Justia Public Benefits Opinion Summaries

Doctors filed suit, alleging violations of the False Claims Act, 31 U.S.C. 3279 and the Michigan Medicaid False Claim Act, as qui tam relators on behalf of the United States/ The claimed that the business defrauded the government by submitting Medicare and Medicaid billings for defective radiology studies, and that the billings were also fraudulent because the business was an invalid corporation. The federal government declined to intervene. The district court dismissed. Sixth Circuit affirmed. The doctors failed to identify any specific fraudulent claim submitted to the government, as is required to plead an FCA violation with the particularity mandated by the FRCP. A relator cannot merely allege that a defendant violated a standard (in this case, with respect to radiology studies), but must allege that compliance with the standard was required to obtain payment. The doctors had no personal knowledge that claims for nondiagnostic tests were presented to the government, nor do they allege facts that strongly support an inference that such billings were submitted.

In 1996 the State sued Defendant Troy Wolff, seeking to establish his paternity and obtain a child support order after the mother and child began receiving public assistance. The court also established a child support obligation for Defendant. The mother was given custody of the child. In 1999 Defendant and the mother stipulated to a reduction of Defendant's child support obligation, and an amended judgment was entered incorporating the stipulation. The State was a party to the action and signed the 1999 stipulation. In January 2009, Defendant and the mother entered into another stipulation pertaining to custody and visitation, and they agreed to modify the child support obligation. The parties agreed that Defendant would no longer have a support obligation to the mother, and that Defendant would not seek support from the mother. The court entered a second amended judgment incorporating the new stipulation. In October 2009, the State moved to vacate the second amended judgment, arguing that it was a party to the action and did not agree to the new stipulation. Defendant argued on appeal that the judicial referee did not have jurisdiction to issue the order to vacate the second amended judgment. Upon review, the Supreme Court concluded that the State was a real party in interest and had standing, the second amended judgment contains unenforceable provisions, and the court did not err in vacating the second amended judgment.

In 1971 the veteran unsuccessfully sought benefits. In 1979, he sought to reopen and provided a psychiatric evaluation. The veteran took steps to appeal the regional office's refusal to reopen. The regional office requested form I-9 to "reactivate" the appeal. He responded that he had already sent the form. The VA responded in 1980 that no further action would be taken unless he submitted the form within 30 days. The veteran did not respond. In 1994, he again sought to reopen. The regional office granted him service connection for bipolar disorder with an effective date of 1994. He contended that the effective date should be 1979. In 2005 the Board rejected his "pending claim" argument because he had not filed Form 1-9 within one year of the 1979 decision. The veterans court agreed. The Federal Circuit reversed. An appeal should set out specific allegations of error of fact or law, such allegations related to specific items in the statement of the case (38 U.S.C. 7105(d)(3) ); the statute must be construed liberally. Since there was a single issue identified in the statement of the case, the 1980 letters were sufficient to identify the issue on appeal and satisfy the statute.

King County sought ways to provide legal defense services to indigent criminal defendants. The County settled on a system of using nonprofit corporations to provide services funded through and monitored by the County's Office of the Public Defender (OPD). Over time, the County took steps to improve and make these nonprofit organizations more accountable to the County. In so doing, it asserted more control over the groups that provided defender services. Respondents are employees of the defender organizations who sued the County for state employee benefits. They argued the County's funding and control over their "independent" organizations essentially made them state employees for the purposes of participating in the Public Employees Retirement System (PERS). Applying the pertinent statues and common law principles, the Supreme Court agreed that employees of the defender organizations are "employees" under state law, and, as such, are entitled to be enrolled in the PERS.

In this case, the court construed Labor Code section 4659(c), which provided for the annual indexing of two categories of workers' compensation benefits, total permanent disability and life pension payments, to yearly increases in the state's average weekly wage (SAWW), so that lifetime disability payments made to the most seriously injured workers would keep pace with inflation. The indexing procedure was sometimes referred to as an "escalator," or one providing for "cost of living adjustments" (COLA's). At issue was whether the operative language of section 4659(c) required the annual COLA's for total permanent disability and life pension payments to be calculated (1) prospectively from the January 1 following the year in which the worker became "entitled to receive a life pension or total disability indemnity," (when the payments actually commenced); (2) retroactively to January 1 following the year in which the worker sustained the industrial injury; or (3) retroactively to January 2004, in every case involving a qualifying industrial injury, regardless of the date of injury or the date the first benefit payment became due. Applying fundamental rules of statutory construction, the court held that the Legislature intended that COLA's be calculated and applied prospectively commencing on the January 1 following the date on which the injured worker first became entitled to receive, and actually began receiving, such benefits payments, i.e., the permanent and stationary date in the case of total permanent disability benefits, and the date on which partial permanent disability benefits became exhausted in the case of life pension payments.

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.

Petitioner served in active military duty from 1972 to 1979, and in the National Guard before and after active service. He also worked as a laborer in a supply company and in coal mines and as a carpenter. In 1997, he claimed entitlement to TDIU, which provides a veteran with a total disability rating when his disability rating is below 100% if the veteran is at least 60% disabled, meets other disability rating criteria, and is unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities. 1 C.F.R. 4.16(a). The VA rejected the claim and, on three remands, petitioner underwent a total of five VA medical examinations. In 2007, the Board denied the claim. The Veterans Court and Federal Circuit affirmed. The VA was not obligated to obtain an industrial survey from a vocational expert in order to evaluate whether petitioner was employable in a job other than his former occupation (i.e., a job that did not involve heavy manual labor).

After prevailing in a suit for social security disability benefits, plaintiff asked for attorney's fees of $25,200 under the Equal Access to Justice Act, 28 U.S.C. 2412(d)(2)(A). The district judge awarded $6,625, cutting the hours from 112 or 116 to 53, adopting objections made by Social Security Administration lawyer, and the hourly rate from $225 to the rate specified in the statute $ 125. The Seventh Circuit reversed and remanded, noting that the Social Security Act provides for awarding a "reasonable fee" for representation in the administrative proceeding and in a successful appeal, 42 U.S.C. 406(a)(1), but the EJA does not provide for "market rate" and creates a presumptive ceiling of $125. The district court did not consider the special circumstances and factors that may be considered under the Act.

After prevailing in a suit for social security disability benefits, plaintiff asked for attorney's fees of $25,200 under the Equal Access to Justice Act, 28 U.S.C. 2412(d)(2)(A). The district judge awarded $6,625, cutting the hours from 112 or 116 to 53, adopting objections made by Social Security Administration lawyer, and the hourly rate from $225 to the rate specified in the statute $ 125. The Seventh Circuit reversed and remanded, noting that the Social Security Act provides for awarding a "reasonable fee" for representation in the administrative proceeding and in a successful appeal, 42 U.S.C. 406(a)(1), but the EJA does not provide for "market rate" and creates a presumptive ceiling of $125. The district court did not consider the special circumstances and factors that may be considered under the Act.