Justia Public Benefits Opinion Summaries

Relators filed suit against medical laboratory businesses in 2007 in state court, alleging that the labs had submitted false claims to the Commonwealth for Medicaid reimbursement. Defendants removed to federal court. After the Commonwealth entered into a settlement agreement with defendants, the district court awarded relators a share of the settlement proceeds. Relators appealed, contending that the district court's award was insufficient under state law. The court vacated and remanded to the state court, concluding that the district court lacked subject matter jurisdiction over the qui tam action. In this case, by the plain terms of the complaint, relators could have prevailed on their state law claims by proving that defendants contravened the Commonwealth’s Medicaid regulations, without showing any violation of federal law. View "Commonwealth of Virginia ex rel. Hunter Labs. v. Commonwealth of Virginia" on Justia Law

The False Claims Act (FCA) forbids private parties from bringing qui tam actions on the government’s behalf alleging fraud on government programs if the complaint rests on allegations that were already publicly disclosed through certain enumerated sources. In this case, Relators brought a qui tam action under the FCA challenging certain billing practices of CVS Caremark Corp. and affiliated companies (collectively, CVS). The district court dismissed the action, concluding that previous disclosures and controversies triggered the FCA’s public disclosure bar. The First Circuit affirmed, holding that the public disclosure bar forbade Relators’ suit. View "Winkelman v. CVS Caremark Corp." on Justia Law

Plaintiffs filed suit against the City, arguing that the City's pension reforms violate the Texas Constitution, Tex. Const. art. XVI 66(d). Two district courts ruled in favor of the City. In these consolidated appeals, the court concluded that Section 66 permits prospective changes to the pension plans of the public employees within its reach. In this case, the Pension Reform complies with Section 66 where Section 66 did not turn plaintiffs’ variable-rate cost-of-living adjustment into a one-way ratchet capable only of upward movement. The court rejected claims raised by plaintiffs of Case No. 15-10416, that only the Texas legislature has the City of Dallas v. Trammel "reserved power" to amend pension plans and thus abrogate contractual rights. The court concluded that this argument is foreclosed by Klumb v. Houston Mun. Employees Pension Sys. Finally, the court concluded that the Pension Reform does not violate the United States Constitution’s contracts clause and takings clause where neither clause create property rights and the right to public pension benefits in Texas is subject to legislative power. Accordingly, the court affirmed the district court's judgments. View "Houten, Jr. v. City of Fort Worth" on Justia Law

Plaintiff was awarded social security disability benefits due to her bipolar disorder. Plaintiff was disabled as of April 15, 2007, but had medically improved to the point she was no longer disabled beginning on March 24, 2009. The court concluded that in closed period cases an ALJ should compare the medical evidence used to determine that the claimant was disabled with the medical evidence existing at the time of asserted medical improvement. Although the ALJ in this case made the appropriate comparison, the court concluded that substantial evidence does not support the ALJ’s finding of medical improvement. The ALJ erroneously focused on only temporary periods and isolated aspects of plaintiff's improvement that were not representative of the continuing severity of her symptoms. In this case, plaintiff's improvement was not sustained and was considerably limited in scope. Accordingly, the court reversed and remanded with instructions. View "Attmore v. Colvin" on Justia Law

Plaintiff Joseph Tanner sought to overturn a decision of defendant California Public Employees’ Retirement System (CalPERS) that significantly reduced his expected retirement benefit. The Court of Appeal found that Tanner’s argument appeared to be that under contract principles, he and the city made a mutual mistake in entering into a November 2006 agreement because they thought all of his compensation in that agreement could be used to calculate the amount of his retirement benefit, and when CalPERS informed them otherwise, they reformed the agreement to achieve their original intent by folding various miscellaneous items of compensation in the November 2006 agreement into his new, greater base salary in the March 2007 agreement. The Court concluded, however, that Tanner’s appeal was without merit regardless of these contract arguments, or any of the other arguments Tanner made. The Court agreed with the trial court that the greater base salary in the March 2007 agreement did not qualify as Tanner’s payrate for purposes of calculating the amount of his retirement benefit because that salary was not paid pursuant to a publicly available pay schedule. For this reason, Tanner had no right to have his retirement benefit calculated based on that greater base salary. View "Tanner v. CalPERS" on Justia Law

