Justia Public Benefits Opinion Summaries

A per diem judge had been credited with retirement service by the Employee Retirement System (ERS) for years under a 1990 memorandum that set eligibility criteria. In 2017, the ERS discovered that the Judiciary had not updated personnel forms as the memorandum appeared to require. Without notice or a hearing, ERS issued a new memorandum rescinding the 1990 policy and retroactively stripped the judge’s retirement credits for service after October 1, 2017. The ERS did not follow rulemaking procedures required by Hawaii’s Administrative Procedure Act.The judge administratively challenged the ERS decision. A hearing officer partially sided with her, but the Board of Trustees of the ERS overruled that recommendation and dismissed all claims. The judge appealed to the Circuit Court of the First Circuit, which reversed the ERS Board, finding that both the 1990 and 2017 memoranda were rules under HRS § 91-1 and invalid because they had not been properly promulgated. On appeal, the Intermediate Court of Appeals (ICA) reversed, agreeing that the memoranda were improperly issued but holding that the circuit court’s reasoning did not support the relief granted.The Supreme Court of the State of Hawai‘i reviewed the case. It held that both the 1990 and 2017 memoranda were rules affecting private rights, not mere internal management or intra-agency communications, and thus subject to statutory rulemaking procedures. The 2017 memorandum and its implementing letter were void as to the judge because they were not lawfully adopted and she had timely challenged them. However, because no timely challenge was made to the 1990 memorandum, it remained valid and controlled her eligibility. The Supreme Court vacated the ICA’s decision, reinstated the circuit court’s judgment, and ordered the ERS to credit the judge for eligible service. View "Martel v. Employee Retirement System" on Justia Law

After separating from his employment with Walman Optical, the claimant created an optical consultation business. He designed a website, spent nearly $3,000 on advertising, and reported a net loss on his tax filings, but had not performed any services for clients or received earnings from the business. Shortly after these activities, he applied for unemployment compensation benefits.The Altoona UC Service Center determined that the claimant was ineligible for benefits, reasoning that his creation of a new business rendered him self-employed. Following a hearing, a referee affirmed this denial, and the Unemployment Compensation Board of Review adopted the referee’s findings and upheld the decision. Both the referee and the Board relied on the “positive steps” test, concluding that the claimant’s actions toward establishing a business meant he was customarily engaged in self-employment, even though he had not performed any services or received any wages.The claimant appealed to the Commonwealth Court of Pennsylvania, arguing that the “positive steps” test conflicted with the statutory requirements for self-employment. The Commonwealth Court, in a divided en banc opinion, affirmed the denial of benefits, holding that the positive steps test remained applicable in the context of a stand-alone business enterprise and that actual remuneration or performance of services was not necessary for a finding of self-employment.The Supreme Court of Pennsylvania reviewed the case and reversed the Commonwealth Court’s order. The Court held that Section 4(l)(2)(B) of the Unemployment Compensation Law sets forth the test for determining self-employment and that the positive steps test is contrary to the statute’s plain language. The Court concluded that self-employment requires the actual performance of services for wages and that merely taking steps to establish a business, without performing such services, does not disqualify a claimant from receiving benefits. View "Precht v. UCBR" on Justia Law

