Justia Public Benefits Opinion Summaries

by
The district court affirmed the North Dakota Department of Human Service’s determination that Harold Ring was ineligible for Medicaid. When these proceedings began, Ring was ninety-six years old and living in the Good Samaritan Home in Mohall. An application for Medicaid was submitted on his behalf in April 2018. It was denied due to disqualifying transfers. Ring’s daughter, Nancy Ring, filed a second Medicaid application on Ring’s behalf in November 2018. The November application was also denied because Ring’s “client share (recipient liability) is more than the medical expenses.” Ring died after the Department issued its decision but before the district court affirmed. No party was substituted on Ring’s behalf for purposes of the district court proceedings. In 2020, Ring's attorney filed a notice of appeal to the North Dakota Supreme Court, claiming the Department’s imposition of a penalty period due to disqualifying transfers was inappropriate because Ring was a vulnerable adult who was financially exploited. On May 1, 2020, the Good Samaritan Society and the Department stipulated to dismissal of the probate petition because “a Special Administrator is not needed at this time.” The court dismissed the petition on May 5, 2020. The Supreme Court determined that essential issues remained unresolved in this matter: since neither side filed a notice of death or moved to substitute a party, the district court did not determine whether this action survived Ring's death, and if it did, whether a proper successor was available for substitution. The matter was remanded for these findings and substitution. View "Ring v. NDDHS" on Justia Law

by
Veterans sought certification for the class of veterans whose disability claims had not been resolved by the Board of Veterans Appeals within one year of the filing of a Notice of Disagreement (NOD), requesting judicial action to compel the Secretary of Veterans Affairs to decide all pending appeals within one year of receipt of a timely NOD. The Veterans Court requested that they separate or limit the requested class action into issues that meet the Federal Rule of Civil Procedure 23(b)(2) “commonality” standard. The veterans declined, stating that “systemic delay” exists in the VA claims system, and broad judicial remedy is required.The Veterans Court denied the requested class certification. While the case was pending, the Veterans Appeals Improvement and Modernization Act of 2017, 131 Stat. 1105 purportedly improved processing times by allowing claimants to choose: higher-level review, a supplemental claim, board review with a hearing and opportunity to submit additional evidence, board review without a hearing, but with an opportunity to submit additional evidence, or board review without a hearing or additional evidence, based on their priorities on appeal.The Federal Circuit affirmed the denial of class certification, citing the lack of proof of commonality. When Congress has crafted a comprehensive remedial structure, that structure warrants evaluation in practice before judicial intervention is contemplated. View "Monk v. Wilkie" on Justia Law

by
The issue presented in this declaratory action before the South Carolina Supreme Court in its original jurisdiction was a challenge to the constitutionality of Governor Henry McMaster's allocation of $32 million in federal emergency education funding for the creation of the Safe Access to Flexible Education ("SAFE") Grants Program. Petitioners contended the program violated South Carolina's constitutional mandate prohibiting public funding of private schools. The Supreme Court held the Governor's decision constituted the use of public funds for the direct benefit of private educational institutions within the meaning of, and prohibited by, Article XI, Section 4 of the South Carolina Constitution. "Even in the midst of a pandemic, our State Constitution remains a constant, and the current circumstances cannot dictate our decision. Rather, no matter the circumstances, the Court has a responsibility to uphold the Constitution." View "Adams v. McMaster" on Justia Law

by
Most people eligible for Medicaid benefits are “categorically needy” because their income falls below a threshold of eligibility. People with higher income but steep medical expenses are “medically needy” once they spend enough of their own assets to qualify, 42 U.S.C. 1396a(a)(10). Plaintiffs contend that medical expenses they incurred before being classified as “medically needy” should be treated as money spent on medical care, whether or not those bills have been paid, which would increase Illinois's payments for their ongoing care.The Seventh Circuit affirmed the dismissal of their suit. Medicaid is a cooperative program through which the federal government reimburses certain expenses of states that abide by the program’s rules. Medicaid does not establish anyone’s entitlement to receive particular payments. The federal-state agreement is not enforceable by potential beneficiaries. Plaintiffs bypassed their administrative remedies and do not have a judicial remedy under 1396a(r)(1)(A). Section 1396a(a)(8) provides that a state’s plan must provide that all individuals wishing to apply for medical assistance under Medicaid shall have the opportunity to do so and that assistance shall be furnished with reasonable promptness to all eligible individuals; some courts have held that this requirement can be enforced in private suits. If such a claim were available, it would fail. Plaintiffs are receiving benefits. The court also rejected claims under the Americans with Disabilities Act, 42 U.S.C. 12131–34, and the Rehabilitation Act, 29 U.S.C. 794. Plaintiffs receive more governmental aid than nondisabled persons. View "Nasello v. Eagleson" on Justia Law

