Justia Public Benefits Opinion Summaries

A longtime deputy sheriff was convicted by a federal jury of mail and wire fraud after she submitted an insurance claim for items stolen during a burglary at her home, some of which she falsely claimed as her own but actually belonged to her employer, the sheriff’s office. She also used her employer’s fax machine and cover sheet in communicating with the insurance company and misrepresented her supervisor’s identity. The criminal conduct arose after a romantic relationship with a former inmate ended badly, leading to the burglary, but the fraud conviction was based on her false insurance claim, not on the relationship or the burglary itself.Following her conviction, the California Public Employees’ Retirement System (CalPERS) determined that her crimes constituted conduct “arising out of or in the performance of her official duties” under Government Code section 7522.72, part of the Public Employees Pension Reform Act, and partially forfeited her pension. The administrative law judge and the San Francisco Superior Court both upheld CalPERS’s decision, reasoning that her actions were sufficiently connected to her employment, particularly in her misuse of employer property and resources and in the context of her relationship with the former inmate.The Court of Appeal of the State of California, First Appellate District, Division One, reversed the trial court’s judgment. The appellate court held that the statute requires a specific causal nexus between the criminal conduct and the employee’s official duties, not merely any job-related connection. The court found that the deputy’s fraudulent insurance claim, although it referenced employer property and resources, did not arise out of or in the performance of her official duties as required by the statute. Accordingly, the pension forfeiture determination was set aside. View "Myres v. Bd. of Admin. for CalPERS" on Justia Law

Christopher Thigpen applied for and received unemployment benefits from the Minnesota Department of Employment and Economic Development (DEED) for 104 weeks spanning March 2020 to March 2022. During this period, Thigpen was employed as a personal care assistant, earning weekly wages, but reported to DEED each week that he had not worked or received other income. This misrepresentation led to Thigpen receiving overpayments totaling $39,605 in standard and pandemic unemployment benefits. In April 2022, DEED reviewed his account, confirmed his employment during the relevant period, and determined that he had obtained the overpayments due to misrepresentation. As a result, DEED assessed a penalty of 40 percent of the overpaid amount, imposed 1 percent monthly interest, and barred Thigpen from receiving any future unemployment benefits until repayment, subject to a statutory ten-year cancellation period.Thigpen appealed the determination before an unemployment law judge, arguing that he did not intend to defraud DEED and misunderstood the forms. After multiple evidentiary hearings, the unemployment law judge found Thigpen’s explanations not credible, upheld the finding of misrepresentation, and applied the statutory penalty, interest, and benefit ineligibility.Thigpen requested certiorari review from the Minnesota Court of Appeals, challenging the sufficiency of evidence, burden of proof, denial of due process, and constitutionality of the penalties under the Excessive Fines Clauses of the U.S. and Minnesota Constitutions. The Court of Appeals rejected all arguments, specifically finding the penalties proportionate and comparable to those for similar offenses in Minnesota and other states.On further appeal, the Minnesota Supreme Court affirmed the Court of Appeals, holding that the penalty, interest, and benefit ineligibility for unemployment benefit misrepresentation do not violate the Excessive Fines Clauses, as they are not grossly disproportionate to the gravity of the offense and are consistent with penalties in Minnesota and other jurisdictions. View "Thigpen vs. Best Home Care LLC" on Justia Law

