SSR 71-30: SECTIONS 413(a), 413(b), AND 422(d), FEDERAL COAL MINE HEALTH AND SAFETY ACT OF 1969; SECTIONS 223(a), 223(b), and 224(a), SOCIAL SECURITY ACT -- DISABILITY INSURANCE BENEFITS -- BLACK LUNG BENEFITS -- MONTHLY PAYMENT PERIOD

20 CFR 410.501

SSR 71-30

The Federal Coal Mine Health and Safety Act of 1969 (Public Law 91-173)

provides cash benefits for coal miners who are totally disabled due to

pneumoconiosis (black lung disease), and for widows of coal miners who

were receiving cash benefits under this Act or who died from the disease.

The black lung benefit provisions in title IV, Part B of such Act have

been held to constitute "periodic benefits" under a Federal workmen's

compensation law within the meaning of section 224 (such as to require a

reduction of the worker's disability insurance benefits of the Social

Security Act. Social Security Ruling 70-39, C.B. 1970, p. 90.

Federal workmen's compensation statutes (after which Part B of P.L.

91-173 is modeled in some respects), are administered in such a way that

the initial payments are computed on a weekly, daily, or even an hourly

basis. However, there is nothing in the Federal Coal Mine Health and

Safety Act or in its legislative history to indicate that such a

construction is either necessary or intended for black lung benefit

purposes.

Advice has been requested as to the periodic payment scheme for black

lung payments and the rationale in support of such payment schedule,

whether daily, weekly, or monthly.

Section 413(b) of the Federal Coal Mine Health and Safety Act of 2969

provides, in pertinent part, that:

Section 223 of the Social Security Act provides that qualified claimants

"shall be entitled to a disability insurance benefit for each month

beginning with the first month" in which all requirements are met.

Therefore, section 413(b), supra, may be said at least

inferentially to suggest monthly payments. However, to "utilize the ...

procedures" used in "determining entitlement" under section 223 is one

thing; to incorporate the entitlement factors and payment procedures

contemplated by section 223 is quite another

ach month

beginning with the first month" in which all requirements are met.

Therefore, section 413(b), supra, may be said at least

inferentially to suggest monthly payments. However, to "utilize the ...

procedures" used in "determining entitlement" under section 223 is one

thing; to incorporate the entitlement factors and payment procedures

contemplated by section 223 is quite another. Thus, an accurate

construction of section 413(b) cannot be derived from the simple reading

of its text, nor can the section be said to incorporate other sections of

the Social Security Act merely because they deal with various kinds of

"procedures." The procedures contemplated therein are those for

"determining entitlement" to disability insurance benefits alone and do

not provide a substantial legal foundation for monthly payments.

Nevertheless, the reference in section 413(b) to the "procedures" of

section 223 of the Act is some evidence that the Congress contemplated (at

least with respect to such factors as the right to, and duration of,

benefit payments) a general scheme of administration like that of the

Social Security Act. No provision of P.L. 91-173 specifically directs or

requires payment on other than a monthly basis.

The following legal authority reasonably contemplates payment on a

monthly basis. Section 412(a) of the Act states that:

Similarly, section 412(b) provides that:

In addition, section 422(d), a provision concerning the payment of

benefits under Part C of title IV of the Act (which is to be administered

by the Department of Labor after 1972), provides that:

Since section 412(a) authorizes payment of Part B benefits, section

422(d) raises an additional, and very strong, inference that coal miner's

benefits were intended to be paid monthly.

des that:

In addition, section 422(d), a provision concerning the payment of

benefits under Part C of title IV of the Act (which is to be administered

by the Department of Labor after 1972), provides that:

Since section 412(a) authorizes payment of Part B benefits, section

422(d) raises an additional, and very strong, inference that coal miner's

benefits were intended to be paid monthly.

Finally sections 426(a) and 508 both confer upon the Secretary of Health,

Education, and Welfare broad power to promulgate regulations to implement

the provisions of the Act and in the absence of express statutory

provisions, this authority undoubtedly extends to prescribing payment

periods.

Distinct, but related, issues concern payments in the first and last

months of entitlement, i.e., months in which the factors of entitlement

are met for only part of the month. Important administrative and policy

considerations, in addition to the statutory foundations indicated above,

favor paying a full month's benefit for the first month in which all

factors of entitlement are met and no benefit for the month in which a

pertinent factor of entitlement (e.g., disability of a miner, unremarried

status of a widow) ceases to exist. This is so, especially with respect to

nonpayment for the month in which a requirement for entitlement ceases to

exist.

