Justia Public Benefits Opinion Summaries

For decades, the U.S. Virgin Islands Government Employees Retirement System (GERS) experienced annual deficits between its assets and projected liabilities to participants. Its aggregate shortfall is now about three billion dollars. The Government of the Virgin Islands (GVI) has sometimes failed to remit to GERS all the employer contributions it is statutorily mandated to make. GERS sued GVI for these contributions, first in 1981, resulting in a consent judgment, and most recently in 2016, when GERS sought to enforce that judgment. GERS claimed that, as far back as 1991, GVI had contributed tens of millions of dollars less than required by the statutory percentages of employee compensation. GERS also claimed that independent of these fixed-percentage contributions, GVI must fund GERS to the point of actuarial soundness.The district court awarded GERS an amount calculated to reflect GVI’s historical percentage-based under-contributions. The Third Circuit affirmed that award of principal but vacated an enhancement of the award that applied late-arriving interest and penalty statutes, enacted in 2005, retroactively. The consent judgment does not require GVI to fund GERS for the gap between its assets and liabilities. Virgin Islands law apparently fails to obligate anyone to fund GERS when employee-compensation-based contributions and associated investment returns fall short of the assets required, based on actuarial assessments, to meet future pension commitments. The citizens of the Virgin Islands (population 106,4052) simply cannot pay the necessary billions. The cure for GERS’s chronic underfunding is legislative. View "Government Employees Retirement System of the Virgin Islands v. Government of the Virgin Islands" on Justia Law

Pavlicek, age 49. applied for Disability and Supplemental Security Income benefits. He suffers from anxiety, depression, severe tremors, and pseudoseizures that resemble epileptic seizures but stem from psychological causes. A truck driver, he has a high-school education. Two non-examining agency consultants determined that he could function with some limitations. Pavlicek testified that he had constant tremors and had seven pseudoseizures in the past 16 months when he lost consciousness; in seven other episodes, he remained conscious. A vocational expert testified about employers’ tolerance for absenteeism and about a hypothetical employee with various restrictions. The treating psychiatrist reported that Pavlicek could not work.The ALJ determined that Pavlicek retained the residual functional capacity to perform medium work with exceptions and could perform work that existed in significant numbers in the national economy. The ALJ largely dismissed the report by the treating psychiatrist, who had not justified how his findings could apply “as far back as 2013,” having not treated Pavlicek until 2015 and who relied heavily on Pavlicek’s subjective reporting. The ALJ noted the “infrequent” nature of the treatment relationship and that the report’s assessment of severe functional limitations was unsupported by the clinical records. The Seventh Circuit affirmed. The decision was supported by substantial evidence. The court rejected claims that the ALJ gave inadequate reasons for rejecting the treating psychiatrist's opinion, afforded too much weight to the opinions of non-examining agency physicians, and posed hypothetical questions to the vocational expert that failed to account for his limitations. View "Pavlicek v. Saul" on Justia Law

Rush retired in 2012. The California State Teachers Retirement System (CalSTRS) calculated his pension as 92.58 percent of his final compensation. Rush disputed the determination of his “final compensation,” defined as “the highest average annual compensation earnable by a member during any period of 12 consecutive months” For 12 consecutive months over portions of two school years, Rush served as an associate dean at a salary significantly higher than his salary during the other portions of those years.CalSTRS applied Education Code section 22115(d): If a member worked at least 90 percent of a school year at the higher pay rate, compensation earnable was to be calculated as if the member earned all service credit for the year at the higher rate. If the member worked less than 90 percent of the year at the higher rate, as Rush did, compensation earnable “shall be the quotient obtained when creditable compensation paid in that year is divided by the service credit for that year.” The court of appeal upheld CalSTRS’s calculation as within the range of reasonable statutory construction. View "Rush v. State Teachers' Retirement System" on Justia Law

