725.535

Federal Register / Vol. 65, No. 245 / Wednesday, December 20, 2000 / Rules and Regulations
claimant, shall be paid by the operator
or carrier immediately when they
become due (see § 725.502(b)). An
operator that fails to pay any benefits
that are due, with interest, shall be
considered in default with respect to
those benefits, and the provisions of
§ 725.605 of this part shall be
applicable. In addition, a claimant who
does not receive any benefits within 10
days of the date they become due is
entitled to additional compensation
equal to twenty percent of those benefits
(see § 725.607). Arrangements for the
payment of medical costs shall be made
by such operator or carrier in
accordance with the provisions of
subpart J of this part.
(b) Benefit payments made by an
operator or carrier shall be made
directly to the person entitled thereto or
a representative payee if authorized by
the district director. The payment of a
claimant’s attorney’s fee, if any is
awarded, shall be made directly to such
attorney. Reimbursement of the fund,
including interest, shall be paid directly
to the Secretary on behalf of the fund.
§ 725.531

Receipt for payment.

Any individual receiving benefits
under the Act in his or her own right,
or as a representative payee, or as the
duly appointed agent for the estate of a
deceased beneficiary, shall execute
receipts for benefits paid by any
operator which shall be produced by
such operator for inspection whenever
the district director requires. A canceled
check shall be considered adequate
receipt of payment for purposes of this
section. No operator or carrier shall be
required to retain receipts for payments
made for more than 5 years after the
date on which such receipt was
executed.
§ 725.532 Suspension, reduction, or
termination of payments.

(a) No suspension, reduction, or
termination in the payment of benefits
is permitted unless authorized by the
district director, administrative law
judge, Board, or court. No suspension,
reduction, or termination shall be
authorized except upon the occurrence
of an event which terminates a
claimant’s eligibility for benefits (see
subpart B of this part) or as is otherwise
provided in subpart C of this part,
§§ 725.306 and 725.310, or this subpart
(see also §§ 725.533 through 725.546).
(b) Any unauthorized suspension in
the payment of benefits by an operator
or carrier shall be treated as provided in
subpart I.
(c) Unless suspension, reduction, or
termination of benefits payments is
required by an administrative law judge,

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the Benefits Review Board or a court,
the district director, after receiving
notification of the occurrence of an
event that would require the
suspension, reduction, or termination of
benefits, shall follow the procedures for
the determination of claims set forth in
subparts E and F.
Increases and Reductions of Benefits
§ 725.533 Modification of benefits
amounts; general.

(a) Under certain circumstances, the
amount of monthly benefits as
computed in § 725.520 or lump-sum
award (§ 725.521) shall be modified to
determine the amount actually to be
paid to a beneficiary. With respect to
any benefits payable for all periods of
eligibility after January 1, 1974, a
reduction of the amount of benefits
payable shall be required on account of:
(1) Any compensation or benefits
received under any State workers’
compensation law because of death or
partial or total disability due to
pneumoconiosis; or
(2) Any compensation or benefits
received under or pursuant to any
Federal law including part B of title IV
of the Act because of death or partial or
total disability due to pneumoconiosis;
or
(3) In the case of benefits to a parent,
brother, or sister as a result of a claim
filed at any time or benefits payable on
a miner’s claim which was filed on or
after January 1, 1982, the excess
earnings from wages and from net
earnings from self-employment (see
§ 410.530 of this title) of such parent,
brother, sister, or miner, respectively; or
(4) The fact that a claim for benefits
from an additional beneficiary is filed,
or that such claim is effective for a
payment during the month of filing, or
a dependent qualifies under this part for
an augmentation portion of a benefit of
a miner or widow for a period in which
another dependent has previously
qualified for an augmentation.
(b) An adjustment in a beneficiary’s
monthly benefit may be required
because an overpayment or
underpayment has been made to such
beneficiary (see §§ 725.540–725.546).
(c) A suspension of a beneficiary’s
monthly benefits may be required when
the Office has information indicating
that reductions on account of excess
earnings may reasonably be expected.
(d) Monthly benefit rates are payable
in multiples of 10 cents. Any monthly
benefit rate which, after the applicable
computations, augmentations, and
reductions is not a multiple of 10 cents,
is increased to the next higher multiple
of 10 cents. Since a fraction of a cent is

