Why It Matters
Coal miners who have developed black lung disease face a fractured system for getting the benefits they need. A recent GAO report published in May reveals that the Department of Labor does not monitor whether coal companies are actually providing the medical benefits they are legally required to cover.
About 22,500 beneficiaries, including miners, survivors, and dependents, received over $153 million in benefits in fiscal year 2025. Yet miners in all six of GAO's focus groups reported challenges with black lung-related medical benefits, and two groups specifically noted difficulty obtaining medical coverage from the coal companies responsible for providing it.
The Big Picture
The Department of Labor administers the Black Lung Benefits Program, which provides income and medical benefits to coal miners who are totally disabled due to black lung disease. In calendar year 2024, there were 7,709 miner beneficiaries receiving federal black lung benefits. The population is aging: 93 percent of miner beneficiaries in 2024 were age 62 or older, while 7 percent were under age 62.
Eighty-seven percent of miner beneficiaries received only federal black lung benefits for their disability. Among younger miners, those under 62, nearly one-fourth received only federal black lung benefit payments, averaging $13,400 annually in 2024.
Yet GAO found that DOL does not monitor responsible operators' provision of medical benefits and does not collect information on whether companies are meeting this obligation. The agency uses timeliness performance measures for claims examiners on parts of the claims process it controls, but has no comparable monitoring system for responsible operators' provision of medical benefits.
GAO conducted six focus groups with 64 miners who had applied for federal black lung benefits in Kentucky, Pennsylvania, Virginia, and West Virginia. These four states had the largest numbers of federal Black Lung Benefits Program beneficiaries, according to DOL data used by GAO. GAO cautioned that the focus-group findings represent the experiences of participating miners and cannot be generalized to other miners in those states or elsewhere.
Broader Context
Four Democratic U.S. senators, John Hickenlooper (D-CO), John Fetterman (D-PA), Tim Kaine (D-VA), and Mark R. Warner (D-VA), requested the GAO study in March 2023 to inform policy aimed at helping coal miners and their families in Appalachia. Their interest came amid a broader legislative push to strengthen black lung benefits. Kaine, Warner, and Fetterman, along with Reps. Morgan McGarvey (D-KY) and Bobby Scott (D-VA), reintroduced the Black Lung Benefits Improvement Act to strengthen miners' access to the program.
The federal system processes claims relatively quickly in its initial stages. Based on GAO's analysis of closed claims from January 2013 to August 2024, the median time for DOL to issue an initial decision was 0.7 years. Forty percent of approved Black Lung Benefits Program claims were appealed.
The Bottom Line
GAO makes one recommendation in its report: that DOL collect information on and monitor responsible operators' provision of medical benefits. GAO said this could include soliciting miners' feedback through the agency's existing customer experience survey. The Department of Labor agreed with the recommendation.
DOL stated it plans to update its customer experience surveys to include questions about medical benefits provided by responsible operators, and that claimants will have the opportunity to provide their contact information to allow DOL to conduct follow-up as needed. The agency also stated it will use survey results to guide any additional actions needed regarding responsible operators' provision of medical benefits.
The recommendation's status is currently Open, meaning DOL has agreed with the recommendation and identified actions it plans to take, but GAO continues to monitor the agency's progress.
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