Surprise, Surprise: KY Republicans Rig Black Lung Diagnosis System, Use Company MDs To Cut Claims
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In order to be awarded benefits for black lung in Kentucky, a miner or a family member of a miner applies for benefits with the state’s Labor Cabinet. The application includes a blood gas analysis indicating breathing impairment, and an X-ray demonstrating that the impairment is caused at least in part by black lung disease. Pulmonologists typically perform the blood gas study, and radiologists typically diagnose the disease by reading the X-ray. Once the claim is filed, the miner’s most recent employer’s insurance company can request to have an X-ray read by a physician of their choosing, and the judge overseeing the case can require a third reading from a “designated evaluator,” whose analysis is presumed to be correct unless there is overwhelming evidence to the contrary.
In 2018 Kentucky lawmakers overhauled many aspects of the state’s workers’ compensation system in legislation known as House Bill 2. One provision of that bill prevented radiologists, whose expertise is in analyzing X-rays, from serving as designated evaluators in state claims, and said only certain pulmonologists could serve in that role. Only two pulmonologists in the state opted to serve in the new system: Dr. Bruce Broudy and Dr. Byron Westerfield. Both have reputations for being more sympathetic to industry. The designated evaluator who read Stanley’s X-ray, Dr. Broudy of the Lexington Clinic, disagreed with the three other physicians involved in Stanley’s case. Dr. Broudy said the miner had a simpler form of the disease, and would therefore be entitled to less money.
“Unfortunately, that’s not uncommon in these cases,” said Tom Moak, a Prestonsburg attorney representing Stanley in his benefits case. “Somebody like Dr. Broudy, who has a history of working for coal companies, generally is considered more conservative. He almost always finds that somebody doesn’t have any black lung, or has one of the lower levels of black lung.” Data from Kentucky’s Department of Workers’ Claims showed that taken together, Drs. Broudy and Westerfield disagreed with the initial diagnosis in 85.5 percent of cases they examined. Both pulmonologists declined to be interviewed for this story. Dr. Broudy told Moak in a recent deposition that in his 40 years of work in black lung cases, 90 to 95 percent of the time he had been working for coal companies or their insurance firms.
The changes to state law have not resulted in a backlog of cases, as opponents had feared. But state records indicate that the restrictions have had an impact on the share of miners who win their claims. The ReSource found that 161 benefits claims were filed but only 16 coal miners were awarded black lung benefits in 2019. That’s the lowest ratio of claims awarded to claims dismissed in the past seven years. (It is important to note, though, that not all claims are resolved in the same calendar year in which they’re filed.)
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https://ohiovalleyresource.org/2020/02/21/black-lung-benefits-drop-for-kentucky-coal-miners-after-controversial-law-change/?fbclid=IwAR0fut6E8jqZUwNsu81i_WllerH0mk5IIvtFrAqTjab6wkOKiHYYAuFEZ3s
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