Justia Public Benefits Opinion Summaries

Consuelo Griselda Nerio Mejia challenged the denial of her disability benefits by the Social Security Administration (SSA). After an administrative law judge (ALJ) denied her application, concluding that despite her severe impairments, she could perform other jobs available in the national economy, Nerio Mejia filed a civil suit. She raised three objections to the ALJ's decision, but the district court only addressed her claim that the ALJ improperly rejected her symptomology testimony, finding that the ALJ failed to provide clear and convincing reasons for doing so. The court reversed the ALJ's decision and remanded the case to the SSA for further proceedings.The United States District Court for the Central District of California found that the SSA's position was not substantially justified, making Nerio Mejia eligible for attorneys' fees under the Equal Access to Justice Act (EAJA). However, the district court reduced the fee award, excluding time spent on two additional issues that the court did not address, citing the Ninth Circuit's decision in Hardisty v. Astrue. The court concluded that fees for work on issues not decided by the court were not compensable under the EAJA.The United States Court of Appeals for the Ninth Circuit reviewed the case and reversed the district court's order reducing the fee award. The Ninth Circuit held that the district court misapplied Hardisty, which did not address the compensability of fees for undecided issues. The appellate court found that the district court's ruling was contrary to the Supreme Court's decision in Hensley v. Eckerhart and the Ninth Circuit's en banc decision in Ibrahim v. United States Department of Homeland Security. These cases establish that a fully compensatory fee should be awarded when a plaintiff achieves excellent results, even if some issues were not decided. The Ninth Circuit remanded the case with instructions to award the full amount of fees requested by Nerio Mejia. View "MEJIA V. O'MALLEY" on Justia Law

Johnathan Bertsch was charged with two counts of deliberate homicide and two counts of attempted deliberate homicide after shooting at a vehicle, killing one person and injuring two others, and subsequently shooting a highway patrol officer. He pleaded guilty to one count of deliberate homicide and three counts of attempted deliberate homicide. The State requested $34,728.14 in restitution based on payments made to the victims by Montana’s Crime Victim Compensation Program. Bertsch, who relied on Social Security payments and had not maintained employment, objected to the restitution due to his indigent status.The Fourth Judicial District Court sentenced Bertsch to four consecutive life terms without parole and imposed the requested restitution amount plus a 10% administrative fee. The court reasoned that any funds Bertsch earned through prison work should go towards restitution. Bertsch appealed the restitution order, arguing that it should be waived as unjust given his financial inability to pay.The Supreme Court of the State of Montana reviewed the case. The court held that the restitution statutes require courts to determine restitution amounts without considering an offender’s ability to pay. Bertsch did not adequately request a waiver or present sufficient evidence to show that restitution was unjust under § 46-18-246, MCA. The court found that a general objection based on indigence did not meet the burden of proof required to waive restitution. The court affirmed the District Court’s order, noting that Bertsch could petition for a waiver or adjustment of restitution if his circumstances changed. View "State v. Bertsch" on Justia Law

K.M., an adult with multiple disabilities, including autism and a seizure disorder, has been receiving Medicaid-funded developmental disabilities services for over twenty years. These services, provided by Washington County Mental Health Services (WCMHS), were supposed to include more than thirty hours of community support each week. However, since March 2020, K.M. has only received two to five hours of support weekly, leading to negative health effects.K.M. petitioned the Human Services Board to order the Department of Disabilities, Aging, and Independent Living (DAIL) to provide the full services he is entitled to. The Board dismissed his petition, stating it failed to specify the action required for compliance and that an order to provide services without available staff was too vague. The Board also interpreted K.M.'s request as seeking a broader policy change, which it deemed outside its authority, citing Husrefovich v. Department of Aging & Independent Living.The Vermont Supreme Court reviewed the case and reversed the Board's dismissal. The Court held that the Board has the statutory authority to order DAIL to provide the services K.M. is entitled to under federal and state law. The Court clarified that while the Board cannot issue broad policy injunctions, it can provide specific relief to individuals. The Court found K.M.'s request for services clear and specific enough to inform DAIL of the required action. The case was remanded to the Board for further proceedings consistent with this opinion. View "In re Appeal of K.M." on Justia Law

The case involves a challenge to two Montana laws, HB 544 and HB 862, and a rule adopted by the Montana Department of Public Health and Human Services (DPHHS) regarding Medicaid funding for abortions. The plaintiffs, including Planned Parenthood of Montana and other healthcare providers, argue that these provisions infringe on the constitutional rights of their patients by imposing restrictions on Medicaid coverage for abortions. Specifically, the laws and rule bar Medicaid from covering abortions provided by non-physicians, require prior authorization for abortion services, and limit Medicaid coverage to abortions deemed "medically necessary" under a restrictive definition.The First Judicial District Court of Lewis and Clark County issued a preliminary injunction to halt the enforcement of HB 544, HB 862, and the DPHHS rule. The court found that the plaintiffs were likely to succeed on the merits of their claims, which included violations of the right to privacy and equal protection under the Montana Constitution. The court applied strict scrutiny, determining that the laws and rule were not narrowly tailored to serve a compelling state interest. The court also found that the plaintiffs would suffer irreparable harm without the injunction and that the balance of equities and public interest favored granting the injunction.The Montana Supreme Court reviewed the case and affirmed the District Court's decision to grant the preliminary injunction. The Supreme Court agreed that the plaintiffs were likely to succeed on the merits, as the challenged provisions infringed on the fundamental right to privacy and equal protection. The court held that the state failed to demonstrate that the laws and rule were narrowly tailored to address a medically acknowledged, bona fide health risk. The Supreme Court also found that the plaintiffs would suffer irreparable harm without the injunction and that the balance of equities and public interest supported maintaining the injunction. View "Planned Parenthood v. State" on Justia Law

