Justia Public Benefits Opinion Summaries

Joanne Ecklund received long-term care services through Minnesota’s Medicaid program, the Minnesota Medical Assistance Program (MMAP). The Minnesota Department of Human Services (DHS) paid $66,052.62 in capitated payments to Medica, Ecklund’s managed care organization (MCO), which in turn paid $8,806.84 to care providers for Ecklund’s services. After Ecklund’s death in 2021, DHS sought to recover the $66,052.62 from her estate under Minnesota Statutes section 256B.15, subdivision 2(a)(1), which allows recovery of medical assistance payments for long-term care services provided to recipients aged 55 or older.The district court, adopting a referee’s recommendation, granted summary judgment in favor of the estate’s personal representative, Jerry Ecklund, limiting DHS’s recovery to the $8,806.84 paid by Medica to the care providers. The Minnesota Court of Appeals affirmed, interpreting the statute to limit DHS’s recovery to the amount actually paid to the providers.The Minnesota Supreme Court reviewed the case and reversed the lower courts' decisions. The court held that Minnesota Statutes section 256B.15, subdivision 2(a)(1), allows DHS to recover the amount of capitation payments made to the MCO for long-term care services provided to the recipient. The court reasoned that the statute’s language and the broader statutory context support DHS’s interpretation, which aligns with federal guidance requiring states to recover capitation payments. The court concluded that DHS is entitled to recover the $66,052.62 in capitated payments from Ecklund’s estate. View "In re the Estate of: Ecklund" on Justia Law

Paul Cropper applied for disability insurance benefits and supplemental security income in February 2020, citing various impairments such as anxiety, depression, ADHD, insomnia, and COPD. His application was denied initially and upon reconsideration by the Social Security Administration. Cropper then requested a hearing before an administrative law judge (ALJ), where he presented opinions from his medical providers indicating severe limitations. The ALJ conducted a five-step analysis and denied the application, finding that while Cropper had severe impairments, he could still perform certain jobs available in the national economy. The ALJ found the opinions of Cropper’s primary care provider and psychiatrist unpersuasive.Cropper sought judicial review in the United States District Court for the District of Minnesota, arguing that the ALJ improperly evaluated the evidence, leading to an incorrect residual functional capacity determination. The district court granted summary judgment in favor of the Commissioner, concluding that substantial evidence supported the ALJ’s decision to find the medical opinions unpersuasive.The United States Court of Appeals for the Eighth Circuit reviewed the case de novo and affirmed the district court’s decision. The court held that the ALJ adequately considered the supportability and consistency of the medical opinions as required by the revised regulations. The court emphasized that the ALJ’s findings were supported by substantial evidence, including the conservative course of treatment and the lack of significant outpatient therapy. The court also noted that the ALJ’s reasoning was sufficiently clear to allow for appropriate judicial review. View "Cropper v. Dudek" on Justia Law

Debra Tucker applied for disability insurance benefits under Title II of the Social Security Act in 2018. After multiple denials at the administrative level, she appealed to the federal district court. In 2023, the district court reversed the final administrative decision of the Commissioner of Social Security, remanding Tucker’s claim for further administrative proceedings. The district court awarded Tucker’s attorney $7,500 in attorney’s fees under the Equal Access to Justice Act (EAJA), along with $402 in costs. Tucker’s attorney had a contingency-fee agreement for twenty-five percent of any past-due benefits awarded. In August 2024, an administrative law judge found Tucker disabled and granted her monthly disability benefits retroactive to February 2018, totaling $124,821.70 in past-due benefits.The district court granted in part and denied in part the attorney’s motion for $31,205.43 in fees under 42 U.S.C. § 406(b), awarding $17,400 instead. The court found the requested fee excessive, amounting to a windfall, and set an imputed hourly rate of $500. The attorney’s motion for reconsideration, reducing the fee request to $22,620, was denied. The attorney appealed, seeking the full $31,205.43.The United States Court of Appeals for the Sixth Circuit reviewed the district court’s decision for abuse of discretion. The appellate court found that the district court properly started with the contingency-fee agreement and then tested it for reasonableness, considering the effective hourly rate and other factors. The district court did not misapply the law by comparing the effective hourly rate to the EAJA rate and the attorney’s ordinary rate. The appellate court affirmed the district court’s decision, concluding that it acted within its discretion in reducing the fee to avoid a windfall. View "Tucker v. Commissioner of Social Security" on Justia Law

