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Claimant sought permanent total disability benefits from the Multiple Injury Trust Fund. The Workers' Compensation Court of Existing Claims held that the claimant's combined injuries rendered the claimant permanently totally disabled and awarded benefits. The Multiple Injury Trust Fund appealed. On appeal, the Court of Civil Appeals reversed, finding claimant ineligible to claim benefits against the Multiple Injury Trust Fund as the claimant was not a "physically impaired person" at the time of the claimant's second on-the-job injury. The dispositive issue presented for the Oklahoma Supreme Court’s review was whether claimant met the statutory definition of a "physically impaired person" at the time of the claimant's second on-the-job injury for purposes of determining eligibility for Multiple Injury Trust Fund benefits. As a corollary, the Court considered whether a duly-executed settlement agreement (memorialized on a form prescribed by the Workers' Compensation Court) constituted an adjudication of the claimant's disabilities. The Court answered both questions in the affirmative. View "Multiple Injury Trust Fund v. Garrett" on Justia Law

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The Eighth Circuit affirmed the denial of plaintiff's application for supplemental security income. The court held that a reasonable mind could find that the record supports the ALJ's determination that plaintiff did not meet Listing 11.17A; the ALJ reasonably found, based on the record as a whole, that plaintiff did not exhibit the deficits in adaptive functioning needed to meet Listing 12.05C; and the ALJ had ample reason to discount the opinion of plaintiff's treating physician and to rely instead on the opinions of the state agency medical consultants, which were more consistent with the medical evidence. View "Vance v. Berryhill" on Justia Law

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Richard Culbertson was counsel for the four plaintiffs in these consolidated Social Security disability benefits cases. At issue in this appeal was the attorney's fees for Culbertson under 42 U.S.C. 406 and the Equal Access to Justice Act (EAJA), 28 U.S.C. 2412(d). The Eleventh Circuit held that the district court did not err in its interpretation and application of Dawson v. Finch, 425 F.2d 1192 (5th Cir. 1970) and by imposing a 24% cap on section 406 fees; it was necessary for the district court to add the requested section 406(b) fee together with his EAJA award; and the district court did not abuse its discretion and did not exceed its authority. Accordingly, the court affirmed the judgment. View "Wood v. Commissioner of Social Security" on Justia Law

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Maxmed sought judicial review of the Secretary of Health and Human Services' determination that the Medicaid program overpaid Maxmed by almost $800,000 for home health care services rendered to Medicare beneficiaries. The Fifth Circuit held that the failure to record the random numbers used in the sample did not necessarily invalidate the extrapolation methodology; the Secretary did not act arbitrarily and capriciously in rejecting the challenge to the independence of the sampling units; Congress clearly envisioned extrapolation in overpayment determinations involving home health agencies like Maxmed, and the Secretary's reliance on extrapolation as a tool was justified; the district court did not abuse its discretion in denying Maxmed's motion to amend or alter the judgment; and the district court properly rejected Maxmed's due process claim. Accordingly, the court affirmed the district court's grant of summary judgment to the Secretary. View "Maxmed Healthcare, Inc. v. Price" on Justia Law

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Elliott worked in a coal mine until 1993 and developed a chronic cough. Three after his retirement, he developed more acute breathing problems. Elliott sought Black Lung Benefits Act, 30 U.S.C. 901–45, benefits in 2012. Helen Mining conceded it was the responsible employer, but challenged Elliott’s entitlement to benefits. The parties stipulated that Elliott had a totally disabling respiratory impairment. Because Helen Mining conceded disability and because Elliott demonstrated more than 15 years of employment, the ALJ determined that section 921(c)(4) applied and that the other elements, including causation, would be presumed, and shifted the burden to Helen Mining. Helen Mining offered the opinions of two doctors, attributing Elliott’s respiratory impairment to adult-onset asthma unrelated to coal dust exposure. The ALJ did not find their testimony persuasive, concluded that Helen Mining had failed to rule out coal dust-induced pneumoconiosis as a cause of Elliott’s disability, and awarded benefits. The Benefits Review Board upheld the award. The Third Circuit affirmed, upholding the application of the 2013 regulation, specifying the standard a coal mine operator must meet to rebut the presumed element of disability causation, 20 C.F.R. 718.305(d)(1). The regulation permissibly fills a statutory gap and Helen Mining did not meet that rebuttal standard. View "Helen Mining Co v. Elliott" on Justia Law

