Justia Public Benefits Opinion Summaries

Sean C. Flynn was laid off from his full-time job at Sun Valley Brewing Company during the COVID-19 pandemic and applied for unemployment benefits from the Idaho Department of Labor (IDOL) on March 25, 2020. Flynn received unemployment benefits from March 29, 2020, through June 27, 2020, while he was still employed part-time as a French teacher for the Community School, Inc. Flynn did not report his earnings from the Community School on the weekly certification forms required by IDOL. Additionally, when Flynn returned to full-time work at Sun Valley Brewing, he inaccurately reported his income for the week ending June 27, 2020.Flynn's claim for unemployment benefits was audited two years later, revealing discrepancies in his reported income. IDOL issued an eligibility determination letter retroactively denying Flynn's unemployment benefits and imposing civil penalties for willfully making false statements or failing to report material facts. Flynn appealed to the Idaho Department of Labor Appeals Bureau, arguing that his omissions were honest mistakes. The Appeals Examiner modified IDOL’s determination, finding Flynn misunderstood the reporting requirements for his part-time job but willfully misreported his income from Sun Valley Brewing for one week.IDOL appealed to the Idaho Industrial Commission, which conducted a de novo review and reversed the Appeals Examiner’s decision. The Commission reinstated IDOL’s original eligibility and overpayment determinations, concluding that Flynn’s omissions were willful based on the explicit instructions provided by IDOL and Flynn’s repeated failure to accurately report his income.The Supreme Court of Idaho affirmed the Commission’s decision, holding that Flynn’s omissions constituted a willful misstatement or concealment of material facts under Idaho Code section 72-1366(12). The Court determined that Flynn knew or should have known the necessity of reporting all income, and his failure to do so was intentional. Neither party was awarded attorney fees on appeal. View "Flynn v. Sun Valley Brewing Company" on Justia Law

The City of Huntington and the Cabell County Commission filed lawsuits against AmerisourceBergen Drug Corp., Cardinal Health, Inc., and McKesson Corp., alleging that the defendants contributed to the opioid epidemic by distributing excessive quantities of opioids to pharmacies. The plaintiffs claimed that the defendants' actions created a public nuisance that should be abated under West Virginia common law. The cases were consolidated and remanded to the United States District Court for the Southern District of West Virginia, which held a ten-week bench trial.The district court ruled in favor of the defendants, concluding that the plaintiffs failed to prove that the defendants' conduct was unreasonable or that it proximately caused the opioid epidemic. The court found that the defendants substantially complied with their duties under the Controlled Substances Act (CSA) and that the plaintiffs did not provide sufficient evidence to show that the volume of opioids distributed was excessive or that the defendants failed to maintain effective controls against diversion. The district court also determined that the plaintiffs' proposed abatement plan was not appropriate.The plaintiffs appealed to the United States Court of Appeals for the Fourth Circuit, contesting the district court's factual findings and legal conclusions. The Fourth Circuit certified a question to the Supreme Court of Appeals of West Virginia, asking whether conditions caused by the distribution of a controlled substance can constitute a public nuisance under West Virginia common law and, if so, what the elements of such a claim are.The Supreme Court of Appeals of West Virginia declined to answer the certified question, citing the disputed factual findings and related legal conclusions on appeal. The court emphasized that it could not address the legal issue without a sufficiently precise and undisputed factual record, and any answer would be advisory given the unsettled facts. View "City of Huntington and Cabell County Commission v. AmerisourceBergen Drug Corporation" on Justia Law

Joanne Ecklund received long-term care services through Minnesota’s Medicaid program, the Minnesota Medical Assistance Program (MMAP). The Minnesota Department of Human Services (DHS) paid $66,052.62 in capitated payments to Medica, Ecklund’s managed care organization (MCO), which in turn paid $8,806.84 to care providers for Ecklund’s services. After Ecklund’s death in 2021, DHS sought to recover the $66,052.62 from her estate under Minnesota Statutes section 256B.15, subdivision 2(a)(1), which allows recovery of medical assistance payments for long-term care services provided to recipients aged 55 or older.The district court, adopting a referee’s recommendation, granted summary judgment in favor of the estate’s personal representative, Jerry Ecklund, limiting DHS’s recovery to the $8,806.84 paid by Medica to the care providers. The Minnesota Court of Appeals affirmed, interpreting the statute to limit DHS’s recovery to the amount actually paid to the providers.The Minnesota Supreme Court reviewed the case and reversed the lower courts' decisions. The court held that Minnesota Statutes section 256B.15, subdivision 2(a)(1), allows DHS to recover the amount of capitation payments made to the MCO for long-term care services provided to the recipient. The court reasoned that the statute’s language and the broader statutory context support DHS’s interpretation, which aligns with federal guidance requiring states to recover capitation payments. The court concluded that DHS is entitled to recover the $66,052.62 in capitated payments from Ecklund’s estate. View "In re the Estate of: Ecklund" on Justia Law

