New York Workers Compensation

Transcription

1 New York Workers Compensation New York Workers Compensation The Workers Compensation Law went into effect in New York on July 1, The law is administered by the NY State Workers Compensation Board and specifically spells out employer obligations, as well as who is covered by the law. Under the law, every employer must: Purchase workers compensation coverage from either a private insurer or the State Insurance Fund, Be self-insured for workers compensation; or, Be exempt from the requirement to provide workers compensation coverage. Exempt Businesses All employments, with only a very few exceptions, must carry workers compensation coverage for its employees. The only businesses exempt from this requirement are sole-proprietorships, partnerships, and one- or two-person corporations with no employees. Employer Benefits and Rights While WC insurance is generally seen as a benefit to employees, it also has significant advantages for employers. An employer who has workers' compensation coverage simply pays premiums, and that's it. They don't have to worry about unexpected costs that might arise from employee injuries. In the case of self-insurance, which we will discuss later, the employer pays benefits to any injured employees in accordance with the requirements of the law, but that is the limit of the employer's responsibility. The primary benefit of WC to employers, as we stated earlier, is that it is an "exclusive remedy," meaning that an injured employee covered by WC may not sue her employer for further damages. Employers also have certain rights under the Workers Compensation Law. An employer may contest its employee s WC claim when it believes the injury did not occur at work or that it is not as serious as the employee claims. Also, an employer may access the Board s electronic case files for WC claims filed by its employees and attend any hearings related to those claims. Who is Covered? Under the Workers Compensation Law, almost all employers are required to provide some form of workers compensation coverage for their employees. By law, the following types of employees are eligible for WC coverage: Employees of all for-profit employers, including part-time employees, family members, and volunteers Employees of counties and municipalities engaged in work defined by law as hazardous Public school teachers, excluding those employed by New York City Public school aides, including those employed by New York City Employees, and some volunteers, of the State of New York Domestic workers employed 40 hours or more by the same employer, including full-time sitters, companions, and live-in maids Farm workers whose employer paid $1,200 or more for farm labor in the previous calendar year 1

2 Any other worker determined by the NY State Workers Compensation Board to be an employee and not specifically excluded from coverage under the law All corporate officers of corporations with more than two officers and/or two stockholders Officers of one- or two-person corporations if they employ other individuals; however, these officers may exclude themselves from coverage. Most paid employees of not-for-profit organizations Who Is NOT Covered? Even though the list of covered employees may seem exhaustive, there are still many people who are not covered by the WC law, including: Volunteers of non-profit organizations Clergy and members of religious orders Teachers in non-profit religious, charitable or educational institutions Amateur athletes participating in activities operated on a non-profit basis Maritime trade employees, federal railroad employees, federal government employees, and others covered by federal WC laws Spouses or minor children of farmers New York City police officers, firefighters, and sanitation workers Certain real estate salespeople who have signed a contract with a broker which states the salesperson is an independent contractor People doing yard work or casual chores; however, coverage is required if a minor employee handles power-driven machinery, such as a lawnmower. Obtaining Insurance Coverage As we mentioned earlier, employers may obtain WC insurance in a few ways purchase from a private insurance carrier, purchase from the State Insurance Fund, or become self-insured. Private Insurance There are hundreds of privately-owned insurance companies to choose from in the state of New York. These insurers may have their own underwriting guidelines, discounts, and incentive programs. Also, not every insurer may provide WC insurance for all types of employment industries, so employers wanting to purchase a policy through a private insurer may need to do some research to find an insurer that best meets their needs. State Insurance Fund - The New York State Insurance Fund (NYSIF) is a competitive, not-for-profit insurance carrier that sells only workers compensation and disability benefits insurance. Coverage is available to any employer in New York State. This can be a very affordable option for employers. By law, workers compensation premiums offered by NYSIF must be fixed at the lowest possible cost sufficient to maintain the solvency of the Fund. Additionally, the State Insurance Fund offers employers in certain industries the opportunity to join a Safety Group Plan, where employers receive discounts and dividends based on the safety performance of the group. These plans are designed for employers in the same industry who make efforts to reduce workrelated injuries and illnesses, thus reducing insurance costs. Self-Insurance In a self-insured company, the employer, rather than an insurance carrier, pays for an injured employee s medical expenses and indemnity benefits. Claims are handled by the employer, an attorney, or a licensed representative of the employer. 2

