Justia Public Benefits Opinion Summaries

A former employee of the County of San Diego pleaded guilty to a felony charge for violating a state conflict-of-interest law, which prohibits public employees from having a financial interest in contracts made in their official capacity. After the guilty plea, but before sentencing, the San Diego County Employees Retirement Association (SDCERA) notified him that a portion of his accrued pension benefits would be forfeited under Government Code section 7522.74, as he had been “convicted” of a job-related felony. At sentencing, the criminal court reduced the offense to a misdemeanor under Penal Code section 17, subdivision (b)(3). The employee then requested reinstatement of his pension benefits, which SDCERA denied.The employee challenged SDCERA’s denial through administrative appeals, including to its chief executive officer and Board of Retirement, but both appeals were denied. He subsequently petitioned the Superior Court of San Diego County for a writ of administrative mandate to set aside SDCERA’s decision. The court denied the petition, finding that section 7522.74 precluded reinstatement of the forfeited pension benefits. The employee timely appealed the judgment.The California Court of Appeal, Fourth Appellate District, Division One, reviewed the case. The court held that a public employee is “convicted” for purposes of Government Code section 7522.74 upon an adjudication of guilt—whether by plea or jury verdict—and not only upon entry of judgment. The reduction of the felony to a misdemeanor at sentencing under Penal Code section 17, subdivision (b)(3), did not retroactively affect the forfeiture. The court affirmed the judgment, concluding that the employee’s pension benefits remained forfeited, and SDCERA properly denied reinstatement. View "Bishop v. San Diego County Employees Retirement Assn." on Justia Law

During a contentious divorce and custody dispute, Amanda Hovanec, who had returned to Ohio from South Africa with her children, conspired with Anthony Theodorou, her romantic partner, to kill her husband, T.H. After failed attempts to hire hitmen in South Africa, Theodorou, at Hovanec’s direction, obtained and shipped etorphine, a dangerous animal tranquilizer, to the United States. Hovanec ultimately used the drug to fatally inject T.H. at her mother Anita Green’s home. Green assisted after the murder by helping to select a burial site, driving the others to dig a grave, and later transporting them and the body for burial. The group also undertook efforts to conceal the crime, including disposing of T.H.’s belongings and misleading authorities. All three were arrested after an investigation revealed dashcam footage of the crime.In the United States District Court for the Northern District of Ohio, Hovanec pleaded guilty to multiple controlled-substance offenses resulting in death, and Green pleaded guilty to being an accessory after the fact. Hovanec received a 480-month sentence; Green received 121 months and was ordered to pay restitution for psychological care for T.H.’s and Hovanec’s children. Both defendants appealed their sentences and, in Green’s case, the restitution order.The United States Court of Appeals for the Sixth Circuit affirmed the sentences for both Hovanec and Green. The appellate court upheld the denial of a sentencing reduction for Green based on her lack of candor regarding knowledge of the murder plan. The court also affirmed the sentencing enhancements for Hovanec’s leadership role and obstruction of justice. However, the court reversed the restitution order against Green, holding that under federal law, restitution for psychological care requires evidence of bodily injury, defined as physical harm or physical manifestations of psychological harm, and remanded for further factual findings on this issue. View "United States v. Green" on Justia Law

