Justia Public Benefits Opinion Summaries

Binder, a law firm representing claimants before the SSA, appealed from summary judgment in two related cases where Binder seeks past attorney's fees. When Binder sought to hold the SSA liable for the fees, the district courts granted summary judgment to the SSA on the basis of sovereign immunity. The court affirmed the judgments and held that, regardless of the SSA’s statutory duties to withhold attorney’s fees from payments to successful claimants, there is no waiver of sovereign immunity in 42 U.S.C. 406(a) that would permit Binder’s lawsuits for money damages. View "Binder & Binder v. Colvin" on Justia Law

The plaintiff, now 62 years old, applied in 2011 to the Social Security Administration for disability benefits, citing ailments including asthma, chronic obstructive pulmonary disease (COPD), asbestosis, and a heel spur in his right foot. He had been a sheet metal journeyman for 33 years; the job requires physical strength and he had been given accommodations on the job for several years. The Social Security Appeals Council declined to review the administrative law judge’s denial and the district judge affirmed. The Seventh Circuit reversed and remanded, referring to the ALJ’s “seemingly inconsistent conclusions” and stating that the denial was “not a reasoned analysis of the plaintiff’s claim.” View "Dimmett v. Colvin" on Justia Law

The Hospital system filed suit seeking to obtain a writ of mandamus compelling HHS to adjudicate immediately its administrative appeals on claims for Medicare reimbursement. The parties agree that, as of February 2014, the Secretary had 480,000 appeals awaiting assignment to an ALJ, and the Secretary conceded in her brief that the number had by then climbed to more than 800,000 appeals, creating a ten-year backlog. The court concluded that the Medicare Act, 42 U.S.C. 1395 et seq., does not guarantee a healthcare provider a hearing before an ALJ within 90 days, as the Hospital System claims. Rather, it provides a comprehensive administrative process that a healthcare provider must exhaust before ultimately obtaining review in a United States district court. The court further concluded that the issuance of a judicial order now, however, directing the Secretary to hear the Hospital System’s claims in the middle of the administrative process, would unduly interfere with the process and, at a larger scale, the work of the political branches. Moreover, such intervention would invite other healthcare providers suffering similar delays to likewise seek a mandamus order, thereby effectively causing the judicial process to replace and distort the agency process. Accordingly, the court affirmed the district court's dismissal of the complaint. View "Cumberland Cnty. Hosp. v. Burwell" on Justia Law

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

Plaintiff-appellant Michael Allman applied for Social Security disability benefits, claiming he could not work due to spina bifida, a shunt in his brain, chronic back pain, headaches, depression, and anxiety. An administrative law judge (ALJ) concluded that plaintiff's residual functional capacity (RFC) permitted him to perform a number of jobs that existed in significant numbers in the national economy, defeating his disability claim. At step two of the applicable five-step sequential evaluation, the ALJ determined that plaintiff's headaches were not a “severe impairment” within the meaning of the Social Security Act and its corresponding regulations. Nevertheless, the ALJ discussed and considered plaintiff's headaches in assessing his RFC to work. After the ALJ denied his claim, the Appeals Council denied review and the district court affirmed after adopting the magistrate judge’s report and recommendation and overruling plaintiff's objections. The district court concluded that plaintiff failed to demonstrate that his headaches qualified as a severe impairment and that the ALJ had provided sufficient bases for not assigning more weight to his doctor's opinion. On appeal, plaintiff challenged, among other things, the district court’s findings regarding the ALJ’s determinations at steps two and four. Finding no reversible error, the Tenth Circuit affirmed the district court. View "Allman v. Colvin" on Justia Law

Cadillac Place (former General Motors Building), a Detroit office complex, is home to state offices, a court of appeals, a restaurant, a gift store, and even a barber shop. It is owned by Michigan Strategic Fund, a public entity, and leased by the state. Babcock, an attorney, s disabled due to Friedreich’s Ataxia, a degenerative neuromuscular disorder that impairs her ability to walk. She worked in Cadillac Place. Babcock alleged that its design features denied her equal access to her place of employment in violation of the Americans with Disabilities Act , 42 U.S.C. 12132, and Section 504 of the Rehabilitation Act of 1973, 29 U.S.C. 794(a). The Sixth Circuit affirmed dismissal. Babcock did not identify a service, program, or activity of a public entity from which she was excluded or denied a benefit. The court noted the dispositive distinction between access to a facility and access to programs or activities. Babcock only identified facilities-related issues. View "Babcock v. State of Mich." on Justia Law

