Justia Public Benefits Opinion SummariesArticles Posted in California Court of Appeal
Ronald F. v. Department of Developmental Services
The trial court denied appellant's petition for writ of administrative mandamus seeking to overturn the denial of his claim for services under the Lanterman Developmental Disabilities Services Act (Lanterman Act), Welf. & Inst. Code, 4500 et seq. The trial court denied the petition based on the doctrine of res judicata because his ineligibility for services had been previously adjudicated in two prior proceedings. The court agreed, and rejected appellant's claim that res judicata does not apply because the court’s decision in Samantha C. v. State Dept. of Developmental Services and a 2003 amendment to the Lanterman Act constitute an intervening change in the law or a doctrinal change that precludes application of the doctrine. In this case, the court concluded that neither the Samantha C. decision nor the 2003 amendment to section 4512 bars application of res judicata. Accordingly, the court affirmed the judgment. View "Ronald F. v. Department of Developmental Services" on Justia Law
Posted in: California Court of Appeal, Public Benefits
N.S. v. Superior Court
N.S. was placed in foster care when she was 11 years old. After she turned 18 in 2014, she remained under the jurisdiction of the juvenile court as a nonminor dependent. (Welf. & Inst. Code, 11400(v).) N.S. had been diagnosed with posttraumatic stress disorder, attention-deficit/hyperactivity disorder, and depressive disorder. She was participating in therapy and taking medication and would be enrolled in an educational program. In 2015, the Agency took the position that N.S. qualified for extended foster care because her mental health diagnoses prevented her from attending an educational or employment program or working at least half time. In 2016, the Agency recommended that N.S.’s dependency be dismissed because her exact whereabouts were unknown. N.S. was abusing methamphetamines and declined offers of housing, substance abuse treatment support, and options to get back on track with services. The Agency sought to have N.S.’s psychotherapist testify as to confidential communications. The court overruled N.S.’s objection. The court of appeal granted a writ prohibiting any inquiry concerning the psychotherapist’s confidential communications with N.S. N.S. did not put her mental condition at issue by responding to questions posed by the Agency in its case-in-chief with respect to her eligibility or by submitting documentation. View "N.S. v. Superior Court" on Justia Law
Posted in: California Court of Appeal, Civil Procedure, Public Benefits
In re W.C.
W.C. was born in Guatemala in 1997. He lived with his grandparents because his mother was dead and his father missing. W.C. left Guatemala because of threats to his safety and came to the U.S. alone, in 2014. At the border, W.C. was taken into protective custody and placed with a distant relative in Oakland. The relative agreed to sponsor W.C. for asylum, but their relationship deteriorated. W.C. became homeless in October 2014. He started using drugs. Taken to a hospital for assessment after cutting himself at school, he was denied treatment because he lacked insurance. W.C. lived at a youth shelter for a while, then told social services he was living with a friend. Eventually, W.C. was suspended from school because he was under the influence of drugs, possessed a knife, and engaged in theft. W.C. requested protective custody. The court ordered him detained, with temporary placement and care provided by the agency. On May 1, 2015, W.C. turned 18. At a May 26 hearing, the agency recommended the dependency be dismissed because the juvenile court had made no legal determination on dependency. On July 7, the juvenile court dismissed the Welfare and Institutions Code section 300 petition. In February 2016, W.C. filed a Request to Return to Juvenile Court Jurisdiction and Foster Care, hoping to participate in job training. The court denied the request. The court of appeal affirmed, holding that a nonminor who was never found a dependent of the court could not reenter and be subject to juvenile court jurisdiction. View "In re W.C." on Justia Law
Posted in: California Court of Appeal, Juvenile Law, Public Benefits
Roberts v. United Healthcare
