Justia Public Benefits Opinion Summaries

The State redesigned the dental insurance plan offered to public retirees in 2014, narrowing coverage but also decreasing premiums paid by retirees. The Retired Public Employees of Alaska challenged the redesign. After a bench trial the superior court concluded that the new plan unconstitutionally diminished retirees’ accrued benefits. The State appealed, arguing that the superior court erred by determining the dental plan was a constitutionally protected “accrued benefit” and by refusing to consider premium rates for retirees as relevant to the diminishment analysis. The Alaska Supreme Court agreed with the State on the second point only: "The Alaska Constitution does protect public retirees’ option to purchase dental insurance as an accrued benefit, but both coverage for retirees and price to retirees influence the value of this option." The Court therefore vacated and remanded for the superior court to reevaluate the plan changes and incorporate premium pricing into its analysis. View "Tshibaka v. Retired Public Employees of Alaska, Inc." on Justia Law

For almost 30 years, Prill worked for the Eau Claire, Wisconsin County Highway Department performing physically demanding work, including driving a dump truck and maintaining roads. She suffered from pain in her lower back and knees, which was exacerbated by a car accident and multiple work injuries. Prill retired in 2014 and later filed for Social Security disability benefits alleging she could no longer perform heavy or medium work. Several doctors examined Prill or reviewed her medical records but reached different conclusions about her physical limitations.An ALJ found Prill’s testimony only partially credible, concluding that her report about the severity of her symptoms and the extent of her limitations was inconsistent with other record evidence. The ALJ also weighed the competing medical evidence and gave greater weight to the opinions of consulting physicians who reviewed Prill’s medical records than to the opinion of Prill’s treating physician. The ALJ concluded that Prill had not been disabled since August 2014. The Appeals Council of the Social Security Administration denied her request for review. The district court and Seventh Circuit affirmed. Substantial evidence supported the ALJ’s decision. The court rejected arguments the ALJ wrongly discounted Prill’s subjective allegations and improperly weighed the differing medical opinions. View "Prill v. Kijakazi" on Justia Law

Social Security retirement benefits are calculated using a formula based on past earnings, 42 U.S.C. 415(a)(1)(A). Under the “windfall elimination” provision, benefits are reduced when a retiree receives a separate pension payment based on employment not subject to Social Security taxes. Pension payments exempt from the windfall reduction include those "based wholly on service as a member of a uniformed service.”A “military technician (dual status),” 10 U.S.C. 10216, is a “civilian employee” assisting the National Guard. Such technicians are required to maintain National Guard membership and must wear uniforms while working. For their work as full-time civilian technicians, they receive civil-service pay. If hired before 1984, they receive Civil Service Retirement System pension payments. As part-time National Guard members, they receive military pay and pension payments from a different arm of the government.The SSA applied the windfall elimination provision to the benefits calculation for Babcock, a dual-status technician. The district court and Sixth Circuit upheld that decision, declining to apply the uniformed-services exception.The Supreme Court affirmed. Civil Service Retirement System pensions generally trigger the windfall provision. Babcock’s technician work was not service “as” a National Guard member. A condition of employment is not the same as the capacity in which one serves. The statute states: “For purposes of this section and any other provision of law,” a technician “is” a “civilian employee,” “authorized and accounted for as” a “civilian.” While working in a civilian capacity, technicians are not subject to the Uniform Code of Military Justice. They possess characteristically civilian rights concerning employment discrimination, workers’ compensation, disability benefits, and overtime work; technicians hired before 1984 are “civil service” members, entitled to pensions as civil servants. Babcock’s civil-service pension payments are not based on his National Guard service, for which he received separate military pension payments. View "Babcock v. Kijakazi" on Justia Law

In this case involving the In-Home Supportive Services (IHSS) program the Supreme Court affirmed the judgment of the court of appeal concluding that sections 631 and 683 of the Unemployment Insurance Code exclude from coverage a provider who is the recipient's minor child, parent, or spouse under the state's unemployment insurance program, holding that the court of appeal did not err.The IHSS program authorized certain Californias, who were disabled or elderly, to receive in-home services from third parties or family members paid for with public funds. Under one program option, service recipients hire their own providers and the providers are paid either by a public entity or by the recipients with funds they have received from a public entity. At issue was whether such a provider qualified for unemployment benefits. The Supreme Court answered the question in the negative, holding that provider who is the recipient's minor child, parent, or spouse is not covered by the state's unemployment insurance program. View "Skidgel v. California Unemployment Insurance Appeals Board" on Justia Law

North Dakota Workforce Safety and Insurance (“WSI”) appealed a district court judgment reversing an administrative order sustaining a WSI order denying Bruce Bahmiller’s claim for workers’ compensation benefits. After review, the North Dakota Supreme Court affirmed the district court judgment, concluding the administrative law judge’s (“ALJ”) finding that Bahmiller failed to file a timely claim for benefits within one year of his work injury was not supported by the weight of the evidence. View "Bahmiller v. WSI, et. al." on Justia Law

