Justia Public Benefits Opinion Summaries

An employee, Matthew I. Ortega, voluntarily quit his job as an office manager at Island Towing after 17 years, citing work-related stress from interactions with law enforcement as the reason. Ortega applied for unemployment benefits, stating that the stress affected his mental health and ability to perform his job. The Nebraska Department of Labor denied his application, finding that he did not have good cause to quit.Ortega appealed to the Nebraska Department of Labor’s Appeal Tribunal, where both he and his supervisor, Chloe Aguilar, testified. Ortega described two specific incidents involving law enforcement that caused him significant stress, one of which occurred 2½ years prior to his resignation. Aguilar confirmed the ongoing negative interactions with law enforcement but stated that there was no way to alleviate the stress. The Appeal Tribunal upheld the denial, stating that Ortega did not provide sufficient evidence, such as medical documentation, to prove that his stress constituted good cause for quitting.Ortega then appealed to the district court for Hall County, which affirmed the Appeal Tribunal’s decision. The district court agreed that Ortega’s stress was a health concern requiring medical evidence and noted that Ortega had not pursued alternative solutions to preserve the employment relationship, such as seeking a leave of absence or modifying his job duties.The Nebraska Supreme Court reviewed the case and affirmed the district court’s judgment. The court held that Ortega failed to meet his burden of proof to show good cause for voluntarily leaving his employment. The court found that the evidence provided, including the details of only one specific negative interaction with law enforcement, was insufficient to establish that Ortega’s work conditions were an increasingly unreasonable burden affecting his health or sense of well-being. View "Ortega v. Albin" on Justia Law

Nattalia Castell was employed as a senior accountant for Money Metals Exchange, LLC. She was discharged after allegedly mishandling an Idaho Department of Labor (IDOL) notice regarding her boyfriend's unemployment benefits application. Castell applied for unemployment benefits, but an IDOL appeals examiner excluded her boyfriend from testifying, denied her request to reopen the hearing to read a statement, and found that she was terminated for employment-related misconduct, making her ineligible for benefits.Castell appealed to the Idaho Industrial Commission, which denied her request to reopen the hearing and affirmed the appeals examiner's decision. The Commission found that Castell's actions constituted misconduct, as she failed to disclose a conflict of interest and mishandled the notice. Castell then appealed to the Idaho Supreme Court.The Idaho Supreme Court reviewed the case and affirmed the Commission's decision. The Court held that the appeals examiner did not err in excluding the boyfriend's testimony or in denying Castell's request to reopen the hearing. The Court also found that the Commission's determination that Castell was discharged for employment-related misconduct was supported by substantial and competent evidence. The Court concluded that Castell's actions disregarded a standard of behavior that Money Metals had a right to expect from its employees, and her claim of retaliation was not supported by evidence. View "Castell v. IDOL" on Justia Law

Nancy Vargas, a bus driver for the Santa Barbara Metropolitan Transit District, injured her foot at work in March 2018. She settled her workers' compensation claim with the district in December 2020, agreeing that the injury caused a 26 percent permanent disability. Vargas also applied for subsequent injury benefits from the Subsequent Injuries Benefits Trust Fund (Fund), listing pre-existing disabilities and disclosing that she was receiving Social Security Disability Insurance (SSDI) payments.The Workers’ Compensation Appeals Board (Board) joined the Fund as a defendant in Vargas’s case. The Fund acknowledged Vargas’s eligibility for benefits but sought a credit for a portion of her SSDI payments, arguing that these payments were for her pre-existing disabilities. The workers’ compensation judge (WCJ) found that the Fund had not proven its entitlement to the credit. The Board upheld this decision, stating that the Fund failed to show that the SSDI payments were awarded for Vargas’s pre-existing disabilities.The California Court of Appeal, Second Appellate District, reviewed the case. The court affirmed the Board’s decision, holding that the Fund bears the burden of proving its entitlement to a credit for SSDI payments under Labor Code section 4753. The court found that the Fund did not provide sufficient evidence to establish that Vargas’s SSDI payments were for her pre-existing disabilities. The court emphasized that the Fund must prove the extent to which SSDI payments are attributable to pre-existing disabilities to reduce subsequent injury benefits. The court also noted that the Fund had ample opportunity to gather evidence but failed to do so. The Board’s order denying the Fund’s petition for reconsideration was affirmed. View "Subsequent Injuries Benefits Trust Fund v. Workers' Compensation Appeals Board" on Justia Law