Arthur Miles was sentenced to a total of 300 months’ imprisonment following two separate federal convictions. After his first sentencing in October 2022, Miles was housed at the Marion County Jail in Indiana for fifteen months—some of this time was before and some after his second federal sentencing. During his time at the county jail, Miles worked as an orderly. He later argued that under the First Step Act of 2018 (“FSA”), he was entitled to earn time credits for this work, which could reduce his sentence, because his federal sentence had commenced and the work was equivalent to an evidence-based recidivism reduction (“EBRR”) program.The United States District Court for the District of Massachusetts reviewed Miles’s habeas petition after a magistrate judge recommended denying the Bureau of Prisons’ (BOP) motion to dismiss. The magistrate judge found that BOP regulations preventing prisoners from earning FSA credits until they arrived at a federal facility conflicted with the FSA’s language. The district court, however, rejected this recommendation and dismissed Miles’s petition, holding that the BOP’s rules did not violate the FSA.The United States Court of Appeals for the First Circuit held that the BOP’s regulation, which delayed the accrual of FSA time credits until a prisoner’s arrival at a federal facility, was invalid because it conflicted with the statutory definition of when a sentence commences. The court further held that a risk and needs assessment is not a prerequisite for earning FSA credits, and that prisoners may earn credits for qualifying programming—such as work as an orderly—performed after sentencing even while housed in non-federal facilities. The court vacated the dismissal of Miles’s habeas petition and remanded for further proceedings to determine his entitlement to credits for his time at the county jail. View "Miles v. Bowers" on Justia Law

The petitioner, a former Legal Administrative Specialist at the Office of Personnel Management (OPM), was diagnosed with major depressive disorder, generalized anxiety disorder, and insomnia. Her treating psychiatrist determined she was unable to work, and OPM subsequently removed her from federal service, citing her medical inability to perform essential job functions. The removal decision relied on medical documentation from her psychiatrist, which described her symptoms and limitations. Following her removal, the petitioner applied for disability retirement benefits through OPM, submitting the same medical documentation.OPM denied the disability retirement application, stating that while it acknowledged her diagnoses and symptoms, there was insufficient “objective” medical evidence to demonstrate the degree of her impairment and her inability to work. On reconsideration, OPM repeated that the documentation lacked details such as test results, psychotherapy notes, and treatment records. The petitioner appealed to the Merit Systems Protection Board (the Board), where OPM maintained its position that her evidence was inadequate. The Board’s administrative judge found that OPM had rebutted the presumption of disability—established when an employee is removed for medical inability—by asserting a lack of objective medical evidence. The Board weighed the evidence and affirmed OPM’s denial, making this its final decision.On review, the United States Court of Appeals for the Federal Circuit addressed whether OPM and the Board could overcome the presumption of disability (as set out in Bruner v. Office of Personnel Management) simply by asserting the absence of objective medical evidence. The court held that such an assertion alone is insufficient to rebut the presumption of disability. Because the Board relied solely on this rationale, the court concluded the presumption was not rebutted, reversed the Board’s final order, and found the petitioner entitled to disability retirement benefits. View "Garland v. Office of Personnel Management" on Justia Law

A miner who worked in West Virginia coal mines for nearly four decades applied for benefits under the Black Lung Benefits Act after retiring in 2015. From mid-2012 through December 2014, he worked for Rhino Energy, LLC as a subcontractor in mines owned by Wildcat Energy, LLC. When Rhino’s subcontract ended, he joined Wildcat’s payroll and continued working at Wildcat until his retirement in October 2015. The dispute centers on which employer—Rhino or Wildcat—should be responsible for paying his black lung benefits.After the miner filed his claim, the district director of the Office of Workers’ Compensation Programs designated Rhino as the responsible operator, finding that Wildcat had not employed the miner for the full year required by regulations and thus was not a potentially liable operator. The district director did not address Wildcat’s financial capacity, nor did he issue a Coverage Statement regarding Wildcat’s insurance status. Rhino contested its designation, arguing Wildcat should be responsible, including as a successor operator, but the district director and subsequently the Administrative Law Judge (ALJ) reaffirmed Rhino’s liability, focusing on the duration of Wildcat’s employment. The Benefits Review Board upheld the ALJ’s decision, agreeing that Wildcat had not employed the miner for a year and noting Rhino had not demonstrated Wildcat’s financial capability.The United States Court of Appeals for the Fourth Circuit reviewed the Board’s order. It held that under the correct interpretation of the regulations, Wildcat had employed the miner for the requisite year based on working days, and because the district director did not issue a Coverage Statement, Wildcat was presumed financially capable of paying benefits. The court determined Wildcat should have been designated as the responsible operator, but because regulations prohibit imposing liability on another operator at this stage, it vacated the Board’s order and remanded with instructions for the Black Lung Disability Trust Fund to pay the miner’s benefits. View "Rhino Energy, LLC v. DOWCP" on Justia Law