Plaintiff filed a class action against United Healthcare, alleging claims of unfair competition, unjust enrichment, and financial elder abuse. Plaintiff had enrolled in a private health plan offering benefits to persons 65 and over as well as disabled persons under the federally funded Medicare Advantage program, 42 U.S.C. 1395w-21 et seq. After he went to an urgent care center outside of the plan's network, he was forced to pay a $50 copayment instead of the $30 copayment for in-network centers. Plaintiff alleged that the plan’s marketing materials misled him (and other enrollees) as to the availability of in-network urgent care centers (and their smaller copayments) and that the absence of any in-network urgent care centers in California rendered the plan’s network inadequate. The court concluded that plaintiff’s misrepresentation and adequacy-of-network based claims was expressly preempted by the preemption clause applicable to Medicare Advantage plans, 42 U.S.C. 1395w-26(b)(3). The court also concluded that plaintiff’s claims, to the extent they challenge a denial of benefits, are subject to dismissal because plaintiff did not first exhaust his administrative remedies under the Medicare Act, 42 U.S.C. 405(g), (h) and 1395ii. Accordingly, the court affirmed the trial court's dismissal of the complaint. View "Roberts v. United Healthcare" on Justia Law
Posted in: California Court of Appeal, Health Law, Insurance Law, Public Benefits
Tanner v. CalPERS
Plaintiff Joseph Tanner sought to overturn a decision of defendant California Public Employees’ Retirement System (CalPERS) that significantly reduced his expected retirement benefit. The Court of Appeal found that Tanner’s argument appeared to be that under contract principles, he and the city made a mutual mistake in entering into a November 2006 agreement because they thought all of his compensation in that agreement could be used to calculate the amount of his retirement benefit, and when CalPERS informed them otherwise, they reformed the agreement to achieve their original intent by folding various miscellaneous items of compensation in the November 2006 agreement into his new, greater base salary in the March 2007 agreement. The Court concluded, however, that Tanner’s appeal was without merit regardless of these contract arguments, or any of the other arguments Tanner made. The Court agreed with the trial court that the greater base salary in the March 2007 agreement did not qualify as Tanner’s payrate for purposes of calculating the amount of his retirement benefit because that salary was not paid pursuant to a publicly available pay schedule. For this reason, Tanner had no right to have his retirement benefit calculated based on that greater base salary. View "Tanner v. CalPERS" on Justia Law
United Educators of San Francisco. v. Cal. Unemp. Ins. Appeals Bd.
In 2010-2011, the San Francisco Unified School District employed 11 substitute teachers who worked on an as-needed basis and 15 paraprofessional classified employees. Each of the 26 employees received a letter during the spring of the 2010-2011 school year advising that they had a reasonable assurance of employment for the following 2011-2012 school year. The 26 sought unemployment benefits for the period between the last date of the regular session of the 2010-2011 school year, May 27, 2011, and the first day of instruction for the 2011-2012 school year, August 15, 2011. The Employment Development Department denied benefits. The California Unemployment Insurance Appeals Board reversed. The trial court and court of appeals ruled in favor of the District: “in effect what the claimants ... are requesting is … a full year‘s income … they have agreed to work and be paid for only 41 weeks of each year. … school employees can plan for those periods of unemployment and thus are not experiencing the suffering from unanticipated layoffs that the employment-security law was intended to alleviate.” View "United Educators of San Francisco. v. Cal. Unemp. Ins. Appeals Bd." on Justia Law
In re Nia A.
The single mother of five children, 8 to 15 years old, struggled with abusive relationships, homelessness and unemployment. They lived primarily in Marin County from 2000 until they moved to Richmond in 2009. In 2015, Mother asked Contra Costa Children & Family Services to place the four youngest children in foster care. CFS did so and filed petitions alleging Mother’s failure to protect and inability to provide support. The court ordered supervised visitation and that CFS refer Mother to substance abuse treatment and parenting education. CFS's disposition report recommended that the court order family reunification services and transfer the case to Marin County. Mother was participating 12- step meetings and alcohol abuse education in Marin and expected to secure a Marin apartment. Marin County court accepted the transfer and continued the case. Later, Marin’s Health and Human Services Department asked the court to transfer the cases back to Contra Costa because it had discovered that a county employee had a familial relationship to the parties, rendering the Department unable to continue services. Mother opposed the transfer; there was no evidence that the proposed transfer served the children’s best interests. The court of appeal remanded the cases to Marin, noting that all of the parties conceded error. View "In re Nia A." on Justia Law
Posted in: California Court of Appeal, Family Law, Public Benefits
Travelers Cas. & Surety Co. v. Workers’ Comp. Appeals Bd.
