U.S. Department of Laborer's Claim for Benefits Interoffice of Workers' Compensation Programs Black Lung Benefits ActResetPrintI hereby claim all benefits which may be payable to me under the Black.
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How to fill out the DOL CM-911 online
Filling out the DOL CM-911 form online is an essential step for miners seeking benefits under the Black Lung Benefits Act. This comprehensive guide provides clear, step-by-step instructions to assist users in completing the form accurately and efficiently.
Follow the steps to fill out the DOL CM-911 online.
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- Begin by entering the miner's full name in the designated field; ensure this is the legal name used for identification purposes.
- Input the miner's Social Security Number in the required format. Note that providing this number is voluntary, but it may assist in processing the claim.
- Fill in the miner's date of birth, specifying the month, day, and year, which helps establish the miner's eligibility.
- Indicate the highest grade of education completed by the miner. This information can be relevant for determining the miner's background.
- Answer whether the miner or someone on their behalf has previously filed a claim for Federal Black Lung benefits. Indicate 'Yes' or 'No' as appropriate.
- If the answer to the previous question is 'Yes,' provide details about the decision made regarding that claim in the remarks section.
- State whether the miner is currently employed in or around coal mines. Depending on the answer, you may be prompted to provide additional information.
- Document the date the miner stopped working in or around coal mines and the state where this occurred. This includes noting the last day of coal mine employment.
- Describe the reasons for stopping work in the coal mines or a coal preparation facility, including any transfers to lighter duties.
- Specify the total number of years the miner has worked in coal mines or related facilities to assess their experience.
- Provide a brief description of any disabilities believed to be linked to pneumoconiosis or other respiratory conditions resulting from coal mine employment.
- Complete the section regarding any state or Federal Workers’ Compensation claims related to the miner's disability, providing as much detail as possible.
- List the names and addresses of employers from the previous calendar year, along with earnings information and the duration of employment.
- Indicate dependent information, including marital status and details regarding any children, addressing their ages and circumstances.
- In the remarks section, provide any additional information necessary regarding the claims, circumstances, or any follow-up required.
- Confirm the understanding of the importance of promptly reporting any changes that could affect the benefits claimed.
- Finalize the form by signing it, including the date and the miner's mailing address, and optionally provide contact details such as telephone number and email address.
- After completing the form, save changes, then you can download, print, or share the completed document as necessary.
Complete your DOL CM-911 form online today to ensure a smoother claims process.
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Get answers to your most pressing questions about US Legal Forms API.
How do you win black lung benefits?
The most important part of applying for Black Lung benefits is obtaining medical evidence about your physical condition. The Black Lung benefits program has limitations on the amount of medical evidence which you and the coal company may give us for determining whether you are entitled to benefits.
Can you get black lung benefits and Social Security?
Over 75 percent of all those awarded miners' black lung benefits are also receiving social security disability, re- tirement, or survivor benefits. Generally speak- ing, this means the black lung beneficiary gets both types of benefits in full.
How long does it take to get Black Lung benefits?
Filing the initial claim with the U.S. Department of Labor takes about a year, during which the individual visits an agency-approved doctor and the coal company can submit evidence to challenge the claim. After that, either side can ask for a hearing before a judge, which Smith says takes between two and four years.
Does a surviving spouse get Black Lung benefits?
(SURVIVOR) The Black Lung Benefits Act provides monthly benefits to eligible surviving family members of coal miners whose deaths were due to black lung disease, or "pneumoconiosis." The Act also provides monthly benefits to survivors of miners who were entitled to benefits based on their own lifetime claims.
Does Black Lung pay back pay?
However, many miners and their families have been subjected to drawn out legal challenges after being awarded black lung benefits. Frequently, these benefits are appealed by employers and, if the benefit determination is overturned, recipients must pay employers back any benefit money they have received.
How long does it take to get black lung benefits after?
There are many steps involved and each of them takes time, so it can be years before a miner or his widow receives benefits. There are state claims and federal claims. Stone Mountain assists miners with federal claims and refers miners and their families to attorneys for the state process.
How much does federal black lung pay per month?
Division of Coal Mine Workers' Compensation (DCMWC) ClaimBenefit RatePrimary beneficiary$737.90Primary beneficiary and one dependent$1,106.90Primary beneficiary and two dependents$1,291.30Primary beneficiary and three or more dependents$1,475.80
Who qualifies for Black Lung benefits?
The Black Lung benefit program established by the Federal Coal Mine Health and Safety Act of 1969 provides monthly benefit payments to coal miners totally disabled as a result of pneumoconiosis, to the widows of coal miners who died as a result of pneumoconiosis, and to their dependents.
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