Nancy Vargas, a bus driver for the Santa Barbara Metropolitan Transit District, injured her foot at work in March 2018. She settled her claim against the district in December 2020, with a stipulated permanent disability of 26 percent. Vargas applied for subsequent injury benefits from the Subsequent Injuries Benefits Trust Fund (Fund), listing pre-existing disabilities and disclosing that she was receiving Social Security Disability Insurance (SSDI) payments. The Fund acknowledged her eligibility but sought to reduce her benefits by the amount of her SSDI payments, claiming these were for her pre-existing disabilities.The Workers’ Compensation Appeals Board (Board) determined that the Fund was not entitled to this reduction, as the Fund had not proven that Vargas’s SSDI payments were awarded for her pre-existing disabilities. The Board found that the evidence provided, including an award letter from the Social Security Administration, did not specify the basis of the SSDI benefits. The Fund’s petition for reconsideration was denied by the Board, which maintained that the Fund needed to show the SSDI payments were for pre-existing disabilities to claim a reduction.The California Court of Appeal, Second Appellate District, reviewed the case. The court affirmed the Board’s decision, holding that the Fund bears the burden of proving its entitlement to a reduction in benefits under section 4753 of the Labor Code. The court found that the Fund did not provide sufficient evidence to establish that Vargas’s SSDI payments were for her pre-existing disabilities. The court emphasized that the Fund must meet its burden of proof by a preponderance of the evidence and that the stipulated disability rating in Vargas’s settlement with her employer did not automatically entitle the Fund to a reduction in benefits. The Board’s order denying the Fund’s petition for reconsideration was affirmed. View "Subsequent Injuries Benefits Trust Fund v. Workers Comp. App. Bd." on Justia Law

Fitschen was diagnosed with advanced cancer and stopped working. In 2000 the Social Security Administration (SSA) found Fitschen eligible for disability benefits. Fitschen returned to work in 2001 but continued to receive benefits for a nine-month “trial work period,” 42 U.S.C. 422(c)(4). After that period, he could continue to work and receive benefits for another 36-month period if his wages did not exceed the level at which a person is deemed to be capable of engaging in substantial work activity. The SSA's 2003 review determined that Fitschen had engaged in substantial work and should not have received benefits for much of 2002-2003. The SSA notified him of his overpayment liability but his benefits continued because he had again ceased substantial work. Fitschen again returned to work in 2004 but did not report the change. The SSA initiated another review in 2007 and suspended his benefits. The SSA may waive recovery of overpayments if the recipient was without fault.In 2019 the Commissioner of Social Security found Fitschen liable for an overpayment of $50,289.70 and declined to waive recovery. The district court and Seventh Circuit affirmed, rejecting an argument that the SSA was procedurally barred from recovering the overpayment because it failed to comply with its “reopening” regulation; the overpayment assessment did not “reopen” Fitschen’s initial eligibility determination or any later determination concerning the continuation or recomputation of his benefits. Substantial evidence supports the finding that Fitschen was at fault. View "Fitschen v. Kijakazi" on Justia Law

Adams, born in 1960, smoked about a pack a day starting at age 18 and worked in coal mines at times between 1979-1995, mostly underground using a “cutting machine” in the “dustiest” areas. Adams struggled to breathe after his retirement. Adams’s 1998 application under the Black Lung Benefits Act, 30 U.S.C. 901(b), was denied because he failed to prove that he had pneumoconiosis. In 2008, Adams sought benefits from Wilgar. His treating physician, Dr. Alam, identified the causes of his 2013 death as cardiopulmonary arrest, emphysema, coal worker’s pneumoconiosis, throat cancer, and aspiration pneumonia.A 2019 notice in the case stated “the Court may look to the preamble to the revised” regulations in weighing conflicting medical opinions. Wilgar unsuccessfully requested discovery concerning the preamble and the scientific studies that supported its conclusions. The ALJ awarded benefits, finding that Adams had “legal pneumoconiosis” and giving Dr. Alam’s opinion that Adam’s coal mine work had substantially aggravated his disease “controlling weight.” All things being equal, a treating physician’s opinion is “entitled to more weight,” 30 C.F.R. 718.104(d)(1). Wilgar's three experts had opined that Adams’s smoking exclusively caused his disease The ALJ gave “little weight” to these opinions, believing that they conflicted with the preamble to the 2001 regulation.The Benefits Review Board and Sixth Circuit affirmed. The preamble interpreted the then-existing scientific studies to establish that coal mine work can cause obstructive diseases, either alone or in combination with smoking. The ALJ simply found the preamble more persuasive than the experts. View "Wilgar Land Co. v. Director, Office of Workers’ Compensation Programs" on Justia Law

