Zurich Am. Ins. Grp. v. Duncan Ex Rel. Duncan

889 F.3d 293
Court of Appeals for the Sixth Circuit·Decided May 3, 2018·No. 17-3625·Published·Cited by 14 cases

Opinion

KAREN NELSON MOORE, Circuit Judge.

Raymond Duncan, a veteran of the U.S. Air Force, was born in 1947 and was a long-term resident of Middlesboro, Kentucky. He worked in the coal-mining industry for over twenty years and developed severe respiratory issues. Raymond filed a claim for benefits under the Black Lung Benefits Act, but he died while his claim was still pending. Raymond's claim was consolidated with a claim for survivor's benefits submitted by his widow, Joanna Duncan. The administrative law judge ("ALJ") awarded benefits to Joanna, on both Raymond's behalf and as his surviving spouse. The Benefits Review Board ("Board") affirmed. Zurich American Insurance Group ("Zurich American"), the insurer of Straight Creek Coal Resources, now petitions this court to review the award. For the following reasons, we DENY its petition.

I. BACKGROUND

A. Statutory and Legal Framework

The Black Lung Benefits Act ("BLBA"), 30 U.S.C. § 901 et seq. , provides benefits to coal miners who are totally disabled due to pneumoconiosis caused by prolonged exposure to coal dust. Pneumoconiosis, commonly called black lung disease, 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). The BLBA's implementing regulations recognize two forms of pneumoconiosis : clinical and legal. Brandywine Explosives & Supply v. Dir., Office of Workers' Comp. Programs , 790 F.3d 657 , 661 (6th Cir. 2015). Clinical pneumoconiosis"consists of those diseases recognized by the medical community as pneumoconioses,"

*297 20 C.F.R. § 718.201 (a)(1), whereas legal pneumoconiosis"includes any chronic lung disease or impairment and its sequelae arising out of coal mine employment," 20 C.F.R. § 718.201 (a)(2). Federal regulations also recognize that pneumoconiosis-clinical and legal-is a "latent and progressive disease which may first become detectable only after the cessation of coal mine dust exposure." 20 C.F.R. § 718.201 (c) ; Sunny Ridge Mining Co. v. Keathley , 773 F.3d 734 , 739 (6th Cir. 2014).

To establish entitlement to benefits under the BLBA, a person must show that (1) he or she is a miner (2) who suffers from pneumoconiosis (3) arising out of coal mine employment, which (4) contributes to (5) his or her total disability. 20 C.F.R. § 725.202 (d) ; Big Branch Res., Inc. v. Ogle , 737 F.3d 1063 , 1069 (6th Cir. 2013). If a miner was employed for at least fifteen years in "one or more underground coal mines," or "in a coal mine other than an underground mine" with "substantially similar" conditions to that of an underground mine, and "demonstrates the existence of a totally disabling respiratory or pulmonary impairment, then there shall be a rebuttable presumption that such miner is totally disabled due to pneumoconiosis, that his death was due to pneumoconiosis, or that at the time of his death he was totally disabled by pneumoconiosis." 1 30 U.S.C. § 921 (c)(4). "Thus, after a showing that the miner (1) was employed for at least fifteen years in underground coal mines [or in coal mines with "substantially similar" conditions] and (2) is totally disabled due to a respiratory or pulmonary impairment, then the rest of the elements outlined in 20 C.F.R. § 725.202 (d) are presumed and the burden shifts to the employer to rebut them." Ogle , 737 F.3d at 1069 . The employer may rebut the fifteen-year presumption by establishing that: "(1) the miner has neither clinical nor legal pneumoconiosis, or (2) the miner's respiratory or pulmonary impairment did not arise out of, or in connection with, employment in a coal mine." Cent. Ohio Coal Co. v. Dir., Office of Workers' Comp. Programs , 762 F.3d 483 , 487 (6th Cir. 2014) ; 30 U.S.C. § 921 (c)(4).

B. Factual History

Raymond began working as an electrician in a strip mine in 1974, and worked in coal mines in a variety of occupations until 1999-except for a period between January 1992 and August 1993. Pet'r App'x at A105 (Emp't Hist. at 1).

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Zurich Am. Ins. Grp. v. Duncan Ex Rel. Duncan, 889 F.3d 293 (6th Cir. 2018).

889 F.3d 293 (Zurich Am. Ins. Grp. v. Duncan Ex Rel. Duncan) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

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