20 CFR 725.701 and 725.705 BLBA

BLBA: 20 CFR § 725.701 - Availability of medical benefits.
(a) A miner who is determined to be eligible for benefits under this part or part 727 of this subchapter
(see § 725.4(d)) is entitled to medical benefits as set forth in this subpart as of the date of his or her
claim, but in no event before January 1, 1974. No medical benefits shall be provided to the survivor or
dependent of a miner under this part.
(b) A responsible operator, other employer, or where there is neither, the fund, shall furnish a miner
entitled to benefits under this part with such medical, surgical, and other attendance and treatment,
nursing and hospital services, medicine and apparatus, and any other medical service or supply, for such
periods as the nature of the miner's pneumoconiosis and disability requires.
(c) The medical benefits referred to in paragraphs (a) and (b) of this section shall include palliative
measures useful only to prevent pain or discomfort associated with the miner's pneumoconiosis or
attendant disability.
(d) The costs recoverable under this subpart shall include the reasonable cost of travel necessary for
medical treatment (to be determined in accordance with prevailing United States government mileage
rates) and the reasonable documented cost to the miner or medical provider incurred in communicating
with the employer, carrier, or district director on matters connected with medical benefits.
(e) If a miner receives a medical service or supply, as described in this section, for any pulmonary
disorder, there shall be a rebuttable presumption that the disorder is caused or aggravated by the
miner's pneumoconiosis. The party liable for the payment of benefits may rebut the presumption by
producing credible evidence that the medical service or supply provided was for a pulmonary disorder
apart from those previously associated with the miner's disability, or was beyond that necessary to
effectively treat a covered disorder, or was not for a pulmonary disorder at all.
(f) Evidence that the miner does not have pneumoconiosis or is not totally disabled by pneumoconiosis
arising out of coal mine employment is insufficient to defeat a request for coverage of any medical
service or supply under this subpart. In determining whether the treatment is compensable, the opinion
of the miner's treating physician may be entitled to controlling weight pursuant to §718.104(d). A
finding that a medical service or supply is not covered under this subpart shall not otherwise affect the
miner's entitlement to benefits.
BLBA: 20 CFR § 725.705 – Arrangements for medical care.
(a) Operator liability. If an operator has been determined liable for the payment of benefits to a miner,
the Office shall notify such operator or insurer of the names, addresses, and telephone numbers of the
authorized providers of medical benefits chosen by an entitled miner, and shall require the operator or
insurer to:

(1) Notify the miner and the providers chosen that such operator will be responsible for the cost
of medical services provided to the miner on account of the miner's total disability due to
pneumoconiosis;
(2) Designate a person or persons with decisionmaking authority with whom the Office, the
miner and authorized providers may communicate on matters involving medical benefits provided
under this subpart and notify the Office, miner and providers of such designation;
(3) Make arrangements for the direct reimbursement of providers for their services.
(b) Fund liability. If there is no operator found liable for the payment of benefits, the Office shall make
necessary arrangements to provide medical care to the miner, notify the miner and medical care facility
selected of the liability of the fund, designate a person or persons with whom the miner or provider may
communicate on matters relating to medical care, and make arrangements for the direct
reimbursement of the medical provider.