Justia Public Benefits Opinion Summaries

Nancy Vargas, a bus driver for the Santa Barbara Metropolitan Transit District, injured her foot at work in March 2018. She settled her claim against the district in December 2020, with a stipulated permanent disability of 26 percent. Vargas applied for subsequent injury benefits from the Subsequent Injuries Benefits Trust Fund (Fund), listing pre-existing disabilities and disclosing that she was receiving Social Security Disability Insurance (SSDI) payments. The Fund acknowledged her eligibility but sought to reduce her benefits by the amount of her SSDI payments, claiming these were for her pre-existing disabilities.The Workers’ Compensation Appeals Board (Board) determined that the Fund was not entitled to this reduction, as the Fund had not proven that Vargas’s SSDI payments were awarded for her pre-existing disabilities. The Board found that the evidence provided, including an award letter from the Social Security Administration, did not specify the basis of the SSDI benefits. The Fund’s petition for reconsideration was denied by the Board, which maintained that the Fund needed to show the SSDI payments were for pre-existing disabilities to claim a reduction.The California Court of Appeal, Second Appellate District, reviewed the case. The court affirmed the Board’s decision, holding that the Fund bears the burden of proving its entitlement to a reduction in benefits under section 4753 of the Labor Code. The court found that the Fund did not provide sufficient evidence to establish that Vargas’s SSDI payments were for her pre-existing disabilities. The court emphasized that the Fund must meet its burden of proof by a preponderance of the evidence and that the stipulated disability rating in Vargas’s settlement with her employer did not automatically entitle the Fund to a reduction in benefits. The Board’s order denying the Fund’s petition for reconsideration was affirmed. View "Subsequent Injuries Benefits Trust Fund v. Workers Comp. App. Bd." on Justia Law

James Morell, a retired research attorney for the Orange County Superior Court, was entitled to a pension under the County Employees Retirement Law of 1937 (CERL). The dispute arose over whether the $3,500 Optional Benefit Program (OBP) payments he received should be included in the calculation of his pension. The OBP allowed attorneys to allocate the $3,500 to various benefits or receive it as taxable cash. Morell allocated portions to a healthcare reimbursement account and cash. The Orange County Employees’ Retirement System (OCERS) excluded these payments from his pension calculation, leading to prolonged litigation.The Los Angeles County Superior Court initially ruled in favor of Morell, ordering OCERS to reconsider its decision without relying on Resolution 90-1551, which OCERS argued required the exclusion of OBP payments. The court found that the resolution had been invalidated and that Morell could not waive his argument that OCERS’ calculation contravened CERL through a settlement agreement.The California Court of Appeal, Second Appellate District, Division One, reviewed the case. The court concluded that Resolution 90-1551, which adopted the provisions of the now-repealed Government Code section 31460.1, remained valid due to a savings clause in Senate Bill 193. This clause preserved actions taken by counties under section 31460.1 before its repeal. The court found that Morell had elected to participate in the OBP and that the payments reflected amounts exceeding his salary.The Court of Appeal reversed the trial court’s judgment and remanded the case with directions to deny Morell’s petition. The court held that Resolution 90-1551 was still valid and that OCERS correctly excluded the OBP payments from Morell’s pension calculation. View "Morell v. Board of Retirement of the Orange County Employees' Retirement System" on Justia Law

In the case before the Court of Appeal of the State of California First Appellate District Division Two, the appellant, Debra Abney, challenged the decision of the State Department of Health Care Services and the City and County of San Francisco to consider money garnished from her Social Security payments as income for the purposes of determining her eligibility for benefits under Medi-Cal.Abney's Social Security payments were being reduced by nearly $600 each month to satisfy a debt she owed to the IRS. The authorities considered this garnished money as income, which led to Abney being ineligible to receive Medi-Cal benefits without contributing a share of cost. Abney argued that the money being garnished was not income “actually available to meet her needs” under the regulations implementing the Medi-Cal program.The trial court rejected Abney's argument, and she appealed. The Court of Appeal affirmed the trial court's decision. The Court of Appeal held that the tax garnishment was "actually available" to meet Abney's needs because it benefitted her financially by helping to extinguish her debt to the IRS. Therefore, the garnished money was correctly considered as income for the purpose of calculating her eligibility for the Medi-Cal program. View "Abney v. State Dept. of Health Care Services" on Justia Law

