Justia Public Benefits Opinion Summaries

Systemic juvenile idiopathic arthritis (SJIA), an autoinflammatory disease, has symptoms including arthritis, fever, rash, and muscle and joint pain, caused by dysfunctional production of proteins, which cells release almost immediately after contact with an antigen. Gardasil, a vaccine against HPV administered in three doses, contains virus-like particles created from an HPV protein, and an adjuvant to generate a robust immune response. Vanessia, born in 1995, was healthy until 2008. After receiving two doses of Gardasil, she experienced an all-over rash. Days later, she had joint pain and high fever. The hospital discharged her with a presumptive diagnosis of SJIA. Vanessia’s family history included SJIA. Her rheumatologist communicated these findings to the doctor who administered Vanessia’s third dose of Gardasil on August 19. Vanessia experienced a SJIA flare on August 25. Vanessia’s Vaccine Act injury claim was rejected. Injuries that do not appear on the Vaccine Injury Table, 42 C.F.R. 100.3, require proof of a medical theory causally connecting the vaccination to the injury; a logical sequence of cause and effect; and proximate temporal relationship between the vaccine and injury. The Claims Court and Federal Circuit affirmed, finding that the claim did not meet the burden of demonstrating proximate temporal relationship. View "Koehn v. Sec'y of Health & Human Servs." on Justia Law

Keathley retired from working at strip mines. His health deteriorated. He sought Black Lung Benefits Act benefits, 30 U.S.C. 901. Keathley established eligibility under the 15 -year presumption; he had worked in mines for more than 16 years and was able to show a totally disabling impairment by medical opinion testimony and tests showing poor pulmonary function. His employer rebutted this presumption by offering testimony by Dr. Broudy, who diagnosed Keathley with “a combination of chronic obstructive asthma and pulmonary emphysema and chronic bronchitis” caused by smoking. Conceding that “coal dust may have contributed,” Broudy concluded that “it’s far more likely that the impairment was due to obstructive airways disease from cigarette smoking and some predisposition to asthma or bronchospasm.” On remand, the ALJ awarded benefits; the Benefits Review Board affirmed, rejecting Broudy’s opinion that “bronchitis associated with coal dust exposure usually ceases with cessation of exposure,” as contrary to federal regulations, which state that “pneumoconiosis” may be “latent and progressive” and arise after exposure ceases. The Sixth Circuit denied the employer’s petition for review. The employer did not challenge the evaluation of individual tests, identify any factor the ALJ overlooked, or offer any basis for distinguishing among the tests. View "Sunny Ridge Mining Co., Inc. v. Keathley" on Justia Law

This case stemmed from plaintiffs' request for tuition assistance for their daughter under the Individuals with Disabilities Education Act (IDEA), 20 U.S.C. 1400 et seq. Plaintiffs filed suit challenging the State Review Officer's (SRO) decision to deny reimbursement for private schooling and the district court reversed in part and ordered the school district to reimburse plaintiffs for May 1, 2009 to May 31, 2009, and for the 2009-2010 school year. Because the court deferred to the SRO's determination that plaintiffs did not meet their obligation to demonstrate the appropriateness of their daughter's placement, plaintiffs cannot recover under the IDEA for any portion of the time she was placed at Family Foundation. Accordingly, the court reversed the judgment of the district court and remanded for entry of an order affirming the SRO's decision. View "Hardison v. Bd. of Ed. Oneonta City Sch. Dist." on Justia Law

Plaintiffs, parents of nine-year-old E.L., who has autism, initiated an administrative complaint against the school board under the Individuals with Disabilities Education Act (IDEA), 20 U.S.C. 1400 et seq. An ALJ determined that the school board violated the IDEA by failing to provide E.L. with required speech therapy but, in all other respects, she was provided an appropriate special education program. The school board appealed and the state review officer reversed the ALJ's conclusion regarding the speech therapy. Plaintiffs then filed a civil action seeking judicial review of the administrative proceedings. The court concluded that E.L. did not exhaust her administrative remedies and that the school board did not violate the IDEA where the review officer's conclusion that E.L. received the speech therapy mandated by her individualized education program is supported by the evidence. Accordingly, the court affirmed the judgment. View "E. L. v. Chapel Hill-Carrboro Board of Education" on Justia Law

