Doris Coal Co. v. Director, Office of Workers' Compensation Programs, U.S. Dept. of Labor

• Decision Date: 05 August 1991
• Docket Number: No. 90-2737,90-2737
• Citation: 938 F.2d 492
• Parties: DORIS COAL COMPANY; Old Republic Insurance Company, Petitioners, v. DIRECTOR, OFFICE OF WORKERS' COMPENSATION PROGRAMS, UNITED STATES DEPARTMENT OF LABOR; Noah Stiltner, Respondents.
• Court: U.S. Court of Appeals — Fourth Circuit

Page 492

938 F.2d 492

DORIS COAL COMPANY; Old Republic Insurance Company, Petitioners, v. DIRECTOR, OFFICE OF WORKERS' COMPENSATION PROGRAMS, UNITED

STATES DEPARTMENT OF LABOR; Noah Stiltner, Respondents.

No. 90-2737.

United States Court of Appeals,

Fourth Circuit.

Argued April 10, 1991.

Decided July 3, 1991.

As Amended Aug. 5, 1991.

Mark Elliott Solomons, Arter & Hadden, Washington, D.C., for petitioners.

Eileen Mary McCarthy, argued, Office of Sol., U.S. Dept. of Labor, Washington, D.C., for respondents; Robert P. Davis, Sol. of Labor, Donald S. Shire, Associate Sol., Barbara J. Johnson, Counsel for Appellate Litigation, Office of Sol., U.S. Dept. of Labor, Washington, D.C., on brief, for respondent Director; Vernon M. Williams, Wolfe & Farmer, Norton, Va., on brief, for respondent Stiltner.

Before RUSSELL, Circuit Judge, CHAPMAN, Senior Circuit Judge, and WILLIAMS, District Judge for the Eastern District of Virginia, sitting by designation.

OPINION

CHAPMAN, Senior Circuit Judge:

Appellants Doris Coal Company and Old Republic Insurance Company appeal the decision of the Benefits Review Board (the "Board") of the United States Department of Labor ("DOL") awarding certain health care benefits under the Black Lung Benefits Act to claimant-appellee Noah Stiltner. We affirm in part and reverse in part, and we remand for further proceedings consistent with this opinion.

I.

Stiltner, born in 1925, worked as a coal miner for Doris Coal for 32 years until he became disabled in 1971 at the age of 46. Prior to 1973 Stiltner filed a claim for benefits with the Social Security Administration under part B of the Black Lung Benefits Act ("the Act") and began receiving regular compensation from the Social Security Administration. Part B benefits are monthly cash benefits paid by the federal government to eligible claimants and do not involve the DOL or mine operators such as appellants. However, part B benefits do not include any health care benefits, which were provided for in part C.

In 1978, Congress amended part C to allow part B miner-beneficiaries to apply for medical benefits under part C. 30 U.S.C. Secs. 931-945. This aspect of the Act, which is administered by the DOL, established a temporary employer-funded federal workers' compensation program to provide benefits in cooperation with the states for total disability or death due to pneumoconiosis. To set up the structure for the private funding, the amendment incorporated substantial parts of the Longshoremen's and Harbor Worker's Compensation Act ("LHWCA"). 33 U.S.C. Secs. 901-948. The LHWCA provides that the responsible employer or its insurance carrier must pay the cost of medical care needed by the worker as a result of any occupationally related injury or disease that is otherwise compensable. 33 U.S.C. Sec. 907. Thus, part C was implemented to require employers to reimburse disabled miners for medical expenses incurred in the treatment of work related pneumoconiosis.

Stiltner filed his part C claim in 1979. The appellants were notified of this claim in March of 1982. Five days later, the appellants agreed to pay the cost of black lung related health care costs that Stiltner had already incurred and would incur throughout his lifetime. The DOL deputy commissioner then issued an uncontested award of benefits to Stiltner requiring appellants to pay all necessary medical expenses incurred in the treatment of his pneumoconiosis. Appellants then began providing benefits, paying out over $22,000 from 1982 to 1986.

