Justia Public Benefits Opinion Summaries

Rosa A. Camacho, a retired Class II member of the Northern Mariana Islands Retirement Fund, claimed that she was entitled to cost-of-living allowances (COLAs) as part of her retirement benefits. When Camacho entered the Retirement Fund in 1980, COLAs were not part of the retirement package. In 1989, the Commonwealth legislature amended the Retirement Fund Act to provide a two percent COLA. Over the years, this provision was repeatedly modified, suspended, and ultimately repealed in 2011. The Commonwealth’s financial difficulties led to a class action and a subsequent settlement agreement in 2013, which entitled participants to 75% of their “Full Benefits,” as defined by statute or guaranteed by the Commonwealth Constitution.The United States District Court for the Northern Mariana Islands held that Camacho was not entitled to COLAs under the settlement agreement, reasoning that COLAs were not constitutionally protected benefits at the time she joined the Retirement Fund and were discretionary by statute as of 2013. Camacho appealed, arguing that the statutory introduction of COLAs during her membership created a protected right under Article III, section 20(a) of the Commonwealth Constitution.The United States Court of Appeals for the Ninth Circuit certified to the Supreme Court of the Commonwealth of the Northern Mariana Islands the question of whether section 8334(e) of the Retirement Fund Act conferred a constitutionally protected accrued benefit in the form of COLAs for Class II members employed when the Act took effect. The Commonwealth Supreme Court answered in the negative, finding that COLAs were legislative policy adjustments and not protected contractual benefits. In accordance with this interpretation, the Ninth Circuit held that Camacho did not acquire a constitutionally protected right to COLAs under section 8334(e). The district court’s decision was affirmed. View "Camacho v. Northern Mariana Islands Settlement Fund" on Justia Law

A Chicago police officer was injured in a traffic accident while responding to a call in 2017, resulting in ongoing back and hip problems. Despite returning to unrestricted duty for a period, his condition worsened, leading to medical leave and various treatments, including surgery for a hip injury and ongoing care for back pain. Multiple physicians were involved in his care. His treating orthopedic specialist eventually deemed him permanently disabled from police work, while a Board-appointed independent medical examiner found him capable of full, unrestricted police duty. The officer sought reinstatement with the police department but was not cleared due to medical opinions regarding his disability. He applied to the Retirement Board for duty disability benefits.The Retirement Board of the Policemen’s Annuity and Benefit Fund of the City of Chicago held a hearing and ultimately denied his application for both duty and ordinary disability benefits, finding the Board-appointed physician’s opinion more credible. The Circuit Court of Cook County affirmed the Board’s decision, holding it was not against the manifest weight of the evidence. The officer appealed, and the Appellate Court, First District, reversed and remanded. The appellate court relied on the Illinois Supreme Court’s holding in Kouzoukas v. Retirement Board of the Policemen’s Annuity & Benefit Fund of Chicago, reasoning that the officer was caught in a “catch-22” because he was not offered a suitable position by the police department and therefore should be considered disabled under the statute.The Supreme Court of Illinois reviewed the Retirement Board’s decision, holding that section 5-156 of the Illinois Pension Code does not require proof of disability from a Board-appointed doctor as a prerequisite to granting benefits; the Board remains the ultimate arbiter of disability. The Court found that the Board’s denial of benefits was not against the manifest weight of the evidence, distinguishing the facts from Kouzoukas. The Supreme Court reversed the appellate court’s judgment and affirmed the circuit court and the Board’s denial of benefits. View "Moreland v. Retirement Board of the Policemen Y Annuity and Benefit Fund of the City of Chicago" on Justia Law