Securus Technologies, LLC (Securus), is one of six telecommunications companies providing incarcerated persons calling services (IPCS) in California. In this original proceeding, Securus challenges the decision of the California Public Utilities Commission (PUC) adopting interim rate relief for IPCS in the first phase of a two-phase rulemaking proceeding. Among other things, the PUC’s decision: (1) found IPCS providers operate as locational monopolies within the incarceration facilities they serve and exercise market power; (2) adopted an interim cap on intrastate IPCS rates of $0.07 per minute for all debit, prepaid, and collect calls; and (3) prohibited providers from charging various ancillary fees associated with intrastate and jurisdictionally mixed IPCS.   The Second Appellate District affirmed the PUC’s decision. The court concluded Securus has not shown the PUC erred by finding providers operate locational monopolies and exercise market power. The court held that facts do not—as Securus contends—demonstrate Securus “cannot recover its costs (including a reasonable rate of return)” under the interim rate cap and do not amount to a “clear showing” that a rate of $0.07 per minute “is so unreasonably low” that “it will threaten Securus’s financial integrity.” Thus, Securus has failed to satisfy its “burden of proving . . . prejudicial error” on constitutional grounds. View "Securus Technologies v. Public Utilities Com." on Justia Law

With the agreement of her supervisor, Johar, a salesperson, left work for about a week to care for a terminally ill relative. While she was away her employer (SWS) decided she had quit. Upon her return, SWS stated business was slow and gave her no new sales appointments. Johar sought unemployment benefits, citing a “temporary layoff.” SWS denied laying Johar off. While conceding that she left with her supervisor’s approval, SWS claimed that Johar’s failure to provide a return date or otherwise communicate with her supervisor while she was away amounted to a voluntary quit. The Employment Development Department agreed, found Johar ineligible for unemployment benefits, ordered reimbursement of benefits improperly paid, and imposed a penalty for willful misrepresentation. The California Unemployment Insurance Appeals Board (CUIAB) affirmed.After Johar sought judicial review, CUIAB confessed error for failing to consider new evidence discovered by Johar while the administrative appeal was pending. The court dismissed the case without reaching the merits. The court of appeal reversed. Johar was entitled to relief on the existing record. She left her job in emergency circumstances with the employer’s approval, thus for good cause; an employee who leaves work for good cause is presumed to have not voluntarily quit. SWS’ evidence did not establish that Johar positively repudiated her obligation to return in clear terms. View "Johar v. California Unemployment Insurance Appeals Board" on Justia Law

The Medi-Cal program, California’s enactment of the federal Medicaid program, was administered by the California Department of Health Care Services (the department) administers the Medi-Cal program. In this case, the department sought reimbursement from a revocable inter vivos trust for the Medi-Cal benefits provided on behalf of Joseph Snukst during his lifetime. Following his death, the probate court ordered the assets in the revocable inter vivos trust to be distributed to the sole beneficiary, Shawna Snukst, rather than to the department. The Court of Appeal concluded federal and state law governing revocable inter vivos trusts, as well as public policy, required that the department be reimbursed from the trust before any distribution to its beneficiary. Judgment was therefore reversed and remanded. View "Riverside County Public Guardian v. Snukst" on Justia Law

Plaintiff Family Health Centers of San Diego operated a federally qualified health center (FQHC) that provided various medical services to its patients, some of whom are Medi-Cal beneficiaries. Section 330 of the Public Health Service Act authorized grants to be made to FQHC’s. In addition, FQHC’s could seek reimbursement under Medi-Cal for certain expenses, including reasonable costs directly or indirectly related to patient care. Plaintiff appealed a trial court’s order denying its petition for writ of mandate seeking to compel the State Department of Health Care Services (DHCS) to reimburse plaintiff for money it expended for outreach services. The Court of Appeal rejected plaintiff’s contention that the trial court and the DHCS improperly construed and applied applicable guidelines in the Centers for Medicare & Medicaid Services Publication 15-1, The Provider Reimbursement Manual (PRM). The Court concluded that the monies spent by plaintiff were not an allowable cost because they were akin to advertising to increase patient utilization of plaintiff’s services. View "Family Health Centers of S.D. v. State Dept. of Health Care Services" on Justia Law