Out-of-work residents of Michigan may claim unemployment benefits if they meet certain eligibility criteria. The State’s Unemployment Insurance Agency oversees the benefits system. In 2011, with the help of private contractors, the Agency began to develop software to administer the unemployment system. The Agency sought to equip the software to auto-adjudicate as many parts of the claims process as possible. The Agency programmed software that used logic trees to help process cases and identify fraud. A claimant’s failure to return the fact-finding questionnaire, for example, led to a fraud finding, as did the claimant’s selection of certain multiple-choice responses. In August 2015, problems arose with some features of the system, prompting the Agency to turn off the auto-adjudication feature for fraud claims.Plaintiffs are four individuals who obtained unemployment benefits, which were terminated after the Agency flagged their claims for fraud. Plaintiffs filed a putative class action against three government contractors and nineteen Agency staffers, raising claims under the Fourth, Fifth, and Fourteenth Amendments, 26 U.S.C. Sec. 6402(f), and Michigan tort law. In a previous proceeding, the court held that plaintiffs’ due process rights clearly existed because they had alleged a deprivation of their property interests without adequate notice and without an opportunity for a pre-deprivation hearing.At this stage, because the remaining plaintiffs have failed to show that these procedures violate any clearly established law, the supervisors of the unemployment insurance agency are entitled to judgment as a matter of law. The court also found that an intervening plaintiff was properly prevented from joining the case, based on her untimely filing. View "Patti Cahoo v. SAS Institute, Inc." on Justia Law

Deborah Dorr requested to reopen an unemployment appeal hearing that was to address Dorr’s appeal of the Idaho Department of Labor’s (“IDOL”) decision denying Dorr’s request to backdate her Pandemic Unemployment Assistance claim. After Dorr failed to appear at the hearing, IDOL dismissed her appeal and subsequently denied her request to reopen the hearing. Dorr appealed IDOL’s denial of her request to reopen, and the Idaho Industrial Commission (“the Commission”) affirmed. The Commission determined due process was satisfied and agreed with IDOL that Dorr’s own negligence was insufficient cause to reopen the hearing. Appealing pro se, Dorr petitioned the Idaho Supreme Court for relief. The Supreme Court concluded Dorr’s briefing did not meet the standard for an appeal under Idaho Appellate Rule 35(a)(6) and as such, her arguments were forfeited. The Commission’s decision upholding the Appeal Examiner’s denial of Dorr’s request to reopen her appeal hearing was affirmed. View "Dorr v. IDOL" on Justia Law

Milhem applied for Social Security disability insurance benefits, alleging that several conditions limited her ability to work. Milihem, age 38, had completed three years of college and had previously worked as a canvasser, receptionist, portrait photographer, and graphic designer. A vocational expert concluded that the evidence supported limiting Milhem’s work to that which can be learned in 30 days or less, that Milhem could stand or walk for at least two hours in an eight-hour workday, and that Milhem “could make judgments commensurate with functions of simple, repetitive tasks”; such an individual could not perform Milhem’s past work, but could work as a router, price marker, and cafeteria attendant, of which there were approximately 53,000, 307,000, and 63,000 jobs in the national economy, respectively. Changing the exertion level to sedentary, the expert testified, would include the work of an addresser, table worker, or document preparer, of which there were approximately 19,000, 23,000, and 47,000 jobs in the national economy, respectively.Based on this testimony, and “considering [Milhem’s] age, education, work experience, and residual functional capacity,” the ALJ found that there were a significant number of jobs that Milhem could perform, so Milhem was not under a qualifying disability. The district court upheld that determination. The Seventh Circuit affirmed. A reasonable person would accept 89,000 jobs in the national economy, a figure supported by substantial evidence, as a significant number. Other circuits have accepted similar numbers as significant. View "Milhem v. Kijakazi" on Justia Law

With the agreement of her supervisor, Johar, a salesperson, left work for about a week to care for a terminally ill relative. While she was away her employer (SWS) decided she had quit. Upon her return, SWS stated business was slow and gave her no new sales appointments. Johar sought unemployment benefits, citing a “temporary layoff.” SWS denied laying Johar off. While conceding that she left with her supervisor’s approval, SWS claimed that Johar’s failure to provide a return date or otherwise communicate with her supervisor while she was away amounted to a voluntary quit. The Employment Development Department agreed, found Johar ineligible for unemployment benefits, ordered reimbursement of benefits improperly paid, and imposed a penalty for willful misrepresentation. The California Unemployment Insurance Appeals Board (CUIAB) affirmed.After Johar sought judicial review, CUIAB confessed error for failing to consider new evidence discovered by Johar while the administrative appeal was pending. The court dismissed the case without reaching the merits. The court of appeal reversed. Johar was entitled to relief on the existing record. She left her job in emergency circumstances with the employer’s approval, thus for good cause; an employee who leaves work for good cause is presumed to have not voluntarily quit. SWS’ evidence did not establish that Johar positively repudiated her obligation to return in clear terms. View "Johar v. California Unemployment Insurance Appeals Board" on Justia Law