Paul Cropper applied for disability insurance benefits and supplemental security income in February 2020, citing various impairments such as anxiety, depression, ADHD, insomnia, and COPD. His application was denied initially and upon reconsideration by the Social Security Administration. Cropper then requested a hearing before an administrative law judge (ALJ), where he presented opinions from his medical providers indicating severe limitations. The ALJ conducted a five-step analysis and denied the application, finding that while Cropper had severe impairments, he could still perform certain jobs available in the national economy. The ALJ found the opinions of Cropper’s primary care provider and psychiatrist unpersuasive.Cropper sought judicial review in the United States District Court for the District of Minnesota, arguing that the ALJ improperly evaluated the evidence, leading to an incorrect residual functional capacity determination. The district court granted summary judgment in favor of the Commissioner, concluding that substantial evidence supported the ALJ’s decision to find the medical opinions unpersuasive.The United States Court of Appeals for the Eighth Circuit reviewed the case de novo and affirmed the district court’s decision. The court held that the ALJ adequately considered the supportability and consistency of the medical opinions as required by the revised regulations. The court emphasized that the ALJ’s findings were supported by substantial evidence, including the conservative course of treatment and the lack of significant outpatient therapy. The court also noted that the ALJ’s reasoning was sufficiently clear to allow for appropriate judicial review. View "Cropper v. Dudek" on Justia Law

Debra Tucker applied for disability insurance benefits under Title II of the Social Security Act in 2018. After multiple denials at the administrative level, she appealed to the federal district court. In 2023, the district court reversed the final administrative decision of the Commissioner of Social Security, remanding Tucker’s claim for further administrative proceedings. The district court awarded Tucker’s attorney $7,500 in attorney’s fees under the Equal Access to Justice Act (EAJA), along with $402 in costs. Tucker’s attorney had a contingency-fee agreement for twenty-five percent of any past-due benefits awarded. In August 2024, an administrative law judge found Tucker disabled and granted her monthly disability benefits retroactive to February 2018, totaling $124,821.70 in past-due benefits.The district court granted in part and denied in part the attorney’s motion for $31,205.43 in fees under 42 U.S.C. § 406(b), awarding $17,400 instead. The court found the requested fee excessive, amounting to a windfall, and set an imputed hourly rate of $500. The attorney’s motion for reconsideration, reducing the fee request to $22,620, was denied. The attorney appealed, seeking the full $31,205.43.The United States Court of Appeals for the Sixth Circuit reviewed the district court’s decision for abuse of discretion. The appellate court found that the district court properly started with the contingency-fee agreement and then tested it for reasonableness, considering the effective hourly rate and other factors. The district court did not misapply the law by comparing the effective hourly rate to the EAJA rate and the attorney’s ordinary rate. The appellate court affirmed the district court’s decision, concluding that it acted within its discretion in reducing the fee to avoid a windfall. View "Tucker v. Commissioner of Social Security" on Justia Law

Ronald Myers pleaded guilty in 2005 to possessing an implement for counterfeiting state securities and transporting a stolen motor vehicle across state lines. He was sentenced to 60 months in prison, 3 years of supervised release, and ordered to pay $40,406 in restitution. Myers completed his sentence in 2010 but was reincarcerated in 2013 on other charges. Since then, over $30,500 has been deposited into his inmate trust account, mostly from family and friends, with a smaller portion from prison wages. Myers still owes over $35,000 in restitution.The United States District Court for the Eastern District of Washington granted the government's motion to turn over funds from Myers's inmate trust account to apply to his restitution obligation. The court rejected Myers's request for an evidentiary hearing to determine which funds were prison wages, concluding that the government had provided sufficient evidence of the account's composition. The court held that the Mandatory Victims Restitution Act (MVRA), 18 U.S.C. § 3664(n), applies to substantial aggregated sums from multiple sources, not just one-time financial windfalls.The United States Court of Appeals for the Ninth Circuit affirmed the district court's order. The court held that § 3664(n) applies to substantial resources from any source, including gradual accumulations from family and friends, and not just to one-time windfalls. The court also found that the district court did not abuse its discretion in declining to hold an evidentiary hearing, as the existing documentary evidence was sufficient. The court concluded that the turnover order did not contravene the judgment's restitution provisions and was consistent with the MVRA's goal of ensuring prompt restitution to victims. View "United States v. Myers" on Justia Law

Edward Amezquita, a U.S. Navy veteran, appealed a decision denying service connection for his left shoulder disability. Prior to his service entrance examination in June 2003, Amezquita had undergone Bankart repair surgery on his left shoulder due to a motor vehicle accident. The service entrance examination noted the surgery but stated he was asymptomatic with no physical limitations. Amezquita served from July 2003 to March 2005. Shortly before his separation, he reported a shoulder injury, which was diagnosed as a sprain. In June 2005, he filed a claim for service connection for his left shoulder disability, which was denied by the VA in September 2005, citing no evidence of aggravation due to service.The Board of Veterans’ Appeals denied Amezquita’s claim in August 2021, finding that the presumption of soundness did not apply because his preexisting condition was noted upon service entry. The Board analyzed the claim under the aggravation standard and found no evidence of in-service aggravation. Amezquita appealed to the U.S. Court of Appeals for Veterans Claims, arguing that his asymptomatic condition should not be considered a noted defect. The Veterans Court affirmed the Board’s decision, relying on precedent that an asymptomatic condition can be noted as a preexisting defect.The United States Court of Appeals for the Federal Circuit reviewed the case. The court affirmed the Veterans Court’s interpretation that an asymptomatic condition can be noted as a preexisting defect under 38 U.S.C. § 1111. The court dismissed Amezquita’s arguments regarding the factual determination that his condition was resolved upon service entry, as it lacked jurisdiction to review factual findings. The decision was affirmed in part and dismissed in part. View "AMEZQUITA v. COLLINS " on Justia Law