by
Beeler, a dual citizen of Canada and the U.S., worked in Canada for 19 years and contributed to the Canada Pension Plan. In 1989 Beeler moved to the U.S. Until she retired in 2013, she worked and paid Social Security taxes. Beeler’s Canadian earnings were not subject to Social Security taxes; her U.S. earnings were not subject to Canada Plan taxes. Beeler has received Canada Pension Plan benefits since 2013. In 2013, Beeler was awarded reduced Social Security retirement benefits because she was entitled to Canada Pension Plan benefits based on work not covered by Social Security taxation.Rejecting claims that the reductions did not apply to Beeler and similarly-situated plaintiffs, the Seventh Circuit affirmed summary judgment in favor of the government. The windfall elimination provision, 42 U.S.C. 415(a)(7)(A)(ii), states that an individual who becomes eligible for a monthly payment “which is based in whole or in part upon his or her earnings for service which did not constitute ‘employment’ as defined in [42 U.S.C. 410]” shall have their benefits recomputed. The provision excludes in part “payment by a social security system of a foreign country based on an agreement between the United States and such foreign country" under 42 U.S.C. 433. The plaintiffs’ work in Canada is not considered “employment” under section 410, so section 415 reduces their Social Security benefits. The agency’s interpretations of the provision and its implementing regulation and its application of the provision to reduce their benefits were permissible. View "Lorraine Beeler v. Andrew M. Saul" on Justia Law

by
Mote served in the Air Force, 1961-1965, participating in missions to Vietnam, where Agent Orange was deployed. Mote later developed coronary artery disease and lung cancer. In 2010, Mote filed a disability claim based. In 2013, Mote filed his Notice of Disagreement with the denial of that claim. He died months later. Mrs. Mote substituted for his claim and filed a dependency-and-indemnity compensation claim. The VA denied Mrs. Mote’s claim in 2015; she filed her Notice of Disagreement and requested a Board of Veterans’ Appeals “Travel Board hearing.”Mote sought mandamus relief, 28 U.S.C. 1651, alleging unreasonable delay. The Veterans Court denied the petition, applying the “Costanza” standard. The government claimed, due to limited resources, it “could not predict how long” Mote might have to wait for a hearing. The Federal Circuit consolidated her appeal with others and held that the Veterans Court should use the Telecommunications Research & Action Center v. FCC (TRAC) standard to evaluate unreasonable-delay mandamus petitions rather than the Costanza standard. On remand, Mote requested a “reasoned decision” from the Board (within 45 days) and periodic progress reports. In March 2019. the Board scheduled her Travel Board hearing for May 2019. The Veterans Court dismissed Mrs. Mote’s mandamus petition without applying the TRAC standard. The Board subsequently remanded for further factual findings.The Federal Circuit again remanded, for a TRAC analysis, noting that Mote sought progress reports, in addition to a decision, and that the Veterans Court was not powerless to fashion other relief, such as a more lenient, specific, deadline. Whether a delay is so egregious as to justify the extraordinary writ depends on issues that are likely to arise frequently among veterans. The Veterans Court is uniquely well-positioned to address these issues first. View "Mote v. Wilkie" on Justia Law

by
McAllister injured his knee while working as a sous chef for a restaurant. The injury occurred as he stood up from a kneeling position while attempting to retrieve food that had been misplaced in the cooler. He had previously had surgery on the knee and had received workers’ compensation benefits at that time. An arbitrator awarded him workers’ compensation benefits but the Illinois Workers’ Compensation Commission reversed, finding that the injury did not “arise out of” his employment. The circuit court and the Appellate Court, Workers’ Compensation Commission Division, affirmed.The Illinois Supreme Court reversed. The injury arose out of an employment-related risk; the acts that caused the injury were risks incident to his employment because these were acts his employer might reasonably expect him to perform in fulfilling his assigned job duties. McAllister was responsible for arranging the walk-in cooler and had a duty to find misplaced food. The court overruled certain cases to the extent that they held that injuries attributable to common bodily movements or routine everyday activities, such as bending, twisting, reaching, or standing up from a kneeling position, are not compensable unless a claimant can prove that he was exposed to a risk of injury from these common bodily movements or routine everyday activities to a greater extent than the general public. View "McAllister v. Illinois Workers' Compensation Commission" on Justia Law