In these consolidated appeals, the Supreme Court affirmed the district court's dismissal of separate actions challenging the Nebraska Department of Health and Human Services' (DHHS) denial of an administrative appeal hearing, holding that the district court correctly determined that the hearing request was untimely submitted to DHHS under the governing regulation.Robert Colwell, DDS, P.C., was a Nebraska corporation through which Colwell (collectively, Colwell) provided medical services. Colwell entered into an agreement with Managed Care of North America (MCNA), which provided managed care services to Nebraska's Medicaid program, agreeing to provide dental services for individuals enrolled in Nebraska Medicaid. When MCNA allegedly failed to compensate Colwell for covered services, Colwell filed one action challenging the MCNA's decision to terminate the Medicaid provider agreement with Colwell. In this action, Colwell filed a request for a fair hearing with DHHS, which DHHS denied and dismissed. Colwell then filed another action challenging the DHHS order of dismissal. The district court dismissed both appeals for lack of subject matter jurisdiction. The Supreme Court affirmed, holding that Colwell's request for a hearing before DHHS was not timely filed within ninety days of the "date of the action." View "Colwell v. Managed Care of North America" on Justia Law

Arnold applied for Social Security disability benefits based on ailments related to her back, heart, and joints, and chronic pain syndrome. Following the initial denial of her claim, Arnold requested a hearing before an ALJ. Arnold testified at the hearing, as did a vocational expert. The ALJ concluded that Arnold was not disabled, finding Arnold had several severe impairments, but that she retained the ability, with certain movement restrictions, to perform her past relevant work as a daycare center director. The district court and Seventh Circuit affirmed the ALJ’s decision, rejecting an argument that the ALJ failed to analyze whether the side effects of her medications impacted Arnold’s ability to work. While there is some evidence of side effects in the record, there is no evidence that the side effects impacted Arnold’s ability to work. On this record, the ALJ was not required to make findings about Arnold’s side effects. View "Arnold v. Saul" on Justia Law

In March 2020, Congress created the Paycheck Protection Program (PPP), which authorized the SBA to guarantee favorable loans to certain business affected by the COVID-19 pandemic. The SBA Administrator promulgated regulations imposing several longstanding eligibility requirements on PPP loan applicants, including that no SBA guarantee would be given to businesses presenting "live performances of a prurient sexual nature." Pharaohs, a business featuring nude dancing, sought a preliminary injunction directing the SBA to give it a PPP loan guarantee.The Second Circuit affirmed the district court's denial of Pharaoh's motion, holding that the district court did not abuse its discretion in finding that Pharaohs has failed to show that it is substantially likely to succeed on its claims that (1) the SBA exceeded its statutory authority to promulgate eligibility restrictions, and (2) the exclusion of nude-dancing establishments from the Program violates the First or Fifth Amendments. The court need not address the remaining preliminary injunction factors in light of its conclusion. View "Pharaohs GC, Inc. v. United States Small Business Administration" on Justia Law

Plaintiffs, former recipients of Social Security disability benefits and former clients of an attorney who orchestrated one of the largest fraud schemes in the history of the SSA, argued in consolidated appeals that SSA's categorical exclusion of allegedly fraudulent medical evidence during the redetermination process was unlawful because they were never afforded any opportunity to rebut the allegation that their evidence was tainted by fraud.The Fourth Circuit joined its sister circuits and held that the SSA's redetermination procedures violate the Administrative Procedure Act (APA) and the Due Process Clause of the Fifth Amendment. The court agreed with plaintiffs that it is arbitrary and capricious for the agency to deny beneficiaries an opportunity to contest the Office of the Inspector General's fraud allegations as to their cases, while permitting other similarly situated beneficiaries to challenge similar allegations arising from SSA's own investigations. The court also agreed with plaintiffs that the SSA's redetermination procedures violated their due process rights under the Fifth Amendment because they were denied the opportunity to contest the Office of the Inspector General's fraud allegations against them. In this case, the court considered each Mathews factor and concluded that each factor supports a finding that the SSA's redetermination procedures violated plaintiffs' due process rights. Accordingly, the court affirmed in No. 19-1989 and reversed in No. 19-2028. View "Kirk v. Commissioner of Social Security Administration" on Justia Law

