Justia Public Benefits Opinion Summaries

Articles Posted in Personal Injury
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The Supreme Court affirmed the judgment of the circuit court determining what portion of a settlement was subject to the Commonwealth's Medicaid lien, holding that there was no error.Appellant was seriously injured in a car accident. Because the Commonwealth's Medicaid program paid for a portion of Appellant's medical care the Commonwealth was entitled to a lien on the proceeds of an ensuing settlement between Appellant and the driver who caused the accident. At issue was what portion of the settlement was subject to the Medicaid lien. The Supreme Court affirmed, holding that the circuit court's judgment was proper under the deferential standard. View "Farah v. Commonwealth" on Justia Law

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Decker employed Pehringer at its Montana open-pit surface mine, 1977-1999. There were periods when Pehringer did not work, including a roughly three-year-long strike. For most of his mining career, Pehringer was regularly exposed to coal dust while working primarily as a heavy equipment operator. After being laid off in 1999, Pehringer was awarded Social Security total disability benefits. He never worked again. In 2014 a month before his sixty-fifth birthday, Pehringer sought black lung benefits, citing his severe COPD, 30 U.S.C. 923(b). A physician determined that “Pehringer is 100% impaired from his COPD” and that coal “dust exposure and smoking are significant contributors to his COPD impairment.”The Benefits Review Board affirmed a Department of Labor (DOL) ALJ’s award of benefits. The Ninth Circuit affirmed, first rejecting a constitutional challenge to 5 U.S.C. 7521(a), which permits removal of an ALJ only for good cause determined by the Merits Systems Protection Board. DOL ALJ decisions are subject to vacatur by people without tenure protection; properly appointed, they can adjudicate cases without infringing the President’s executive power. The ALJ did not err in adjudicating Pehringer’s claim nor in rejecting untimely evidentiary submissions. Decker did not rebut the presumption of entitlement to benefits after a claimant established legal pneumoconiosis and causation, having worked for at least 15 years in substantially similar conditions to underground coal mines. View "Decker Coal Co. v. Pehringer" on Justia Law

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Kirby received a flu shot in her arm on October 8, 2013. One week later, she complained of persistent arm pain, numbness, and tingling that began immediately after the injection. On October 16, Dr. Henry diagnosed Kirby with radial neuritis and complications due to vaccination. Two weeks later, Kirby reported that her wrist and hand had become “very weak.” On November 12, Kirby began working with a physical therapist. Her physical therapy discharge summary reported that Kirby’s pain was a “0/10,” she had regained full muscle strength except in right thumb extension, and her numbness had decreased by 80%. On December 12, Kirby reported mild right arm pain in the morning, almost normal strength, and occasional tingling, but no numbness in her thumb. Dr. Henry determined she had achieved maximum medical improvement.Kirby visited a nurse practitioner five times in January 2014-July 2015, for reasons unrelated to her vaccine injury and generally reported “feeling fine.” On October 13, 2015, she complained of mild, intermittent pain in her right arm. She had no imitations due to the pain, and no muscle weakness.The Federal Circuit reinstated Kirby’s compensation award under the Vaccine Act, 42 U.S.C. 300aa–1. A finding that Kirby’s vaccine injury lasted more than six months was not arbitrary. A reasonable fact-finder could conclude that Kirby’s testimony is not inconsistent with her medical records from January 2014 through July 2015. The court also rejected an argument concerning causation. View "Kirby v. Secretary of Health & Human Services" on Justia Law

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The parents were domiciled in Nassau, the Bahamas. Mother traveled to the U.S. five times while pregnant. A.R. was born in November 2015, in Nassau, and lived in Nassau for six months. He received his first two sets of vaccinations in Nassau, with no apparent adverse consequences. During his six-month well-child visit in Nassau, A.R. received his third set of eight vaccinations that are listed in the Vaccine Injury Table and were manufactured by companies with a U.S. presence. Days later, A.R. became ill. A.R. was flown to Nicklaus Children’s Hospital in Miami, Florida, where he was diagnosed with hemophagocytic lymphohistiocytosis, an autoimmune disease of the blood. He remained in Florida as an outpatient, returning to Nassau for Christmas, and months later, was diagnosed with acute myeloid leukemia. A.R. underwent treatment, at Cincinnati Children’s Hospital and at Johns Hopkins before he died.The Federal Circuit affirmed the dismissal of the parents’ Vaccine Act claim (42 U.S.C. 300aa). The parents asserted that the condition that caused A.R.’s death was a complication resulting from the treatment he had received for his vaccine-induced condition. The Act grants standing to a person who “received [a covered] vaccine outside the” U.S. if “such person returned" to the U.S. not later than 6 months after the vaccination. A.R., while living outside of his mother’s body, was never present in the U.S. before his vaccinations such that his entrance for medical treatment could be a “return.” View "Dupuch-Carron v. Secretary of the Department of Health & Human Services" on Justia Law