by
Peeters sought disability benefits, citing degenerative disc disease in the lumbar spine, degenerative joint disease of the right shoulder, depressive disorder, post-traumatic stress disorder, generalized anxiety disorder, and learning disabilities. Peeters has not sustained gainful employment since 2014. After a hearing, an ALJ denied Peeters disability benefits in 2016. On stipulated remand, the Appeals Council instructed the ALJ to reconsider Peeters’ maximum residual functional capacity, obtain evidence and examples of jobs Peeters could perform from a vocational expert, provide a new hearing, and issue a new decision. At the second hearing in 2018, the ALJ issued a 15-page decision denying Peeters disability benefits because he failed to meet the severity requirements of 20 C.F.R. pt. 404 and 20 C.F.R. pt. 416.The district court and Seventh Circuit affirmed the denial as supported by substantial evidence. The court upheld the greater weight given to the opinions of six state agency psychologists who evaluated Peeters; three found Peeters would have moderate limitations completing a normal workday and carrying out detailed instructions, but could handle simple two to three-step instructions, while three found Peeters capable of performing light work. View "Peeters v. Saul" on Justia Law

by
John served in the Army in the 1960s. In 1972, John and Roberta married. In 2001, they separated. In 2005, a New York court issued a Separation Judgment, requiring John to pay Roberta $300 per month in spousal maintenance. In 2006, the VA granted John service connection for various disabilities; he began receiving monthly compensation. The New York court held a hearing where both parties appeared with counsel with a proposed settlement. That Stipulation provided that no later than December 2006 John was to pay Roberta $7,000 for past and future maintenance, health insurance, and other obligations. John made the payment. In 2010, following John’s relocation, a Pennsylvania state court issued a Divorce Decree.In 2008, Roberta had filed a VA claim for apportionment, 38 U.S.C. 5307, of John’s disability benefits. John objected, arguing only that the 2006 Stipulation “precluded” the claim. The VA denied Roberta’s claim, despite her demonstrated financial need, concluding she had “voluntarily renounced" maintenance or support. The Board of Veterans’ Appeals granted Roberta special apportionment from the 2008 date of her claim until the date of her 2010 divorce. The Veterans Court and Federal Circuit affirmed. A state court domestic relations separation agreement plays no role in VA’s determination of entitlement to special apportionment. John’s remedy lay in state court where he could sue for breach of contract. Special apportionment turns not on the veteran’s degree of support but on the dependent’s showing of hardship. View "Batcher v. Wilkie" on Justia Law

by
The plaintiffs sought Social Security disability and/or supplemental security income benefits. In each case, the application was denied, and an ALJ upheld the denial. The Appeals Council denied relief. The plaintiffs sought judicial review. While the appeals were pending, the plaintiffs moved to raise an issue they had not raised during administrative hearings--a challenge to the ALJs’ appointments, citing the Supreme Court’s 2018 "Lucia" decision that SEC ALJs had not been appointed in a constitutionally legitimate manner and that remand for a de novo hearing before a different ALJ was required. The district courts agreed that the Appointments Clause challenges were forfeited and affirmed the denials of benefits.The Sixth Circuit vacated and remanded for new hearings before constitutionally appointed ALJs other than the ALJs who presided over the first hearings. There is no question that Social Security ALJs are inferior officers who were required to be, but were not, appointed consistently with the Appointments Clause. There are no statutory or regulatory exhaustion requirements governing Social Security proceedings and, while a court may still impose an implied exhaustion rule, such a requirement is inappropriate because the regulations provide no notice to claimants that their failure to raise an Appointments Clause challenge at the ALJ level will preclude them from later seeking a judicial decision on the issue. View "Flack v. Commissioner of Social Security" on Justia Law