[2] The employment and medical history of the claimant are examined, including a complete pulmonary evaluation paid for by the Black Lung Disability Trust Fund.

[4] Right of rebuttal is offered to the relevant coal mine operator, and final determination is made by the director of the examining district office.

[3] The fairness of these administrative proceedings, however, has recently been called into question in light of an increasing lack of resources for miners to contest claims accompanied by a resurgence in black lung disease.

Payments are made by the operator of the mine most recently employing an affected worker or from the Black Lung Disability Trust Fund.

Starting January 1, 2019 the rate was reduced to $0.50 per ton for coal from subsurface mines and $0.25 per ton for surface mines, limited to 2% of selling price that was established in the original Black Lung Benefits Revenue Act of 1977 rather than the updated rates that was used to pay the fund that was established in the Consolidated Omnibus Budget Reconciliation Act of 1985.