Michael Lincoln applied for disability insurance benefits and supplemental security income, alleging that his ability to work was limited due to conditions including prostate cancer, for which he received treatment beginning in late 2019. His treatment concluded in mid-2020, and his cancer entered remission. Lincoln continued to experience symptoms such as fatigue and reported using a cane at times, but also engaged in various daily activities. He claimed an inability to work beginning in October 2019.An administrative law judge (ALJ) held a hearing in May 2022 and, in August 2022, concluded that Lincoln was not disabled. The ALJ determined that Lincoln had the residual functional capacity to perform “light work” with certain postural limitations, and specifically found that Lincoln could perform his past work as a school bus driver. In reaching this conclusion, the ALJ found that Lincoln’s subjective complaints regarding fatigue and cane use were not entirely consistent with the medical evidence and daily activities. The ALJ also found the opinions of state agency medical consultants more persuasive than that of Lincoln’s treating nurse practitioner. The Appeals Council denied further review, making the ALJ’s decision final. The United States District Court for the Central District of Illinois affirmed the ALJ’s decision.On appeal, the United States Court of Appeals for the Seventh Circuit reviewed the ALJ’s findings, applying a deferential “substantial evidence” standard. The court held that substantial evidence supported the ALJ’s determination regarding Lincoln’s residual functional capacity, including the findings related to Lincoln’s fatigue, cane use, and the persuasiveness of medical opinions. Accordingly, the court affirmed the judgment of the district court, upholding the denial of benefits. View "Lincoln v. Bisignano" on Justia Law

A federal prisoner was sentenced in December 2020 and, due to pending charges in another jurisdiction, was held at a detention center in Rhode Island rather than being promptly transferred to his designated Bureau of Prisons (BOP) facility in South Carolina. During this period of post-sentencing detention, the prisoner claims to have participated in programs under the First Step Act (FSA), thereby accruing approximately 150 days of time credits, which could reduce his time in custody. However, the BOP did not recognize these credits because he had not undergone a formal risk and needs assessment—the BOP’s prerequisite for awarding such credits—until his eventual arrival at the designated facility in March 2022.After exhausting administrative remedies, the prisoner filed a pro se habeas petition in the United States District Court for the District of South Carolina, seeking recognition of his alleged FSA credits. The magistrate judge, without briefing or discovery, recommended dismissal. The district court adopted this recommendation, concluding that the BOP’s regulation reasonably required an initial assessment before credits could be earned, and applied Chevron deference to uphold the agency's interpretation. The district court also found no evidence the prisoner had “successfully participated” in qualifying programs before arrival at the BOP facility and dismissed the petition without prejudice, refusing to require a government response.On appeal, the United States Court of Appeals for the Fourth Circuit vacated the district court’s judgment and remanded. The Fourth Circuit held that the case was not moot, as the prisoner could still benefit from the FSA credits if his risk status changed or a warden approved his release. The court further held that, in light of the Supreme Court’s decision in Loper Bright Enterprises v. Raimondo, which overturned Chevron deference, the district court must independently determine whether the BOP’s interpretation of “successful participation” aligns with the best reading of the statute. View "Benson v. Warden FCI Edgefield" on Justia Law