For many years, attorney Conn obtained social security benefits for his clients by submitting fraudulent reports and bribing an Administrative Law Judge. After the government discovered this fraud, the SSA decided to redetermine whether each of Conn’s 1,500 claimants was actually eligible for disability benefits. The SSA held hearings and allowed the claimants to submit evidence but categorically excluded medical reports created by the doctors with whom Conn had conspired because it had “reason to believe” fraud was involved in the creation of the reports (42 U.S.C. 1383(e)(7)(A)(ii))). The claimants were not permitted to challenge that finding. After the denials of their claims, 57 plaintiffs filed suit.The Sixth Circuit held that the exclusion of the reports violated the Due Process Clause and the APA. On remand, the district courts concluded that remand to the SSA was proper because “the Commissioner erred in some respect in reaching the decision to deny benefits.”The Sixth Circuit affirmed the subsequent denial of the plaintiffs’ motions for attorney’s fees under the Equal Access to Justice Act. The government’s position in the litigation was “substantially justified,” in light of the precedent cited by the government, the rationale for the decision, and the fact that district courts across the country have split on this issue. The case involved numerous issues of first impression. Despite the fact that the government’s arguments were rejected, a reasonable person could have believed them to be correct. View "Wireman v. Commissioner of Social Security" on Justia Law

Zellweger applied for disability benefits in 2013, claiming a per se disabling spinal condition equivalent to Listing 1.04. His amended onset date was August 28, 2013. His last-insured status expired on September 30, 2013, so the application presented a narrow question: whether he was disabled during the one-month period from August 28 to September 30 (42 U.S.C. 416(i)(3)(B)). The primary medical basis for his application was cervical and lumbar degenerative disc disease.An ALJ denied his claim, concluding that the medical evidence did not meet the criteria for Listing 1.04 and that Zellweger could perform light work. A magistrate reversed, ruling that the ALJ’s discussion was too cursory at step three of the sequential analysis prescribed in the agency regulations: assessing whether the claimant has an impairment that meets or medically equals one of the Listings. Although the ALJ explained his reasoning more thoroughly later in his decision, the magistrate refused to consider that discussion.The Seventh Circuit reversed and remanded. The sequential process is not so rigidly compartmentalized. Nothing prohibits a reviewing court from reading an ALJ’s decision holistically. The ALJ thoroughly analyzed the medical evidence at the step in the sequential analysis that addresses the claimant’s residual functional capacity. That analysis elaborated on the more cursory discussion at step three and was easily adequate to support the ALJ’s rejection of a per se disability under Listing 1.04. View "Zellweger v. Saul" on Justia Law

As part of its response to the COVID-19 pandemic, Congress enacted the Families First Coronavirus Response Act (Families First Act), which provides for emergency assistance to households participating in the Supplemental Nutrition Assistance Program (SNAP).The Ninth Circuit affirmed the district court's order denying a motion for a preliminary injunction brought by a putative class of Californians, who normally receive the maximum monthly allotment of SNAP benefits, seeking to bar the USDA from denying California's request under section 2302(a)(1) of the Families First Act to issue emergency allotments to households already receiving maximum SNAP benefits. After determining that plaintiffs had Article III standing, the panel held that the USDA, which administers SNAP, correctly interpreted the statute by concluding that it allows households receiving less than the maximum monthly allotment of SNAP benefits to be brought up to the maximum but does not permit those already receiving the maximum to be given any additional benefits. When the panel examined the Families First Act as a whole, as well as other statutes addressing emergency SNAP benefits, three considerations lead it to conclude that the government's reading of section 2302(a)(1) is more consistent with the overall statutory scheme. Therefore, because plaintiffs were unlikely to succeed on the merits of their claims, the district court did not abuse its discretion in denying a preliminary injunction. View "Hall v. United States Department of Agriculture" on Justia Law