Contact us5000 Waterdam Plaza Drive, Suite 180McMurray, PA 15317Phone: (724) 941-1650office@lungsatworkpa.org Name * First Name Last Name Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Phone * (###) ### #### Email * How many years have you (or the miner) worked in a coal mine? * Are you: Retired Coal Miner Active Coal Miner Widow Other Family Member Do you (or the miner) have trouble breathing? Yes No Have you (or the miner) ever filed a claim for Federal Black Lung Benefits before? Yes No Additional Details: I would like to be contacted to: Schedule a respiratory evaluation Discuss Black Lung disability benefits and filing a claim Other Thank you!