3 If an employer chooses to self-insure, it must apply to the Board s Office of Self Insurance. Part of this application process includes providing a security deposit, such as cash, securities, or a surety bond. This security deposit is set aside to cover employee claims should the self-insured employer default on its obligation to provide benefits. In addition to the security deposit, an insurer must also complete an application and supply proof of its financial ability to pay claims. Group Self Insurance Sometimes, an employer may not be big enough to be able to self-insure on its own, but may still be able to reap the cost-saving benefits of self-insurance by joining a group self-insured trust. In group self-insurance, employers engaged in similar industries pool their assets and workers compensation claims, thus spreading the costs among the whole group. Similar to a single self-insurer, employer groups must file an application with the Board s Office of Self- Insurance. Requirements for approval include: At least two group members must be employers is a similar industry Aggregate net worth of group must be at least $1 million Have a combined payroll of at least $500,000 What Does Workers Compensation Insurance Cover? As we already mentioned, workers compensation provides important benefits for employees who suffer injuries at work and need coverage for damages, medical bills, and lost wages. It is important to note that employees do not contribute to the cost of this coverage it is the responsibility of the employer to pay for it. Employees are entitled to benefits if, while they are at work and engaging in their work duties, they suffer an accidental injury or occupational disease. An injury or illness that is purely mental, such as work-related stress, is not covered if the mental injury resulted from a lawful personnel decision, such as a legitimate disciplinary action, performance evaluation, job transfer, or termination. All injuries must arise out of and in the course of employment to be compensable. However, no benefits will be paid if the employee was injured due to intoxication from drugs or alcohol, or if the employee intentionally injured himself or another employee, even while in the course of covered employment. Additionally, an employee will not receive benefits if she is injured in voluntary, off-duty activities, unless the employer required her participation and provided compensation. Workers compensation benefits are normally only paid to an employee. However, should the employee suffer a grave injury under covered, work-related circumstances, benefits may also be paid to a related third party, such as a spouse. Grave injuries are especially severe, such as death, loss of a limb or member of the body, paraplegia or quadriplegia, blindness, deafness, facial disfigurement, or an acquired brain injury resulting in permanent total disability. Occupational Illness and Disease Some jobs involve an inherent risk of occupational disease. This is not the same thing as a work-related accident. Generally, an employee can receive benefits for disability due to occupational disease if it was caused by a condition to which the employment significantly contributed, or if the employment was a significant factor in causing the disease s development, and if the employment exposed the worker to a greater risk of contracting the disease. An occupational illness or disease may develop over time, so employees are given up to two years to file a claim for occupational disease. This two-year time limit starts either at the time of disability or death, or at the time when the claimant should have reasonably been able to determine that the disease was employment-related. 3

4 General or Punitive Damages General damages for pain and suffering, and punitive damages for employer negligence, are usually not available in workers compensation plans. Benefits Provided There are four major categories of benefits offered under the Workers Compensation Law: medical benefits, income benefits, death benefits, and rehabilitation benefits. Let s take a look at each of these. Medical Benefits - These benefits pay for all medical expenses that an employee has due to a work-related injury. They cover all the medical care that an injured worker requires, from a qualified doctor or surgeon, nurse, or hospital. There is no dollar limit to medical benefits. Income Benefits - These pay the employee a portion of the wages lost as the result of a work-related injury. Regardless of whether the injury is temporary or permanent, income benefits provide 66 2/3% of the insured s lost wages for the entire duration of the disability. This amount is subject to weekly minimum and maximum limits. Injured employees must wait seven days before income benefits will begin, and if the disability continues for two weeks or more, the employee is eligible to receive retroactive benefits from the start of the disability. Death Benefits - The third type of employee benefits under workers' compensation are death benefits. These benefits go to an employee s dependents if the employee dies from an injury or disease arising out of his employment. Death benefits pay 66 ⅔% of the deceased employee s average weekly wage to the employee s spouse and/or children, subject to a maximum dollar amount. The surviving spouse may receive this benefit for life or until remarriage. A spouse who remarries is paid a two-year lump sum of benefits. Surviving children are eligible to receive benefits until they turn 18, or until they turn 23 if they remain in school full-time. The death benefit may also pay funeral expenses up to $6,000 in Metropolitan New York counties, and up to $5,000 in all others. Rehabilitation Benefits - The fourth type of workers compensation benefits are rehabilitation benefits. These are paid for services that aid in the employee s recovery and ability to return to some form of gainful employment. Outline of a Workers Compensation Policy A Workers Compensation policy does not have a lot of parts, and it is fairly easy to get to know. Information Page (aka Declarations Page ) Similar to the Declarations Page found on other insurance policies, this introductory page simply lists the employer, address, and other basic information, including premium. General Section In this section, you will find the policy s general definitions and conditions. Part One: Workers Compensation Part one of a workers' compensation policy really does no more than agree to all benefits required by that particular state s workers compensation law due to a work-related injury. There is no limit to the amount of coverage other than the benefits required by law. For example, if the law says that an injured employee gets disability and medical benefit for the rest of their life, that s exactly what it means, and there is no limit except that which the law may otherwise provide. Part Two: Employers Liability Since workers' compensation insurance is an "exclusive remedy," it usually shields employers from lawsuits due to on-the-job injuries. However, there are some situations in which the employee can sue. This is where Employers Liability coverage comes in. 4

