Justia Public Benefits Opinion Summaries

Crump applied for social security disability benefits based on her long history of numerous mental health impairments, including bipolar disorder and polysubstance abuse disorder. An administrative law judge denied benefits, finding that Crump, despite her severe impairments, could perform work limited to simple and repetitive tasks. The district court affirmed. The Seventh Circuit vacated. The ALJ did not adequately account for Crump’s difficulties with concentration, persistence, or pace in the workplace. An ALJ generally may not rely merely on catch-all terms like “’simple, repetitive tasks’” because there is no basis to conclude that they account for problems of concentration, persistence or pace. In addition, observing that a person can perform simple and repetitive tasks says nothing about whether the individual can do so on a sustained basis. Beyond disregarding the Vocational Expert’s opinion in response to a second hypothetical, the ALJ gave short shrift to the medical opinions of Crump’s treating psychiatrist. View "Crump v. Saul" on Justia Law

The ALJ who ruled on Hess’s application for social security disability benefits concluded that Hess had “moderate difficulties” in “concentration, persistence or pace,” but offered a detailed explanation for why she believed those difficulties were not serious and why Hess was capable of performing simple tasks. She found that Hess was “limited to jobs requiring understanding, remembering, and carrying out only simple instructions and making only simple work-related decisions[.]” In a series of hypothetical questions meant to include Hess’s limitations, she asked a vocational expert whether there were jobs in the national economy available to someone with those limitations. The expert said there were. The ALJ decided that Hess was not disabled and rejected his claim. The district court determined that the ALJ had erred because, in her hypothetical questions to the vocational expert, she failed to include or account for her finding that Hess had “moderate” difficulties in “concentration, persistence, or pace.” The Third Circuit reversed, refusing to elevate “form over substance.” An ALJ’s statement of a limitation confining a person to “simple tasks” is permissible after a finding of “moderate” difficulties in “concentration, persistence, or pace,” if the ALJ offers a “valid explanation” for it. The explanation given by the ALJ was “valid.” View "Hess v. Commissioner of Social Security" on Justia Law

Krell, a former ironworker, applied for Social Security disability benefits. Krell was notified that a vocational expert would testify at his hearing and that Krell had the right to request a subpoena for documents or testimony “that you reasonably need to present your case.” Krell’s counsel requested a subpoena to require the vocational expert to produce documents upon which the expert may rely in forming opinions, including statistics, reports, surveys, summaries, work product, and a description of the methodologies used by publishers or compilers of the statistics. The ALJ did not respond. At the hearing, the ALJ denied the request, reasoning that it had not specified what the documents would show and why these facts could not be shown without a subpoena and that counsel could challenge the testimony post‐hearing. During cross‐examination, the vocational expert stated that to determine available job numbers, he relied on Wisconsin occupational projections produced by the Department of Workforce Development. Krell made no post‐hearing challenge. The ALJ found that Krell was disabled and entitled to benefits, but only as of 2014, rather than 2011. Based on the expert’s testimony, the ALJ concluded that up to 2014, Krell was able to perform work existing in significant numbers in the economy. The Social Security Appeals Council denied review. The district court concluded that the ALJ had erred in denying Krell’s subpoena request. The Seventh Circuit reversed. While Krell’s case was pending, the Supreme Court held (Biestek) that a vocational expert is not categorically required to produce his supporting data. Krell advanced no reason why it was necessary for the expert to produce his underlying sources. View "Krell v. Saul" on Justia Law

