Justia Public Benefits Opinion Summaries

Plaintiffs, a class of economically vulnerable Arizonians who receive public health care benefits through the state's Medicaid agency, sued the U.S. Secretary of Health and Human Services (Secretary) and the Director of Arizona's medicaid agency (director)(collectively, defendants), alleging that the heightened mandatory co-payments violated Medicaid Act, 42 U.S.C. 1396a, cost sharing restrictions, that the waiver exceeded the Secretary's authority, and that the notices they received about the change in their health coverage was statutorily and constitutionally inadequate. The court affirmed the district court's conclusion that Medicaid cost sharing restrictions did not apply to plaintiffs and that Arizona's cost sharing did not violate the human participants statute. The court reversed the district court insofar as it determined that the Secretary's approval of Arizona's cost sharing satisfied the requirements of 42 U.S.C. 1315. The court remanded this claim with directions to vacate the Secretary's decision and remanded to the Secretary for further consideration. Finally, the court remanded plaintiffs' notice claims for further consideration in light of intervening events.

Defendant Daniel Cadle appealed a district court order that confirmed an arbitration award against him on Plaintiff Kerry Hicks’s claims of defamation and intentional infliction of emotional distress. Defendant’s objections concerned whether the dispute was properly referred to arbitration. The district court rejected Defendant’s objections for various reasons, holding that he was judicially estopped from challenging the arbitrator’s authority and that the dispute was properly referred to arbitration. Upon review of the lower court record, the Tenth Circuit affirmed the district court’s decision, holding judicial estoppel prevented Defendant from raising the arbitration issue on appeal. The Court declined to address issues unrelated to that rationale and dismissed Defendant’s case.

Plaintiff-Appellant Debra Kruse appealed the Commissioner of Social Security’s denial of benefits, claiming that an Administrative Law Judge (ALJ) erred in considering her medical source evidence and her credibility. Plaintiff claimed she was disabled by panic disorder, depression, joint disease and foot edema. She applied for Supplemental Security Income, but the ALJ concluded she was not disabled. Upon review of the ALJ’s decision and the applicable legal authority, the Tenth Circuit affirmed the Commission’s determination, finding substantial evidence and analysis to support the ALJ’s decision.

Plaintiff-Appellant Jeffrey McFerran appealed a district court judgment that affirmed the Commissioner of Social Security’s denial of his application for disability benefits. Plaintiff sought benefits based on degenerative disc disease of the lumbar and cervical spine and associated pain; coronary artery disease; hypertension; obesity; post surgery hernia; knee and shoulder limitations; depression; and anxiety. He had worked for the postal service following 40 years with the Air Force. The Veterans Administration determined Plaintiff was "entitled to receive service connected compensation at the 100 percent rate." An administrative law judge (ALJ) denied benefits at the last step of the five-step sequential process for determining disability. Finding that the Commissioner failed to follow the correct legal standards in denying benefits, the Tenth Circuit reversed Plaintiff’s case and remanded it for further proceedings.

Plaintiff-Appellant Patrick Dorman appealed a district court's denial of his request for an Equal Access to Justice (EAJA) fee. Plaintiff filed his application for social security disability benefits in 2004 alleging that he became disabled on December 30, 2003, due to breathing problems and depression. The agency denied his applications initially and on reconsideration. Plaintiff obtained a hearing before an administrative law judge (ALJ) who determined that he could return to his past relevant work and, therefore, upheld the denial of his application. Plaintiff then appealed administratively to the Appeals Council, which denied review of the ALJ’s decision. Plaintiff thereafter unsuccessfully appealed the Council's decision to the district court. Plaintiff then appealed to the Tenth Circuit court, raising essentially the same issues he had presented in the district court but this time focusing his argument on the ALJ’s failure to properly evaluate his mental impairments. The Tenth Circuit found merit to Plaintiff's argument and overturned the lower courts' decisions. Plaintiff's counsel thereafter petitioned the district court for an award of EAJA fees. Upon review, the Tenth Circuit concluded the district court abused its discretion in denying Plaintiff's EAJA fee motion. Consequently, the Court reversed the district court’s denial of his EAJA motion for fees and costs, and remanded the case with instructions to grant the motion and to award a reasonable fee and appropriate costs to Plaintiff.

Petitioner Patricia Kalar petitioned the Supreme Court to challenge the reduction of her benefits by Respondent New Hampshire Department of Health and Human Services. The Department conducted an inquiry into Petitioner's income and expenses as part of a mandatory, periodic "recertification" process for determining Petitioner's food stamp benefits. At the last inquiry, the Department determined that Petitioner's food stamp benefit should be reduced. Petitioner argued on appeal that the Department erred in its calculation that served as the basis of its reduction determination. Upon review, the Supreme Court could not conclude that the reduction in Petitioner's benefits was due to miscalculations by the Department. The Court affirmed the Department's decision.

Appellant appealed the district court's order, which affirmed the decision of the Commissioner of the Social Security Administration (Commissioner), denying appellant's application for disability benefits (DIB) under Title II of the Social Security Act, 42 U.S.C. 401 et seq. At issue was whether the ALJ committed legal error by failing to correctly apply the requisite five-step sequential evaluation process. The court held that the ALJ's failure to follow the mandated procedure was more than a mere oversight in opinion writing and that the ALJ was required to follow one of two paths at step five of the sequential process and there was no record indicating that the ALJ followed either path. Accordingly, the court reversed the district court's order affirming the Commissioner's decision and instructed the district court to remand the case to the Commissioner for further proceedings.

A veteran of the Vietnam War, who suffers from post-traumatic stress disorder and schizophrenia, applied for disability benefits in 1981 but his claim was rejected. Years later, the Veterans Court concluded that he was entitled to benefits stemming from the initial claim. The veteran challenged the procedures of the Board of Veterans Appeals in retrospectively assessing his level of disability during the years 1980 to 2007. The Federal Circuit upheld the determination, stating that the legal process was sufficient to satisfy Fifth Amendment rights. The veteran has had his day in court concerning the staged rating assessment, which included a total disability period exceeding five years and reduction of the rating during subsequent periods.

Appellant alleged that he was disabled as a result of Post Traumatic Stress Disorder, Parkinson's disease, Attention Deficit Disorder, and peripheral neuropathy and that these mental and physical limitations he had as a result of these conditions, combined with his advanced age and limited job skills, rendered him unable to perform any work available in the national economy. Appellant challenged the district court's affirmance of the Social Security Administration's (SSA) denial of his claim for disability benefits. The court affirmed the judgment and held that the ALJ's findings were supported by substantial evidence.

Plaintiff, an eleven-year-old special education student, lived in the Minnesota Independent School District No. 15 (district). An ALJ for the Minnesota Department of Education determined that the district had denied plaintiff a free appropriate public education (FAPE) within the meaning of the Individuals with Disabilities Education Act (IDEA), 20 U.S.C. 1400-1482. After plaintiff filed an action in federal court seeking attorney fees and costs, both parties filed cross-motions for judgment on the administrative record. The district court reversed the ALJ's decision and denied plaintiff's motion for fees and costs and plaintiff appealed. The court affirmed the district court's judgment and held that plaintiff was not denied a FAPE where the district court did not fail to give "due weight" to the results of the administrative hearing; where the district court did not commit procedural violations of the IDEA; and where the district court did not violate the IDEA's substantive requirements.