5 Employers Liability, which is Part Two of a workers compensation policy, covers the insured when employees claim injuries that are not subject to workers' compensation law, such as injuries caused by the employer's negligence; claims by others for damages caused by the insured's employees; and claims by an injured employee's relatives for consequential damages. The Employers Liability section does exclude coverage in certain circumstances, however. For instance, no coverage is provided for liability losses when the employer takes on such liability under contract. The policy also excludes coverage for employee injuries and punitive damages when the worker is employed unlawfully. Finally, employee injuries that the employer intentionally causes or aggravates are also excluded. This coverage usually has a minimum limit of $100,000 per accident and may also contain a per employee limit and an overall limit for total claims. Part Three: Other States - Part Three of the Workers Comp Policy contains Other States coverage conditions, in order to give employees the broadest coverage possible while taking into account the various ways workers earn their living. Coverage may be provided for accidents occurring in other states not specifically listed on the policy Information Page or in Part One. However, the employer must notify the insurer as soon work starts in another state (as it will affect the employer s premium). Part Four: Your Duties if Injury Occurs - The next section of a WC policy outlines the obligations of the employer in the event of an accident. When an employee suffers a work-related injury, the employer is required by law to make sure that the employee receives immediate medical care. The employer must also report the injury to the insurer right away and then cooperate with the investigation, settlement, and/or defense of the claim, making sure to provide the insurer with all notices and legal papers related to the case. It is important that the employer not make any payments or assume any obligations unless he does so at his own cost, and never interfere with the insurer s right to recover losses from others. At the same time, all ethical requirements that apply to the insurer and adjuster also apply to the employer. It is essential in any claim situation for all parties to conduct themselves in a responsible and ethical manner. Honesty and integrity are necessary in order to achieve a fair negotiation and settlement. Part Five: Premiums - Premiums that an employer pays for a workers compensation policy are largely based on risk classifications. This topic is beyond the scope of this course, so we will not spend any time on it. Additional Premium Impactors - Other factors can also affect the premium, such as the employer s history of loss, because this history can indicate the likelihood of future losses. An employer s history of losses is compared to that of other companies in the same industry and then this comparison is used to either increase or decrease the manual rate. Finally, an additional fee, or assessment, is added to the cost of each WC policy. The purpose of this assessment is to fund the Workers Compensation Board, Special Fund for Disability Benefits, and Uninsured Employers Fund. By law, the Workers Compensation Board is not funded by state taxes, so it levies assessments on insurance carriers and self-insurers to cover its administrative costs. The insurers then pass this cost on to insureds in the form of increased premiums. Independent Contractors Independent contractors sometimes file WC claims stating that they are employees, even though they are not. Insurance companies may charge higher premiums for employers that use independent contractors, in order to protect themselves from excess losses not otherwise expected. Audits Insurance companies can audit an employer and its policy usually once every three years. Here the insurer secures copies of the company s financial information, including the amount of payroll paid 5

