Justia Public Benefits Opinion Summaries

This action arose when claimant, a former customer service representative for Verizon New England, Inc. ("Verizon"), was denied unemployment benefits. At issue was whether the board of review of the division of unemployed assistance ("board") erred because Verizon took the "last step" in the termination process that entitled claimant to unemployment benefits. The court affirmed the judgment of the district court, which affirmed the decision of the board, to deny claimant benefits because the court agreed with the board's conclusion that the claimant did not meet her burden of showing that her decision to leave was involuntary, where she was not compelled to apply for the termination, did not believe her job was in jeopardy, and left in part for personal reasons.

Petitioner was awarded disability insurance benefits for a period beginning in 1983. In 2002 the Social Security Administration produced evidence he had engaged in substantial gainful employment; the Appeals Council accordingly reopened and remanded to an administrative law judge, who determined that petitioner was not entitled to disability benefits. The district court and Sixth Circuit affirmed. Petitioner's subsequent application for supplemental security income benefits was denied; the district court and Sixth Circuit affirmed. The petitioner then sought a writ of mandamus to compel the SSA to reopen his case and reinstate benefits. The Sixth Circuit dismissed for lack of jurisdiction to issue a writ directly to the agency.

Plaintiff Angela Weigel appealed a district court order that denied her supplemental Social Security Income benefits. On appeal to the Tenth Circuit, she challenged the court's findings that she was able to work despite her documented disabilities. Upon consideration of the administrative record, the Tenth Circuit found that the Administrative Law Judge's analysis of Plaintiff's case did not make the requisite findings required by law to justify the denial of benefits. The Court vacated the lower court's order and remanded the case for further proceedings.

Claimant appealed the district court's judgment upholding the Commissioner of Social Security's denial of her application for disability insurance. Appellant raised several issues of error on appeal. The court held that a certain physician's post-hearing letter did not contain any additional information and was not relied upon in the decision making process, and its receipt did not violate claimant's due process rights; that the ALJ did not err in finding claimant retained the residual functional capacity to perform certain kinds of low-stress work; that there was no error in the decision not to order a consultative examination regarding claimant's mental impairments; and that a hypothetical question posed to the Vocation Expert adequately addressed impairments supported by the record. Accordingly, the court affirmed the judgment where substantial evidence on the record as a whole supported the ALJ's decision.

Plaintiff applied for disability benefits based on combined impairments including bullous emphysema, depression, anxiety, and bipolar disorder and alleged that her disability began when her right lung collapsed. Plaintiff appealed the district court's decision affirming the Commissioner of Social Security's denial of her application for disability insurance benefits and supplemental security income benefits under Titles II and XVI of the Social Security Act, 42 U.S.C. et seq. The court held that the administrative law judge ("ALJ") erred by failing to follow the requirements of 20 C.F.R. 404.1520(a) in determining whether plaintiff's mental impairments were severe and, if severe, whether they met or equaled a listed impairment. Accordingly, the court reversed the judgment of the district court with instructions to remand to the ALJ to conduct a proper review of plaintiff's mental impairments.

Plaintiff brought action under the False Claims Act, 31 U.S.C. 3729, claiming that the company used a kickback scheme and knowingly caused submission of false Medicare, Medicaid, and TRICARE claims by hospitals and doctors. The district court held that hospital claims at issue were not false or fraudulent, and that doctor claims were false or fraudulent, but not materially so. The First Circuit reversed. If kickbacks affected the transactions underlying the claims, the claims failed to meet a condition of payment and were false, regardless of the hospital's participation in or knowledge of the kickbacks. It cannot be said, as a matter of law, that the alleged misrepresentations were not capable of influencing Medicare's decision to pay the claims.

Plaintiff, on behalf of a class of similarly situated plaintiffs who received Medicaid assistance and were subject to a Medicaid lien pursuant to 53-2-612, MCA, sued defendant alleging that defendant had collected a greater amount than it was entitled from plaintiffs' recoveries from other sources. The parties raised several issues on appeal. The court held that Ark. Dept. of Health & Human Servs. v. Ahlborn applied retroactively to all class members' claims and that defendant must raise affirmative defenses with respect to individual class members to avoid Ahlborn's effect. The court held that the applicable statute of limitations to be 27-2-231, MCA, which provided for a five-year limitations period. The court declined to disturb the district court's order requiring defendant to compile data on individual class members' claims. The court reversed the district court's determination as to interest assessed against defendant, and concluded that no interest could be assessed until two years after any judgment had been entered, under 2-9-317, MCA. The court concluded that the term "third party" in the Medicaid reimbursement statutes included all other sources of medical assistance available to Medicaid recipients, including private health or automobile insurance obtained by the Medicaid recipient. The court reversed the district court's grant of summary judgment to the class on its proffered distinction between "first party" and "third party" sources. The court affirmed the district court's conclusion that plaintiffs' "made whole" claim was immaterial in light of Ahlborn.

The Equal Access to Justice Act entitles a prevailing party to fees only if the position of the United States was not substantially justified. The Seventh Circuit affirmed denial of fees for a remand to an administrative law judge for an explanation of the determination of a precise date on which the social security applicant became disabled. The ALJ did not ignore, mischaracterize, selectively cite, or otherwise bungle a significant body of relevant evidence, but committed the sort of articulation error that ordinarily does not taint the commissionerâs position. A reasonable person could conclude that both the ALJâs opinion and the commissionerâs defense of the opinion had a rational basis in fact and law.

The Second Injury Fund appealed the Arkansas Workers' Compensation Commission (Commission) finding that the Fund was not entitled to a statutory offset for Appellee Cleveland Osborn's Veterans Administration (VA) benefits. The Supreme Court found that the Commission made its decision based on the "plain language" of the statute: "the legislature intended for the amount of workers' compensation benefits payable to an injured worker to be reduced 'dollar-for-dollar' by the amount of benefits that the worker has previously received for the same medical services under any of the listed group plans." Veterans Administration benefits are not listed as one of the "group plans" in the statute. The Court found that the Fund was not entitled to the offset.

Appellant Fairfield City Schools (Fairfield) sought reimbursement for a total disability compensation award given to one of its employees. Edward Carpenter, Jr. had hypertension since 1995. In 2002, he injured his back while at work. Mr. Carpenterâs injury resulted in a considerable amount of disability compensation. In 2008, Fairfield requested handicap reimbursement from the Ohio Bureau of Workersâ Compensation for at least part of the disability payments it made to Mr. Carpenter. Fairfieldâs application alleged that Mr. Carpenterâs pre-existing hypertension is a cardiac disease that delayed his recovery from back surgery, contributing to prolonged disability payments. The Bureau rejected Fairfieldâs application as âinsufficient to establish cardiac disease as a pre-existing condition.â Fairfield appealed the Bureauâs decision multiple times. With every appeal, Fairfield added additional doctorâs reports and Bureau datasheets to support its argument that hypertension is a cardiac disease. The court of appeals eventually denied Fairfieldâs appeal and application for a writ of mandamus. The appellate court found that the Bureau had exclusive authority to weigh the evidence Fairfield submitted, and the Bureau could find Fairfieldâs evidence insufficient to prove hypertension was a cardiac disease. Fairfield appealed to the Supreme Court, and the Court agreed with the Bureauâs and appellate courtâs decisions. The Court affirmed the lower courtâs judgment.