§ 725.701 - What medical benefits are available?

§ 725.701 Availability of What medical benefits .are available?

(a) A miner who is determined to be eligible for benefits under this part or part 727 of this subchapter (see § 725.4(d)) is entitled to medical benefits as set forth in this subpart as of the date of his or her claim, but in no event before January 1, 1974. No medical Medical benefits shall may not be provided to the survivor or dependent of a miner under this part.

(b) A responsible operator, other employer, or where there is neithernone, the fund, shall must furnish a miner entitled to benefits under this part with such medical , surgical, and other attendance and treatment, nursing and hospital services, medicine and apparatusservices and treatments (including professional medical services and medical equipment, prescription drugs, outpatient medical services, inpatient medical services, and any other medical service, treatment or supply, ) for such periods as the nature of the miner's pneumoconiosis and disability requires.

(c) The medical benefits referred to in paragraphs (a) and (b) of this section shall include palliative measures useful only to prevent pain or discomfort associated with the miner's pneumoconiosis or attendant disability.

(d) The costs recoverable under this subpart shall include the An operator or the fund must also pay the miner's reasonable cost of travel necessary for medical treatment (to be determined in accordance with prevailing United States government mileage rates) and the reasonable documented cost to the miner or medical provider incurred in communicating with the employeroperator, carrier, or district director OWCP on matters connected with medical benefits.

(e)

(1) If a miner receives a medical service or

supply

treatment, as described in this section, for any pulmonary disorder, there

shall

will be a rebuttable presumption that the disorder is caused or aggravated by the miner's pneumoconiosis.

(2) The party liable for the payment of benefits may rebut the presumption by producing credible evidence that the medical service or

supply

treatment provided was for a pulmonary disorder apart from those previously associated with the miner's disability, or was beyond that necessary to effectively treat a covered disorder, or was not for a pulmonary disorder at all.

(

f) Evidence

3) An operator or the fund, however, cannot rely on evidence that the miner does not have pneumoconiosis or is not totally disabled by pneumoconiosis arising out of coal mine employment

is insufficient

to defeat a request for coverage of any medical service or

supply

treatment under this subpart.

(4) In determining whether the treatment is compensable, the opinion of the miner's treating physician may be entitled to controlling weight pursuant to § 718.104(d) of this subchapter.

(5) A finding that a medical service or

supply

treatment is not covered under this subpart

shall

will not otherwise affect the miner's entitlement to benefits.