Federal standards on the state compensation system for pneumoconiosis benefits. Although initially funded through general revenues, most new claim filings became the responsibility of the coal industry on July 1, 1973. This article discusses the nature of the black lung program, develops cost estimates for the first eighteen months of the privately-funded phase of the program, and analyzes the program in terms of the economic theory of externalities. The economic analysis indicates that the allocation of the costs of the program among mine operators is far from ideal when gauged by theoretical standards. It is hoped that future attempts at Federal intervention will avoid some of the problems which have plagued the black lung program by more thorough and rational pre-implementation planning. Most of the recent attention to workmen's compensation has been directed to the possibility that the National Commission on State Workmen's Compensation Laws may result in Federal intervention in the heretofore state operated system.' Surprisingly little attention has been given to the fact that, even prior to the formation of the Commission, the Federal government had already undertaken direct intervention in the state workmen's compensation program. By virtue of the Federal Coal Mine Health and Safety Act for 1969,2 Congress superceded state prerogatives over workmen's compensation for coal miners who were disabled by coal workers' pneumoconiosis (CWP), which is more commonly referred to J. David Cummins, Ph.D., is Assistant Professor of Insurance in the University of Pennsylvania. Dr. Cummins is also Assistant Director of the S. S. Huebner Foundation and is author of Development of Life Insurance Surrender Values in the United States. Douglas G. Olson, Ph.D., is Associate Professor of Insurance in The Wharton School. He is also an Assistant Editor of this Journal. This paper was submitted in July, 1973. 1 See: The Report of the National Commission on State Workmen's Compensation Laws (Washington: U.S. Government Printing Office, 1972). 2 Federal Coal Mine Health and Safety Act of 1969, Pub. L. No. 91-173, 83 Stat. 742 (1969) (codified at 30 U.S.C. ?? 901-960 (1970) ).

Black Lung Benefits

To the Editor.— On Sept 30, 1972, a new set of regulations for black lung benefits was published in the Federal Register . The regulations included some interim standards designed to facilitate the more rapid processing of black lung compensation claims. Since that time, the Appalachian Laboratory for Occupational Respiratory Diseases has repeatedly been asked by physicians in the field of industrial medicine and chest diseases what percentage of working miners are eligible to receive black lung benefits under the interim standards. At the present time and until 1973, a miner may qualify for black lung benefits if (1) his chest roentgenogram shows evidence of pneumoconiosis— either simple or complicated; (2) he has worked for 15 years in a coal mine and has sufficient ventilatory impairment to meet the criteria shown in the table published on page 20646 of the Federal Register ; and (3) he has certain other respiratory impairments, such