6 during the period, in order to determine the amount of premium that should be paid vs. that which was paid. Sometimes an employer may have to pay an additional premium, and sometimes (although it s rare that this works out), the employer may receive a refund, or credit against future premiums. Following an audit where additional premium is owed, or refunded, the insurer will adjust the premiums (up or down) for future payment. Part Six: Conditions - Workers compensation policies include conditions that outline the rights of the insurer. For instance, the insurer has the right to inspect the workplace, safety manuals and procedures, and other administrative policies at any time. Also, the insured cannot transfer any of its rights or duties without the written consent of the insurer. The conditions section also explains how the policy can be cancelled by either party. Lastly, it requires the first named insured that is, the employer to act on behalf of all insureds with respect to any policy transactions. Selected Endorsements Some of the most common endorsements to a Workers Compensation policy include: Voluntary Compensation Endorsement This endorsement adds voluntary compensation insurance to the standard workers compensation policy and provides coverage that may be excluded under the Workers Compensation Law. When added to a policy, this endorsement obligates the insurer to provide coverage for employees that may otherwise be exempt from coverage under the Workers Compensation Law, such as part-time domestic employees and volunteers. Foreign Coverage Endorsement This endorsement adds WC coverage for employees that were hired in the United States and are temporarily working outside the US, its territories, or Canada for more than 90 days. It does not include coverage for any employees that were hired oversees. Policy Cancellation The Workers Compensation Law requires insurers to notify employers of policy cancellation within specific period of time. For cancellation due to non-payment of premiums, the employer must be notified by certified mail at least 10 days prior to the cancellation. If the policy is being cancelled for any other reason, the insured must notify both the employer and the Chairman of the Workers Compensation Board at least 30 days prior to the cancellation. If an employer receives cancellation notice for non-payment of premium and does not promptly pay the outstanding balance, the policy will not be reinstated, even if the premiums are eventually paid in full. An employer with a WC policy through the State Insurance Fund must provide the Fund with 30 days written notice before purchasing coverage from a different carrier. If either the insurer or the employer cancel a policy anytime other than the policy anniversary date, the insurer will charge a rate penalty based on the time the policy was in effect during the policy period, in addition to any premium due. Claim Reporting Requirements -When an accident happens, the employee should seek medical treatment and provide the employer with written notification of the accident as soon as possible, or within 30 days. The insurer will investigate the accident and may even contact the employee s health care provider to ensure the employee is receiving proper care. Throughout the claim process, the employer should remain in contact with the insurer and provide any additional necessary information. All written communications between the insurer, employer, and health care provider must also be provided to the injured employee and her legal representative, if applicable. Minor Injuries If an employee s injury is minor, the employer may choose to just pay for the first aid treatment without filing a WC claim. In this case, the employer would complete an Employer s First Report of Work-Related Injury/Illness form and keep on file for at least 18 months. This would be appropriate if the employee s injury only required one or two first aid treatments and less than a full day missed from work. 6

7 Reporting Injuries All other injuries must be reported to the Workers Compensation Board and to the insurer within 10 days of the accident. If the employer fails to report the injury within 10 days, it is subject to a misdemeanor and a fine up to $2,500. In this case, an employer would need to complete an Employer s First Report of Work-Related Injury/Illness and file it with Workers Compensation Board. An employer s statements on this form are binding, but it is not an admission that the employer agrees with facts presented by the employee. It is merely a statement that an employee reported a work-related injury or illness. The Timeline of a Claim Immediately As we mentioned earlier, an injured employee should immediately seek medical treatment and notify her employer within 30 days. The Board may excuse the lack of notice if notice cannot be provided, if the employer already knows about the accident, or if the employer is not harmed in any way by the lack of notice. Within 48 Hours of the Accident - The employer reports the injury to the Workers Compensation Board and the insurer. The doctor completes a preliminary medical report and sends it to the Board District Office, the employer or insurer, the injured employee and her legal representative, if applicable. Within 14 Days of the First Report of Injury The insurer provides the employee with a written statement of her rights. This may be within 14 days of receiving the form from the employer or within 14 days of sending the first check, whichever is earlier. Every Two Weeks The insurer sends benefit payments to the injured employee, as long as the case is not disputed. If the insurer stops making payments for any reason, it must notify the Board. Periodically The injured employee s doctor submits a progress report to the Board. Before 12 Weeks of Lost Work Time If the employee is still unable to return to work and still receiving benefits, the insurer considers whether it is necessary for the employee to receive rehabilitative treatment. Insurer s Responsibilities The insurer must decide to pay benefits or dispute the claim within 18 days from the date of the employee s disability, 10 days after the employer learns of the accident, or 10 days after receiving the claim form, whichever is greater. If the insurer agrees with the claim, it begins paying benefits if the injured employee has lost more than seven days of work and notifies all parties that payments have begun. If the employee has lost less than seven days of work and is not going to receive benefits, or if the employer is disputing the claim, the insurer must notify all parties. Hearings The Board will normally send a notice of hearing to the insurer or self-insured employer. The employer does not have to attend the hearing unless it receives a notice of hearing that requests the employer s attendance or if the insurer requests that the employer attend. Additional Workers Compensation Laws The Volunteer Firefighters and Volunteer Ambulance Workers Benefits Laws (VFAW Law) - In recognition of the selfless service of volunteer firefighters and volunteer ambulance workers, New York enacted the VFAW Law, which provides cash benefits and medical care for volunteers who suffer an injury or illness in the line of duty. The program is administered by the Workers Compensation Board, and the insurance coverage is paid for by each local political subdivision (county, city, town, etc). Volunteer members are not required to contribute to the cost of this coverage. Who is Covered? - Under the VFAW Law, all New York State volunteer firefighters are covered if they are actively volunteering members of a county, city, town, village, or fire district. Most New York State volunteer ambulance workers are covered if they are active members of a contracted ambulance company. However, ambulance companies that are not contracted by a county, city, town, village, or other political subdivision, may provide optional coverage for their volunteers. 7