Ronald Myers pleaded guilty in 2005 to possessing an implement for counterfeiting state securities and transporting a stolen motor vehicle across state lines. He was sentenced to 60 months in prison, 3 years of supervised release, and ordered to pay $40,406 in restitution. Myers completed his sentence in 2010 but was reincarcerated in 2013 on other charges. Since then, over $30,500 has been deposited into his inmate trust account, mostly from family and friends, with a smaller portion from prison wages. Myers still owes over $35,000 in restitution.The United States District Court for the Eastern District of Washington granted the government's motion to turn over funds from Myers's inmate trust account to apply to his restitution obligation. The court rejected Myers's request for an evidentiary hearing to determine which funds were prison wages, concluding that the government had provided sufficient evidence of the account's composition. The court held that the Mandatory Victims Restitution Act (MVRA), 18 U.S.C. § 3664(n), applies to substantial aggregated sums from multiple sources, not just one-time financial windfalls.The United States Court of Appeals for the Ninth Circuit affirmed the district court's order. The court held that § 3664(n) applies to substantial resources from any source, including gradual accumulations from family and friends, and not just to one-time windfalls. The court also found that the district court did not abuse its discretion in declining to hold an evidentiary hearing, as the existing documentary evidence was sufficient. The court concluded that the turnover order did not contravene the judgment's restitution provisions and was consistent with the MVRA's goal of ensuring prompt restitution to victims. View "United States v. Myers" on Justia Law

Edward Amezquita, a U.S. Navy veteran, appealed a decision denying service connection for his left shoulder disability. Prior to his service entrance examination in June 2003, Amezquita had undergone Bankart repair surgery on his left shoulder due to a motor vehicle accident. The service entrance examination noted the surgery but stated he was asymptomatic with no physical limitations. Amezquita served from July 2003 to March 2005. Shortly before his separation, he reported a shoulder injury, which was diagnosed as a sprain. In June 2005, he filed a claim for service connection for his left shoulder disability, which was denied by the VA in September 2005, citing no evidence of aggravation due to service.The Board of Veterans’ Appeals denied Amezquita’s claim in August 2021, finding that the presumption of soundness did not apply because his preexisting condition was noted upon service entry. The Board analyzed the claim under the aggravation standard and found no evidence of in-service aggravation. Amezquita appealed to the U.S. Court of Appeals for Veterans Claims, arguing that his asymptomatic condition should not be considered a noted defect. The Veterans Court affirmed the Board’s decision, relying on precedent that an asymptomatic condition can be noted as a preexisting defect.The United States Court of Appeals for the Federal Circuit reviewed the case. The court affirmed the Veterans Court’s interpretation that an asymptomatic condition can be noted as a preexisting defect under 38 U.S.C. § 1111. The court dismissed Amezquita’s arguments regarding the factual determination that his condition was resolved upon service entry, as it lacked jurisdiction to review factual findings. The decision was affirmed in part and dismissed in part. View "AMEZQUITA v. COLLINS " on Justia Law

The petitioners, current and retired Natural Resources Police Officers employed by the West Virginia Division of Natural Resources (DNR), have been receiving a statutory "subsistence allowance" since 1996. This allowance was included in their reported "compensation" to the West Virginia Consolidated Public Retirement Board (the Board) for calculating retirement annuities under the Public Employees Retirement System (PERS). In 2014, the Board discovered this inclusion was erroneous and decided to correct it by refunding overpaid contributions to active and inactive officers and adjusting retirement annuities for retired officers.The Circuit Court of Kanawha County reversed the Board's decision, finding the subsistence allowance was pensionable compensation. On appeal, the West Virginia Supreme Court held in West Virginia Consolidated Public Retirement Board v. Clark (Clark I) that the subsistence allowance was not "compensation" for PERS purposes and that the Board failed to correct the error in a timely manner for retired officers. The case was remanded for further proceedings.The Supreme Court of Appeals of West Virginia reviewed two certified questions from the Circuit Court of Kanawha County. The first question asked if the holding in Clark I required the subsistence pay received by all retired and active DNR officers to be included in calculating their pensionable income. The court answered "no," clarifying that Clark I's holding was limited to retired officers and did not apply to active and inactive officers. The second question asked if the petitioners were entitled to recover reasonable attorneys' fees from the Board. The court declined to answer, stating that it did not present an issue of law but rather a question of fact. View "Clark v. West Virginia Consolidated Public Retirement Board" on Justia Law

Travon Celey, a former employee of Children’s National Medical Center, was terminated on March 1, 2022, for accumulating six instances of tardiness within a twelve-month period. Celey subsequently applied for unemployment benefits, but a claims examiner from the District of Columbia Department of Employment Services (DOES) disqualified him, citing gross misconduct due to repeated tardiness following warnings.Celey appealed the decision to the Office of Administrative Hearings (OAH). Despite filing the appeal well beyond the fifteen-day deadline, OAH extended the deadline due to good cause and excusable neglect. During the hearing, the Hospital presented evidence and testimony showing that Celey had been warned and suspended for his tardiness, referencing both the independent Attendance Policy and the collective bargaining agreement (CBA) policy. The CBA policy mandated termination after the sixth instance of tardiness, while the independent Attendance Policy allowed for termination only after the eighth instance.The OAH administrative law judge (ALJ) found that the Hospital had issued inconsistent rules, failing to clearly notify Celey of the specific policy that applied to him. The ALJ concluded that Celey did not willfully violate the Hospital’s expectations and was therefore qualified to receive unemployment benefits.The District of Columbia Court of Appeals reviewed the case and affirmed the OAH decision. The court held that substantial evidence supported the ALJ’s finding that Celey was not adequately informed about the CBA policy, which was crucial for determining his eligibility for unemployment benefits. The court emphasized that the issue was whether Celey was on notice that his conduct could lead to termination, not whether the Hospital was justified in terminating him. View "Children's National Medical Center v. Celey" on Justia Law