A former railroad employee, Demetris Hill, was convicted of theft of government property and making a false claim to the Railroad Retirement Board (RRB). Hill had been receiving monthly disability benefits from the RRB since 2012, based on his claim that he was unable to perform substantial gainful activity. As a condition of receiving these benefits, Hill was required to report any changes in his employment status, including any ownership in a family business. Despite this, Hill helped his ex-wife start a janitorial business, SparClean Premier Cleaning Solutions, and failed to report his involvement to the RRB.Hill was initially charged in a 60-count indictment for theft of government money or property. A superseding indictment later charged him with one count of theft of government property, one count of making false claims to the government, and one count of wire fraud. After a jury trial, Hill was found guilty of theft of government property and making false claims but was acquitted of wire fraud. The district court denied Hill’s motion for judgment of acquittal and sentenced him to 33 months for each conviction, to be served concurrently, followed by supervised release. Hill appealed his convictions.The United States Court of Appeals for the Eleventh Circuit reviewed Hill’s appeal. The court found sufficient evidence that Hill was not entitled to the disability payments because he engaged in substantial gainful activity and failed to report his involvement with SparClean. The court also found that Hill knowingly deprived the government of its property by continuing to receive the payments without reporting his employment status. Additionally, the court held that receiving direct deposits while failing to disclose his employment constituted making a false claim to the government. Hill’s arguments regarding the sufficiency of evidence, the jury instruction, and the constitutionality of the False Claims Act were rejected. The Eleventh Circuit affirmed Hill’s convictions. View "USA v. Hill" on Justia Law

The case involves Bradley Rodriguez, who applied for disability benefits and supplemental security income, claiming a disability due to a traumatic brain injury, bipolar disorder, and depression. His application was denied by an Administrative Law Judge (ALJ) with the Social Security Administration (SSA). The Appeals Council also denied his request for review. Rodriguez then filed a federal lawsuit challenging the denial of benefits, raising several constitutional issues regarding the appointment of SSA ALJs, Appeals Council members, and the Commissioner of the SSA. He also argued that the ALJ’s decision was not supported by substantial evidence.The United States District Court for the Southern District of Florida granted summary judgment in favor of the Commissioner of the SSA. The court found that the ALJ was properly appointed, the Appeals Council members were not principal officers requiring presidential appointment and Senate confirmation, and the for-cause removal provision for the Commissioner was unconstitutional but severable. The court also held that Rodriguez was not entitled to a new hearing because he did not show that the unconstitutional removal provision caused him any harm. Additionally, the court determined that the ALJ’s decision was supported by substantial evidence.The United States Court of Appeals for the Eleventh Circuit reviewed the case and affirmed the district court’s decision. The court held that the Commissioner had the statutory authority to appoint SSA ALJs and properly exercised that authority through ratification in July 2018. The Appeals Council members were deemed inferior officers, not principal officers, and thus did not require presidential appointment and Senate confirmation. The court also agreed that the for-cause removal provision for the Commissioner was unconstitutional but severable, and Rodriguez did not demonstrate entitlement to retrospective relief. Finally, the court found that the ALJ’s decision was supported by substantial evidence, including medical records and vocational expert testimony. View "Rodriguez v. Social Security Administration" on Justia Law

A mother sought child support from the father for their adult son, who has autism and receives government aid. The mother argued that the father, who earns a substantial income, should contribute to their son's support. The father contended that the son's receipt of government aid under the State Supplementary Program for Aged, Blind, and Disabled (SSP) relieved him of any financial responsibility under Family Code section 3910, which mandates parental support for adult children who are incapacitated and without sufficient means.The Superior Court of Los Angeles County ruled in favor of the father, interpreting Welfare and Institutions Code section 12350 to mean that the receipt of government aid barred the mother from seeking child support from the father. The court also limited the attorney’s fees awarded to the mother, reasoning that the case presented a narrow legal issue that did not justify extensive litigation costs.The California Court of Appeal, Second Appellate District, Division One, reversed the lower court's decision. The appellate court held that Welfare and Institutions Code section 12350 only prevents government entities from seeking reimbursement from relatives for the cost of aid provided to recipients. It does not bar a parent from seeking child support from the other parent under Family Code section 3910. The court emphasized that the legislative intent behind these statutes was to prevent the public from bearing the financial burden of supporting individuals who have relatives capable of providing support.The appellate court remanded the case for further proceedings to determine the appropriate amount of child support and to reconsider the attorney’s fees award in light of its ruling. The court clarified that the family court must now address whether the son is incapacitated from earning a living and without sufficient means, and if so, determine the appropriate support amount. View "Marriage of Cady & Gamick" on Justia Law