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In July 2010, L.M. was born at full-term and developed normally for six months. In February 2011, L.M. received childhood vaccines, including the diphtheria-tetanus-acellular pertussis vaccination. By that evening, L.M. had a fever, was lethargic, had poor muscle tone, and would not eat., Any disturbance caused L.M. to scream. L.M. began to have several seizures a day. At seven years of age, L.M. could crawl and walk with the assistance of a walker. She had a poorly coordinated grasp, suffered cortical visual impairments, and was nonverbal, though she could use a few signs to express ideas such as “yes,” and “no.” Testing revealed that L.M. had a genetic mutation.In a claim under the National Vaccine Injury Compensation Program, L.M. alleged that the vaccinations administered to L.M. in February 2011, significantly aggravated L.M.’s pre-existing condition under two alternative theories. The Special Master denied the petition, finding that L.M.’s genetic mutation was “the most compelling explanation for her predisposition to develop a seizure disorder.” The Federal Circuit affirmed the denial of an “on-table” claim, finding no support for an argument that most encephalopathies do not become acute until after vaccination. The court vacated and remanded the denial of an “off-table” claim, which requires determining whether the child’s receipt of vaccinations significantly aggravated her seizure disorder in the face of an underlying genetic mutation. View "Sharpe v. Secretary of Health and Human Services" on Justia Law

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In 2012, Lozano gave birth to a baby. While still hospitalized, Lozano received a tetanus-diphtheria-acellular-pertussis (Tdap) vaccination. Two weeks later, Lozano reported a low-grade fever, body aches, and breast tenderness. Lozano’s symptoms persisted through visits to her physician and the emergency room. She developed abdominal pain, difficulty urinating, weakness, loss of balance, vision changes, neck pain, headache, vomiting, and dizziness. A brain MRI suggested that Lozano possibly had multiple sclerosis (MS), acute disseminated encephalomyelitis (ADEM), or vasculitis. Lozano’s symptoms improved with steroid treatment, following a working diagnosis of MS. After several months, a repeat MRI “showed dramatic improvement, suggesting that ADEM was a more likely etiology, which was confirmed through later serological findings.” Lozano’s doctors opine that ADEM is the likely explanation for her symptoms.Lozano sought compensation under the National Childhood Vaccine Injury Act, 42 U.S.C. 300aa. Lozano’s expert opined that Lozano’s ADEM was the result of her receipt of the Tdap vaccine. The special master granted Lozano’s petition, finding that her expert’s testimony and the supporting medical literature demonstrated that the Tdap vaccine can cause autoimmune diseases such as ADEM and that Lozano offered preponderant evidence of a proximate temporal relationship between the vaccine and her injury. The Claims Court and Federal Circuit upheld the award of a lump-sum payment of $1,199,216.86, finding that the decision was neither an abuse of discretion nor contrary to law and that the fact-findings were neither arbitrary nor capricious. View "Lozano v. Secretary of Health and Human Services" on Justia Law

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The First Circuit affirmed the order of the district court finding that Plaintiff was disabled as defined under 20 C.F.R. 404.1520 and awarding her benefits, holding that there was very strong evidence of Plaintiff's disability, without any contrary evidence, to justify an award of benefits.At age thirty-four, Plaintiff filed applications for Social Security Disability Benefits and Supplemental Security Income. The Commissioner of Social Security denied Plaintiff's applications. In an independent assessment of her claim, an ALJ agreed with the Commissioner's decision, finding that Plaintiff was not disabled as defined under the Social Security Act. A federal magistrate judge found that substantial evidence did not support the ALJ's denial of benefits and recommended reversing the Commissioner's decision and remanding the case for further development of the facts. The district court agreed with the magistrate judge's findings but bypassed the need for further fact-finding and awarded benefits. The First Circuit affirmed, holding that there was overwhelming evidence to support a finding of disability and an award of benefits and that a remand for further proceedings was unnecessary. View "Sacilowski v. Saul" on Justia Law