Baptist began working at Ford’s assembly plant, operating a forklift. Less than three months later, Baptist inadvertently hit a pillar, injuring his left wrist. He visited Ford’s medical department and submitted an injury report. An investigator and Ford’s physician doubted Baptist’s account of his injury; Baptist did not report the incident properly and refused to release medical records from a prior workers’ compensation case against another employer involving an injury to his other wrist. Ford paid for Baptist’s initial visit to an orthopedic surgeon, Dr. Heller. The parties are litigating Baptist’s workers’ compensation claim. After working two months, Baptist again sought medical attention. Dr. Heller diagnosed him with a complete ligament tear, recommended surgery, indicated that Baptist was not able to perform the essential function of his job, and cleared him to return to work if he did not lift or grip over five pounds with his left hand. Disagreeing with Ford's doctor, Baptist believed that this prevented him from operating the forklift and asked for another position. He did not work for several days. Ford suspended him for one month. When Baptist returned, he was told that the only available work was as a forklift driver. Baptist later testified that he was told that he would be fired unless he agreed to state that his injury did not happen at work. The company denied this assertion. Baptist was discharged for having three consecutive absences without justification. In a suit alleging retaliation for exercising his workers’ compensation rights, the court granted Ford summary judgment. The Seventh Circuit vacated. A triable issue exists regarding whether Baptist was put to the impracticable choice between keeping his job or giving up a key argument for workers’ compensation. View "James Baptist v. Ford Motor Company" on Justia Law

Petitioner seeks review of the Board's denial of his request to reopen the Board's 1999 benefits determination. The court concluded that the Railroad Retirement Act, 45 U.S.C. 231g, grants the court jurisdiction to review Board decisions denying requests to reopen initial benefits determinations. The court concluded, however, that the Board’s decision to deny petitioner's request to reopen was reasonable where it was reasonable for the Board to conclude that there were no errors in the allocation of petitioner's earnings that, if corrected, would have given him insured status at the time of the decision. Further, petitioner provided little to no explanation of how his initial decision contained a clerical error or an error that appears on the face of the evidence. Accordingly, the court denied the petition for review. View "Stovic v. RRRB" on Justia Law

Plaintiff appealed the denial of her application for supplemental security income. Plaintiff based her claims of disability on depression, anxiety, and obsessive-compulsive disorder. Plaintiff alleged that these conditions caused her difficulties with maintaining focus, energy, concentration, social interactions, and a regular schedule. The court concluded that the ALJ properly discounted plaintiff's credibility; the ALJ gave good reasons for the weight accorded to the medical evidence where the ALJ was entitled to discount the opinions of plaintiff's treating physician insofar as they relied on plaintiff's subjective complaints; and sufficient medical evidence supports the ALJ's determination of residual functional capacity. Accordingly, the court affirmed the judgment. View "Julin v. Colvin" on Justia Law

Student and Guardian seek reimbursement from the district for the cost of Student's private education, claiming that the district failed to comply with the procedural requirements of the Individuals with Disabilities Education Act, 20 U.S.C. 1400–1491o (IDEA), and thus failed to provide a free appropriate public education (FAPE) in the least restrictive environment (LRE) for Student. The district court affirmed the ALJ's denial of reimbursement. In regard to the June 2009 individualized education program (IEP), the court agreed with the lower courts that any procedural failure on the part of the district was caused by Guardian, and that, in any event, the Jordon Intermediate School placement was a FAPE. In regard to the June 2011 IEP, the court concluded that the IDEA does not require the school district to conduct all assessments possible. In this case, the district court did not violate the IDEA by failing to assess Student for anxiety and failing to determine the baseline for Student's speech and language goals. Finally, the Buena Park placement offer was a FAPE in the LRE for Student. Accordingly, the court affirmed the judgment. View "Baquerizo v. Garden Grove USD" on Justia Law

Thomas applied for Supplemental Security Income in 2010 when she was 55 years old. An administrative law judge identified her medically determinable impairments as degenerative changes in her back and left shoulder, Graves’ disease, and dysthymic disorder (a form of chronic depression), but concluded that the impairments did not impose more than minimal limitations on Thomas’s ability to work and denied her application. The Seventh Circuit reversed and remanded. The ALJ’s omission of fibromyalgia from Thomas’s medically determinable impairments and his conclusion that she has no severe impairments were not supported by substantial evidence. Thomas’s doctors’ lack of specialization in rheumatology was not an acceptable basis for discounting their assessments. View "Thomas v. Colvin" on Justia Law