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Critical Access Hospitals are reimbursed by Medicare for the reasonable and necessary costs of providing services to Medicare patients. The Medicaid program requires states to provide additional (DSH) payments to hospitals that serve a disproportionate share of low-income patients, 42 U.S.C. 1396a(a)(13)(A)(iv). In Kentucky, DSH payments are matched at 70% by the federal government. Kentucky’s contribution to DSH programs comes from payments from state university hospitals and Kentucky Provider Tax, a 2.5% tax on the revenue of various hospitals, including Appellants, The amount of DSH payments a hospital receives is unrelated to the amount of KP-Tax it paid. During the years at issue, DSH payments covered only 45% of Appellants' costs in providing indigent care. Appellants filed cost reports in 2009 and 2010 claiming their entire KP-Tax payment as a reasonable cost for Medicare reimbursement. Previously, they had received full reimbursement; for 2009 and 2010, however, the Medicare Administrative Contractor denied full reimbursement, offsetting the KP-Tax by the amount of DSH payments Appellants received. The Provider Reimbursement Review Board and Centers for Medicare and Medicaid Services upheld the decision. The Sixth Circuit affirmed, reasoning that the net economic impact of Appellants’ receipt of the DSH payment in relation to the cost of the KP-Tax assessment indicated that the DSH payments reduced Appellants’ expenses such that they constituted a refund. View "Breckinridge Health, Inc. v. Price" on Justia Law

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Presumptive service connection exists for veterans who served in the Persian Gulf War and have chronic: undiagnosed illness; medically unexplained chronic multisymptom illness (MUCMI); or any diagnosed illness as determined by the Secretary, 38 U.S.C. 1117(a)(2). VA regulations define MUCMI as “a diagnosed illness without conclusive pathophysiology or etiology, that is characterized by overlapping symptoms and signs and has features such as fatigue, pain, disability out of proportion to physical findings, and inconsistent demonstration of laboratory abnormalities. Chronic multisymptom illnesses of partially understood etiology and pathophysiology, such as diabetes and multiple sclerosis, will not be considered medically unexplained.”. Both the statute and regulation identify sleep disturbances and signs or symptoms involving the respiratory system as possible MUCMI manifestations. The VA revised its M21-1 Manual, changing the definition of MUCMI to require “both an inconclusive pathology, and an inconclusive etiology.” Under the subsection “Signs and Symptoms of Undiagnosed Illnesses or MUCMIs,” the VA added, “Sleep apnea cannot be presumptively service-connected (SC) under the provisions of 38 C.F.R. 3.317 since it is a diagnosable condition.” The Federal Circuit dismissed a veterans’ group’s petition for review for lack of jurisdiction, reasoning that the revisions are not binding and not reviewable under 38 U.S.C. 502. View "Disabled American Veterans v. Secretary of Veterans Affairs" on Justia Law

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This case focused on whether the Department for Children and Families (DCF) could deny an applicant temporary housing assistance under General Assistance (GA) Rule 2652.3 for having left her housing in response to a notice of termination without cause from her landlord. DCF argued that applicant Dezarae Durkee caused her own loss of housing and therefore was ineligible for assistance. The Human Services Board upheld this determination. Applicant argued that leaving in response to a notice of termination without cause does not constitute causing her own lack of housing and sought a declaration of such damages. The Vermont Supreme Court granted the declaratory judgment but concluded damages were not appropriate relief. View "In re Appeal of Dezarae Durkee" on Justia Law

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Sunny Radebaugh contested both her inability to cross-examine the nurse who performed an annual assessment and the Department of Health and Social Services' reversal of an administrative law judge’s determination. Radebaugh was a Medicaid in-home nursing care benefits recipient, who had her benefits terminated by the Department after an annual assessment. The assessment concluded that Radebaugh’s physical condition had materially improved to the point where she no longer required the benefits. She challenged the termination of her benefits at an administrative hearing, and the nurse who performed the assessment did not testify. Following the hearing, the administrative law judge determined that the Department erroneously terminated her benefits. The Department, as final decision maker, reversed the administrative law judge’s determination and reinstated the decision to terminate Radebaugh’s benefits. Radebaugh appealed to the superior court, which first determined that the Department had violated her due process rights but then reversed itself and upheld the Department’s decision. After review, the Alaska Supreme Court concluded Radebaugh waived the right to challenge her inability to cross-examine the nurse who performed the assessment. The Court held that the agency sufficiently supported its final decision. The Court therefore affirmed the superior court’s affirmance of the Department’s final decision. View "Radebaugh v. Dept. of Health & Social Services" on Justia Law

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The Eighth Circuit affirmed the denial of plaintiff's social security disability benefits, holding that substantial evidence supported the ALJ's decision to deny benefits. The court held that substantial evidence supported the ALJ's decision to assign little weight to the opinion of plaintiff's treating psychiatrist based on internal inconsistency and conflict with other evidence on the record; the ALJ did not err by assigning insufficient weight to the opinions of plaintiff's caseworker and Mental Health Paraprofessional (MHPP); and the ALJ's residual functioning capacity determination, as well as the other evidence in the record, reflected the limitations of plaintiff's ability to follow instructions, socialize, and maintain concentration. View "Chesser v. Berryhill" on Justia Law