Justia Public Benefits Opinion Summaries

Plaintiff appealed the denial of social security disability benefits, alleging that the Appeals Council erred by failing to provide an explanation for why it disregarded the treating physician’s opinion and that the ALJ’s decision is not supported by substantial evidence in light of a treating physician’s opinion. The court agreed and held that, based on the record, including the physician's opinion, the ALJ's determination is not supported by substantial evidence in the record. Accordingly, the court vacated the judgment and remanded for further proceedings. View "Lesterhuis v. Colvin" on Justia Law

Legislation, effective in 2004 requires that injured workers’ requests for medical treatment be evaluated through a process called utilization review (UR). Under the UR process, a request for treatment cannot be denied by a claims adjustor and must be approved unless a clinician determines that the treatment is medically unnecessary. Workers can challenge decisions denying requested treatment, but employers cannot challenge decisions approving it. The 2004 legislation called for administrative adoption of uniform standards for physicians to use in evaluating treatment. In 2013, additional reforms went into effect, establishing a new procedure, independent medical review (IMR), to resolve workers’ challenges to UR decisions. Stevens challenged the constitutionality of the IMR process, arguing that it violated the state Constitution’s separation of powers clause, its requirements that workers’ compensation decisions be subject to review and the system “accomplish substantial justice,” and principles of due process. The court of appeal rejected those claims, but remanded Stevens’s request for a home health aid. The Legislature has plenary powers over the workers’ compensation system under article XIV, section 4 of the state Constitution. California’s scheme for evaluating workers’ treatment requests is fundamentally fair and affords workers sufficient opportunities to present evidence and be heard. View "Stevens v. Workers' Comp. Appeals Bd," on Justia Law

A single mother of five children subject to dependency proceedings sought to reverse a court order denying her further reunification services with respect to her three oldest children and to stay a hearing under Welfare and Institutions Code 366.26 that had been set for September 16, 2015. She claims the court erred in denying her further reunification services because she has made and continues to make reasonable efforts to address the problems that led to the removal of her children, so denial of additional services is not in the children’s best interests. The court of appeal stayed the hearing, but ultimately denied the petition and lifted the stay. Mother has received extensive child welfare services and has taken advantage of them only sporadically. The children have been involved with the dependency system for 11 years, and have spent six years in out-of-home placement with multiple caregivers, not always in healthful circumstances. Mother’s drug abuse, mental instability, and abusive relationships with men, have exposed the children to a continuing risk of harm, delayed their educational development, and left them without a stable home. The court’s factual findings in determining to withhold further services were supported by substantial evidence. View "D.T. v. Superior Court" on Justia Law

Plantiff filed suit challenging the denial of his claim for disability benefits under Title II of the Social Security Act, 42 U.S.C. 423. Because the ALJ based his decision on a credibility assessment of plaintiff's testimony without holding an additional hearing as required by the Hearings, Appeals, and Litigation Law Manual (HALLEX), the court held that defendant was prejudiced by the HALLEX violation. Accordingly, the court reversed and remanded with instructions that the case be remanded to the Commissioner for further proceedings. View "Morgan, Jr. v. Colvin" on Justia Law

Luke Joerg (“Luke”) was a developmentally disabled adult who had lived with his parents his entire life and had never worked. Luke was struck by a car in 2007. John Joerg (“Joerg”), Luke’s father, filed an action against State Farm Mutual Automobile Insurance Company, Joerg’s uninsured motorist carrier. Joerg filed a motion in limine to exclude evidence of any collateral source benefits to which Luke was entitled, including discounted benefits under Medicare and Medicaid. The trial court precluded State Farm from introducing evidence of Luke’s future Medicare or Medicaid benefits. The jury awarded a total of $1,491,875 in damages, including $469,076 for future medical expenses. The Second District Court of Appeal reversed the award for future damages, concluding that Luke’s Medicare benefits should not have been excluded by the collateral source rule. The Supreme Court quashed the decision below, holding that the trial court properly excluded evidence of Luke’s eligibility for future benefits from Medicare, Medicaid, and other social legislation as collateral sources. View "Joerg v. State Farm Mut. Auto. Ins. Co." on Justia Law