8 In the Line of Duty Volunteer firefighters or ambulance workers benefit claims are generally considered no-fault. The amount of benefits paid are not influenced by any perceived negligence by either the volunteer member or the company. The only exception is that no benefits are paid if the volunteer member s injury was the result of his/her intoxication from drugs or alcohol, or resulted from the intent to injure himself/herself or another person. However, for benefits to apply, the injury or illness must occur in the line of duty. This term covers a wide range of work-related activities from responding to emergency calls to attending company meetings, maintaining company equipment to participation in fundraising activities. On the other hand, coverage is not provided for injuries that occur outside of the line of duty. Such activities include: Participation in recreational activities, other than noncompetitive fundraising events Work performed in the service of a private employer, public corporation, or special district Work performed while on leave or suspension from duty Work performed which the volunteer was instructed not to perform Competitive events in which the volunteer is a competitor (baseball, basketball, etc.) Cash Benefits - The amounts of cash benefit for total disability, scheduled loss, and death benefits are fixed under the law. For other types of injuries, the weekly cash benefit is determined by the volunteer member s loss of earning capacity based on the member s ability to perform work in his/her regular employment. There is no waiting period for benefit pay-out. Disability Classifications Permanent Total Disability This is the most severe class of disability and means the volunteer member has completely and permanently lost all capacity for earning. The maximum weekly benefit for this classification is $400. Temporary Total Disability In this class, the volunteer has completely lost the capacity for earning, but only temporarily. Temporary Partial Disability Here, the volunteer member has temporarily lost some capacity for earning, but not all. The amount the member receives is based on the percentage of lost earning capacity and the date on which injury occurred. If the member has lost 75% or more of the earning capacity, he/she receives the maximum weekly cash benefit, but if the member suffers 25% or less of lost earning capacity, he/she receives no cash benefit. Permanent Partial Disability In this class of disability, the volunteer member permanently loses part of the capacity for earning. The weekly benefit rates are structured the same was as that of Temporary Partial Disability. Scheduled Loss This class of disability is a subset of Permanent Partial Disability. It involves the loss of hearing, eyesight, or the loss of, or loss of use of, a part of the body. Benefits are limited to a set number of weeks based on the percentage of loss. Disfigurement A volunteer member who suffers a permanent and severe disfigurement to face, head, or neck may be entitled to a maximum benefit of $20,000. Medical care Necessary medical care is always paid, regardless of the length of disability. The volunteer member may choose any authorized medical professional from whom to seek care. The doctor is not allowed to collect payment from the patient. Instead, the costs are paid by either the political subdivision or the insurance carrier. However, if the claim is disputed, the doctor may require the patient to sign a form that guarantees the volunteer member will pay the medical bills if the claim is denied by the Workers Compensation Board. 8