Medi–Cal, California’s program under the joint federal-state Medicaid program (Welf. & Inst. Code 14000), provides health care services to certain low-income individuals and families, including the aged, blind, disabled, pregnant women, and others. (42 U.S.C. 1396). Beginning in 2013-2014, there were delays in the determination of applications for Medi-Cal benefits, sometimes with severe consequences for applicants who did not obtain needed medical care. Applicants and an advocacy organization sued the California Department of Health Care Services (DHCS). The court ordered DHCS to make Medi-Cal eligibility determinations within 45 days unless certain exceptions applied. The court of appeal reversed. The trial court did not abuse its discretion by declining to abstain but California law does not impose on DHCS a duty to make all Medi-Cal eligibility determinations within 45 days. There is an obligation to determine Medi-Cal eligibility within 45 days under federal regulation 32 CFR 435.912(c)(3)(ii), but that obligation is subject to exceptions so that the underlying obligation is not sufficiently clear and plain to be enforceable in mandate. It was not clear whether DHCS was out of compliance with an overall performance benchmark of processing 90% of applications within 45 days; absent such evidence, it was error to issue writ relief applicable across-the-board. View "Rivera v. Kent" on Justia Law

The Social Security Act permits judicial review of “any final decision . . . after a hearing” by the Social Security Administration (SSA), 42 U.S.C. 405(g). Claimants for Title XVI supplemental security income disability benefits must generally proceed through a four-step process before federal-court review: seek an initial determination of eligibility; seek reconsideration; request a hearing before an administrative law judge (ALJ); and seek review of the ALJ’s decision by the Appeals Council within 60 days of receiving the ALJ’s ruling. If the claimant misses that deadline and cannot show good cause for doing so, the Appeals Council dismisses the request. Smith’s claim for disability benefits was denied on initial determination, upon reconsideration, and on the merits by an ALJ. The Appeals Council dismissed Smith’s request for review as untimely. Smith sought judicial review of the dismissal. The Sixth Circuit affirmed dismissal for lack of jurisdiction, holding that the Appeals Council’s dismissal of an untimely petition is not a “final decision.”A unanimous Supreme Court reversed. An Appeals Council dismissal on timeliness grounds after a claimant has had an ALJ hearing on the merits qualifies as a “final decision . . . made after a hearing” under section 405(g). The Appeals Council’s dismissal is the final stage of review, 20 CFR 416.1472; Smith obtained the kind of hearing that section 405(g) most naturally suggests. The dismissal is not merely collateral but an end to a proceeding in which a substantial factual record has been developed. The Court noted that “Congress designed [the statute as a whole] to be ‘unusually protective’ of claimants” and “the strong presumption that Congress intends judicial review of administrative action.” View "Smith v. Berryhill" on Justia Law

A husband and wife appealed denials of their Permanent Fund Dividends (PFDs) for 2014 and 2015. The husband’s 2014 PFD application was denied because he had been absent from the state for more than five years, creating a presumption of nonresidence that he was unable to rebut. The wife’s application was denied because her PFD eligibility as an accompanying military spouse depended on her husband’s. After the denials were affirmed by an Administrative Law Judge (ALJ), the couple appealed to the superior court. While this appeal was pending they both applied for 2015 PFDs and were again denied. The husband’s 2015 application was denied because his residency for PFD purposes was severed in the 2014 PFD proceedings and he had not reestablished it. The wife’s application was again denied because of her accompanying-spouse status. They appealed the 2015 denials too; the superior court consolidated the 2014 and 2015 cases and affirmed both denials. The Alaska Supreme Court determined neither spouse met the residency requirements to qualify for either a 2014 or a 2015 PFD under the plain language of the applicable statute. The Court therefore affirmed the ALJs’ decisions. View "Jones v. Alaska, Department of Revenue" on Justia Law