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In October 2012, Jeske, working at a cemetery, was carrying a heavy casket when she stumbled, injuring her back. Four years later, she applied for disability insurance benefits and supplemental security income based on disability; she claimed that back and spine problems, anxiety, depression, and suicidal tendencies made her unable to work. At a hearing, Jeske told the ALJ that she was 44 years old and lived with her husband and three sons. She changed the date on which she allegedly became disabled to more than a year after her injury because she had substantial gainful activity in 2013. She explained that she received treatment through a workers’ compensation program and her employer allowed her to work from home many days. When the doctor released her from treatment, Jeske’s boss no longer permitted her to work from home and she quit. Since then she has worked as a part-time security guard.The ALJ found Jeske not disabled under the Social Security Act, 42 U.S.C. 423(d), 1382c(3). The Seventh Circuit affirmed. The ALJ applied the proper standards and sufficiently explained the decision. Although the evidence showed Jeske suffered from limiting back pain, abundant evidence supports the ALJ’s determination that her condition lacked the requirements of a presumptively disabling impairment. The use of daily-living activities, to assess credibility and symptoms, was not improper. The evidence supported a conclusion that Jeske could perform light work with specific restrictions. View "Jeske v. Saul" on Justia Law

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The Supreme Court affirmed the judgment of the trial court enjoining the application of Arizona statutes authorizing the recording of liens against third-party tortfeasors to allow hospitals to recover health care costs for Medicaid patients beyond the amounts provided by Medicaid, holding that the statues are preempted to the extent hospitals utilize them against third-party tortfeasors for "balance billing" to recover costs beyond Medicaid reimbursement.Plaintiffs were patients who were treated at defendant hospitals under the state's contract provider for the federal Medicaid program, which negotiates reimbursement rates with hospitals. Defendants recorded liens against the third-party tortfeasors who caused the patients' injuries in order to recover the remainder of their fees exceeding Medicaid reimbursement. Plaintiff brought this class action challenging the liens, arguing that Ariz. Rev. Stat. 33-931(A) and 36-2903.01(G)(4) (the lien statutes) were preempted by federal Medicaid law. The trial court enjoined application of the lien statutes. The Supreme Court affirmed, holding (1) Plaintiffs had a private right of action to challenge the lien statutes; and (2) the lien statutes are unconstitutional as applied. View "Ansley v. Banner Health Network" on Justia Law

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Arthur Noreja appeals the denial of his claim for disability benefits. Noreja filed his disability claim in March 2012. In July 2013, following a hearing, an ALJ issued a detailed written order – exceeding 13 pages with single spacing – in which she denied Noreja’s claim. The ALJ found Noreja had several severe impairments, including “arthritis of the left upper extremity and right lower extremity,” “cognitive disorder,” and “headaches.” Nevertheless, the ALJ determined that these impairments (or a combination of the impairments) did not warrant relief. The ALJ found that Noreja had the residual functional capacity (“RFC”) to do “medium” work, subject to various limitations, and that there were “jobs that exist in significant numbers in the national economy” which Noreja could perform. The Appeals Council disagreed with the ALJ’s assessment, and remanded with direction for further proceedings. Once more, however, the ALJ determined that Noreja did not have “an impairment or combination of impairments” that warranted relief, reiterated that Noreja had the RFC to do "medium" work, subject to various limitations, and that there were jobs in existence "in significant numbers" which Noreja could perform. The ALJ did not obtain a new consultative mental examination before issuing her May 2016 decision, but she procured additional evidence regarding Noreja’s impairments. On appeal of the second ALJ decision, Noreja alleged the ALJ failed to follow an instruction in the Appeals Council's remand order. The Tenth Circuit held: (1) it had jurisdiction to determine whether an alleged ALJ violation of an Appeals Council order warranted reversal; but (2) the Court's “usual” review standards remained in force, meaning that the alleged violation was material only if it showed the ALJ meaningfully failed to apply the correct legal standards, or the denial of benefits was unsupported by substantial evidence; and (3) applying those standards here, the ALJ’s denial of Noreja’s application had to be affirmed. View "Noreja v. Commissioner, SSA" on Justia Law