Justia Public Benefits Opinion Summaries

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Skelton sustained an ankle injury in 2012, and a shoulder injury in 2014, while working for the DMV. In the latter incident, she also claimed to have sustained an injury to her neck. Skelton filed separate workers’ compensation benefits applications. Skelton sought to be reimbursed for her wage loss for time missed at work for medical treatment and for medical evaluations (temporary disability indemnity (TDI)). Skelton’s work hours were not flexible, and she could not visit her doctors on weekends. She initially used her sick and vacation leave but eventually, her paycheck was reduced for missed time. She was then “forced to miss doctors’ appointments.” Skelton’s shoulder injury was found permanent and stationary in November 2017. Her ankle injury was not yet permanent and stationary at the time of the hearing. DMV contended that Skelton was not entitled to TDI because she had returned to work, citing Labor Code section 4600(e)(1). The Appeals Board affirmed that Skelton was not entitled to TDI for wage loss to attend medical treatment appointments following her return to work but was entitled to TDI for wage loss to attend medical-legal evaluations. The court of appeal affirmed. DMV’s obligation to pay temporary disability benefits is tied to Skelton’s actual incapacity to perform the tasks usually encountered in her employment and the resulting wage loss. View "Skelton v. Workers Compensation Appeals Board" on Justia Law

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Chang filed a qui tam action against the Center, asserting claims on behalf of the United States and the state under the False Claims Act (FCA). and the Delaware False Claims Act. Chang alleged that the Center had sought and received funding from the state and federal governments by misrepresenting material information. Both governments declined to intervene as plaintiffs. Chang filed an amended complaint and the Center answered. Nearly three years after Chang filed his original complaint, the U.S. and Delaware moved to dismiss the case, asserting that they had investigated Chang’s allegations and discovered them to be “factually incorrect and legally insufficient.” The court granted the motions without conducting an in-person hearing or issuing a supporting opinion. The Third Circuit affirmed. If the government chooses not to intervene, the relator may still “conduct the action” but the government may still “dismiss the action notwithstanding the objections of the person initiating the action if the person has been notified by the Government of the filing of the motion and the court has provided the person with an opportunity for a hearing on the motion,” 31 U.S.C. 3730(c)(2)(A). Chang never requested a hearing; the FCA does not guarantee an automatic in-person hearing to relators before their cases may be dismissed. View "Chang v. Children's Advocacy Center of Delaware" on Justia Law

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Plaintiff-relator Matthew Omlansky, by virtue of knowledge gleaned as a state employee involved with the Medi-Cal program, brought this qui tam action in the name of the State of California alleging that defendant Save Mart Supermarkets (Save Mart) had violated the False Claims Act in its billings to Medi-Cal for prescription and nonprescription medications, charging a higher price than cash customers paid in violation of 2009 statutory provisions capping Medi-Cal charges at a provider’s usual and customary price (“statutory cap”). Per the trial court, the gist of the alleged fraud upon Medi-Cal, Save Mart generally offered a lower price for medications to cash customers, and would also match a lower price that a competitor was offering (although it appears from an exhibit to the complaint that the latter applied only to prescriptions), but did not apply these discounts from its list prices in the billings it submitted to Medi-Cal. The State declined to intervene. The trial court sustained a demurrer to the original complaint because all of the alleged violations occurred during a period when the 2009 statutory cap was subject to a federal injunction. Plaintiff then filed an essentially identical amended complaint. The only significant change was an allegation in paragraph 45 that Save Mart’s billing practices favoring cash customers continued from December 2016 to March 2017 after the expiration of the injunction, specifying six examples of “illegal pricing.” The court sustained Save Mart’s demurrer to this pleading as to two of the six grounds raised, and denied leave to amend. It entered a judgment of dismissal. Plaintiff timely appealed, but the Court of Appeal concurred with the grounds for the trial court’s ruling, thereby affirming dismissal of Plaintiff’s complaint. View "Omlansky v. Save Mart Supermarkets" on Justia Law

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Plaintiff appealed the denial of his application for Social Security disability benefits, claiming that he had various physical impairments and that he suffered from bipolar disorder. The Eleventh Circuit held that, although plaintiff's claim of bias was forfeited, the ALJ's conclusion contained errors that must be addressed. In this case, the ALJ failed to articulate good cause for discounting two treating physicians' opinions; substantial evidence does not support the finding that plaintiff's bipolar disorder was non-severe; and the ALJ failed to consider plaintiff's mental impairments when assessing his residual functional capacity. Accordingly, the court affirmed in part, reversed in part, and remanded with instructions. View "Schink v. Commissioner of Social Security" on Justia Law

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Rodriguez, a Gulf War veteran, served as a Santa Cruz police officer. 1995-2007. He applied for industrial disability retirement in 2011 with the California Public Employee’s Retirement System based on his PTSD diagnosis that was caused in part by his work for the city. After litigation, the city granted Rodriguez disability retirement but denied his claim of industrial causation. He began receiving benefits in December 2016. Rodriguez requested a finding that his disability was industrial from the Workers’ Compensation Appeals Board in April 2017. The Board concluded that Rodriguez’s disability was industrial, but that he was barred from receiving industrial disability retirement benefits because his claim for a finding of industrial causation was untimely under the five-year time limitation in Government Code section 21171. The court of appeal reversed. Section 21171 applies only to rescind, alter or amend an earlier industrial determination. Section 21174 applies to initial determinations and states that a retiree claiming an industrial disability that is disputed will not receive the additional benefits “unless the application for that determination is filed with the Workers’ Compensation Appeals Board... within two years after the effective date of the member’s retirement.” If a claimant applies for a determination of industrial causation within two years of retirement but more than five years after the injury, the Board cannot modify its determination that an injury is industrial or not; nothing precludes the Board from making the initial determination of industrial causation. View "Rodriguez v. Workers' Compensation Appeals Board" on Justia Law