The plaintiff, Mya Noelia Fallon, applied for Supplemental Security Income (SSI) under the Social Security Act, citing epileptic seizures and cognitive and behavioral limitations. Her application included assessments from her neurologist, Dr. Joseph Drazkowski, and licensed professional counselor (LPC) Terry Galler, who noted significant cognitive impairments and anxiety disorders. An Administrative Law Judge (ALJ) found Fallon not disabled, giving minimal weight to the opinions of Dr. Drazkowski and LPC Galler, and discrediting other medical and lay testimony.The United States District Court for the District of Arizona partially reversed the ALJ's decision, finding errors in the discounting of some witnesses but agreeing with the ALJ's assessment of Dr. Drazkowski's and LPC Galler's opinions. The case was remanded for further consideration. On remand, the ALJ again found Fallon not disabled, incorporating the prior evaluations. Fallon appealed, and the district court affirmed the ALJ's decision, refusing to revisit its prior conclusions about the medical opinions based on the law-of-the-case doctrine.The United States Court of Appeals for the Ninth Circuit reviewed the case. The court held that the law-of-the-case doctrine applies in the social security context, meaning that the district court did not abuse its discretion by refusing to reconsider the evaluations of Dr. Drazkowski and LPC Galler. The court explained that a social-security applicant has two options to preserve the right to appeal: immediately appeal the remand order or proceed on remand, understanding that the district court may decline to revisit settled issues. The Ninth Circuit affirmed the district court's decision, noting that Fallon forfeited her ability to challenge the evaluations by not raising the issue in her first appeal. View "FALLON V. DUDEK" on Justia Law

Dennis Jones, a 42-year-old part-time grocery store cashier, applied for Social Security disability benefits, claiming that conditions related to his premature birth, including a cerebral hematoma, had worsened and prevented him from working full-time. The Social Security Administration denied his application, and Jones requested an administrative hearing. An Administrative Law Judge (ALJ) found that Jones had the residual functional capacity to perform light work with certain limitations and concluded that he was not disabled.The United States District Court for the Northern District of Illinois affirmed the ALJ's decision. Jones then appealed to the United States Court of Appeals for the Seventh Circuit, arguing that the ALJ failed to properly evaluate a statement from Dr. James Runke, a consultative examiner, which Jones contended was a medical opinion.The Seventh Circuit agreed with Jones that Dr. Runke's statement, which indicated that Jones's pain and joint strain limited him to working 20 hours per week, constituted a medical opinion under the 2017 revised regulations. However, the court held that the ALJ was not required to evaluate the persuasiveness of this medical opinion because it addressed an issue reserved to the Commissioner of Social Security—whether Jones was capable of performing regular or continuing work. Consequently, the ALJ had no obligation to provide an analysis of Dr. Runke's statement. The Seventh Circuit affirmed the district court's decision, upholding the denial of benefits. View "Jones v Dudek" on Justia Law

William Dexter Lucas was involved in schemes to fraudulently obtain small-business loans from the government and vehicle loans from private institutions. He pleaded guilty to conspiracy to commit bank and wire fraud and waived his right to appeal. His presentence investigation report (PSR) included details of his fraudulent activities and mentioned allegedly fraudulent social security benefits he had been receiving. At sentencing, the district court ordered Lucas to pay restitution to both the private institutions and the Social Security Administration (SSA). Lucas appealed his sentence, challenging the restitution orders for the vehicle loans and social security benefits.The United States District Court for the Southern District of Texas initially handled the case. Lucas objected to the PSR's restitution calculations, arguing that the vehicle loans restitution was ordered to the wrong victim and incorrectly calculated, and that the social security benefits restitution was improper because he was entitled to the benefits and the alleged fraud was not part of the same scheme as the offenses in his indictment. The district court recalculated the vehicle loans restitution but upheld the SSA restitution, finding that Lucas's statement to the SSA was fraudulent and that the SSA fraud was part of the same conduct as the fraud alleged in the indictment.The United States Court of Appeals for the Fifth Circuit reviewed the case. The court held that the SSA restitution was erroneous because the SSA fraud was not part of the same scheme or conspiracy as the offenses in the indictment. The court affirmed the vehicle loans restitution, finding that Lucas's challenge to the calculation was barred by his appeal waiver and that the dealerships were proper victims. The court affirmed the vehicle loans restitution but vacated the SSA restitution award. View "United States v. Lucas" on Justia Law