Sometime during the mid-1980s, Stiltner began going to a Dr. Modi for treatment for his breathing problems. Dr. Modi submitted bills to appellants for treatment, each time listing pulmonary disease as the condition being treated. On seventeen of these bills, Modi noted that the condition treated was not related to Stiltner's employment. Nine of the seventeen billings also included treatment for non-respiratory ailments ranging from hiatal hernia to heart disease. The other eight billings were for some type of respiratory ailment. Stiltner also submitted bills for drugs prescribed by Dr. Modi for testosterone (for impotence), valium, antibiotics, heart medications, antacids, and other drugs to treat gastrointestinal and urinary tract disorders. Appellants did not believe that these treatment and prescription bills related to Stiltner's pneumoconiosis and refused to pay them.

Modi notified DOL of appellants' refusal to pay the bills. At the same time, appellants attempted to exercise their right to have Stiltner examined by their doctor. The DOL rejected appellants' request and ordered appellants to pay the disputed bills. Appellants then requested a hearing before an Administrative Law Judge ("ALJ"). The ALJ granted appellants' request for a medical exam, and appellants submitted two medical reports on Stiltner by a Dr. Sutherland ¹ to the ALJ. Dr. Sutherland's reports indicated that Stiltner had early stage simple pneumoconiosis, but that most of Modi's treatment bills were not for treatment of this disorder.

Although neither Stiltner nor Modi presented any contradictory evidence, the ALJ rejected Sutherland's reports, since the DOL had found in 1982 that Stiltner was totally disabled by his pneumoconiosis rather than other causes. The ALJ rejected appellants' argument that Stiltner's pulmonary disorders were caused by something other than his pneumoconiosis. The ALJ also rejected appellants' request to limit Stiltner's recovery to medical expenses for pulmonary disorders and to deny recovery for the additional but non-related treatment that Modi had included on nine of the seventeen bills in dispute. The ALJ found that it would be impractical "to attempt to separate the number of minutes the doctor spent treating each condition for each hospital or office visit." Since Modi had indicated that he treated Stiltner's pulmonary ailment each time he saw Stiltner, the ALJ concluded that all of Modi's treatments were made as a result of Stiltner's pneumoconiosis. Accordingly, the ALJ ordered appellants to pay all of Dr. Modi's treatment bills. The ALJ also ordered appellants to pay all of the prescription bills relating to the treatment of pulmonary disease and acute bronchitis; however, he denied recovery for the drugs prescribed for non-pulmonary disorders. ²

Appellants then appealed to the Board, arguing that there was no evidence in the record that all of Dr. Modi's treatments were related to the treatment of pneumoconiosis. Three members of the Board found that the ALJ did not err in concluding that it was impractical to require the physician to indicate which treatment was related to the lung disorder. The Board based this finding on the liberal intent of the Act to provide medical benefits to claimants. Two members of the Board dissented. Both members believed that the record did not support the ALJ's decision that the medical bills arose from treatment for the pneumoconiosis. Appellants now appeal the majority's decision.

II.

A claimant is entitled to medical benefits under part C of the Act to pay the cost of medical treatment incurred as a result of his pneumoconiosis. See 20 C.F.R. Sec. 725.701(b). To qualify for these benefits, a claimant must prove (1) that the mine operator should be held generally responsible for the miner's pneumoconiosis and (2) that the particular expense incurred was necessary to treat the miner's pneumoconiosis.

A mine operator is responsible for the miner's pneumoconiosis if either (1) it is determined in an adjudication that the miner is totally disabled due to pneumoconiosis, and is, therefore, entitled to benefits under the Act, or (2) the mine operator voluntarily agrees to pay the cost of such treatment by conceding the miner's general eligibility. Lute v. Split Vein Coal Co., 11 Black Lung Rep. (MB) 1-82, 1-84 (1987). In this case, Old Republic voluntarily agreed to pay for treating Stiltner's pneumoconiosis in 1982. Therefore, the only issue in this case is whether Stiltner met his burden of proof in establishing that the medical bills submitted by Dr. Modi were for the reasonable treatment of his pneumoconiosis.

Appellants argue that they should not have to pay for any of the seventeen billings submitted by Dr. Modi because Modi's notes indicated that the treatment was not "related to the patient's employment" and because Dr. Sutherland's reports establish that Stiltner's pneumoconiosis had not advanced to the point which would require such extensive treatment. Appellants further argue that, even if they are liable for the treatment of the pulmonary disorders, they should not have to pay for the other medical charges which Modi included on nine of the bills but which concerned unrelated health problems. For the reasons explained below, we affirm the ALJ's finding that appellants cannot challenge Stiltner's expenses...