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Brintley is blind. To navigate the internet, she uses a screen reader that scans webpages and narrates their contents. The technology struggles with some material, especially pictures and video. With some effort, companies can make their websites fully screen-reader compatible. The credit unions, established under Michigan law, maintain a limited brick-and-mortar presence; both operate websites. Brintley tried to browse these websites but found her screen reader unable to process some of their content. A “tester” of website compliance with the Americans with Disabilities Act, Brintley sued the credit unions, seeking compensatory and injunctive relief, arguing that the websites were a “service” offered through a “place of public accommodation,” entitling her to the “full and equal enjoyment” of the websites. 42 U.S.C. 12182(a). The district court rejected an argument that Brintley failed to satisfy Article III standing. The Sixth Circuit reversed. To establish standing, Brintley must show that she sustained an injury in fact, that she can trace the injury to the credit unions’ conduct, and that a decision in her favor would redress the injury. Brintley must show an invasion of a “legally protected interest” that is “concrete and particularized” and “actual or imminent” and that affects her in some “personal and individual way.” Brintley lacks eligibility under state law to join either credit union and her complaint does not convey any interest in becoming eligible to do so. View "Brintley v. Belle River Community Credit Union" on Justia Law

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A1 learned that government auditors thought that the company had overcharged a federal agency by several million dollars for services provided to Medicare beneficiaries. A1 challenged the auditors’ decisions at two levels of the Medicare appeals process but changed the auditors’ minds only in a few minor ways. The government tried to start collecting the money, as the regulatory regime allows, 42 U.S.C. 1395ff(a)(5), (c)(3)(E). Fearing bankruptcy from the government’s recoupment efforts, A1 obtained a preliminary injunction, barring the government from recouping the money until A1 received a hearing before an administrative law judge. The Sixth Circuit vacated the injunction, first holding that although A1 did not proceed to the third and fourth levels of the administrative appeal, the district court had jurisdiction over A1’s constitutional claims. On the merits, the court identified unanswered questions regarding the statistics concerning the relief likely to be obtained at the third level of administrative review; details about A1’s choice not to take advantage of an option to escalate its claim to the fourth and final level of administrative review; and the parties’ awareness of a recoupment option that might have allowed A1 to obtain an ALJ hearing before making most or even all of its recoupment payments. View "A1 Diabetes & Medical Supply v. Alex Azar II" on Justia Law

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The Eighth Circuit affirmed the denial of social security disability insurance benefits and supplemental security income to plaintiff. The court held that substantial evidence supported the ALJ's conclusion that plaintiff's work as a receptionist constituted "substantial gainful activity." In this case, she worked predominately as a receptionist, was paid for the work, and performed work that plainly involved significant physical or mental activities. The court held that plaintiff performed activities beyond her core duties as a receptionist only occasionally, and her responsibilities as a receptionist alone constituted substantial gainful activity. View "Sloan v. Saul" on Justia Law

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In February 2015, Johnson’s landlord under the Housing and Community Development Act Section 8 housing assistance program (42 U.S.C. 1437f(o)) served a “lease violation notice” informing Johnson that she had violated her lease by following another tenant to his apartment and using profanity. In June 2015, Landlord issued a “notice to cease” stating that management had received a complaint from a resident alleging that she had used pepper spray against him. On February 29, 2016, Landlord served a “ninety-day notice of termination of tenancy.” In June, when Johnson failed to vacate, Landlord filed an unlawful detainer action. In August, the action was settled by a stipulation; Landlord agreed to reinstate Johnson’s tenancy on the condition that she conform her conduct to the lease. Landlord retained the right to apply for entry of judgment based on specified evidence of breach. In October, Landlord applied for entry of judgment, claiming that Johnson violated the stipulation. Johnson was evicted in January 2017. In February, the Oakland Housing Authority, which administers the Section 8 program, terminated Johnson's benefits. The court of appeal found no violation of Johnson’s procedural due process rights in terminating her from the program. Johnson was given sufficient notice of the grounds for termination: she failed to supply the Authority with required eviction documentation; she committed and was evicted for serious repeated lease violations. The hearing officer did not abuse its discretion in refusing to excuse the violation. View "Johnson v. Housing Authority of City of Oakland" on Justia Law

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California State Teachers’ Retirement System (CalSTRS) manages contributions made by employees and member school districts to the State Teachers’ Retirement Fund. (Ed. Code 22000.) In 2014, the Baxter petitioners, formerly employed by the Salinas Unified High School District sought to prevent CalSTRS from continuing to reduce their monthly retirement benefit payments and to restore prior monies they claimed CalSTRS had wrongfully withheld to recoup overpayments made as a result of a years-long miscalculation by the District. The trial court held that a three-year limitations period barred CalSTRS from recouping the prior overpayments. The court of appeal reversed, finding that the continuous accrual theory applied. A second suit challenged the reductions. Before the court of appeal addressed Baxter, the trial court granted relief in the second suit, finding CalSTRS’s claims time-barred. The court of appeal followed Baxter, holding that the continuous accrual theory applies. CalSTRS was time-barred from pursuing any claim against teachers as to pension benefit overpayments made more than three years before CalSTRS commenced an action but is not time-barred from pursuing any claim concerning periodic overpayments to teachers and adjustments to teachers’ future monthly benefits, where the payment accrued not more than three years prior to commencement of an action. The reduction in benefits made by CalSTRS did not constitute the commencement of an “action.” CalSTRS constructively commenced an “action” when these teachers filed their verified petition and complaint in the superior court on February 1, 2016. View "Blaser v. State Teachers' Retirement System" on Justia Law