Justia Public Benefits Opinion Summaries

Olivia, born in 2000, apparently healthy, became ill after her first vaccinations. Her condition required extensive hospitalization; she still requires a ventilator and a wheelchair. Her parents filed a petition with the National Vaccine Injury Compensation Program, 42 U.S.C. 300aa-1 to34. Olivia's injuries are not covered by a table of injuries presumed to be caused by vaccines, so the parents were required to show that one of the administered vaccines caused or significantly aggravated her condition. They submitted two reports by experts. The special master identified unanswered questions, but the parents took the position that it was unreasonable to require such detail at the pre-hearing stage. Based on failure to submit a supplemental report and failure to identify a clear theory of causation, the special master dismissed. The claims court affirmed. The Federal Circuit reversed. The special master did not appropriately review the evidence of causation under the summary judgment standard. View "Simanski v. Sec'y of Health & Human Servs." on Justia Law

Firefighters, who suffered career-ending injuries during required training exercises, obtained line-of-duty disability pensions and sought continuing health coverage under the Public Safety Employee Benefits Act, 820 ILCS 320/10, which requires employers of full-time firefighters to pay health insurance premiums for the firefighter and family if the firefighter suffers a catastrophic injury as a result of a response to what is reasonably believed to be an emergency. The trial court dismissed a declaratory judgment action by one firefighter and affirmed denial of the insurance benefit for one firefighter. The appellate court affirmed. The supreme court held that an "emergency" means an unforeseen circumstance calling for urgent and immediate action and can arise in a training exercise. The other firefighter had obtained a declaratory judgment, which was affirmed by the appellate court. The supreme court distinguished the situation because, although he was instructed to "respond as if it were an actual emergency," he was not injured while making an urgent response to unforeseen circumstances involving an imminent danger to person or property. View "Gaffney v. Bd. of Tr. of Orland Fire Prot. Dist." on Justia Law

After a 1999 auto accident, plaintiff had severe back pains and was diagnosed with a Chiari malformation, a protrusion of brain tissue into the spinal canal. After three operations on her brain and spine, her vision and speech problems lessened, but she developed hydrocephalus, a buildup of cerebrospinal fluid in the brain that required installation of a shunt in her brain. She has not worked since the auto accident and was last insured for social security disability benefits in June 2005 (when she was 34 years old), so only if she was disabled from full-time work by that date is she eligible for benefits. An administrative law judge found her capable of sedentary work. The Seventh Circuit reversed, finding that the ALJ failed to bridge the gap between medical testimony and plaintiff's testimony and his conclusion. View "Bjornson v. Astrue" on Justia Law

Law Firm filed a verified petition for a writ of mandamus to compel Housing Authority to provide copies of all records that documented any and all instances of lead poisoning in the last fifteen years in any dwelling owned or operated by Housing Authority. The court of appeals (1) granted Law Firm's motion for summary judgment regarding the request for lead-poisoning documents and ordered Housing Authority to produce the documents, and (2) granted $7,537 in attorney fees to Law Firm. The Supreme Court reversed in part, holding (1) to the extent that Law Firm's request properly sought the lead-poisoning records, the court of appeals did not err in granting the writ of mandamus to compel Housing Authority to provide access to them; (2) the personal identifying information in Housing Authority's lead-poisoning documents was not obtainable under the Public Records Act, but the remainder of the completed forms was subject to disclosure; and (3) the court of appeals erred in awarding attorney fees to Law Firm. Remanded. View "State ex rel. O'Shea & Assocs. Co., L.P.A. v. Cuyahoga Metro. Hous. Auth." on Justia Law

Petitioner, a bookkeeper, part-time receptionist, and house-cleaner, developed reflexive sympathetic dystrophy after she fell. After reducing her hours, she stopped working in April 2008. Her application for disability benefits and SSI was denied in June 2008. In June 2009, she had a hearing before an ALJ, who denied her applications, finding that she was not disabled because she had the residual functional capacity to perform sedentary work with certain limitations and that jobs meeting those criteria were available. Eight months later, the Appeals Council denied review. The district court held that the ALJ's RFC determination was not supported by substantial evidence. The Third Circuit reversed, holding that the ALJ adequately explained the decision and properly relied on a 2008 report by the state agency medical consultant. View "Chandler v. Comm'r of Soc. Sec." on Justia Law