The petitioners, current and retired Natural Resources Police Officers employed by the West Virginia Division of Natural Resources (DNR), have been receiving a statutory "subsistence allowance" since 1996. This allowance was included in their reported "compensation" to the West Virginia Consolidated Public Retirement Board (the Board) for calculating retirement annuities under the Public Employees Retirement System (PERS). In 2014, the Board discovered this inclusion was erroneous and decided to correct it by refunding overpaid contributions to active and inactive officers and adjusting retirement annuities for retired officers.The Circuit Court of Kanawha County reversed the Board's decision, finding the subsistence allowance was pensionable compensation. On appeal, the West Virginia Supreme Court held in West Virginia Consolidated Public Retirement Board v. Clark (Clark I) that the subsistence allowance was not "compensation" for PERS purposes and that the Board failed to correct the error in a timely manner for retired officers. The case was remanded for further proceedings.The Supreme Court of Appeals of West Virginia reviewed two certified questions from the Circuit Court of Kanawha County. The first question asked if the holding in Clark I required the subsistence pay received by all retired and active DNR officers to be included in calculating their pensionable income. The court answered "no," clarifying that Clark I's holding was limited to retired officers and did not apply to active and inactive officers. The second question asked if the petitioners were entitled to recover reasonable attorneys' fees from the Board. The court declined to answer, stating that it did not present an issue of law but rather a question of fact. View "Clark v. West Virginia Consolidated Public Retirement Board" on Justia Law

Travon Celey, a former employee of Children’s National Medical Center, was terminated on March 1, 2022, for accumulating six instances of tardiness within a twelve-month period. Celey subsequently applied for unemployment benefits, but a claims examiner from the District of Columbia Department of Employment Services (DOES) disqualified him, citing gross misconduct due to repeated tardiness following warnings.Celey appealed the decision to the Office of Administrative Hearings (OAH). Despite filing the appeal well beyond the fifteen-day deadline, OAH extended the deadline due to good cause and excusable neglect. During the hearing, the Hospital presented evidence and testimony showing that Celey had been warned and suspended for his tardiness, referencing both the independent Attendance Policy and the collective bargaining agreement (CBA) policy. The CBA policy mandated termination after the sixth instance of tardiness, while the independent Attendance Policy allowed for termination only after the eighth instance.The OAH administrative law judge (ALJ) found that the Hospital had issued inconsistent rules, failing to clearly notify Celey of the specific policy that applied to him. The ALJ concluded that Celey did not willfully violate the Hospital’s expectations and was therefore qualified to receive unemployment benefits.The District of Columbia Court of Appeals reviewed the case and affirmed the OAH decision. The court held that substantial evidence supported the ALJ’s finding that Celey was not adequately informed about the CBA policy, which was crucial for determining his eligibility for unemployment benefits. The court emphasized that the issue was whether Celey was on notice that his conduct could lead to termination, not whether the Hospital was justified in terminating him. View "Children's National Medical Center v. Celey" on Justia Law

The plaintiff, Mya Noelia Fallon, applied for Supplemental Security Income (SSI) under the Social Security Act, citing epileptic seizures and cognitive and behavioral limitations. Her application included assessments from her neurologist, Dr. Joseph Drazkowski, and licensed professional counselor (LPC) Terry Galler, who noted significant cognitive impairments and anxiety disorders. An Administrative Law Judge (ALJ) found Fallon not disabled, giving minimal weight to the opinions of Dr. Drazkowski and LPC Galler, and discrediting other medical and lay testimony.The United States District Court for the District of Arizona partially reversed the ALJ's decision, finding errors in the discounting of some witnesses but agreeing with the ALJ's assessment of Dr. Drazkowski's and LPC Galler's opinions. The case was remanded for further consideration. On remand, the ALJ again found Fallon not disabled, incorporating the prior evaluations. Fallon appealed, and the district court affirmed the ALJ's decision, refusing to revisit its prior conclusions about the medical opinions based on the law-of-the-case doctrine.The United States Court of Appeals for the Ninth Circuit reviewed the case. The court held that the law-of-the-case doctrine applies in the social security context, meaning that the district court did not abuse its discretion by refusing to reconsider the evaluations of Dr. Drazkowski and LPC Galler. The court explained that a social-security applicant has two options to preserve the right to appeal: immediately appeal the remand order or proceed on remand, understanding that the district court may decline to revisit settled issues. The Ninth Circuit affirmed the district court's decision, noting that Fallon forfeited her ability to challenge the evaluations by not raising the issue in her first appeal. View "FALLON V. DUDEK" on Justia Law