A parent applied to a state-run program providing compensation for family members who give extraordinary care to individuals with significant medical needs. The applicant’s young child required extensive daily assistance due to chronic health issues. The Department of Health and Human Services denied the application, explaining that the child’s score on a standardized assessment, created internally by the Department, did not meet the minimum threshold to qualify for the program. The assessment assigned points based on responses to a set of questions about the child’s needs, and only those scoring at least fifty percent of possible points for their age group were deemed eligible.After the application was denied, the parent pursued an administrative appeal. The administrative law judge upheld the denial, finding that, under the Department’s rules, only the assessment score determined eligibility for “extraordinary care,” and other medical details were not considered. The Department adopted this finding in a final order and denied a rehearing. The parent then appealed to the District Court of Burleigh County, which affirmed the Department’s decision.On further appeal, the Supreme Court of North Dakota reviewed whether the Department could use the assessment and its scoring rubric to determine eligibility, even though these criteria had not been formally promulgated as administrative rules. The Court held that because these tools operated as binding eligibility requirements of general applicability, they were rules under North Dakota’s Administrative Agencies Practice Act and should have been formally adopted through the rulemaking process. The Court reversed the district court’s order and remanded the case with instructions for further proceedings consistent with its opinion. View "Ferderer v. NDDHHS" on Justia Law

A small convenience store in downtown Los Angeles, owned by an individual, participated in the Supplemental Nutrition Assistance Program (SNAP) and served many customers who used electronic benefit transfer (EBT) cards. In early 2022, the Food and Nutrition Service of the United States Department of Agriculture detected suspicious patterns in the store’s SNAP transactions. Over six months, the store processed hundreds of unusually large transactions, nearly 200 transactions that depleted a household’s monthly benefits in one day, numerous rapid consecutive transactions by the same household, and many transactions for the same dollar amount. Following a physical inspection and review of these patterns, the Agency charged the store with trafficking in SNAP benefits, meaning exchanging benefits for cash or non-eligible goods.After receiving a charge letter and providing a response that generally denied wrongdoing and offered explanations for customer behavior, the store was permanently disqualified from SNAP by the Agency. The owner and the store sought administrative review and submitted additional documents, including affidavits and receipts, but the Agency upheld its decision. The plaintiffs then filed for judicial review in the United States District Court for the Central District of California. The government moved for summary judgment, and the plaintiffs relied on much of the same evidence previously submitted. The district court granted summary judgment for the government, finding that the plaintiffs failed to raise a genuine dispute of material fact as to whether trafficking had occurred.On appeal, the United States Court of Appeals for the Ninth Circuit reviewed the district court’s grant of summary judgment de novo. The court held that the government’s evidence established suspicious transaction patterns supporting an inference of SNAP trafficking and that the plaintiffs failed to provide sufficient evidence to create a genuine dispute as to the legitimacy of the flagged transactions. The Ninth Circuit affirmed the district court’s grant of summary judgment in favor of the government. View "BROTHERS MARKET LLC NO. 2 V. USA" on Justia Law

An employee worked for Cowin & Company for nearly three decades, performing construction in coal mines and regularly being exposed to coal dust. Years after his employment ended, he filed a claim for benefits under the Black Lung Benefits Act, alleging total disability due to pneumoconiosis (“black lung disease”) caused by his coal mine work. The claimant relied on a regulatory presumption that applies to miners who have a disabling breathing impairment and at least fifteen years of qualifying coal mine employment. A key dispute in the case involved how to calculate a “year” of coal mine employment under Department of Labor regulations.An administrative law judge initially granted benefits, finding the claimant had at least fifteen years of qualifying employment, thus triggering the presumption. Cowin & Company appealed to the Benefits Review Board, which vacated the benefits award in part and instructed the judge to recalculate the length of coal mine employment, questioning the method used to credit years of employment. On remand, the judge again found more than fifteen years, but the Board disagreed with the method, holding that a claimant must prove both a 365/366-day period of employment and at least 125 working days during that period. Ultimately, after further proceedings, the administrative law judge found only 13.76 years of qualifying employment, and the Board affirmed the denial of benefits.The United States Court of Appeals for the Eleventh Circuit reviewed the Board’s decision. The court held that, under the plain text of the relevant regulation, a claimant establishes a “year” of coal mine employment by showing at least 125 working days in or around coal mines during a calendar year or partial periods totaling one year. The court granted the petition for review, vacated the Board’s decision, and remanded for further proceedings. View "Hayes v. Director, OWCP" on Justia Law