Black Lung Benefits Act Presumption of Entitlement to Benefits Rebuttal Standard Set Forth by Regulation Ultra Vires
Helen Mining Co. v. Elliott, PICS Case No. 17-1049 (3rd Cir. June 14, 2017) Krause, J. (29 pages).
Statute's silence as to inclusion of coal mine operators in benefit entitlement presumption standard meant that federal agencies were empowered to promulgate regulations filling in statutory gap. Order of the Benefits Review Board affirmed.
Employer Helen Mining Company, a coal mine operator, petitioned for review of an award of black lung benefits to claimant James Elliott. Under the Black Lung Benefits Act, a miner had to establish four element to be entitled to benefits: (1) disease; (2) disease causation; (3) disability; and (4) disability causation. If a miner worked more than 15 years in an underground coal mine and could establish disability, he was entitled to a rebuttable presumption of entitlement to black lung benefits. Over the decades, responsibility for black lung benefit claims that were initially administered by the Secretary of Labor and paid out of federal funds were ultimately shifted over to coal mine operators. However, when the presumption was reinstated by the Affordable Care Act, the standards for rebutting the presumption of entitlement to benefits still only referred to the Secretary, with no explicit provision for rebuttal by operators. The Department of Labor issued a regulation to fill in the legislative gap, encompassing both the Secretary and operators. Specifically, the regulation required the opposing part to establish that no part of a miner's total disability was caused by pneumoconiosis.
Claimant filed a timely claim for BLBA benefits, alleging he suffered respiratory issues due to his coal mine employment. Employer conceded it was the responsible employer, but challenged claimant's entitlement to benefits. At a hearing before an ALJ, employer attempted to rebut the presumption that claimant was entitled to benefits through expert testimony attributing claimant's respiratory impairment to adult-onset asthma unrelated to coal dust exposure. The ALJ did not find employer's expert testimony persuasive, and ruled that it failed to rebut the presumption that claimant was entitled to benefits.
On appeal to the Benefits Review Board, employer argued that it should not have been required to meet the rebuttal standard set forth in the DOL regulation because it was ultra vires to the BLBA. The BRB rejected that argument and affirmed the ALJ, holding that the regulation was valid and that the ALJ was correct to apply it because it filled in the statutory gap omitting reference to coal mine operators.