The concept of entitlement to payment beginning with the entire month of

filing and ending with the month prior to the month in which the

termination event occurs not only is actuarially sound and presents an

equitable treatment of claimants' interest, but administratively is

preferable to pro-rated initial payment, pro-rated months of adjustments

in benefits, and pro-rated termination of payment.

t of entitlement to payment beginning with the entire month of

filing and ending with the month prior to the month in which the

termination event occurs not only is actuarially sound and presents an

equitable treatment of claimants' interest, but administratively is

preferable to pro-rated initial payment, pro-rated months of adjustments

in benefits, and pro-rated termination of payment.

This approach parallels that provided for payments under title II of the

Social Security Act and utilizes the advantage of existing payment

mechanisms and procedural economies which were anticipated by Congress in

assigning the administration of the black lung benefit program to the

Social Security Administration. Inferential support is also evident from

section 413(b) in the reference of that section to the "procedures" of

section 223 of the Social Security Act. For instance, section 223(a)(1)(D)

of the Act provides that entitlement to disability insurance benefits

shall end" . . . with the month preceding the month in which [the

beneficiary] dies. . . ."

A further consideration in the payment of monthly benefits is the

guidance derived from the absence in P.L. 91-173 of any provision with

respect to the disposition of underpayments. If benefits were payable for

all or part of the month in which the miner's or widow's death occurred,

there would, in nearly all cases, be an underpayment for that month. With

the absence of a provision (like that provided in section 204(d) of the

Social Security Act) which would facilitate payment of such underpayments,

the Administration could not receive "good acquittance" for an

underpayment of benefits except by payment to the legal representative of

the deceased beneficiary's estate.

ere would, in nearly all cases, be an underpayment for that month. With

the absence of a provision (like that provided in section 204(d) of the

Social Security Act) which would facilitate payment of such underpayments,

the Administration could not receive "good acquittance" for an

underpayment of benefits except by payment to the legal representative of

the deceased beneficiary's estate.

Accordingly, the absence of any "facility of payment" provision with

respect to underpayments, the absence of any clear direction in the

statute to pay for the month of death, and the analogy drawn by the

statute itself to section 223 of the Social Security Act, could, when

taken together, be considered a statutory direction with respect to the

issue of "nonentitlement" for the month of death. However, the most

abrasive effects of such a policy are reduced by the payment of a full

month's benefit for the first month of entitlement. Additionally, while a

miner would receive no benefit for the month of death (any such benefit

could be payable only to a legal representative), his widow could receive

a full month's benefit for that month in her own right.

In addition to the foregoing considerations, the effective date of an

application for the pertinent benefits must be established. Guidance for

this requirement (section 414(c) of P.L. 91-173) appears somewhat

ambiguous, in stating:

If the antecedent to "a claim therefor" is the word "benefits," i.e., a

claim for benefits, no benefits could be paid prior to the date of filing.

If, however, the antecedent of the words "a claim therefor" is the word

"period," i.e., a claim for a period of entitlement, then, within the

context of a program providing for monthly payments, with an application

requirement but with no provision for retroactivity, a "claim" becomes a

claim for a period of entitlement. Since the word "period" is not

expressly defined by statute, its definition as a calendar month is not

precluded

im therefor" is the word

"period," i.e., a claim for a period of entitlement, then, within the

context of a program providing for monthly payments, with an application

requirement but with no provision for retroactivity, a "claim" becomes a

claim for a period of entitlement. Since the word "period" is not

expressly defined by statute, its definition as a calendar month is not

precluded. Thus, a claim filed by a qualified individual at any time

within a monthly period would entitle that individual to the benefits for

the full period, i.e., the entire calendar month.

As indicated above, the Federal Coal Mine Health and Safety Act of 1969

contains many indications that the Congress intended a monthly payment

procedure. The Secretary of Health, Education, and Welfare has broad

powers to administer the Act in a manner to make that administration as

efficient as possible. This negates any inference that administratively

onerous limitations should be implied where none are clearly expressed in

the statute. Further, since the Act is remedial in nature, it should be

given a liberal construction in order to effectuate its purpose.

Accordingly, it is held that black lung benefit payments may be

made on a monthly basis upon the filing of a claim for payment by a

qualified individual at any time within a payment period, such claim

entitling the individual to a full month's payment, regardless of the date

within the month on which the claim is filed; but no payment is required

for any month or part thereof in which a terminating event occurs.