Miller is a single father who, before his alleged disability, held positions as a security guard, machine operator, material handler, and night-club bouncer. In 2006, Miller visited a hospital emergency department with an injured knee. He did not return to work but applied for disability insurance benefits, and supplemental security income. On remand from the Appeals Council, an ALJ determined that Miller was not disabled within the meaning of the Social Security Act and did not qualify for benefits. The Appeals Council declined another review. The district court granted summary judgment, affirming the denial of benefits. Miller’s timely appeal followed. The Sixth Circuit vacated, finding the decision not supported by substantial evidence. A determination concerning Miller’s residual functional capacity (particularly his ability to stand) did not comport with the ALJ’s determination that a doctor’s assessment should be accorded significant weight; the limited discussion of Miller’s obesity arguably did not comply with SSR 02- 1p; the ALJ’s focus on isolated, often stale, portions of the record was an insufficient basis to determine that Miller could conduct work activities on a sustained basis, especially in light of the Appeals Council’s original decision to remand for failure to adequately evaluate Miller’s mental impairments. View "Miller v. Comm'r of Social Sec." on Justia Law

Plaintiff Leslie Taylor asked the Colorado Medicaid program to combine the benefits she received through two assistance programs to help her get to medical appointments. If approved, this combination would allow the agency to pay attendants for time driving Taylor to and from her appointments. The agency refused, and the plaintiffs in this case alleged that the refusal constituted discrimination against Taylor based on her disability. The Tenth Circuit concluded that this refusal did not constitute discriminate against Taylor based on her disability. View "Taylor v. Colorado Dept of Health Care" on Justia Law

Before enactment of the 2008 Veterans’ Benefits Improvement Act, if a veteran seeking DVA benefits died while his claim was pending, the veteran’s survivor could not take the place of the veteran and continue prosecuting the claim. The survivor had to file a claim for accrued benefits, 38 U.S.C. 5121, proceeding from the beginning of the process, regardless of how far the veteran’s claim had progressed. The Act, 38 U.S.C. 5121A, authorizes eligible survivors to be “substituted as the claimant for the purposes of processing the claim to completion.” The Federal Circuit rejected a challenge to regulations intended to implement the Act, which require that a request to substitute be filed with the agency of original jurisdiction (DVA regional office) within one year of the claimant’s death; the prospective substitute is required to submit evidence of his eligibility to substitute; and, if the claimant died while his appeal was pending before the Board of Veterans’ Appeals, the Board must dismiss the appeal without prejudice so that the agency of original jurisdiction can address the substitution request. If the agency of original jurisdiction grants the request to substitute, then the case returns to the same place on the Board’s docket that it held at the time of the veteran’s death. View "Nat'l Org. of Veterans Advocates, Inc. v. Sec'y of Veterans Affairs" on Justia Law

Cogburn served in the Army, 1968-1971, including 12 months in Vietnam. In 1974, Cogburn sought VA disability compensation and pension benefits based on a severe nervous condition. A 1975 denial of his pension claim did not address the disability claim. He did not appeal. In 1983, Cogburn again sought disability compensation and pension benefits. He was diagnosed with Post-PTSD after a VA examination that failed to connect Cogburn’s PTSD to stressors from military service; the VA granted a non-service connection pension but denied service connection. In 1985, the Board of Veterans’ Appeal concluded that the record did not identify any in-service traumatic events, noting that Cogburn repeatedly failed to attend VA examinations to determine if service-connected stressors caused his PTSD. The Board determined that “the preponderance of the medical evidence suggests that the veteran’s post service emotional and adjustment difficulties are manifestations of schizophrenia.” There was no opportunity for further review. In 2002, Cogburn claimed that his 1974 disability compensation claim was never adjudicated. The RO determined that the claim was adjudicated as a claim for PTSD and had been implicitly denied in the 1985 decision. In 2012, on remand, the Board affirmed the finding of implicit denial. The Veterans Court and Federal Circuit affirmed; the implicit denial rule applies to both formal and informal claims. Its use does not violate the VA due process regulation's notice provision.. View "Cogburn v. McDonald" on Justia Law