During the COVID-19 pandemic, full-time civil service employees working as instructors and teachers at facilities operated by the New York State Department of Corrections and Community Supervision sought unemployment benefits when their optional summer work was suspended in 2020. These employees, paid an annual salary under a collective bargaining agreement, applied for regular state unemployment benefits as well as federal pandemic-related benefits authorized by the CARES Act. Initially, their applications for benefits were granted. However, the New York State Department of Labor subsequently determined that, because the employees continued to receive their annual salary and did not meet the statutory requirements for "total unemployment" under state law, they were ineligible for both state and federal benefits, and were charged with overpayments.After hearings, Administrative Law Judges upheld the Department of Labor’s revised determinations, concluding that the claimants were not entitled to benefits due to failure to meet the "total unemployment" requirement. The Unemployment Insurance Appeal Board affirmed these decisions. On further appeal, the Appellate Division also affirmed, finding that substantial evidence supported the Board’s determination that the claimants were not "totally unemployed" during the summer in question. The court reasoned that the annual salary compensated the claimants for the entire year, including the summer, making them ineligible for unemployment benefits under state law and, consequently, ineligible for federal pandemic benefits.The New York Court of Appeals reviewed the case and held that the Department of Labor properly applied New York’s "total unemployment" requirement when evaluating eligibility for both CARES Act and related federal benefits. The court concluded that this requirement does not conflict with the CARES Act, which does not define "unemployed" or "partially unemployed" and incorporates state law for determining benefit eligibility. The court affirmed the orders of the Appellate Division. View "Klosterman v. Department of Corrections and Community Supervision" on Justia Law

Crystal Hultz, a woman born in 1987, stopped working full-time in December 2013 due to multiple health conditions, including lupus, fibromyalgia, spinal disorders, and depression. Although some of her conditions improved with treatment and surgery, she continued to experience severe, persistent symptoms of fibromyalgia, leading to fatigue and periods of being bedridden. Her daily functioning depended heavily on support from her family. Based on these ongoing symptoms, Hultz applied for Social Security disability benefits, asserting that her fibromyalgia and related health problems rendered her unable to work.Her claims for benefits were initially denied by the Social Security Administration (SSA) and again after reconsideration. Following a hearing, an Administrative Law Judge (ALJ) denied her applications, a decision upheld by the SSA's Appeals Council. Hultz sought review in the United States District Court for the District of Maryland, which remanded the case to the ALJ for further consideration of certain impairments. On remand, another ALJ again denied benefits, finding that Hultz's subjective reports of her symptoms were not fully supported by objective medical evidence. The District Court affirmed this denial.The United States Court of Appeals for the Fourth Circuit reviewed the case and found that the ALJ erred by discounting Hultz’s subjective testimony about her fibromyalgia symptoms based on a lack of objective medical evidence. The Fourth Circuit emphasized its precedent that, for conditions like fibromyalgia—which cannot be measured by objective tests—ALJs may not use the absence of such evidence to discredit claimants’ subjective accounts. The court also held that the ALJ improperly gave little weight to the opinion of Hultz’s treating physician. The Fourth Circuit reversed the denial of benefits and remanded the case for a calculation of benefits. View "Hultz v. Bisignano" on Justia Law

This case involves the eligibility of H.D. for Vermont’s General Assistance Emergency Housing Program as of July 1, 2025. The Department for Children and Families (DCF) determined that H.D. had exceeded the program’s eighty-day housing limit by counting days she received before the start of fiscal year 2026 (FY26). H.D. contended that only the days received during FY26 should count toward the limit, based on the language of the Fiscal Year 2026 Appropriations Act. At the time of the appeal, H.D. had exhausted her eighty days under the Board’s interpretation, no longer lived in emergency housing, and was ineligible for further benefits under the statute.The Human Services Board reviewed DCF’s determination and ruled in H.D.’s favor. The Board interpreted the statute to mean that only days received during FY26 should be counted, making H.D. eligible for emergency housing at the time of her application. DCF then appealed this decision to the Vermont Supreme Court.The Vermont Supreme Court determined that the case was moot. It found that, because H.D. had already exhausted her eighty-day benefit and was no longer eligible for emergency housing under the statute, there was no longer an actual controversy between the parties. The Court also rejected DCF’s argument that the case was “capable of repetition but evading review,” concluding that DCF failed to show a reasonable expectation that H.D. would be subject to the same action again. The Court emphasized that its jurisdiction is limited to live controversies and that it cannot issue an advisory opinion on the statutory interpretation for future cases. As a result, the appeal was dismissed as moot. View "In re Appeal of H.D." on Justia Law