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80089

not a multiple of 10 cents, a benefit rate
which contains such a fraction in the
third decimal is raised to the next
higher multiple of 10 cents.
(e) Any individual entitled to a
benefit, who is aware of any
circumstances which could affect
entitlement to benefits, eligibility for
payment, or the amount of benefits, or
result in the termination, suspension, or
reduction of benefits, shall promptly
report these circumstances to the Office.
The Office may at any time require an
individual receiving, or claiming
entitlement to, benefits, either on his or
her own behalf or on behalf of another,
to submit a written statement giving
pertinent information bearing upon the
issue of whether or not an event has
occurred which would cause such
benefit to be terminated, or which
would subject such benefit to reductions
or suspension under the provisions of
the Act. The failure of an individual to
submit any such report or statement,
properly executed, to the Office shall
subject such benefit to reductions,
suspension, or termination as the case
may be.
§ 725.534

Reduction of State benefits.

No benefits under section 415 of part
B of title IV of the Act shall be payable
to the residents of a State which, after
December 31, 1969, reduces the benefits
payable to persons eligible to receive
benefits under section 415 of the Act
under State laws applicable to its
general work force with regard to
workers’ compensation (including
compensation for occupational disease),
unemployment compensation, or
disability insurance benefits which are
funded in whole or in part out of
employer contributions.
§ 725.535 Reductions; receipt of State or
Federal benefit.

(a) As used in this section the term
‘‘State or Federal benefit’’ means a
payment to an individual on account of
total or partial disability or death due to
pneumoconiosis only under State or
Federal laws relating to workers’
compensation. With respect to a claim
for which benefits are payable for any
month between July 1 and December 31,
1973, ‘‘State benefit’’ means a payment
to a beneficiary made on account of
disability or death due to
pneumoconiosis under State laws
relating to workers’ compensation
(including compensation for
occupational disease), unemployment
compensation, or disability insurance.
(b) Benefit payments to a beneficiary
for any month are reduced (but not
below zero) by an amount equal to any
payments of State or Federal benefits

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Federal Register / Vol. 65, No. 245 / Wednesday, December 20, 2000 / Rules and Regulations

received by such beneficiary for such
month.
(c) Where a State or Federal benefit is
paid periodically but not monthly, or in
a lump sum as a commutation of or a
substitution for periodic benefits, the
reduction under this section is made at
such time or times and in such amounts
as the Office determines will
approximate as nearly as practicable the
reduction required under paragraph (b)
of this section. In making such a
determination, a weekly State or Federal
benefit is multiplied by 41⁄3 and a
biweekly benefit is multiplied by 21⁄6 to
ascertain the monthly equivalent for
reduction purposes.
(d) Amounts paid or incurred or to be
incurred by the individual for medical,
legal, or related expenses in connection
with this claim for State or Federal
benefits (defined in paragraph (a) of this
section) are excluded in computing the
reduction under paragraph (b) of this
section, to the extent that they are
consistent with State or Federal Law.
Such medical, legal, or related expenses
may be evidenced by the State or
Federal benefit awards, compromise
agreement, or court order in the State or
Federal benefit proceedings, or by such
other evidence as the Office may
require. Such other evidence may
consist of:
(1) A detailed statement by the
individual’s attorney, physician, or the
employer’s insurance carrier; or
(2) Bills, receipts, or canceled checks;
or
(3) Other evidence indicating the
amount of such expenses; or
(4) Any combination of the foregoing
evidence from which the amount of
such expenses may be determinable.
Such expenses shall not be excluded
unless established by evidence as
required by the Office.
§ 725.536

Reductions; excess earnings.

In the case of a surviving parent,
brother, or sister, whose claim was filed
at any time, or of a miner whose claim
was filed on or after January 1, 1982,
benefit payments are reduced as
appropriate by an amount equal to the
deduction which would be made with
respect to excess earnings under the
provisions of sections 203 (b), (f), (g),
(h), (j), and (l) of the Social Security Act
(42 U.S.C. 403 (b), (f), (g), (h), (j), and
(l)), as if such benefit payments were
benefits payable under section 202 of
the Social Security Act (42 U.S.C. 402)
(see §§ 404.428 through 404.456 of this
title).

