DECISION AND ORDER- DENYING IN PART AND GRANTING IN PART WAIVER OF OVERPAYMENT OF BENEFITS UNDER THE BLACK LUNG BENEFITS ACT
In the Matter of:
BILL H. RAMEY,
Claimant
v.
DIRECTOR, OFFICE OF WORKERS' COMPENSATION PROGRAMS,
Party-in-Interest
Appearances:
Andrew Delph, Esq. For the Claimant
Karen Barefield, Esq., For the Director
Before: RICHARD A. MORGAN Administrative Law Judge
This case arises from a claim for benefits under the “Black Lung Benefits Act,” Title IV of the Federal Coal Mine Health and Safety Act of 1969, as amended, 30 U.S.C. § 901, et seq. (“Act”), and applicable federal regulations, mainly 20 C.F.R. Parts 404 and 725. (“Regulations”).
Congress created a Black Lung Disability Trust Fund (“Trust Fund”) in order to provide claimants with interim benefit payments, i.e., where the operator liable for payments does not commence them within thirty days of the initial eligibility determination. 30 U.S.C. §§ 901-945; 9501(d). Here, the claimant was paid benefits, under the Act. Section 413(b) of the Act authorizes the Department of Labor to recover erroneous Trust Fund payments or “overpayments.” 30 U.S.C. § 923(b). The Director, Office of Workers’ Compensation Programs (“OWCP”)(“Director”) claims an overpayment was made because the claimant’s award of interim benefits was overturned on appeal. The claimant seeks waiver of the overpayment.
The claimant filed for black lung benefits on March 25, 2010. The District Director issued a Proposed Decision and Order awarding benefits on November 29, 2010. The employer objected to that finding and requested a formal hearing. The claimant was paid interim benefits by the Black Lung Disability Trust Fund. On July 12, 2012, an Administrative Law Judge issued a Decision and Order Denying Benefits. This denial of benefits was not appealed.
On October 10, 2012, the District Director notified the claimant of an overpayment in the amount of $26,021.44 which includes $12,050.56 in monthly benefits and $13, 970.88 in medical benefits. The District Director made a preliminary finding that the claimant was without fault. On December 7, 2012, the District Director denied waiver of overpayment, finding that the claimant had not shown either that recovery of the overpayment would defeat the purpose of the Act or that recovery would be against equity and good conscience. The claimant responded to the District Director’s initial determination by letter dated December 5, 2012, received by the U.S. Department of Labor on December 12, 2012, requesting a waiver of this overpayment, submitting an overpayment questionnaire and requesting an additional 90 days to submit receipts, bank statements and other supporting evidence pertaining to his request for a waiver of overpayment. By letter dated January 8, 2013. Claimant submitted financial information including bills, bank statements and other evidence.
On June 27, 2013, the District Director issued a “final determination” finding that the overpayment is now considered a debt due and owing to the Federal government which must be repaid. By letter dated July 3, 2013, the claimant, through his attorney requested a formal hearing and the case was referred to the Office of Administrative Law Judges. I was assigned the case on August 27, 2013. I conducted a formal hearing on August 20, 2015 in Charleston, West Virginia. Director’s Exhibits (“DX”) 1-12 and Claimant’s Exhibit (“CX”) 1 were admitted with no objections.
.....SEE ARTICLE FOR DETAILS
It is ordered that the claim for waiver of recovery of an overpayment in the amount of $26,021.44 is denied in part, and granted in part. Waiver of recovery is hereby DENIED in regard to the $12,050.56 in monthly benefits paid to the claimant. Waiver of the overpayment of $13,970.88 in medical benefits is hereby GRANTED, as recovery would be “against equity and good conscience.” The claimant must reimburse the Black Lung Trust Fund for the adjusted overpayment, in the amount of $12,050.56.
In the Matter of:
BILL H. RAMEY,
Claimant
v.
DIRECTOR, OFFICE OF WORKERS' COMPENSATION PROGRAMS,
Party-in-Interest
Appearances:
Andrew Delph, Esq. For the Claimant
Karen Barefield, Esq., For the Director
Before: RICHARD A. MORGAN Administrative Law Judge
This case arises from a claim for benefits under the “Black Lung Benefits Act,” Title IV of the Federal Coal Mine Health and Safety Act of 1969, as amended, 30 U.S.C. § 901, et seq. (“Act”), and applicable federal regulations, mainly 20 C.F.R. Parts 404 and 725. (“Regulations”).
Congress created a Black Lung Disability Trust Fund (“Trust Fund”) in order to provide claimants with interim benefit payments, i.e., where the operator liable for payments does not commence them within thirty days of the initial eligibility determination. 30 U.S.C. §§ 901-945; 9501(d). Here, the claimant was paid benefits, under the Act. Section 413(b) of the Act authorizes the Department of Labor to recover erroneous Trust Fund payments or “overpayments.” 30 U.S.C. § 923(b). The Director, Office of Workers’ Compensation Programs (“OWCP”)(“Director”) claims an overpayment was made because the claimant’s award of interim benefits was overturned on appeal. The claimant seeks waiver of the overpayment.
The claimant filed for black lung benefits on March 25, 2010. The District Director issued a Proposed Decision and Order awarding benefits on November 29, 2010. The employer objected to that finding and requested a formal hearing. The claimant was paid interim benefits by the Black Lung Disability Trust Fund. On July 12, 2012, an Administrative Law Judge issued a Decision and Order Denying Benefits. This denial of benefits was not appealed.
On October 10, 2012, the District Director notified the claimant of an overpayment in the amount of $26,021.44 which includes $12,050.56 in monthly benefits and $13, 970.88 in medical benefits. The District Director made a preliminary finding that the claimant was without fault. On December 7, 2012, the District Director denied waiver of overpayment, finding that the claimant had not shown either that recovery of the overpayment would defeat the purpose of the Act or that recovery would be against equity and good conscience. The claimant responded to the District Director’s initial determination by letter dated December 5, 2012, received by the U.S. Department of Labor on December 12, 2012, requesting a waiver of this overpayment, submitting an overpayment questionnaire and requesting an additional 90 days to submit receipts, bank statements and other supporting evidence pertaining to his request for a waiver of overpayment. By letter dated January 8, 2013. Claimant submitted financial information including bills, bank statements and other evidence.
On June 27, 2013, the District Director issued a “final determination” finding that the overpayment is now considered a debt due and owing to the Federal government which must be repaid. By letter dated July 3, 2013, the claimant, through his attorney requested a formal hearing and the case was referred to the Office of Administrative Law Judges. I was assigned the case on August 27, 2013. I conducted a formal hearing on August 20, 2015 in Charleston, West Virginia. Director’s Exhibits (“DX”) 1-12 and Claimant’s Exhibit (“CX”) 1 were admitted with no objections.
.....SEE ARTICLE FOR DETAILS
ORDER
It is ordered that the claim for waiver of recovery of an overpayment in the amount of $26,021.44 is denied in part, and granted in part. Waiver of recovery is hereby DENIED in regard to the $12,050.56 in monthly benefits paid to the claimant. Waiver of the overpayment of $13,970.88 in medical benefits is hereby GRANTED, as recovery would be “against equity and good conscience.” The claimant must reimburse the Black Lung Trust Fund for the adjusted overpayment, in the amount of $12,050.56.
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