Source: http://www.dol.gov/brb/References/reference_works/bla/bldesk/BD03-A.HTM
Timestamp: 2015-01-29 22:25:44
Document Index: 193961445

Matched Legal Cases: ['§923', '§410', '§931', '§725', '§931', '§725', '§722', '§922', '§725', '§932', '§424', '§924']

BD03-A
A. REQUIREMENT TO FILE STATE WORKERS' COMPENSATION CLAIM;
Section 413(c) of the Act, 30 U.S.C. §923(c), as implemented by 20 C.F.R. §410.219(a) and (b), which applies only to Part B and Section 415 transition claims, Debusk v. Pittsburgh & Midway Coal Co., 12 BLR 1-15 (1988), requires that a claimant file a claim under applicable state workers' compensation law prior to filing a claim under the Act, unless such a filing would be futile. See Marsella v. Starvaggi Industries, Inc., 2 BLR 1-286, 1-293 (1979); Legrand v. Zeigler Coal Co., 1 BLR 1-645, 1-651-52 (1978). Section 421, 30 U.S.C. §931, applies to Part C claims. Debusk, 12 BLR at 1-17; see Lewis v. Pittsburgh & Midway Coal Co., 6 BLR 1-643 (1983); Perry v. Lueking Coal Co., 1 BLR 1-104 (1977); 20 C.F.R. §725.402, 725.403 and comments accompanying promulgation of Section 725.403, 43 Fed. Reg. 36772, 36790 (August 18, 1978). The Board has held that, as regards a claim filed under Part C, the filing requirement is waived as futile if the state workers' compensation law is not one of those listed by the Secretary of Labor as a qualifying state plan pursuant to Section 421(b), 30 U.S.C. §931(b). Perry v. Lueking Coal Co., 1 BLR 1-104, 1-107 (1979); see also 20 C.F.R. §§725.402, 725.403. Inasmuch as the Secretary of Labor, as of that date, had determined that no state workers' compensation law provided adequate coverage for pneumoconiosis within the meaning of Section 421, see 20 C.F.R. §722.152(b), the Board held that claimant was not required to file a state claim, thereby rejecting employer's contention that it was released from liability under Part C of the Act. Debusk, 12 BLR at 1-17. The Board has held in cases involving lump sum awards considered under the "offset" regulation that primary emphasis is on: (1) whether periods for which payments are made run concurrently; and, if so, (2) whether the amount of benefits to which claimant is entitled during each separate month should offset one against the other. Scuilli v. Bethlehem Mines Corp., 8 BLR 1-206 (1985). The Board has held that a duly executed settlement of a state workers' compensation pneumoconiosis claim does not bar the claim for federal black lung benefits, whether filed under Part B or Part C. Honaker v. Jewell Ridge Coal Corp., 2 BLR 1-947, 1-949 (1980); McCarty v. Clinchfield Coal Co., 1 BLR 1-914, 1-915 (1978); Hileman v. Clinchfield Coal Co., 1 BLR 1-531, 1-533-34 (1978); Murphy v. Q and G Coal Co., 1 BLR 1-455, 1-459-460 (1978). It should be noted, however, that the amount of the settlement or state award for disability due to pneumoconiosis will be applied to offset the federal black lung benefit. Couch v. Shamrock Coal Co., 2 BLR 1-342 (1979). Concurrent state benefits for contracting pneumoconiosis are duplicative and the federal benefits must be offset, regardless of whether the state program includes a disability requirement. 30 U.S.C. §§922(b), 932(b); Ball v. Jewell Coal & Coke Co., 6 BLR 1-693 (1983); Gray v. United States Steel Corp., 1 BLR 1-237, 1-240 (1977), remanded sub nom. United States Steel Corp. v. Gray, 588 F.2d 1022 (5th Cir. 1979). The Board has rejected employer's contention that Section 725.435(b) is invalid and held that it provides for offset only of state payments received concurrently with federal payments; any offset provision which should diminish a federal black lung award by any amounts other than those duplicative of the federal black lung award would do violence to the Act's concern for the adequacy of compensation. Ball, supra; Stewart v. Harman Mining Corp., 5 BLR 1-854 (1983), aff'd sub nom. Harman Mining Co. v. Director, OWCP, 826 F.2d 1388, 10 BLR 2-291 (4th Cir. 1987). Employers have attempted to use the principles of full faith and credit, res judicata, and collateral estoppel in arguing that a claim adjudicated under a state workers' compensation law should bar a federal claim. See, e.g., Newport News Shipbuilding and Dry Dock Co. v. Director, OWCP, 583 F.2d 1273 (4th Cir. 1978); but see Pettus v. American Airlines, Inc., 587 F.2d 627 (4th Cir. 1978), where employer's argument was successful.
[no statutory provision in Part C for offset against black lung benefits due to receipt of unemployment compensation or for excess earnings] Fisher v. Bethlehem Mines Corp., 1 BLR 1-591 (1978); see also 20 C.F.R. §725.535.
[in Part B claims, 30 U.S.C. §932(b), providing offset of state workers' compensation benefits against black lung benefits, and 42 U.S.C. §424(a), providing offset of state workers' compensation payments against Social Security disability benefits, may be jointly applied so long as total offset against both federal programs does not exceed 100 percent of state workers' compensation payment] Freeman v. Harris, 625 F.2d 1303 (5th Cir. 1980).
[questions regarding offset appropriately considered once claimant is determined entitled to benefits; issue of offset may always be raised] Crider v. Dean Jones Coal Co., 6 BLR 1-606 (1983).
[Board upheld Section 725.535(d), prohibiting offset of attorney fees] Ball v. Jewell Coal & Coke Co., 6 BLR 1-693 (1983); Warren v. Harlan Fuel Co., 6 BLR 1-582 (1983).
[30 U.S.C. §924a, added by 1978 Amendments, strictly limited to medical services; can not be relied on by Part B beneficiaries to seek reimbursement for reduction in monthly benefits resulting from offset for excess earnings] Kosh v. Director, OWCP, 8 BLR 1-168, 1-171 (1985), aff'd No. 85-3508 (3d Cir. May 6, 1986)(unpub.).
[under "adjustment" regulation, Section 725.535(d), net state benefits are computed for each month by subtracting monthly attorney fees from monthly state benefits; net state benefits then are offset against federal black lung benefits] Scuilli v. Bethlehem Mines Corp., 8 BLR 1-206 (1985).
The Board held that employer was not entitled to an offset against the federal award for black lung benefits because claimant's state award was for disability due to a back injury and the Act limits offs