Tamica Rainey, a Chicago police officer, was injured in duty-related car accidents in 2013 and 2015. She was awarded duty disability benefits in 2017 based on injuries to her neck and shoulder. As required by statute, Rainey’s disability status was periodically reviewed, and in 2022, after multiple hearings and submissions of medical records, the Retirement Board of the Policemen’s Annuity and Benefit Fund of the City of Chicago discontinued her duty disability benefits, concluding she was no longer disabled from her duty-related injuries. However, when Rainey attempted to return to work, the police department determined she could not perform her duties.Rainey sought administrative review in the Circuit Court of Cook County, which reversed the Board’s decision, relying on precedent that an officer remains disabled if the department cannot provide a position with needed accommodations. The circuit court also awarded Rainey attorney fees and costs under section 5-228(b) of the Illinois Pension Code. The Board appealed, and the Appellate Court of Illinois, First District, affirmed both the restoration of Rainey’s benefits and the award of attorney fees and costs.The Supreme Court of Illinois reviewed the Board’s challenge to the attorney fees and costs award. The court held that section 5-228(b) of the Illinois Pension Code authorizes an award of attorney fees and costs not only to police officers who successfully challenge the initial denial of duty or occupational disease disability benefits, but also to those who successfully challenge the discontinuation of such benefits. The court rejected the Board’s argument that statutory attorney fee awards are limited to initial applications, finding the statute’s plain language and legislative intent favor such awards for both denial and discontinuation challenges. The Supreme Court affirmed the judgments of the appellate and circuit courts and reversed the Board’s decision. View "Rainey v. Retirement Board of the Policemen & Annuity and Benefit Fund of the City of Chicago" on Justia Law

Several employees of the City and County of San Francisco who joined the city’s retirement system at age 40 or older and later retired due to disability challenged the method used to calculate their disability retirement benefits. The city’s retirement system uses two formulas: Formula 1, which provides a higher benefit if certain thresholds are met, and Formula 2, which imputes service years until age 60 but caps the benefit at a percentage of final compensation. Plaintiffs argued that Formula 2 discriminates against employees who enter the system at age 40 or above, in violation of the California Fair Employment and Housing Act (FEHA).Initially, the San Francisco City and County Superior Court sustained the city’s demurrer, finding the plaintiffs had not timely filed an administrative charge. The California Court of Appeal reversed that decision, allowing the case to proceed. After class certification and cross-motions for summary judgment, the trial court found triable issues and held a bench trial. At trial, plaintiffs presented expert testimony based on hypothetical calculations, while the city’s expert criticized the lack of actual data analysis and highlighted factors such as breaks in service and purchased credits.The California Court of Appeal, First Appellate District, Division Four, reviewed the trial court’s post-trial decision. The appellate court affirmed the trial court’s judgment, holding that the plaintiffs failed to prove intentional age discrimination or disparate impact under FEHA. The court found substantial evidence that Formula 2 was motivated by pension status and credited years of service, not age. The plaintiffs’ evidence was insufficient because it relied on hypotheticals rather than actual data showing a disproportionate adverse effect on the protected group. The appellate court also affirmed the denial of leave to amend the complaint, finding no reversible error. The judgment in favor of the city was affirmed. View "Carroll v. City & County of S.F." on Justia Law

During a government shutdown that began on October 1, 2025, the United States Department of Agriculture (USDA) announced it would not provide November Supplemental Nutrition Assistance Program (SNAP) benefits, affecting millions of Americans who rely on these funds for food. Despite having approximately $6 billion in contingency funds appropriated by Congress for emergencies, USDA stated it would not use these funds, arguing they were unavailable once regular appropriations lapsed. Plaintiffs, including nonprofits, local governments, a union, and a food retailer, filed suit, alleging that USDA’s suspension of benefits was arbitrary, capricious, and contrary to law under the Administrative Procedure Act (APA).The United States District Court for the District of Rhode Island granted a temporary restraining order (TRO) requiring USDA to provide either full or partial November SNAP payments by specified dates. The government chose to provide partial payments but failed to do so in a timely manner, as many recipients would not receive benefits by the court’s deadline. The district court found the government had not complied with its order, both by failing to resolve administrative burdens and by not ensuring timely disbursement. As a result, the court ordered USDA to make full November SNAP payments, including by using funds from the Section 32 fund in combination with contingency funds. The government appealed and sought a stay of the district court’s order.The United States Court of Appeals for the First Circuit reviewed the government’s request for a stay pending appeal. The court held that the government had not met its burden to justify a stay, finding it had failed to show a likelihood of success on the merits or that irreparable harm would result from compliance. The court emphasized the immediate and substantial harm to SNAP recipients if benefits were withheld and denied the government’s motion for a stay. View "Rhode Island State Council of Churches v. Rollins" on Justia Law