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§ 725.537 Reductions; retroactive effect of
an additional claim for benefits.

Except as provided in § 725.212(b),
beginning with the month in which a
person other than a miner files a claim
and becomes entitled to benefits, the
benefits of other persons entitled to
benefits with respect to the same miner,
are adjusted downward, if necessary, so
that no more than the permissible
amount of benefits (the maximum
amount for the number of beneficiaries
involved) will be paid.
§ 725.538 Reductions; effect of
augmentation of benefits based on
subsequent qualification of individual.

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More than one reduction event.

If a reduction for receipt of State or
Federal benefits and a reduction on
account of excess earnings are
chargeable to the same month, the
benefit for such month is first reduced
(but not below zero) by the amount of
the State or Federal benefits, and the
remainder of the benefit for such month,
if any, is then reduced (but not below
zero) by the amount of excess earnings
chargeable to such month.
Overpayments; Underpayments
§ 725.540

(a) Ordinarily, a written request that
the benefits of a miner or surviving
spouse be augmented on account of a
qualified dependent is made as part of
the claim for benefits. However, it may
also be made thereafter.
(b) In the latter case, beginning with
the month in which such a request is
filed on account of a particular
dependent and in which such
dependent qualifies for augmentation
purposes under this part, the augmented
benefits attributable to other qualified
dependents (with respect to the same
miner or surviving spouse), if any, are
adjusted downward, if necessary, so that
the permissible amount of augmented
benefits (the maximum amount for the
number of dependents involved) will
not be exceeded.
(c) Where, based on the entitlement to
benefits of a miner or surviving spouse,
a dependent would have qualified for
augmentation purposes for a prior
month of such miner’s or surviving
spouse’s entitlement had such request
been filed in such prior month, such
request is effective for such prior month.
For any month before the month of
filing such request, however, otherwise
correct benefits previously certified by
the Office may not be changed. Rather
the amount of the augmented benefit
attributable to the dependent filing such
request in the later month is reduced for
each month of the retroactive period to
the extent that may be necessary. This
means that for each month of the
retroactive period, the amount payable
to the dependent filing the later
augmentation request is the difference,
if any, between:
(1) The total amount of augmented
benefits certified for payment for other
dependents for that month, and
(2) The permissible amount of
augmented benefits (the maximum
amount for the number of dependents
involved) payable for the month for all
dependents, including the dependent
filing later.

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§ 725.539

Overpayments.

(a) General. As used in this subpart,
the term ‘‘overpayment’’ includes:
(1) Payment where no amount is
payable under this part;
(2) Payment in excess of the amount
payable under this part;
(3) A payment under this part which
has not been reduced by the amounts
required by the Act (see § 725.533);
(4) A payment under this part made
to a resident of a State whose residents
are not entitled to benefits (see
§§ 725.402 and 725.403);
(5) Payment resulting from failure to
terminate benefits to an individual no
longer entitled thereto;
(6) Duplicate benefits paid to a
claimant on account of concurrent
eligibility under this part and parts 410
or 727 (see § 725.4(d)) of this title or as
provided in § 725.309.
(b) Overpaid beneficiary is living. If
the beneficiary to whom an
overpayment was made is living at the
time of a determination of such
overpayment, is entitled to benefits at
the time of the overpayment, or at any
time thereafter becomes so entitled, no
benefit for any month is payable to such
individual, except as provided in
paragraph (c) of this section, until an
amount equal to the amount of the
overpayment has been withheld or
refunded.
(c) Adjustment by withholding part of
a monthly benefit. Adjustment under
paragraph (b) of this section may be
effected by withholding a part of the
monthly benefit payable to a beneficiary
where it is determined that:
(1) Withholding the full amount each
month would deprive the beneficiary of
income required for ordinary and
necessary living expenses;
(2) The overpayment was not caused
by the beneficiary’s intentionally false
statement or representation, or willful
concealment of, or deliberate failure to
furnish, material information; and
(3) Recoupment can be effected in an
amount of not less than $ 10 a month
and at a rate which would not
unreasonably extend the period of
adjustment.

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