The plaintiff, who has a disability, took the New Mexico bar exam in February 2020 and was approved for testing accommodations. She alleged that these accommodations were not properly provided during the exam. Subsequently, she initiated legal action, amending her complaint multiple times before any defendant appeared. The third amended complaint asserted claims under Titles II and III of the Americans with Disabilities Act (ADA), § 504 of the Rehabilitation Act, and other federal and state laws.The United States District Court for the District of New Mexico dismissed all claims. Specifically, it dismissed claims against the National Conference of Bar Examiners (the National Conference) for lack of personal jurisdiction, and permitted amendment of the complaint only to allow a Title III ADA claim against the New Mexico Board of Bar Examiners (the State Board). The district court later dismissed the Title III claim against the State Board on Eleventh Amendment sovereign immunity grounds. It also granted summary judgment to the State Board on the Rehabilitation Act claim, finding the Board did not receive federal funds, and denied the plaintiff’s requests for additional discovery as insufficient under Rule 56(d).On appeal, the United States Court of Appeals for the Tenth Circuit affirmed the district court’s judgment. The court held that the plaintiff had not properly preserved her entitlement to jurisdictional discovery regarding the National Conference, nor did she adequately request or specify discovery that could alter the personal jurisdiction determination. The court also found no abuse of discretion in denying additional discovery on the Rehabilitation Act claim, as the plaintiff failed to meet procedural requirements. Finally, the Tenth Circuit concluded that the State Board was protected by Eleventh Amendment immunity from Title III ADA claims and that the plaintiff failed to show any waiver or valid abrogation of immunity. The judgment below was affirmed. View "Spann v. National Conference of Bar Examiners" on Justia Law

The plaintiff applied for disability benefits from the Social Security Administration (SSA) but was denied at the agency level. She then sought judicial review in the United States District Court for the Northern District of Ohio. After the Commissioner of Social Security reviewed the case further, the Commissioner moved to remand the matter to the Administrative Law Judge (ALJ) for additional proceedings, specifically for further articulation regarding the persuasiveness of the evidence and further consideration of medical opinions. The Commissioner did not argue that the ALJ committed reversible error. The plaintiff agreed to a remand but requested that the court issue instructions to award her benefits outright.The district court granted the Commissioner’s motion for remand, reasoning that factual disputes remained and that it was not prepared to award benefits. The court remanded the case to the SSA for further consideration without affirming, modifying, or reversing the ALJ’s decision, and without expressly finding reversible error or making the specific predicate findings required for a remand under Sentence Six of 42 U.S.C. § 405(g). The plaintiff appealed the district court’s order.The United States Court of Appeals for the Sixth Circuit reviewed the case. The court held that a district court may not remand a Social Security case under Sentence Four of 42 U.S.C. § 405(g) without explicitly affirming, modifying, or reversing the decision of the ALJ. The appellate court found that the district court’s order failed to comply with the requirements of either Sentence Four or Sentence Six and that district courts do not have inherent authority to issue other types of remand orders in Social Security cases. The Sixth Circuit therefore vacated the district court’s order and remanded the matter for further proceedings consistent with the opinion. View "Follen v. Commissioner of Social Security" on Justia Law

A dispute arose regarding the proceeds of a federal life insurance policy held by a United States Postal Service employee, who was insured under the Federal Employees’ Group Life Insurance Act (FEGLIA). Shortly before his death from cancer, he executed a beneficiary designation form naming his ex-wife and their two sons as beneficiaries. However, he failed to fully complete a section of the form, omitting certain requested information. After his death, the form was processed but ultimately rejected by the employer’s HR office because it was incomplete and received after the employee’s death. Under FEGLIA, absent a valid designation, the benefits would have gone to his widow, who passed away during the litigation, leaving her daughter as the estate’s representative.The plaintiffs (ex-wife and sons) sued in the United States District Court for the District of Massachusetts, seeking a declaration that the January 2017 designation form was valid. The District Court converted the case to an interpleader proceeding. After an evidentiary hearing and additional discovery, the court found that the form met all statutory requirements for a valid designation under FEGLIA, was signed and witnessed, and that there was no evidence the decedent lacked mental capacity when signing. The court denied the defendant’s motions for additional discovery and summary judgment, and granted summary judgment for the plaintiffs.On appeal, the United States Court of Appeals for the First Circuit reviewed the District Court’s rulings for abuse of discretion and de novo as appropriate. The First Circuit held that the designation form was valid under federal law, as it was signed and witnessed, and that omitted information did not affect statutory requirements. The court also held that the appellant failed to present medical evidence of incapacity, so the challenge to mental competency failed. The judgment for the plaintiffs was affirmed. View "Hebert v. Donahue" on Justia Law