Ramona Craig applied for Social Security disability benefits and, after her application was denied, she filed suit challenging that denial. The key issue in her case was whether she had properly exhausted her administrative remedies before seeking judicial review. The magistrate judge specifically warned Craig that she needed to present sufficient evidence of exhaustion prior to proceeding with her lawsuit. Despite these warnings, Craig did not provide the necessary evidence before the district court entered final judgment.The United States District Court for the Western District of Texas reviewed Craig’s case and dismissed it without prejudice, finding that she had failed to demonstrate exhaustion of administrative remedies. After the district court entered its final judgment, Craig submitted an additional document intended to establish exhaustion, but this filing occurred after the judgment was entered.On appeal, the United States Court of Appeals for the Fifth Circuit considered whether it could review Craig’s post-judgment filing. The Fifth Circuit held that, under Rule 10(a) of the Federal Rules of Appellate Procedure, the record on appeal does not include documents filed in the district court after the entry of final judgment. The court further declined to exercise its discretion to take judicial notice of the post-judgment filing. The Fifth Circuit affirmed the district court’s dismissal without prejudice, holding that the district court lacked subject matter jurisdiction because Craig failed to establish exhaustion of administrative remedies based on the filings made before final judgment. The court clarified that Craig may file a new case or seek to reopen the existing case if she wishes to pursue her claims. View "Craig v. Bisignano" on Justia Law

Nita and Kirtish Patel operated two companies that provided mobile diagnostic medical services. To obtain Medicare reimbursement for neurological testing, they falsely represented that a licensed neurologist would supervise the tests. In reality, Kirtish, who lacked a medical license, wrote the reports, and Nita forged a physician’s signature. Their fraudulent scheme generated over $4 million, including substantial Medicare payments.In 2014, a former employee filed a sealed qui tam action in the United States District Court for the District of New Jersey, alleging healthcare fraud and asserting claims under the False Claims Act. The Patels were subsequently arrested and each pleaded guilty to one count of healthcare fraud. Their plea agreements did not address or preclude future civil or administrative actions. After their guilty pleas, the Government intervened in the qui tam action and obtained summary judgment against the Patels, relying on collateral estoppel from their criminal admissions. The District Court trebled the Medicare loss and imposed civil penalties, resulting in a judgment exceeding $7 million. Nita appealed, and the United States Court of Appeals for the Third Circuit affirmed her liability under the False Claims Act.Both Patels later moved to vacate their criminal sentences under 28 U.S.C. § 2255, arguing ineffective assistance of counsel because their attorneys did not advise them that their guilty pleas could have collateral estoppel effects in the civil qui tam action. The District Court denied their motions, finding that counsel’s performance was not objectively unreasonable and that the Patels were aware their plea agreements did not preclude civil actions.On appeal, the United States Court of Appeals for the Third Circuit held that the Sixth Amendment does not require criminal defense counsel to advise clients of collateral consequences such as civil liability under the False Claims Act. The court affirmed the District Court’s judgment, concluding that Padilla v. Kentucky’s holding is limited to deportation consequences and does not extend to civil liability. View "Patel v. USA" on Justia Law