A.B., a 40-year-old male diagnosed to suffer from severe schizophrenia, has been subject to conservatorships on and off for 20 years. A.B. has no real property or significant assets; his only income is $973.40 in monthly social security benefits. The public guardian was most recently appointed as A.B.’s conservator in 2016 and reappointed annually until the dismissal of the conservatorship in 2019. In August 2017, the public guardian was awarded $1,025 and county counsel was awarded $365 in compensation for services rendered 2016-2017. In 2018, the court entered an order for compensation for the public guardian and county counsel in the same amounts covering 2017-2018. The public guardian sought compensation for services rendered 2018-2019, $1,569.79 for its services, and $365 for county counsel.The court found that the request for compensation was just, reasonable, and necessary to sustain the support and maintenance of the conservatee, and approved the petition, again ordering the public guardian to defer collection of payment if it determined that collection would impose a financial hardship on the conservatee. The court of appeal reversed. While the court had sufficient information before it to enable consideration of the factors enumerated in Probate Code section 2942(b), the court failed to do so and improperly delegated responsibility to the public guardian to defer collection. View "Conservatorship of A.B." on Justia Law

Appellant N.A. was a nonminor former dependent (NFD). While a minor, she lived with a legal guardian, who received financial aid (aid to families with dependent children-foster care, or AFDC-FC) on N.A.’s behalf. When N.A. was 17 years old, she moved out of the guardian’s home. The San Diego County Health and Human Services Agency was not informed of this circumstance, and AFDC-FC payments to the guardian continued past N.A.’s 18th birthday. The guardian provided some financial support to N.A. after she moved out, but at some point, the guardian stopped providing support altogether. Thereafter, N.A. petitioned to return to juvenile court jurisdiction and foster care, which would provide her with certain services and financial aid, under Welfare & Institutions Code section 388.1. At that time, the Agency became aware of N.A.’s prior living circumstance and determined that she and the guardian became ineligible for AFDC-FC payments when N.A. moved out of the guardian’s home before N.A. turned 18. The Agency sent notice of its decision to the guardian. Based on its determination that N.A. was not actually eligible to receive AFDC-FC payments after she turned 18, the Agency recommended denying her petition for reentry. The juvenile court denied N.A.’s petition for reentry, but ordered the Agency to notify N.A. directly of its eligibility determination so that she could pursue administrative remedies. On appeal, N.A. contended the juvenile court’s order was based on an erroneous interpretation of section 388.1 and related statutes. Alternatively, N.A. argued that the court should have decided the AFDC-FC eligibility issue because exhausting the administrative hearing process would be futile under the circumstances. Finding no reversible error, the Court of Appeal affirmed the order. View "In re N.A." on Justia Law

The Court of Appeal reversed the superior court's decision reversing the ALJ's finding that A.V. met the statutory criteria for developmental disability: he had a qualifying condition of autism, i.e., ASD; his ASD was substantially disabling; and the condition originated before age 18. The ALJ rejected the Regional Center's argument that a qualifying condition must not only originate but must also become "substantially disabling" before age 18. Although the superior court agreed with the ALJ's decision to the extent it found a claimant's qualifying condition need not become substantially disabling before age 18, it found that the ALJ erred by weighing the parties' evidence "on an even playing field" rather than deferring to the Regional Center's opinions about A.V.'s eligibility for services under the Lanterman Developmental Disabilities Services Act.The court concluded that the superior court erred when it deferred to the Regional Center's eligibility determinations. The court explained that a fair hearing under the Act is just that – an even playing field on which the participants present their evidence to an impartial hearing officer. In this case, the superior court owed deference not to the Regional Center's evaluators but to the administrative process created to fairly resolve disputes over eligibility for services. Accordingly, the court directed the superior court to review the petition under the appropriate standard on remand. View "Tri-Counties Ass'n v. Ventura County Public Guardian" on Justia Law