What GAO Found

The Black Lung Benefits Program provides benefits (income and medical benefits) to coal miners who are totally disabled due to black lung disease. These miners may also receive other benefits, such as state workers' compensation payments, for their black lung disability. According to GAO's analysis, in 2024, there were 7,709 miner beneficiaries. Ninety-three percent of these miners were age 62 or older, and 87 percent received only federal black lung benefits for their disability. They may also have been eligible for Social Security retirement benefits. For the 7 percent who were under age 62, GAO found that most received additional benefits for their black lung disability. However, nearly one-fourth received only federal black lung benefit payments, which averaged $13,400 annually.

The Department of Labor (DOL) has taken some steps to address miners' challenges with federal black lung benefits. For example, to address lengthy claims, it uses timeliness performance measures for claims examiners on parts of the claim process that it controls. According to GAO's analysis of closed claims from 2013 to 2024, the median time for DOL to issue an initial decision was 0.7 years (see figure). Appealed claims took longer to close. Forty percent of approved claims were appealed. According to a DOL official, approved claims are generally appealed by responsible operators-the entities liable for claimants' benefits, such as coal mine operators.

Median Federal Black Lung Processing Time for Miner Claims, Jan. 2013-Aug. 2024

Miners in all six of GAO's focus groups reported challenges with black lung-related medical benefits, with two groups specifically noting difficulty obtaining coverage from responsible operators. DOL does not monitor responsible operators' provision of medical benefits. While DOL collects feedback from miners, it does not collect information on this topic. DOL officials said they regularly conduct surveys of miners and could add such a question to a survey. Without collecting information on and monitoring responsible operators' provision of medical benefits, DOL risks not achieving the mission of the program. As a result, miners might not receive the coverage of black lung-related medical expenses to which they are entitled.

Why GAO Did This Study

DOL is responsible for administering the Black Lung Benefits Program, by reviewing claim applications, issuing initial claim decisions, and administering benefits. About 22,500 beneficiaries, including miners, survivors, and dependents, received over $153 million in benefits in fiscal year 2025.

GAO was asked to review the federal and state benefits that miners and their families receive due to black lung disease. This report examines, among other things, (1) the benefits miners and their families receive for black lung disease and (2) the challenges miners and their families may have faced in obtaining federal black lung benefits and the steps DOL has taken to address these challenges.

GAO analyzed DOL benefits data for calendar year (CY) 2024, which included state workers' compensation benefits; Social Security Administration benefits data for February 2025; and DOL claims data for CY 2013-2024. GAO generated hypothetical benefits packages for miners. GAO conducted six focus groups with miners who had applied for federal black lung benefits in Kentucky, Pennsylvania, Virginia, and West Virginia. GAO interviewed miners, survivors, DOL officials, and black lung clinic representatives; and reviewed relevant federal laws, regulations, and agency documents. GAO assessed DOL's monitoring of responsible operator medical benefits against congressional budget justifications and federal internal controls.