HD2 - A Study of Coal Workers' Pneumoconiosis Under the Virginia Workers' Compensation Act

  • Published: 1993
  • Author: Virginia Workers' Compensation Commission
  • Enabling Authority: House Joint Resolution 249 (Regular Session, 1992)

Executive Summary:
House Joint Resolution 249 of the 1992 session of the Virginia General Assembly requested the Workers' Compensation Commission to study coal workers' pneumoconiosis cases reviewed in 1990 and 1991 to determine the reason for denial of claims.

The Virginia Workers' Commission examined 639 claims processed in 1990 and 1991. Approximately 20 percent of all claims were accepted by agreement or were the subject of compromise settlements. A total of 525 claims were the subject of hearings. Of these 8 percent were denied due to procedural reasons such as lack of jurisdiction. Approximately 92 percent were denied because x-ray evidence failed to meet the minimum standard for compensability.

A significant number of claims filed and referred to the Commission hearing docket were filed by miners for the sole purpose of protecting their right to future compensation benefits. Before July 1, 1992, the Virginia Workers' Compensation Act required an employee who received a diagnosis of pneumoconiosis to file for benefits within the period required by statute, regardless of whether the level of pneumoconiosis was compensable. The General Assembly amended Code § 65.2-406 as of July 1, 1992 to require filing only when x-rays established the presence of the minimum compensable level of coal workers' pneumoconiosis.

The Commission has established an independent Pulmonary Committee composed of physicians specializing in pulmonary disease and radiology to act as a tie-breaker when x-ray evidence is in dispute. These specialists, certified by the National Institute of Occupational Safety and Health and known as "B" readers, consider disputed x-rays by comparing them with standard radiographs. A three-physician consensus determines whether the x-ray evidence meets the necessary standard. After a technical medical decision from the Pulmonary Committee is communicated to the Commission, the Commission determines compensability under the Pneumoconiosis Guide.

Differences between the opinions of employees' and employers' medical experts are basically subjective. The Commission believes that the system it has formulated to resolve subjective differences of opinion through the Pulmonary Committee is the most scientific means to provide fair and unbiased analysis of x-rays and obtain reliable resolution of claims.