Justia Public Benefits Opinion Summaries

Rodriguez, a Gulf War veteran, served as a Santa Cruz police officer. 1995-2007. He applied for industrial disability retirement in 2011 with the California Public Employee’s Retirement System based on his PTSD diagnosis that was caused in part by his work for the city. After litigation, the city granted Rodriguez disability retirement but denied his claim of industrial causation. He began receiving benefits in December 2016. Rodriguez requested a finding that his disability was industrial from the Workers’ Compensation Appeals Board in April 2017. The Board concluded that Rodriguez’s disability was industrial, but that he was barred from receiving industrial disability retirement benefits because his claim for a finding of industrial causation was untimely under the five-year time limitation in Government Code section 21171. The court of appeal reversed. Section 21171 applies only to rescind, alter or amend an earlier industrial determination. Section 21174 applies to initial determinations and states that a retiree claiming an industrial disability that is disputed will not receive the additional benefits “unless the application for that determination is filed with the Workers’ Compensation Appeals Board... within two years after the effective date of the member’s retirement.” If a claimant applies for a determination of industrial causation within two years of retirement but more than five years after the injury, the Board cannot modify its determination that an injury is industrial or not; nothing precludes the Board from making the initial determination of industrial causation. View "Rodriguez v. Workers' Compensation Appeals Board" on Justia Law

California State Teachers’ Retirement System (CalSTRS) manages contributions made by employees and member school districts to the State Teachers’ Retirement Fund. (Ed. Code 22000.) In 2014, the Baxter petitioners, formerly employed by the Salinas Unified High School District sought to prevent CalSTRS from continuing to reduce their monthly retirement benefit payments and to restore prior monies they claimed CalSTRS had wrongfully withheld to recoup overpayments made as a result of a years-long miscalculation by the District. The trial court held that a three-year limitations period barred CalSTRS from recouping the prior overpayments. The court of appeal reversed, finding that the continuous accrual theory applied. A second suit challenged the reductions. Before the court of appeal addressed Baxter, the trial court granted relief in the second suit, finding CalSTRS’s claims time-barred. The court of appeal followed Baxter, holding that the continuous accrual theory applies. CalSTRS was time-barred from pursuing any claim against teachers as to pension benefit overpayments made more than three years before CalSTRS commenced an action but is not time-barred from pursuing any claim concerning periodic overpayments to teachers and adjustments to teachers’ future monthly benefits, where the payment accrued not more than three years prior to commencement of an action. The reduction in benefits made by CalSTRS did not constitute the commencement of an “action.” CalSTRS constructively commenced an “action” when these teachers filed their verified petition and complaint in the superior court on February 1, 2016. View "Blaser v. State Teachers' Retirement System" on Justia Law

Goldstein worked until March 2013. The Employment Development Department (EDD) granted him unemployment insurance benefits, which he received in March 2013 through August 10, 2013. In August 2013, he successfully applied for disability benefits, which he received until he exhausted his maximum benefit amount in September 2014. Goldstein filed another unemployment claim, which had an effective date of March 23, 2014. EDD determined that Goldstein’s second claim was invalid under Unemployment Insurance Code section 1277 because during the benefit year of his first claim he neither was paid sufficient wages nor performed any work. An ALJ and the Appeals Board agreed while acknowledging that disability benefits qualify as wages under section 1277.5. The court of appeal affirmed, finding that the Board erred, but the error was not prejudicial. A claimant can establish a valid claim under section 1277(a) even if he received unemployment insurance benefits during the benefit year of the prior valid claim if both the earnings and work requirements are satisfied. Goldstein satisfied the earnings requirement and the Board erred in ruling otherwise but there is no evidence Goldstein performed services for pay during that time. View "Goldstein v. California Unemployment Insurance Appeals Board" on Justia Law