A personal care assistance provider agency in Minnesota was audited by the Department of Human Services (DHS) for recordkeeping deficiencies related to its provision of services under the state’s Medicaid program. The agency, which served both traditional and PCA Choice recipients, was found to have various documentation errors, including missing or incomplete care plans and timesheets, as well as timesheets lacking required elements. DHS did not allege fraud or that services were not provided, but sought to recover over $420,000 in payments, arguing that these deficiencies constituted “abuse” under state law and justified monetary recovery.After an evidentiary hearing, an administrative law judge (ALJ) recommended limited recovery for some missing documentation but rejected most of DHS’s claims, finding that DHS had not shown the deficiencies resulted in improper payments. The DHS Commissioner disagreed, ordering full repayment. The Minnesota Court of Appeals reversed the Commissioner’s decision, holding that DHS must prove not only that the provider engaged in “abuse” but also that the abuse resulted in the provider being paid more than it was entitled to receive. The court also determined that provider agencies must maintain care plans for both traditional and PCA Choice recipients in their files.The Minnesota Supreme Court affirmed in part, reversed in part, and remanded. It held that, to obtain monetary recovery under Minn. Stat. § 256B.064, subd. 1c(a), DHS must prove either: (1) the provider engaged in conduct described in subdivision 1a and, had DHS known of the conduct before payment, it would have been legally prohibited from paying under a statute or regulation independent of subdivision 1a; or (2) the payment resulted from an error such that the provider received more than authorized by law. The Court also held that provider agencies must keep care plans for all PCA services, including PCA Choice, in their files. View "In the Matter of the SIRS Appeal by Best Care, LLC" on Justia Law

A firefighter with fifteen years of service applied for disability pension benefits from a municipal pension fund, claiming he was permanently disabled due to post-traumatic stress disorder (PTSD) resulting from several traumatic events encountered during his career. The pension fund’s Board of Trustees denied his application after a hearing, finding he did not meet the policy’s requirements for a mental health disability benefit, specifically the requirement that the traumatic events causing the disability be “unexpected” within the context of his regular duties.The applicant sought judicial review in the Chancery Court for Hamilton County, which reviewed the Board’s decision under Tennessee’s Uniform Administrative Procedures Act (UAPA). The trial court found the Board’s interpretation of the policy arbitrary and capricious, holding that the events were unexpected to the applicant and that the policy should be construed in favor of the employee. The trial court reversed the Board’s denial and awarded benefits. The Tennessee Court of Appeals affirmed, finding the policy ambiguous and applying a liberal construction doctrine to interpret the policy in favor of the applicant.On further appeal, the Supreme Court of Tennessee held that the term “unexpected” in the policy was not ambiguous and should be given its plain meaning. The Court concluded that the Board’s decision was supported by substantial and material evidence and was not arbitrary or capricious. The Court also held that the liberal construction doctrine did not apply because the policy was unambiguous. Accordingly, the Supreme Court of Tennessee reversed the judgments of the Court of Appeals and the trial court, reinstating the Board’s denial of disability benefits, and remanded the case for further proceedings consistent with its opinion. View "Long v. Chattanooga Fire and Police Pension Fund" on Justia Law

A firefighter employed by the City of Birmingham developed hypertension during his employment and applied to the City of Birmingham Retirement and Relief System for both extraordinary and ordinary disability benefits, arguing that his condition and the medications required to control it prevented him from safely performing his job. He detailed unsuccessful attempts to manage his hypertension with various medications and provided medical opinions supporting his claim that only beta-blockers, which are not recommended for firefighters, could control his blood pressure. The Board, after considering the opinion of its medical expert, denied both applications, concluding that he had not exhausted all other antihypertensive regimens.The firefighter sought review of the Board’s decisions by filing a petition for a writ of mandamus in the Jefferson Circuit Court, as permitted by statute. Initially, the circuit court dismissed the action for lack of service, but the Supreme Court of Alabama reversed that dismissal and remanded the case. After service was obtained, the respondents argued that the claim for extraordinary disability benefits failed as a matter of law because the hypertension was not caused by a specific workplace accident, and that the Board’s denial of ordinary disability benefits was not manifestly wrong. The circuit court denied the mandamus petition without a hearing or consideration of evidence beyond the pleadings.The Supreme Court of Alabama affirmed the circuit court’s denial of extraordinary disability benefits, holding that the statutory requirements were not met because the disability did not result from an accident at a definite time and place. However, the Supreme Court reversed the denial of ordinary disability benefits, finding that the circuit court erred by not allowing the petitioner to present evidence or reviewing the evidence considered by the Board. The case was remanded for further proceedings on the ordinary disability claim. View "Hoffman v. City of Birmingham Retirement and Relief System" on Justia Law