Florida challenged a federal agency document known as the “Informational Bulletin” that interpreted Medicaid’s hold-harmless rule and threatened to claw back billions in Medicaid funds if certain state practices continued. Florida’s Medicaid funding system relies on a Directed Payment Program, under which local governments assess special fees on private hospitals, pool these fees, and transfer the funds to the state agency, which then uses them to secure additional federal matching funds. The state feared the new federal interpretation could jeopardize its program and moved to preliminarily enjoin the Bulletin’s implementation.The United States District Court for the Southern District of Florida, following a magistrate judge’s recommendation, denied Florida’s motion for a preliminary injunction and dismissed the case for lack of subject matter jurisdiction. The district court held that the Bulletin was not a “final agency action” under the Administrative Procedure Act (APA), and therefore not subject to judicial review.The United States Court of Appeals for the Eleventh Circuit reviewed the case and found that, contrary to the district court’s conclusion, the Bulletin was indeed a final agency action subject to judicial review under the APA. However, the Eleventh Circuit held that Florida was unlikely to succeed on the merits of its challenge, concluding that the Bulletin’s interpretation of the Medicaid hold-harmless rule was consistent with the statutory text, was not arbitrary or capricious, and did not require notice-and-comment rulemaking. The court thus reversed the dismissal of the complaint, affirmed the denial of the preliminary injunction, and remanded the case for further proceedings. View "Florida Agency for Health Care Administration v. Administrator for the Centers for Medicare & Medicaid Services" on Justia Law

The claimant served in the U.S. Navy and, upon his voluntary separation in 1992, received a lump sum Special Separation Benefit (SSB) under 10 U.S.C. § 1174a. Many years later, in 2017, he was awarded VA disability compensation with entitlement to a total disability rating, effective from late 2016. The Department of Veterans Affairs (VA) notified him that it would withhold a portion of his monthly disability benefits to recoup the SSB payment, which the claimant contested, arguing that SSB payments are not subject to recoupment and that the relevant statutory authority did not apply to his situation.The Board of Veterans’ Appeals found that the VA acted properly in withholding his disability compensation to recoup the SSB payment. The claimant then appealed to the United States Court of Appeals for Veterans Claims, which affirmed the Board’s decision. He sought reconsideration, asserting that the court had relied upon the wrong statutory provision. The Veterans Court granted reconsideration, but in its new decision, it again held that the relevant statute required recoupment of his SSB payment from his VA disability compensation, and affirmed the Board’s decision.The United States Court of Appeals for the Federal Circuit reviewed the statutory interpretation de novo. The court held that 10 U.S.C. § 1174(h)(2) applies to SSB payments received under 10 U.S.C. § 1174a, requiring such payments to be deducted from VA disability compensation. The court rejected the claimant’s alternative statutory interpretation, finding it inconsistent with the statutory text and structure. The court also dismissed for lack of jurisdiction arguments that were not addressed by the Veterans Court. The judgment was affirmed in part and dismissed in part. View "COLAGE v. COLLINS " on Justia Law

The case concerns the Montana Department of Public Health and Human Services’ attempt to recover $5,360.89 in Medicaid benefits paid on behalf of a deceased recipient, Florence Pound. The sole heir, Minta Johnson, inherited Pound’s home, the primary estate asset valued at approximately $200,000. After Pound’s death, Johnson, as personal representative, published notice to creditors as required by Montana law. The Department submitted its claim one day after the four-month statutory deadline for creditor claims had expired, and the Probate Court denied the claim as untimely. The estate was then distributed entirely to Johnson.Following the denial of its claim in the Eleventh Judicial District Court (Probate Court), the Department filed a new action in the Fourth Judicial District Court, seeking recovery from Johnson personally under a separate statute, § 53-6-167(2), MCA, which allows the Department to seek reimbursement from anyone who received property from the estate. The District Court granted summary judgment to Johnson, reasoning that the Department’s untimely creditor’s claim barred further action and that issue preclusion applied because the same underlying issue had already been decided in probate.The Supreme Court of the State of Montana reviewed the matter de novo. It held that the Department’s statutory right under § 53-6-167(2), MCA, to recover Medicaid benefits from an heir is independent of the probate creditor claim process, and that a missed probate deadline does not bar a subsequent action against an heir. The Court further found that issue preclusion did not apply because the probate court lacked jurisdiction to consider the Department’s statutory claim against the heir, and the issues in the two proceedings were not identical. The Supreme Court reversed the District Court’s dismissal and remanded for judgment in favor of the Department. View "Department of Public Health and Human Services v. Johnson" on Justia Law