The Pennsylvania Supreme Court granted discretionary review to determine whether the Commonwealth Court erred in holding appellant Daniel Harmon was disqualified from receiving unemployment compensation benefits pursuant to Section 402.6 of the Unemployment Compensation Law. Appellant was a part-time employee at Brown’s Shop Rite beginning February 14, 2013. By December, he was convicted of driving with a suspended license and sentenced to a term of 60 days’ imprisonment to be served on 30 consecutive weekends, beginning March 14, 2014 and ending August 7, 2014. Appellant’s employment with Brown’s Shop Rite was terminated on March 24, 2014 due to a violation of company policy, which was unrelated to his incarceration. He then filed for benefits and received them for the week ending March 29, 2014 through the week ending July 26, 2014. This period included weeks when appellant was serving his sentence of weekend incarceration. The Supreme Court held appellant was not disqualified from receiving unemployment compensation benefits, and therefore reversed the order of the Commonwealth Court. View "Harmon v. UCBR" on Justia Law

The Public Employees Retirement Law, Government Code section 21156, defines disability as being “incapacitated physically or mentally.” A governmental employee loses the right to claim disability benefits if terminated for cause. The Third Appellate District identified exceptions: under “Haywood,” a terminated-for-cause employee can qualify for disability retirement when the conduct which prompted the termination was the result of the disability; under “Smith,” a terminated employee may qualify for disability retirement if he had a “matured right” to a disability retirement before that conduct; Smith further recognized that “a court, applying principles of equity,” could deem an employee’s right to a disability retirement to be matured to survive a dismissal for cause. The Board of Administration of the California Public Employees Retirement System (CalPERS) adopted a precedential decision (Vandergoot) that an employee settling a pending termination for cause and agreeing not to seek reemployment is “tantamount to a dismissal,” precluding a disability retirement. Martinez, a former state employee, settled the termination for cause action against her and agreed to resign and not re-apply for employment. CalPERS denied her application for disability retirement. The trial court and court of appeal concluded that Haywood and Smith were binding as stare decisis and that “Vandergoot is a reasonable extension.” The courts rejected an argument that a 2008 enactment tacitly “superseded” Haywood and Smith. View "Martinez v. Public Employees' Retirement System" on Justia Law

The 2007 Act, 40 ILCS 5/16-106(10), amended the Pension Code, which governs the Teachers’ Retirement System (TRS): An officer or employee of a statewide teachers’ union was permitted to establish TRS service credit if the individual: was certified as a teacher no later than February 27, 2007, applied to the TRS within six months, and paid into the system both the employee contribution and employer (state) contribution, plus interest, for his prior union service. Plaintiff worked as a union lobbyist from 1997 until his 2012 retirement. In 2006, plaintiff obtained a substitute teaching certificate. In January 2007, he worked one day as a substitute teacher. Within six months, plaintiff became a member of the TRS. Plaintiff then contributed $192,668 to the system for his union service. In 2011, the Chicago Tribune published an article, identifying plaintiff and criticizing the law that allowed him to qualify for a teacher’s pension. In response to the negative media coverage, the 2012 Act repealed the 2007 amendment and provided for a refund of contributions. TRS eliminated plaintiff’s service credits and refunded his contributions. Plaintiff sought a declaratory judgment that the retroactive repeal violated the state constitution’s pension protection clause (Ill. Const. 1970, art. XIII).The Illinois Supreme Court ruled in favor of plaintiff. The 2007 amendment's inclusion of a cutoff date did not render it unconstitutional special legislation (Ill. Const. 1970, art. IV); the amendment applied generally to all eligible employees who met its criteria. Under the pension clause, “once a person commences to work and becomes a member of a public retirement system, any subsequent changes to the Pension Code that would diminish the benefits conferred by membership in the retirement system cannot be applied to that person.” View "Piccioli v. Board of Trustees of the Teachers’ Retirement System" on Justia Law