Louisiana, represented by its Attorney General, filed this lawsuit in 2014 against defendants, Molina Healthcare, Inc., Molina Information Systems, L.L.C. d/b/a Molina Medicaid Solutions, and Unisys Corporation. As described in the state’s petition, “[o]ver the last thirty (“30”) years, the Defendants have been the fiscal agent responsible for processing Louisiana’s Medical pharmacy provider reimbursement claims.” Pursuant to a contract to which the state itself was allegedly a party, “the Defendants assumed operational liability” of a “customizable” computerized system known as the Louisiana Medicare Management Information System (“LMMIS”). As part of defendants’ duties, they were “responsible for the operation and maintenance of LMMIS, as well as creating and implementing design changes to the LMMIS that comply with State and federal mandates.” The crux of the state’s allegations in this lawsuit is that Unisys caused the Louisiana Department of Health (“LDH”) to overpay Medicaid pharmacy providers through Unisys’ improper operation and management of LMMIS. The Louisiana Supreme Court granted certiorari review in this case to review the correctness of the appellate court’s ruling, sustaining an exception of no right of action for the Attorney General’s lawsuit against the defendants. By statute, the Louisiana Department of Health had the capacity to sue and be sued for programs that it administered, such as Medicaid. However, because the Louisiana Department of Health delegated–and defendants allegedly contractually accepted–some of the administrative functions of the state’s Medicaid program, the Supreme Court found the Attorney General had the capacity, and hence a right of action, to prosecute this lawsuit. View "Louisiana ex rel. Caldwell v. Molina Healthcare, Inc." on Justia Law

The Supreme Court affirmed the district court's order affirming the denial of LeVeta Winslow's 2016 application for Medicaid benefits, holding that Nebraska's Department of Health and Human Services (DHHS), Division of Medicaid and Long-Term Care properly determined that Winslow was ineligible for Medicaid due to excess resources.DHHS determined that Winslow was ineligible for Medicaid because her resources, which included a house, were above $4,000. The district court affirmed the denial of benefits, finding that the house did not qualify for Winslow's home and thus was not exempt from consideration as an available resource as Winslow's home. The Supreme Court affirmed, holding (1) the district court correctly determined that the house was not subject to the home exemption for Winslow's Medicaid application; (2) the district court erred in determining that the property was not eligible for the other real property exception because Winslow lacked authority to liquidate while it was held by a revocable trust; and (3) Winslow failed to provide sufficient documentation that she was under the available resource limit if she could exclude the house, and therefore, the district court did not err in failing to find that DHHS was required to provide Winslow an IM-1 form for the house while it was held by the trust. View "Winslow v. State ex rel. Peterson" on Justia Law

The Supreme Court affirmed the order of the district court affirming the decision of the Nebraska Department of Health and Human Services (DHHS) terminating Appellant's status as a Medicaid service provider, holding that the district court's affirmance of the sanction imposed by DHHS was not arbitrary, capricious, or unreasonable.Based on Appellant's failures to adhere to the standards for participation in Medicaid, DHHS terminated Appellant's provider agreements for good cause and then informed Appellant of her permanent exclusion from the Medicaid program. The DHHS director of the Division of Medicaid and Long-Term Care ruled that DHHS' decision to terminate Appellant as a Medicaid service provider was proper. The district court affirmed. The Supreme Court affirmed, holding (1) the court's finding that Appellant billed for overlapping services was based on competent evidence; and (2) DHHS' sanction to permanently exclude Appellant from the Medicaid program was not arbitrary or capricious. View "Tran v. State" on Justia Law

Goldstein worked until March 2013. The Employment Development Department (EDD) granted him unemployment insurance benefits, which he received in March 2013 through August 10, 2013. In August 2013, he successfully applied for disability benefits, which he received until he exhausted his maximum benefit amount in September 2014. Goldstein filed another unemployment claim, which had an effective date of March 23, 2014. EDD determined that Goldstein’s second claim was invalid under Unemployment Insurance Code section 1277 because during the benefit year of his first claim he neither was paid sufficient wages nor performed any work. An ALJ and the Appeals Board agreed while acknowledging that disability benefits qualify as wages under section 1277.5. The court of appeal affirmed, finding that the Board erred, but the error was not prejudicial. A claimant can establish a valid claim under section 1277(a) even if he received unemployment insurance benefits during the benefit year of the prior valid claim if both the earnings and work requirements are satisfied. Goldstein satisfied the earnings requirement and the Board erred in ruling otherwise but there is no evidence Goldstein performed services for pay during that time. View "Goldstein v. California Unemployment Insurance Appeals Board" on Justia Law