The primary question in this case was whether a workplace injury that Plaintiff Nancy Petock characterized as an aggravation or worsening of an earlier compensable injury can give rise to a new three-year period in which she could demand reinstatement or reemployment. The trial court held that it could not and granted Defendant Asante's (dba Asante Health System) summary judgment motion. Although the Court of Appeals agreed with the trial court that an aggravation of an earlier injury cannot give rise to new reinstatement rights, it concluded that there was a disputed issue of fact as to whether Plaintiff had sustained a "new and separate injury" in 2005 that would give rise to those rights, and remanded the case. On review, Plaintiff argued that the Court of Appeals erred in holding that an aggravation of an earlier injury cannot give rise to a right to reinstatement under ORS 659A.043 or a right to reemployment under ORS 659A.046. Though the Supreme Court disagreed with some of the appellate court's reasoning, it affirmed the decision to reverse the trial court for further proceedings: "Even if defendant were correct that the same facts cannot give rise to an aggravation claim and a compensable injury claim (a proposition with which [the Court] noted our disagreement), [the Court] fail[ed] to see the relevance of that proposition in the context of defendant's summary judgment motion. On this record, Plaintiff was free to argue that her 2005 injury was a compensable injury." View "Petock v. Asante" on Justia Law

Plaintiff applied for Social Security disability insurance benefits and an ALJ denied the claim, noting that plaintiff failed to provide an opinion from his treating physician. When plaintiff requested review of his claim by the Appeals Council, he submitted a letter from his treating physician detailing the injuries and recommending significant restrictions on plaintiff's activity. The Appeals Council made this letter part of the record but denied plaintiff's request for review. Thus, the ALJ's decision denying benefits became the final decision of the Commissioner of the Social Security Administration. Plaintiff appealed, contending that the Appeals Council erred by failing to articulate specific findings justifying its denial of his request for review. The court rejected the argument and held that the Appeals Council need not explain its reasoning when denying review of an ALJ decision. But because in this case the court could not determine if substantial evidence supported the denial of benefits, the court reversed and remanded. View "Meyer, III v. Astrue" on Justia Law

For 12 months following his injury, plaintiff, a police officer injured on duty, received salary under the Public Employee Disability Act. For a short time thereafter, he received salary through a combination of accrued sick and vacation time, light duty, and temporary total disability payments under the Workers’ Compensation Act. While plaintiff received salary under PEDA, the city deducted 20 percent of his health insurance premiums from his paycheck, in accordance with the collective bargaining agreement. After PEDA benefits expired, plaintiff continued to pay 20 percent of the premiums. When he was awarded a line-of-duty disability pension under the Illinois Pension Code, the city began paying 100 percent of the premiums, as required by the Public Safety Employee Benefits Act, 820 ILCS 320/10(a). Plaintiff's request for reimbursement for premiums paid since the date of injury was refused. The circuit court entered summary judgment for the city. The appellate court reversed. The Illinois Supreme Court reversed the appellate court. Under PSEBA, an employer's obligation to pay the entire health insurance premium for an injured officer and his family attaches on the date that it is determined that the injury is "catastrophic," the date it is determined that the injured officer is permanently disabled and eligible for a line-of-duty disability pension. View "Nowak v. City of Country Club Hills" on Justia Law

Hit by a vehicle in 2004, plaintiff had medical bills of $82,036 that were paid in full by Medicare. The owner of the vehicle settled with plaintiff for $125,000. Medicare sought reimbursement of $62,338 under 42 U.S.C. 13955y(b)(2)(B)(i)., which plaintiff paid under protest. An ALJ rejected plaintiff's argument that an unknown motorist was responsible for 90 percent of the damage so that only 10 percent of the settlement was for medical expenses and the rest was for pain and suffering. The Medicare Appeals Council, district court, and Sixth Circuit affirmed, noting that plaintiff presented no evidence of hardship. View "Hadden v. United States" on Justia Law

Claimant David Tarbet worked for Employer J.R. Simplot Company for thirty-six years until an accident in 2007 left him totally and permanently disabled. The issue before the Industrial Commission (Commission) was whether Employer was liable for all or only a part of Claimant’s income benefits. If Claimant’s total disability resulted solely from the last accident, Employer would be liable for all of the income benefits. If his total disability resulted from the combined effects of both that injury and impairments that pre-existed that injury, then Employer was liable only for that portion of the income benefits for the disability caused by the accident, and the Industrial Special Indemnity Fund (ISIF) would be liable for the remainder. The Industrial Commission found that the April 2007 accident was Claimant’s final industrial accident, that he was totally and permanently disabled as a result of the final accident, and that the impairments that existed prior to that accident did not contribute to his total disability. It found that ISIF was not liable for Claimant’s benefits and dismissed the complaint against it. Employer then appealed. Upon review of the Commission's record, the Supreme Court affirmed the Industrial Commission's order. View "Tarbet v. J.R. Simplot Co. " on Justia Law