The plaintiffs retired from the Louisville Metropolitan police department and received free health insurance, administered by Kentucky Retirement Systems. Kentucky initially paid all of their healthcare costs. After the officers turned 65, Medicare became the primary payer, leaving Kentucky to cover secondary expenses. Each officer came out of retirement, joining county agencies different from the ones they served before retiring. They became eligible for healthcare benefits in their new positions. Kentucky notified them that federal law “mandate[d]” that it “cannot offer coverage secondary to Medicare” for retirees “eligible to be on [their] employer’s group health plan” as “active employees.” Some of the officers then paid for insurance through their new employers; others kept their retirement insurance by quitting or going part-time. The officers sued.The district court granted summary judgment to the officers, ordered Kentucky to reinstate their retirement health insurance, and awarded the officers some of the monetary damages requested. The Sixth Circuit affirmed. The officers have a cognizable breach-of-contract claim. Under Kentucky law, the Kentucky Retirement Systems formed an “inviolable contract” with the officers to provide free retirement health insurance and to refrain from reducing their benefits, then breached that contract. The Medicare Secondary Payer Act of 1980 did not bar Kentucky from providing Medicare-eligible police officers with state retirement insurance after they reentered the workforce and became eligible again for employer-based insurance coverage, 42 U.S.C. 1395y. View "River City Fraternal Order of Police v. Kentucky Retirement Systems" on Justia Law

Plaintiff, a retired "dual status technician" with the National Guard, argues that the civil service pension he received in connection with his employment as a dual status technician – a civilian position that requires concurrent National Guard membership – is not subject to reduction under the Social Security Act's Windfall Elimination Provision because the pension falls within an exception applicable to payments based wholly on work performed as a member of a uniformed service. The district court granted summary judgment to plaintiff and the Administration appealed.The Second Circuit reversed the Administration's calculation of plaintiff's Social Security retirement benefits. The court read the plain language of the statute and used traditional tools of statutory interpretation, holding that a civil service pension based on federal civilian employment as a dual status technician does not fall within the uniformed service exception. Therefore, the court remanded for further proceedings consistent with the court's opinion. View "Linza v. Saul" on Justia Law

McAllister injured his knee while working as a sous chef for a restaurant. The injury occurred as he stood up from a kneeling position while attempting to retrieve food that had been misplaced in the cooler. He had previously had surgery on the knee and had received workers’ compensation benefits at that time. An arbitrator awarded him workers’ compensation benefits but the Illinois Workers’ Compensation Commission reversed, finding that the injury did not “arise out of” his employment. The circuit court and the Appellate Court, Workers’ Compensation Commission Division, affirmed.The Illinois Supreme Court reversed. The injury arose out of an employment-related risk; the acts that caused the injury were risks incident to his employment because these were acts his employer might reasonably expect him to perform in fulfilling his assigned job duties. McAllister was responsible for arranging the walk-in cooler and had a duty to find misplaced food. The court overruled certain cases to the extent that they held that injuries attributable to common bodily movements or routine everyday activities, such as bending, twisting, reaching, or standing up from a kneeling position, are not compensable unless a claimant can prove that he was exposed to a risk of injury from these common bodily movements or routine everyday activities to a greater extent than the general public. View "McAllister v. Illinois Workers' Compensation Commission" on Justia Law

In 1983, Rice sought benefits under the Black Lung Benefits Act (BLBA), 30 U.S.C. 901–45. The Department of Labor (DOL) looks to employers that employed the miner for at least one year and are capable of paying benefits. The miner’s most recent employer that meets these requirements is the “responsible operator.” Employers must either qualify as a self-insurer or purchase BLBA insurance. KRCC operated a coal mine where Rice worked in 1982-1983 but he was employed by a separate corporate entity, KRMS, which charged KRCC for the cost of Rice’s labor. The entities' ownership and management overlapped; KRMS had no assets and operated out of KRCC's offices. KRCC obtained BLBA coverage from Bituminous Casualty but only listed 10 employees. The other 150 were employed by KRMS. An ALJ identified KRMS as the responsible operator, then denied Rice’s claim on the merits. Rice appealed; KRCC and Bituminous successfully moved to be dismissed from the case, because the ALJ identified KRMS as the responsible operator.In 2002, Rice filed another BLBA claim. DOL again notified KRCC and Bituminous that KRCC might be the responsible operator. Bituminous claims it “denied coverage based on the fraudulent arrangements” between KRCC and KRMS. DOL refused to dismiss Bituminous.The Sixth Circuit affirmed, rejecting arguments that DOL was collaterally estopped from finding that KRCC was the responsible operator; that Bituminous was entitled to rescind its insurance agreement based on fraud by KRCC; and that delays in DOL administrative proceedings violated its right to due process. View "Karst Robbins Coal Co. v. Director, Office of Workers’ Compensation Programs" on Justia Law

The California State Teachers’ Retirement System (CalSTRS) determined that Ernest Moreno’s retirement benefits had been incorrectly calculated and initiated proceedings to adjust Moreno’s retirement benefits and collect the overpayment. The trial court denied Moreno’s petition for writ of administrative mandamus challenging the CalSTRS actions. Moreno appealed, contending: (1) CalSTRS’s adjustment of his retirement benefits and collection of the overpayment were barred by the statute of limitations found in Education Code section 22008 (c) because CalSTRS was on inquiry notice of the problem as early as 2008; and (2) CalSTRS should have been equitably estopped from adjusting his retirement benefits and collecting the overpayments. After review, the Court of Appeal concluded: (1) CalSTRS was not on inquiry notice of the reporting error that led to overpayment until December 2014 when it began an audit of Moreno’s retirement benefits, and, therefore, CalSTRS’s adjustments to Moreno’s retirement benefits and collection of overpayments were not barred by the statute of limitations; and (2) CalSTRS was not equitably estopped because CalSTRS was not apprised of (or on notice about) the overpayments until December 2014. View "Moreno v. Cal. State Teachers' Retirement System" on Justia Law