The Centralia state-operated developmental center, one of seven Illinois SODCs, houses approximately 200 severely disabled individuals, some having the mentality of an infant or toddler. Many also have serious aggressive, or self-destructive behavioral disorders. The seven SODCs have, in total, about 1800 residents, while about 10,000 people with severe developmental disabilities live in community-based facilities: houses or apartments in residential settings that accommodate one to eight residents. The state agency provides services (such as housing and medical care) to approximately 25,000 developmentally disabled persons. Another 23,000 or so are on a waiting list; 6000 are considered to be in emergency situations. Since 2012 Illinois has been trying to shift SODC residents to community-based facilities, in accordance with a national trend: community-based facilities are cheaper than SODCs and there is evidence that even persons who are severely disabled mentally or behaviorally or both do better in community-based facilities. A suit, on behalf of the Centralia SODC residents, alleged violation of the Americans with Disabilities Act, 42 U.S.C. 12132. The Seventh Circuit affirmed denial of a preliminary injunction to prevent assessment and transfer of those residents, reasoning that the urgency required for emergency relief had not been shown. View "Ill. League of Advocates for Developmentally Disabled v. Ill. Dep't of Human Servs." on Justia Law

The Supreme Court granted certiorari in this matter to determine whether a retiree of the City of Slidell, plaintiff Dean Born, could continue participating in the City of Slidell's health insurance plan following the City's adoption of Ordinance No. 3493, which required each city retiree to apply for Medicare coverage upon reaching the age of sixty-five. After review, the Supreme Court affirmed the Court of Appeal's finding that the City could not terminate plaintiff's desired plan coverage and require him to accept Medicare coverage, because plaintiff retired before the effective date of the Ordinance. View "Born v. City of Slidell" on Justia Law

In 2009, plaintiff Dr. Ralph Slaughter retired as president of Southern University System (“Southern”) after thirty-five years of service. Upon retirement, the Louisiana State Employees’ Retirement System (“LASERS”) began paying plaintiff retirement benefits. Plaintiff filed suit against Southern for past due wages. The district court ruled that Southern had miscalculated plaintiff’s income base by including supplemental pay plaintiff had received from the Southern University Foundation, and determined plaintiff’s terminal pay (500 hours of unused leave) and retirement should have been calculated only on his annual base salary due from Southern. The court of appeal affirmed on appeal, noting plaintiff “manipulated the system and used his position for his own benefit.” Southern sent a letter to LASERS advising it had committed an error in including supplemental funds in plaintiff’s earnings. Because plaintiff's lawsuit was ongoing at the time, LASERS filed a concursus proceeding seeking to deposit the disputed amount of plaintiff’s benefit in the registry of court pending resolution of the litigation. Plaintiff filed an exception of no cause of action. The district court granted the exception and dismissed the second suit with prejudice. LASERS did not appeal this judgment. After the first suit became final, LASERS sent correspondence to plaintiff advising it intended to retroactively reduce his retirement benefit starting June 1, 2012 “due to an error made by Southern University in the reporting of your earnings.” Relying on La. R.S. 11:192, LASERS maintained it could adjust benefits and further reduce the corrected benefit to recover overpayment within a reasonable number of months. Plaintiff then filed the instant suit against LASERS, seeking a writ of mandamus, injunctive relief, and a declaratory judgment confirming LASERS had no authority or ability to reduce his retirement benefits. The petition alleged plaintiff’s retirement benefits should have been calculated based on the entirety of his earnings over thirty-five years of employment, including salary supplements. The Supreme Court was called on to determine whether the lower courts erred in finding the defendant retirement system failed to prove that it followed the proper procedure before initiating action to reduce and recoup plaintiff’s retirement benefits. The Court found the lower courts did not apply the proper statutory analysis and reached an erroneous result. The case was remanded for further proceedings. View "Slaughter v. Louisiana State Employees' Retirement System" on Justia Law

Plaintiff appealed the denial of his application for disability insurance benefits and supplementary security income, arguing that the ALJ erred in refusing to give proper weight to the opinion of a consultative examining physician, and in finding that plaintiff's 2012 testimony was not credible and failing to consider his vision limitations when evaluating his residual functioning capacity. The court agreed that the ALJ erred in both respects and reversed the judgment of the district court, remanding for further proceedings. View "Henry v. Commissioner" on Justia Law

The Juvenile Court found R.G., a nonminor dependent within the transition jurisdiction of the juvenile court (Welf. & Inst. Code, 450), ineligible for extended foster care support payments between January 13 and March 13, 2015, because he was neither employed at least 20 hours per week nor participating in a program or activity that promoted or removed barriers to employment, as is required to receive financial support pursuant to section subdivisions (b)(4) and (b)(3) of section 11403 of the California Fostering Connections to Success Act, under which certain youth in foster care may continue receiving financial assistance after turning 18. The court of appeal agreed and reversed. The undisputed evidence indicated that R.G.’s activities, which were primarily self-directed, included formulating a specific job search plan; applying online and in person to numerous jobs; following up with prospective employers; receiving feedback from an independent living skills program specialist on how to improve his resume and job applications; and maintaining contact with the social worker on his progress. This evidence showed that he was working toward his goals during the period in question as contemplated by the statute. View "In re R.G." on Justia Law