Plaintiff Michelle Rubin applied for Social Security Disability Insurance benefits in 2019, citing major depressive disorder as her disabling condition. An administrative law judge (ALJ) denied her claim, concluding that Rubin was not disabled under the Social Security Act. Rubin exhausted the administrative appeals process and subsequently challenged the final decision in the United States District Court for the Southern District of New York, which affirmed the denial of benefits.The ALJ found that Rubin had not engaged in substantial gainful activity since her alleged onset date and had a severe impairment of major depressive disorder. However, the ALJ determined that Rubin did not meet the criteria for a listed impairment and had the residual functional capacity (RFC) to perform a full range of work with certain nonexertional limitations. The ALJ partially discounted the opinion of Rubin’s treating psychiatrist, Dr. Paul, who had opined that Rubin met the criteria for a listed impairment and was unable to work full-time. The ALJ also found that Rubin could not perform her past relevant work but could perform other jobs existing in significant numbers in the national economy.The United States Court of Appeals for the Second Circuit reviewed the case and found that the ALJ’s decision was not supported by substantial evidence. The court noted that the ALJ had misinterpreted the medical and lay evidence, failing to appreciate the consistent narrative that supported Dr. Paul’s opinion. The court concluded that the ALJ erred in determining that Rubin did not meet the criteria for a listed impairment, particularly the paragraph C criteria of Listed Impairment 12.04. The court vacated the district court’s judgment and remanded the case to the agency for further proceedings, including a fuller consideration of the existing evidence and the results of a consultative examination. View "Rubin v. O'Malley" on Justia Law

Raymond Zaborowski, a U.S. Army veteran suffering from anxiety and PTSD, applied for Social Security disability benefits, claiming his conditions have prevented him from working since 2014. An administrative law judge (ALJ) denied his claim, stating that medical evidence indicated he could still perform light work.Zaborowski appealed to the United States District Court for the Eastern District of Pennsylvania, where he consented to jurisdiction by a magistrate judge. The magistrate judge upheld the ALJ's decision, leading Zaborowski to appeal further.The United States Court of Appeals for the Third Circuit reviewed the case. Zaborowski argued that the regulation requiring ALJs to explain their decisions violated the Social Security Act, that the ALJ failed to properly explain the supportability and consistency of medical opinions, and that the ALJ's findings were not supported by substantial evidence. The Third Circuit reviewed the legal issues de novo and the ALJ's factual findings for substantial evidence.The court held that the regulation complies with the statute, as it requires ALJs to explain the dispositive reasons for their decisions, specifically focusing on supportability and consistency. The court found that the ALJ adequately addressed these factors in her analysis, noting that the opinions of two psychologists were consistent with the record, while the treating psychiatrist's opinion was not. The court also found substantial evidence supporting the ALJ's decision, including the psychologists' opinions and evidence of Zaborowski's ability to live independently and assist his mother.The Third Circuit affirmed the decision, concluding that the ALJ's denial of benefits was supported by substantial evidence and that the regulation did not violate the Social Security Act. View "Zaborowski v. Commissioner Social Security" on Justia Law

M.G. and C.V., medically fragile children under New Mexico’s Medicaid program, sued the New Mexico Human Services Department (HSD) for failing to provide the private duty nursing (PDN) hours they are entitled to. They sought a preliminary injunction to compel HSD to take good faith steps to provide these hours. The district court granted the injunction, and HSD appealed.The United States District Court for the District of New Mexico found that M.G. and C.V. were consistently not receiving their required PDN hours, which placed them at risk of severe medical harm. The court concluded that M.G. and C.V. were likely to succeed on the merits of their Medicaid Act claims, which mandate the provision of PDN services. The court also found that the children would suffer irreparable harm without the injunction, that the balance of harms favored the plaintiffs, and that the injunction was in the public interest. The injunction required HSD to take specific steps, such as negotiating with managed care organizations and increasing monitoring of PDN hour shortfalls, to provide the necessary PDN hours.The United States Court of Appeals for the Tenth Circuit affirmed the district court’s decision. The appellate court held that M.G. and C.V. had standing to seek injunctive relief and that the district court did not err in its conclusions. The court found that the injunction was not impermissibly vague and that the Supreme Court’s decision in Armstrong v. Exceptional Child Center, Inc. did not preclude the issuance of the injunction. The Tenth Circuit concluded that the district court acted within its discretion in granting the preliminary injunction, given the likelihood of success on the merits, the risk of irreparable harm, the balance of harms, and the public interest. View "M.G. v. Armijo" on Justia Law