Black lung benefits given to widows as a result of Affordable Care Act

RICHMOND – The widows of two coal miners will be receiving benefits under the Black Lung Benefits Act after a federal appeals court affirmed the award of benefits by the Department of Labor Benefits Review Board.

The U.S. Court of Appeals for the Fourth Circuit issued its decision on the consolidated appeal on July 5. Judge Albert Diaz wrote the opinion and was joined by judges Paul V. Niemeyer and Andre M. Davis.

Representing petitioner Union Carbide Corporation were Kathy Lynn Snyder and Amy Jo Holley of Jackson Kelly's Morgantown office.

In addition to lifetime disability benefits for coal miners, the Black Lung Benefits Act provides survivors’ benefits to certain of their dependents. Over the years, the statute has been amended numerous times.

In 2010, the Patient Protection and Affordable Care Act reinstated automatic survivors’ benefits in certain situations. Resultantly, survivors whose claims fell in a prescribed time window would no longer need to show the miner’s death was caused by pneumoconiosis but only that the miner was eligible to receive BLBA benefits at the time of his death.

Arlie C. Richards worked as a coal miner for more than 30 years, and Union Carbide paid the BLBA benefits that he began receiving in 1987 until his death in January 1994. Virginia Richards, Arlie Richards’ widow, filed a claim for survivors’ benefits in February 1994 and the protracted claim was finally denied on May 6, 2006, because she failed to prove her husband’s death was due in part to pneumoconiosis.

Virginia Richards filed a subsequent claim in May 2009. After the claim was denied, she requested a hearing before an administrative law judge and while that request was pending, Congress enacted the Affordable Care Act. The ALJ acknowledged the change in the law and issued a summary decision awarding benefits to Virginia Richards, since her husband had been receiving benefits at the time of his death.

Union Carbide appealed to the Benefits Review Board, arguing that the subsequent claim was barred by statute and by principles of res judicata. In January 2012, the en banc board issued a split decision affirming the award of benefits.

The opinion states that the board made four principle determinations:

First, it held that the plain text of Section 932(l), as amended by Section 1556, authorizes its application to subsequent claims. Second, it held that Mrs. Richards had demonstrated a change in a condition of entitlement unrelated to her husband’s physical condition, thus satisfying Section 725.309(d)(3). Third, the Board concluded that res judicata did not bar Mrs. Richards’s subsequent claim because a determination of entitlement under Section 932(l) did not require relitigation of the prior finding that Mr. Richards’s death was unrelated to pneumoconiosis. Finally, the board modified the benefit accrual date, clarifying that benefits for successful subsequent claims are payable from the month following the prior denial.

Don Morgan filed a claim for lifetime disability benefits in 1987, after working as a coal miner for 19 years. Like the Richardses’ claim, there were protracted proceedings and his 1991 award was finally affirmed by the Fourth Circuit in 2004. Don Morgan died months before that decision.

In May 2004, Mary Ellen Morgan, Don Morgan’s widow, filed a claim for survivors’ benefits. Although the district director initially approved her claim, an ALJ denied benefits after ruling that she had not proved that Don Morgan’s death was due to pneumoconiosis. Mary Ellen Morgan appealed but the Benefits Review Board affirmed her denial.

After Congress amended the BLBA via the Affordable Care Act, Mary Ellen Morgan filed a second, subsequent claim and, as he did in the Richards case, the director moved for a summary decision awarding benefits. The ALJ granted the motion and Peabody Coal Company, Don Morgan’s former employer, appealed to the Board arguing that the claim was barred by res judicata. The Board, relying on its decision in Richards, affirmed the award.

Union Carbide Corporation and Peabody Coal Company appealed the respective awards to the Fourth Circuit which consolidated the appeals.

“The central issue before us is whether, in light of the ACA amendments to Section 932(l) of the BLBA, a final decision denying benefits on a prior claim bars a survivor from receiving benefits through a subsequent claim,” Diaz wrote.

The coal companies argued that the widows were ineligible for automatic derivative survivors’ benefits under the amended ACA. They argued that the amendment does not expressly authorize departure from the traditional principles of res judicata so the widow’s previously denied claims should have precluded them from bringing subsequent claims under the amended Act.

The change in the law, the companies argued, does not negate the preclusive effect of the denied claims particularly because the record evidence remained unchanged since the denial of the widow’s initial claims.

The widows argued that the amendment to the act did not merely change the process by which survivors could prove their entitlement, but it created a previously unavailable cause of action. Res judicata was inappropriate because the subsequent claims relied on facts different from the initial claims, they asserted.

They pointed out that the initial claims turned on whether their husbands had died from pneumoconiosis while this fact was irrelevant to the subsequent claims which were only concerned with whether the miners were eligible to receive benefits at the time of their deaths.

“Like Respondents,” Diaz wrote, “we recognize that the record evidence has not changed since the denial of the original claims and that the only relevant change is one of law. Nevertheless, we conclude that the instant subsequent claims arise from operative facts that are separate and distinct from those underlying Respondents’ initial claims, and therefore constitute new causes of action.

“Whereas Respondents’ initial claims turned on whether the deceased miners died due to pneumoconiosis, these subsequent claims concern only whether the miners were determined to be eligible to receive black lung benefits at the time of their deaths - an entirely unrelated factual issue.

"Meanwhile, the statutory change in law provides a previously unavailable basis for relief that justifies the instant claims, since res judicata does not bar claims that the parties have not had a ‘full and fair opportunity to litigate.’”

“Under the plain language of Section 1556 and principles of res judicata, Mrs. Richards and Mrs. Morgan are entitled to survivors’ benefits. In compliance with Section 1556(c)’s time limitations, Respondents filed their instant subsequent claims after January 1, 2005, and their claims were pending on and after March 23, 2010.

“Meanwhile, res judicata does not bar their claims, since Section 1556 created a new cause of action not available to them at the time they brought their initial claims. Respondents are therefore entitled to automatic derivative benefits under 30 U.S.C. § 932(l), and we accordingly deny Union Carbide’s and Peabody’s petitions for review.”