Hernandez filed a voluntary Chapter 7 bankruptcy petition in December 2016, reporting one sizable asset: a pending workers’ compensation claim valued at $31,000. To place that claim beyond the reach of creditors, she listed it as exempt under section 21 of the Illinois Workers’ Compensation Act, 820 ILCS 305/21, applicable via 11 U.S.C. 522(b). Two days after filing for bankruptcy, Hernandez settled the claim. Hernandez owed significant sums to three healthcare providers who treated her work-related injuries. The providers objected to her claimed exemption, arguing that 2005 amendments to the Illinois Act enable unpaid healthcare providers to reach workers’ compensation awards and settlements. The bankruptcy court denied the exemption and the district judge affirmed. The Seventh Circuit certified to the Illinois Supreme Court the question: Whether the Illinois Workers’ Compensation Act, as amended, allows care-provider creditors to reach the proceeds of workers’ compensation claims. The court noted that Section 21 has been interpreted by bankruptcy courts to create an exemption for these assets; 2005 amendments imposed a new fee schedule and billing procedure for care providers seeking remuneration. The Illinois Supreme Court has not addressed the interplay between these competing components of state workers’ compensation law. View "Hernandez v. Marque Medicos Fullerton, LLC" on Justia Law

Winsted was 42 years old when he applied for disability benefits, asserting an onset date of October 2010. Although he initially alleged he became disabled in 2005, two prior applications alleging this onset date were denied and deemed administratively final. Winsted suffers from multiple physical impairments, including degenerative disc disease, osteoarthritis, and anxiety, mostly associated with his previous work in hard labor as an industrial truck driver, a highway maintenance worker, and an operating engineer. An ALJ denied benefits, finding that Winsted could work with certain limitations. The district court affirmed. The Seventh Circuit remanded. The ALJ did not adequately explain how the limitations he placed on Winsted’s residual functional capacity accounted for the claimant’s mental difficulties; the ALJ did not consider Winsted’s difficulties with concentration, persistence, and pace. View "Winsted v. Berryhill" on Justia Law

Tramble worked for various Kentucky coal companies from at least May 1963 until June 1985. Tramble’s 1987 claim for benefits under the Black Lung Benefits Act (BLBA), 30 U.S.C. 901–944, indicated that he had stopped working due to a job-related back injury. That claim was denied although the parties stipulated to 17 years of qualifying coal mine employment. The ALJ found that medical evidence established that Tramble suffered from coal workers’ pneumoconiosis but was not totally disabled. After his 2008 death, Tramble’s widow sought survivor’s benefits. Reversing an award by an ALJ, the Department of Labor Benefits Review Board found that the ALJ failed to explain adequately how he calculated the 15.25-years of underground coal mine employment that justified application of the 15-year statutory presumption of entitlement to benefits. On remand, the ALJ again awarded benefits. The Board again reversed. The Sixth Circuit remanded. Further fact-finding is required to ensure that all relevant evidence has been considered. The court rejected Incoal’s argument that, in order to be credited with one year of coal mine employment, a miner must be on the payroll of a mining company for 365 consecutive days and have worked 125 of those days in or around a coal mine . View "Shepherd v. Incoal, Inc." on Justia Law

Ross worked as a coal miner for approximately 30 years. He smoked cigarettes for almost as long but was able to quit after his first heart attack. Ross continued to work as a coal miner even though he suffered another heart attack and had difficulty breathing at work. Approximately six years after Ross stopped working in the coal mines, his breathing problems became severe. In 2012, Ross sought benefits under the Black Lung Benefits Act, 30 U.S.C. 901. The Department of Labor’s Benefits Review Board vacated a denial. On remand, the ALJ granted Ross’s claim. The Board affirmed. The Seventh Circuit enforced the decision. Rejecting a due process argument, the court noted the employer had the opportunity to argue its case twice before the ALJ and twice before the Board, including the chance to submit supplemental medical opinion evidence. A theory that something must be amiss because the ALJ changed his mind on remand is particularly unpersuasive here because the parties submitted five additional medical opinions after the Board’s second decision. Ross proved by a preponderance of the evidence that he was totally disabled. View "Consolidation Coal Co. v. Director, Office of Workers’ Compensation Programs, United States Department of Labor" on Justia Law