9 Disability Benefits Coverage Law In New York, most employers are also required to provide disability coverage for their employees for injuries and illnesses that occur off-the-job. The Disability Benefits Law provides cash benefits to workers who suffer lost wages due to injuries or illnesses that occurred outside of their employment. Employers may collect employee contributions to offset the cost of providing this benefit, but it is not required. If the employer collects employee contributions, they normally equate to ½ of 1% of the employee s wages, not to exceed a total of 60 cents per week from all sources of employment. Under this law, such disability payments only include weekly cash benefits medical costs are not included. The benefits equal 50% of the employee s average weekly wage, but not more than the maximum weekly benefit of $170. Benefits may continue for a maximum of 26 weeks and start after a seven-day waiting period. Within five days of learning of the employee s disability, employers are required to supply the employee with a Statement of Rights Under the Disability Benefits Law. Who is Covered? - Under the Disability Benefits Law, most employees working for covered employers for at least four consecutive weeks are covered. An employer becomes covered four weeks after it has employed at least one person for 30 consecutive days in a calendar year. Additional covered employees include domestic employees who work at least 40 hours per week for one employer and employees of a non-covered employer who provides coverage voluntarily by filing an Application for Voluntary Coverage with the Workers Compensation Board. When an employee of a covered employer changes jobs to work for another covered employer, that employee is protected from day-one of the new job. If an employee of a covered employer loses her job, she is still protected for the first 26 weeks of unemployment as long as she is eligible for and claiming unemployment insurance benefits during that time. Who is Not Covered? - Not everyone is covered under the Disability Benefits Law. Those not covered include: An employer s minor child Daytime students in elementary or secondary school, who work part-time Golf caddies Government and railroad employees Maritime or farm laborers Clergy members People performing work for religious or charitable institutions who receive aid in return for their work Officers of one- or two-person corporations who own all the stock and have no employees Corporate officers, professionals, and teachers employed by a non-profit religious, charitable, or education institution, people receiving rehabilitation services from such an institution Federal Workers Compensation Laws Some exposures fall outside the area of state workers compensation benefits. In other words, there are some circumstances where WC doesn't apply, because the workers have protection under a different law. Federal Employee Compensation Act (FECA) -Certain workers in the federal government are covered by other programs than regular workers compensation. The Federal Employees Compensation Act, or FECA, provides insurance for civilian employees of the federal government. As with other WC programs, benefits are issued as a result of disability or death that is sustained while the employee is on the job. 9

10 FECA pays medical expenses and two-thirds of normal monthly salary while the injured employee is unable to work. Additional payments may be made for permanent injuries or to dependents. FECA also provides compensation for survivors if an employee is killed. The Federal Employers Liability Act (FELA) - was enacted in 1908, before most state workers comp laws. FELA only protects interstate railroad workers and their families, by allowing workers who are not covered by regular WC laws to sue their employers. Railroad workers have successfully held on to their rights under this act, as the awards in lawsuits tend to be several times greater than the benefits they might receive under workers' compensation. The Jones Act -The Jones Act, also known as the Merchant Marine Act of 1920, protects injured seamen by allowing them to sue their employers for damages and to choose a jury trial. Coverage falls under the Employers' Liability section of their business insurance, and insurers usually require a Maritime Coverage endorsement for these exposures. Employers who don't want to require seamen to sue for benefits may opt for the Voluntary Compensation Maritime Coverage endorsement, which provides workers' compensation benefits for injured seamen. Longshore and Harbor Workers Compensation Act - The Longshore and Harbor Workers' Compensation Act provides compensation and medical care to employees who are injured while on the job on navigable waters of the United States. This coverage also extends to areas that adjoin these waters, such as docks and machinery for loading and unloading, or for repairing or building ships, and provides compensation for disability or death. Covered employees receive two-thirds of their weekly salary for as long as the injury continues. Fifty percent pay is given to a surviving spouse and sixteen percent to any dependent children. As with state workers' comp programs, employers of workers who fall into this category must either purchase insurance from a licensed insurer or obtain the Department of Labor's permission to self-insure. Black Lung Benefits Act - The Black Lung Benefits Act provides monthly payments and medical treatment to coal miners who become totally disabled from Black Lung Disease. This is an example of when a disease is specifically linked to the occupation of an employee. These benefits are given to individuals who are employed in our nation's coal mines. Monthly benefits are also given to dependent survivors of the miner if it is determined that pneumoconiosis substantially contributed to the miner's death. Medical payments are limited to treatment of conditions directly related to black lung disease. Coal mine operators must secure coverage for their employees either by qualifying as a self-insurer, or by purchasing coverage through a private or state insurer. Claims can be filed by present and former coal miners as well as their dependents. Payments for these claims are the responsibility of the last coal mine operator for whom the miner worked for at least a oneyear period. Coal mine operators must begin paying benefits within 30 days of a determination of liability. 10