After the death of her husband, who had worked in coal mining for nearly 28 years, a widow applied for survivor benefits under the Black Lung Benefits Act (BLBA). Her husband died in 2014 following a hospitalization, and she filed her claim shortly thereafter. The BLBA provides survivor benefits to eligible dependents if a miner’s death is due to pneumoconiosis (“black lung disease”) arising from coal mine employment. A key question in this case was whether the miner’s terminal arterial blood gas (ABG) studies, taken during his last hospitalization, could be used to establish that he was totally disabled due to a chronic respiratory or pulmonary condition at the time of his death.Initially, the District Director awarded benefits and identified the employer as the responsible operator. The employer requested a hearing before the Office of Administrative Law Judges. The first Administrative Law Judge (ALJ) denied benefits, finding that although the miner worked long enough to invoke a presumption that his death was due to pneumoconiosis, the ABG tests lacked an adequate physician’s report linking the results to a chronic condition, as required by regulation. The widow sought modification, arguing that a mistake of fact had been made. A second ALJ granted modification and awarded benefits, relying on a comprehensive report from one of the physicians that sufficiently connected the ABG results to the miner’s chronic lung disease. The Benefits Review Board (BRB) affirmed, holding that the widow established her entitlement to benefits and that the employer failed to rebut the statutory presumption.The United States Court of Appeals for the Fourth Circuit reviewed the case and denied the employer’s petition. The court held that substantial evidence supported the BRB’s decision affirming the award of benefits. Specifically, the court found the physician’s report was sufficient to link the terminal ABG results to a chronic respiratory condition, thus satisfying regulatory requirements and entitling the widow to the statutory presumption. The court also concluded that the ALJ properly granted modification based on a mistake of fact. View "Clinchfield Coal Company v. Mullins" on Justia Law

A neurologist submitted a Freedom of Information Act (FOIA) request to the United States Social Security Administration (SSA) seeking documents about how the SSA evaluates disability claims for migraines and other headache disorders. The SSA determined that this request was not directly related to the administration of any of its benefit programs. Relying on a provision in the Social Security Act (42 U.S.C. § 1306(c)), the SSA required the requester to pay the full cost of processing the request, which totaled $2,908. The requester paid the fee but later objected because the SSA did not respond within the statutory deadline set by FOIA.The United States District Court for the District of Vermont found in favor of the requester. The district court concluded that FOIA’s provision prohibiting fees when the agency fails to respond on time superseded the Social Security Act’s cost-reimbursement clause. As a result, the court ordered the SSA to refund the fee and awarded the requester attorneys’ fees and costs. The court reasoned that allowing the SSA to charge fees despite late responses would undermine the FOIA amendments designed to ensure agency timeliness.On appeal, the United States Court of Appeals for the Second Circuit considered whether the Social Security Act’s cost-reimbursement provision or FOIA’s fee-preclusion provision controlled. The Second Circuit held that the plain language of § 1306(c), which begins with a “notwithstanding” clause, explicitly exempts the SSA from FOIA’s fee rules for requests not directly related to program administration. The court agreed with the SSA’s determination that the request was not program-related and found the statute unambiguous. Therefore, the court reversed the district court’s judgment and vacated the award of attorneys’ fees and costs. View "Shapiro v. U.S. Soc. Sec. Admin." on Justia Law