Essintial Enterprise Solutions, LLC, a staffing and services company, received a $7 million Paycheck Protection Program (PPP) loan during the COVID-19 pandemic. The company calculated its loan amount based on its reported payroll costs, which included payments made to both employees and independent contractors. After the loan was issued and the company applied for forgiveness, its bank approved forgiveness of the full amount. However, the Small Business Administration (SBA) reviewed the forgiveness request and determined that payments made to independent contractors were not eligible as “payroll costs” under the CARES Act, resulting in only partial forgiveness. The SBA forgave approximately $3.7 million and denied forgiveness for the remainder that was based on contractor payments.Essintial challenged the SBA’s decision by filing suit in the United States District Court for the Middle District of Pennsylvania. The company argued that the SBA’s interpretation of “payroll costs” was erroneous and violated the Administrative Procedure Act (APA). The District Court agreed with Essintial, granting summary judgment in its favor. It held that the SBA’s exclusion of independent contractor payments from payroll costs was arbitrary and capricious, and ordered full loan forgiveness for Essintial.On appeal, the United States Court of Appeals for the Third Circuit reviewed the statutory definition of “payroll costs” in the CARES Act de novo. The Third Circuit held that the SBA’s interpretation was correct: payments to independent contractors by a business are not included as “payroll costs” for PPP loan forgiveness purposes. The court concluded that the CARES Act provides two separate definitions of “payroll costs” depending on the borrower’s type, and Essintial’s payments to independent contractors did not qualify. The Third Circuit reversed the District Court’s judgment and remanded for further proceedings. View "Essintial Enterprise Solutions LLC v. SBA" on Justia Law

Darrell Meade worked as a coal miner for 37 years and applied for benefits under the Black Lung Benefits Act, which provides compensation to miners totally disabled by pneumoconiosis. A Labor Department claims examiner initially found that Meade qualified for benefits and that Dominion Coal Corporation was responsible for payment. However, the administrative law judge reviewing the case denied the claim, concluding that Meade’s medical evidence—including x-rays, biopsies, and CT scans—did not establish the irrebuttable presumption of complicated pneumoconiosis required for benefits.Meade appealed to the Benefits Review Board. The Board agreed with the judge’s findings regarding the x-ray and biopsy evidence but determined that the judge had not sufficiently evaluated or explained his analysis of the conflicting expert opinions on the CT scans. The Board vacated the denial in part and remanded the case, instructing the judge to address the competing expert rationales and to provide a clear explanation for his findings. On remand, the judge found Dr. DePonte’s interpretation of the scans more persuasive than Dr. Adcock’s and concluded that the evidence supported a diagnosis of complicated pneumoconiosis, awarding benefits to Meade. Dominion Coal Corporation appealed, challenging both the Board’s standard of review and the judge’s authority based on alleged unconstitutional removal protections.The United States Court of Appeals for the Fourth Circuit reviewed the Board’s interlocutory and final orders. The court held that it had jurisdiction to review interlocutory Board orders after a final order was issued. It found that the Board properly remanded the case when the administrative law judge failed to adequately explain his reasoning and that substantial evidence supported the final award of benefits. The court also rejected Dominion’s constitutional challenge, holding that Dominion had not shown harm from the removal protections. The Fourth Circuit denied Dominion’s petition for review. View "Dominion Coal Corporation v. DOWCP" on Justia Law

