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In 2006, Moreno fell off scaffolding and landed on his back while working. An orthopedist found a soft tissue injury but no signs of fracture. He continued to feel significant pain. A follow-up test revealed acute lumbar radiculopathy—lower back pain caused by compression, inflammation or injury to a spinal nerve root. Moreno also is diabetic, has high blood pressure, and is obese. Moreno sought treatment from a psychologist, who reported that Moreno manifested depressed mood, irritability, memory difficulties, inability to concentrate, and an ongoing inability to sleep, sometimes for days. Moreno took several medications. In 2007, Moreno sought Supplemental Security Income and Disability Insurance Benefits. An ALJ affirmed the denial of his application. In the district court, the parties agreed to a remand to a different ALJ, who concluded that Moreno was not disabled although he was suffering from severe impairments and could not perform his past work as a drywall taper. The Seventh Circuit reversed. The ALJ improperly relied on an outdated assessment although later evidence containing new, significant medical diagnoses reasonably could have changed the reviewing physician’s opinion. Doctors’ notes set forth problems with Moreno becoming distracted, “spacing out,” and experiencing difficulties concentrating; these limitations were not included in the hypothetical question posed to the vocational expert. View "Moreno v. Berryhill" on Justia Law

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In 2006, Moreno fell off scaffolding and landed on his back while working. An orthopedist found a soft tissue injury but no signs of fracture. He continued to feel significant pain. A follow-up test revealed acute lumbar radiculopathy—lower back pain caused by compression, inflammation or injury to a spinal nerve root. Moreno also is diabetic, has high blood pressure, and is obese. Moreno sought treatment from a psychologist, who reported that Moreno manifested depressed mood, irritability, memory difficulties, inability to concentrate, and an ongoing inability to sleep, sometimes for days. Moreno took several medications. In 2007, Moreno sought Supplemental Security Income and Disability Insurance Benefits. An ALJ affirmed the denial of his application. In the district court, the parties agreed to a remand to a different ALJ, who concluded that Moreno was not disabled although he was suffering from severe impairments and could not perform his past work as a drywall taper. The Seventh Circuit reversed. The ALJ improperly relied on an outdated assessment although later evidence containing new, significant medical diagnoses reasonably could have changed the reviewing physician’s opinion. Doctors’ notes set forth problems with Moreno becoming distracted, “spacing out,” and experiencing difficulties concentrating; these limitations were not included in the hypothetical question posed to the vocational expert. View "Moreno v. Berryhill" on Justia Law

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Felton, then employed by Hewlett-Packard, sustained a minor injury to his knee while volunteering on a Douglas County search and rescue team. Felton sought insurance benefits from Douglas County and its workers' compensation insurance carrier. The third-party claims adjustor, ASC, notified Felton that it had calculated his average monthly wage (AMW) for the purpose of determining the amount of benefits based upon the statutorily deemed wage of a search and rescue volunteer as set forth in NRS 616A.157, which is $2,000 per month. ASC awarded Felton a one-percent permanent partial disability (PPD) or whole person impairment (WPI). A hearing officer affirmed the award. Felton appealed only the determination that his AMW should be set at the statutorily deemed wage of a search and rescue volunteer. The appeals officer affirmed, holding that Felton was not entitled to an AMW that aggregated his statutorily deemed wage and his earned wage from his private employment. The Nevada Supreme Court reversed. The plain language of the statutes and regulations requires the aggregation of concurrently earned wages. View "Felton v. Douglas County" on Justia Law

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Aponte moved into his mother's one-bedroom New York City Housing Authority (NYCHA)-owned apartment and cared for her until she died in 2012. Two requests for Aponte to be granted permanent permission to live with his mother were denied. After she died, Aponte requested to be allowed to lease her apartment as a "remaining family member." NYCHA denied his request, finding that Aponte lacked permanent permission to reside in the apartment; management properly denied such permission because Aponte's presence would have violated occupancy rules for overcrowding. A person lacking permanent permission to reside in an apartment is not eligible for RFM status. The Court of Appeals upheld the denial. Under its rules, NYCHA could not have granted Aponte permanent permission to reside in his mother's apartment, and thus could not have granted his request for RFM status. NYCHA's rules contemplate that a tenant may require a live-in home-care attendant, either for a transient illness or the last stages of life, and expressly allow for such an attendant as a temporary resident, even if that permission will result in "overcrowding," regardless of whether the attendant is related to the tenant. NYCHA's policy is not arbitrary and capricious for not allowing Aponte to bypass the 250,000-household waiting line as a reward for enduring an "overcrowded" living situation while caring for his mother. View "Aponte v Olatoye" on Justia Law