Dreher had been a maintenance supervisor at an Alliance apartment complex for 74 days when he slipped and fell on concrete walkway in the complex in the rain. Dreher sustained a fractured pelvis and injuries to his neck, shoulder, leg, and knee. He suffered gait derangement, a sleep disorder, and headaches. Dreher required surgery to repair pelvic fractures, another surgery to repair a torn meniscus, and another surgery to address issues with his foot and ankle. Dreher sought compensation for a psychiatric injury. An evaluation concluded that Dreher suffered a psychiatric disability as a result of the accident, including depression, difficulty sleeping, and panic attacks. The ALJ found that Dreher sustained an injury arising out of and in the course of his employment but denied his claim as barred by section 3208.3(d) because Dreher was employed by Alliance for less than six months and his psychiatric injury did not result from a sudden and extraordinary employment condition. On reconsideration, the Workers’ Compensation Appeals Board found that the injury was not barred. The court of appeal annulled the decision. Dreher’s testimony that he was surprised by the slick surface because the other walkways had a rough surface, and that the walkway was later resurfaced, did not demonstrate that his injury was caused by an uncommon, unusual, or totally unexpected event. View "Travelers Cas. & Surety Co. v. Workers' Comp. Appeals Bd." on Justia Law
Astorga v. Retirement Board
Plaintiff challenged the trial court's denial of her petition for a writ of mandate. The trial court concluded that the Board correctly calculated plaintiff's effective date of disability retirement. Plaintiff raised two questions on appeal: (1) whether donated sick leave or vacation time from co-workers is considered "regular compensation" of the disabled employee under Government Code section 31724, and (2) whether the incremental payments of sick leave, vacation and holiday pay should be "compressed" to achieve an earlier date of retirement. The court concluded that the first question is not properly before it. In regards to the second question, the court concluded that Katosh v. Sonoma County Employees' Retirement Assn. confirmed the bright line rule that disability retirement benefits are not available until the day following the day paid leave was last received. Therefore, the trial court properly denied her petition for writ of mandate challenging that date. The court affirmed the judgment. View "Astorga v. Retirement Board" on Justia Law
Posted in: California Court of Appeal, Public Benefits
Macy v. City of Fontana
In 2011, the California Legislature adopted legislation which dissolved the redevelopment agencies (RA's) that had been formed by municipalities throughout the state under the provisions of the Community Redevelopment Law (CRL). Before their dissolution, the operations of RA's were funded by way of so-called "tax increment" financing. Shortly before the Legislature dissolved RA's, plaintiffs-appellants Virginia Macy, a low-income resident of the city; Libreria Del Pueblo, Inc.; and California Partnership filed a petition for a writ of mandate against the Fontana Redevelopment Agency alleging the agency failed to provide the low- and moderate-income housing required under the CRL. Plaintiffs asked for relief in the form of the payment of $27 million into the agency's low- and moderate-income housing fund (LMIHF). AB 26 created successor agencies that were given responsibility over certain obligations of each dissolved RA. Importantly, under the dissolution legislation, the liability of successor agencies was limited to the value of the assets those agencies received from their respective predecessor RA's. After enactment of AB 26, plaintiffs amended their petition and added defendant and respondent City of Fontana (the city), initially in its role as the successor agency provided by AB 26, and later also in its separate capacity as a municipal corporation. In its capacity as a municipal corporation, the city filed a demurrer to the petition, arguing that under AB 26 only a successor agency may be held liable for the preexisting obligations of an RA. The trial court sustained the demurrer without leave to amend. Plaintiffs appealed, but the Court of Appeal affirmed: the low- and moderate-income housing were never the liabilities of municipalities and their general funds. "An extension of RA statutory liabilities to municipalities and their general funds would require a very clear expression of the Legislature's intention to depart from the historical treatment of low- and moderate-income housing obligations; no such expression appears in AB 26 or later amendments to the dissolution legislation." View "Macy v. City of Fontana" on Justia Law