Vernon Vanderpool worked underground for over twenty years in coal mines, primarily as a roof bolter and section foreman. After retiring due to a back injury, he developed progressively worsening respiratory symptoms and was eventually diagnosed with pneumoconiosis, commonly known as black lung disease. In 2014, Vanderpool filed a claim for benefits under the Black Lung Benefits Act, asserting that his respiratory ailments rendered him totally disabled.Following his claim, the District Director of the U.S. Department of Labor’s Office of Workers’ Compensation Programs issued a decision awarding benefits. Clinchfield Coal Company, Vanderpool’s former employer, contested this decision. An Administrative Law Judge (ALJ) held a hearing and upheld the award, finding total disability based on pulmonary function tests and medical opinion evidence. Clinchfield then appealed to the Benefits Review Board, arguing that the ALJ erred in crediting certain pulmonary function tests and in weighing medical opinions. The Board rejected these arguments and affirmed the ALJ’s decision.The United States Court of Appeals for the Fourth Circuit reviewed Clinchfield’s petition, applying a highly deferential standard to the ALJ’s findings. The court held that the ALJ properly applied regulatory standards regarding pulmonary function tests, treating deviations from quality standards as affecting the weight rather than admissibility of the evidence. The ALJ’s assessment of medical opinions, including his rationale for crediting one expert over others, was sufficiently explained and satisfied the requirements of the Administrative Procedure Act. Substantial evidence supported the finding of total disability, permitting invocation of the statutory presumption of disability under the Act. As a result, the Fourth Circuit affirmed the Board’s decision and denied Clinchfield’s petition for review. View "Clinchfield Coal Company v. DOWCP" on Justia Law

A veteran who suffered a traumatic brain injury from an improvised explosive device while deployed sought financial assistance under the Traumatic Servicemembers’ Group Life Insurance (TSGLI) program after experiencing a stroke within two years of the injury. The Army denied his claim, determining the stroke was a physical illness or disease, not a qualifying traumatic injury as defined by the relevant statute and regulations. The veteran then petitioned the Department of Veterans Affairs (VA) to amend its rules to include coverage for illnesses or diseases caused by explosive ordnance, arguing these conditions are analogous to those already covered under existing exceptions for injuries resulting from chemical, biological, or radiological weapons.The VA initially denied the rulemaking petition but agreed to further review as part of a program-wide assessment. After several years, extensive consultation with medical experts, and consideration of the petition and supporting materials, the VA issued a final denial. It concluded that expanding coverage to delayed illnesses or diseases linked to explosive ordnance would be inconsistent with TSGLI’s purpose, which focuses on immediate injuries, would deviate from the insurance model underlying the program, and could threaten its financial stability. The VA also found insufficient evidence of a direct causal relationship between explosive ordnance, traumatic brain injury, and downstream illnesses like stroke.The United States Court of Appeals for the Federal Circuit reviewed the VA’s denial under the highly deferential “arbitrary and capricious” standard of the Administrative Procedure Act. The court held that the VA provided a reasoned explanation addressing the petitioner’s arguments and the record, and did not act arbitrarily or capriciously. The petition for review was therefore denied. View "MCKINNEY v. SECRETARY OF VETERANS AFFAIRS " on Justia Law

The Missouri General Assembly enacted two statutes effective August 28, 2023: the SAFE Act, which generally prohibits health care providers from performing gender transition surgeries or prescribing cross-sex hormones and puberty-blocking drugs for minors, and the Medicaid ban, which precludes MO HealthNet payments for such treatments when used for gender transition. The statutes include specific exemptions, such as for treatment of certain medical conditions and for minors already receiving such care prior to enactment. E.N., on behalf of her minor child and joined by medical professionals and organizations, challenged both laws, alleging violations of equal protection, due process, and the gains of industry clause under the Missouri Constitution.The Circuit Court of Cole County conducted a two-week bench trial and entered judgment in favor of the State, upholding the constitutionality of both statutes. The court found the challengers had raised only facial challenges and determined that neither statute violated the constitutional provisions cited. The challengers appealed, raising multiple points of error regarding the constitutional analysis and factual findings at trial.The Supreme Court of Missouri reviewed the circuit court’s determination de novo, applying a presumption of constitutionality. Relying on recent decisions from the United States Supreme Court and the United States Court of Appeals for the Eighth Circuit, the court held that both statutes classify based only on age and medical use, not on sex or transgender status. Thus, rational-basis review applied. The court found that the statutes are rationally related to legitimate state interests, such as safeguarding minors and managing public resources, and do not infringe fundamental rights. The court affirmed the circuit court’s judgment, concluding that the challengers failed to demonstrate any constitutional violation. View "E.N. v. Kehoe" on Justia Law