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Me. Rev. Stat. 39-A, 221 entitles an employer to a credit for workers’ compensation benefits previously paid for the same liability period when the employee was also receiving Social Security retirement benefits. Plaintiff was paid total incapacity workers’ compensation benefits by his employer, Interstate Brands International, after he sustained injuries in an initial workplace accident. For three years, Plaintiff collected Social Security retirement benefits while receiving the full amount of the workers’ compensation benefits. When Interstate learned that Plaintiff was receiving Social Security benefits, it sought a credit against the ongoing incapacity payments pursuant to section 221. A hearing officer determined that Interstate was entitled to a credit of nearly $25,000. The Workers’ Compensation Appellate Division vacated the decree, concluding that section 221 does not allow a reduction based on incapacity overpayments made in the past. The Supreme Judicial Court vacated the Appellate Division’s decision, holding that Interstate was entitled to a credit for incapacity benefit overpayments made to Plaintiff during the same period when he received Social Security retirement benefits. View "Urrutia v. Interstate Brands International" on Justia Law

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The Eighth Circuit vacated the district court's decision affirming the denial of social security disability benefits to plaintiff. The court held that substantial evidence on the record as a whole supported the ALJ's decision to give plaintiff's treating physician's residual functioning capacity (RFC) assessments little weight and to rely more heavily on other opinions in the record. However, a conflict marred the expert's testimony that an individual with plaintiff's RFC could perform the work of a new accounts clerk. Therefore, the court remanded with instructions for the district court to return the case to the Social Security Administration for a new step-five determination. View "Thomas v. Berryhill" on Justia Law

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At issue was the relationship between Conn. Gen. Stat. 45a-655(b) and (d) in determining whether a spousal support order previously rendered by the probate court was binding on the Commission of Social Services when calculating the allowance that may be diverted to the support of the community spouse of a Medicaid eligible institutionalized person pursuant to 42 U.S.C. 1396r-5. The Commissioner decided to set a community spouse allowance for Paul Valliere in the amount of $0 with respect to the Medicaid benefit that paid for the long-term residential care of his wife, Majorie Valliere. The trial court sustained the administrative appeal brought by Plaintiffs, Paul and Ellen Shea, conservatrix and executrix of Majorie’s estate. The Supreme Court affirmed, holding that the probate court did not exceed its authority under section 45a-655 by ordering community spouse support in an amount that exceeded that which the Department of Social Services could order pursuant to 42 U.S.C. 1396r-5. View "Valliere v. Commissioner of Social Services" on Justia Law

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At issue was the relationship between Conn. Gen. Stat. 45a-655(b) and (d) in determining whether a spousal support order previously rendered by the probate court was binding on the Commission of Social Services when calculating the allowance that may be diverted to the support of the community spouse of a Medicaid eligible institutionalized person pursuant to 42 U.S.C. 1396r-5. The Commissioner decided to set a community spouse allowance for Paul Valliere in the amount of $0 with respect to the Medicaid benefit that paid for the long-term residential care of his wife, Majorie Valliere. The trial court sustained the administrative appeal brought by Plaintiffs, Paul and Ellen Shea, conservatrix and executrix of Majorie’s estate. The Supreme Court affirmed, holding that the probate court did not exceed its authority under section 45a-655 by ordering community spouse support in an amount that exceeded that which the Department of Social Services could order pursuant to 42 U.S.C. 1396r-5. View "Valliere v. Commissioner of Social Services" on Justia Law

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The North Dakota Department of Human Services appealed a district court judgment reversing the Department's order deciding Sanford HealthCare Accessories received overpayments for medical equipment supplied to Medicaid recipients and ordering recoupment. The North Dakota Supreme Court reversed and remanded, concluding the district court erred in deciding the Department's failure to comply with the statutory time requirement for issuing its final order precluded the Department from acting. View "Sanford Healthcare Accessories, LLC v. N.D. Dep't of Human Services" on Justia Law

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The North Dakota Department of Human Services appealed a district court judgment reversing the Department's order deciding Sanford HealthCare Accessories received overpayments for medical equipment supplied to Medicaid recipients and ordering recoupment. The North Dakota Supreme Court reversed and remanded, concluding the district court erred in deciding the Department's failure to comply with the statutory time requirement for issuing its final order precluded the Department from acting. View "Sanford Healthcare Accessories, LLC v. N.D. Dep't of Human Services" on Justia Law