Glen Coal Co. v. Director, Office of Workers' Compensation Programs

77 F. App'x 878
CourtCourt of Appeals for the Sixth Circuit
DecidedOctober 15, 2003
DocketNos. 01-4014, 02-3195
StatusPublished
Cited by4 cases

This text of 77 F. App'x 878 (Glen Coal Co. v. Director, Office of Workers' Compensation Programs) is published on Counsel Stack Legal Research, covering Court of Appeals for the Sixth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Glen Coal Co. v. Director, Office of Workers' Compensation Programs, 77 F. App'x 878 (6th Cir. 2003).

Opinion

REVISED OPINION

GIBBONS, Circuit Judge.

Glen Coal Company and its insurer, Old Republic Insurance Company, (collectively “Glen Coal”) appeal an order of the United States Department of Labor Benefits Review Board (“Board”) awarding reimbursement to Jess Seals, a former coal miner, for medical benefits under Part C of the Black Lung Benefits Act, 30 U.S.C. §§ 901-945. After a previous appeal to this court, an administrative law judge determined on remand that Seals’s disputed medical treatment was related to his coal workers’ pneumoconiosis, and the Board affirmed. Glen Coal argues in this appeal that the administrative decisions below improperly eased Seals’s burden of proving that his medical treatments were related to his pneumoconiosis, improperly weighed the opinion of Seals’s treating physician, and improperly applied a revised regulation to the ease. For the following reasons, we affirm.

I.

The Black Lung Benefits Act is intended to “provide benefits ... to coal miners who [880]*880are totally disabled due to pneumoconiosis and to the surviving dependents of miners whose death was due to such disease.” 30 U.S.C. § 901(a); Glen Coal Co. v. Seals, 147 F.3d 502, 505 (6th Cir.1998) (Boggs, J. concurring and Moore, J., concurring and dissenting) (“Seals I”). Pneumoconiosis is “a chronic dust disease of the lung and its sequelae, including respiratory and pulmonary impairments, arising out of coal mine employment.” 30 U.S.C. § 902(b).

As explained in the previous appeal to this court, Part B of the Black Lung Benefits Act, 30 U.S.C. §§ 921-925, establishes a federally funded program providing monthly disability payments benefits to claimants, but no health care benefits. Seals I, 147 F.3d at 505. Part B claims are administered by the Social Security Administration. They are paid by the federal government and do not involve the mine operators or the Department of Labor (“DOL”). Id.

By contrast, Part C of the Black Lung Benefits Act “establishes an employer-funded federal workers compensation program to provide benefits, in cooperation with the states, for total disability or death due to pneumoconiosis, and is administered by the DOL.” Id. (citing 30 U.S.C. §§ 931-945). That is, Part C benefits are industry-funded liabilities, payable either by a coal mine operator (or its insurer) who employed the miner or, where there is no liable operator, by the Black Lung Disability Trust Fund, which is funded by an excise tax on mined coal. 30 U.S.C. § 932(c); 26 U.S.C. § 9501(d). While Part B benefits provide a monthly disability payment, Part C benefits provide payment for medical treatment related to pneumoconiosis. Part C benefits are governed by 20 C.F.R. §§ 725.701-725.707. As explained in Seals I, obtaining Part C benefits is a two-step process. The first step determines whether the miner is totally disabled from pneumoconiosis such that the employer is hable for Part C benefits; the second step determines whether the employer is liable for individual medical expenses by determining whether the treatment in question is related to pneumoconiosis. Seals I, 147 F.3d at 505-06.

Seals worked as a coal miner for approximately seventeen years and stopped working in 1972, following a back injury. Id. at 506. Within a year of stopping work, Seals was awarded Part B benefits from the Social Security Administration. On June 27,1979, Seals filed a claim for health benefits under Part C of the Act, the benefits at issue in this appeal. The DOL identified Glen Coal, Seals’s former coal mine employer, as the responsible operator potentially hable for the payment of Part C medical benefits and so notified Glen Coal in 1984. Glen Coal “agreed without further proceedings to pay the cost of black lung related health care provided to Seals.” Id. On May 29, 1984, Glen Coal signed an Agreement to Pay Medical Benefits, which stated that Seals “meets the standards of total disability1 [881]*881under the Black Lung Benefits Act (30 U.S.C. § 901 et seq.)”

The agreement signed by Glen Coal also stated:

The coal mine operator understands that this document may be the basis for the issuance of an Award of Medical Benefits and order to Pay Medical Benefits in this claim.
The above-named coal operator agrees to pay medical benefits to the claimant/miner for reasonable medical charges directly resulting from treatment of the miner’s coal worker’s pneumoconiosis ...

Based on this agreement, the DOL awarded Part C medical benefits to Seals in June 1984, ordering Glen Coal to “provide to the claimant all reasonable and necessary medical benefits required for the treatment of his pneumoconiosis condition ... in accordance with ... the [Black Lung Benefits] Act.”

In 1985, Seals submitted pharmacy bills totaling approximately $1,900 for broncho-dilators,2 antibiotics, and doctor visits. Glen Coal refused to pay them, stating in letters to the pharmacist that Seals had no or very mild pneumoconiosis and that there was no evidence that the treatment was for a condition related to pneumoconiosis. Seals I, 147 F.3d at 507. Seals submitted the bills to the DOL for review and its medical consultant, Dr. Leon Cander, recommended that Glen Coal should pay for the bronchodilator treatments, but not the antibiotics. On August 10, 1988, the DOL adopted that recommendation and ordered Glen Coal to pay for Seals’s bronchodilator treatment only. Id. Glen Coal refused, arguing that the record contained no justification for bronchodilator therapy and that Seals’s most recent x-ray had been negative for pneumoconiosis. Id. The DOL forwarded the case to the Office of Administrative Law Judges on May 18, 1989.

Administrative Law Judge (ALJ) Clement J. Kichuk heard the case on November 6, 1991. Glen Coal submitted the opinion of Dr. Abdulkader Dahhan, who had examined Seals and reviewed his medical records, and Dr. Ben V. Branscomb, who had also reviewed Seals’s medical records. Seals submitted the opinion of his treating physician, Dr. G.S. Kanwal. The DOL submitted the opinion of Dr. Bernard P. McQuillan, who reviewed the bills from two of Seals’s doctor visits.

On June 2, 1992, the ALJ issued a decision ordering Glen Coal to pay for both the bronchodilators and the antibiotics.

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77 F. App'x 878, Counsel Stack Legal Research, https://law.counselstack.com/opinion/glen-coal-co-v-director-office-of-workers-compensation-programs-ca6-2003.