Grenadyor is a pharmacist formerly employed by Ukrainian Village Pharmacy, which with pharmacies that serve similar communities in other states (joined as additional defendants in this suit), is alleged to be controlled by individuals of Ukrainian origin, mainly members of the Bogacheck family. Grenadyor claims that the pharmacy defrauded the government by making gifts to customers (such as tins of caviar), or forgiving their copays, to induce them to have their prescriptions filled by it rather than by competing pharmacies. He also alleged that the pharmacy sought government reimbursement for drugs that were not delivered to the buyers. The district court dismissed his complaint under the False Claims Act, 31 U.S.C. 3729, which also claimed retaliation. The Seventh Circuit affirmed as to the kickback claims under the Act, noting that Grenadyor was unable to name any person who had received more than $50 worth of kickbacks in a year, when the court requested that he do so. Allegations about claims for reimbursement for undelivered prescriptions were also inadequate. The court reversed with regard to the retaliation claim. View "Grenadyor v. Ukrainian Vill. Pharmacy" on Justia Law

Ven-A-Care of the Florida Keys, Inc. filed the first of two qui tam actions alleging that Baxter Healthcare Corporation had defrauded the federal Medicaid and Medicare programs. Ven-A-Care and Baxter eventually reached a settlement agreement. Before the district court dismissed Ven-A-Care’s action against Baxter, Linnette Sun and Greg Hamilton filed a qui tam action against Baxter. Baxter moved for partial summary judgment, asserting that the settlement had released Sun and Hamilton’s claims. Sun and Hamilton then filed a Fed. R. Civ. P. 60(b) motion requesting a reopening of the Ven-A-Care judgment, arguing that the Ven-A-Care settlement could not release their claims until they got a fairness hearing under the False Claims Act. The district court denied the motion and dismissed Sun and Hamilton’s suit, concluding that the Ven-A-Care complaint stated all the essential facts of the fraud alleged by Sun and Hamilton and thus had triggered the False Claims Act’s first-to-file bar. The First Circuit affirmed, holding that because Ven-A-Care’s earlier-filed complaint already provided the essential facts about the same scheme pled in Sun and Hamilton’s complaint, section 3730(b)(5) of the False Claims Act prevented Sun and Hamilton’s suit from going forward. View "United States, ex rel. Sun v. Baxter Healthcare Corp." on Justia Law

Plaintiff appealed the denial of his application for social security disability insurance (SSDI). Plaintiff alleged that the ALJ erred by failing to order an intelligence quotient (IQ) test, evaluating plaintiff's intellectual capacity, and accepting a vocational expert's assessment. Without an essential IQ test, the ALJ could not make an informed choice about whether plaintiff's mild mental retardation met listing 12.05C. The court concluded that plaintiff must be afforded an IQ test and a reevaluation of his disability applications. Accordingly, the court reversed and remanded with directions to further develop the record. View "Lott, Jr. v. Colvin" on Justia Law

Dillip Mullings owned a NAPA auto-parts store in Seward called Resurrection Bay Auto Parts, Inc. Mullings hired Dennis Alder to be the store manager, a position Alder held from 2006 to 2010, when he was terminated. Alder did not keep a time card, but it was undisputed that he typically worked from 6:30 a.m. to 6:30 p.m. Monday through Friday. The extent of Alder’s overtime was not at issue on appeal; Mullings conceded that Alder worked over 40 hours a week. It was also undisputed that Alder was paid a salary and did not receive overtime pay. Once terminated, Alder sought unemployment compensation from the State. The Department of Wage and Hour determined that Alder was entitled to overtime pay, and attempted to negotiate a settlement on his behalf with Resurrection Bay. Alder later sued seeking overtime pay. The employer claimed the Alder was exempt from the overtime laws, but the superior court found he was not and awarded overtime pay and liquidated damages. The employer appealed. Because the employer failed to show that the manager satisfied all four requirements of the overtime laws’ exemption for executive employees, the Supreme Court affirmed the finding that the manager was owed overtime pay under Alaska and federal law. Furthermore, the Court affirmed the superior court’s award of liquidated damages, because the employer failed to carry his burden of demonstrating by clear and convincing evidence that he acted in good faith. View "Resurrection Bay Auto Parts, Inc. v. Alder" on Justia Law

Debtor lived in a rent-stabilized apartment for over forty years. Debtor filed for Chapter 7 bankruptcy and listed the value of her unexpired rent-stabilized lease as personal property exempt from the bankruptcy estate under N.Y. Debt. & Cred. Law 282(2) as a “local public assistance benefit.” The bankruptcy court struck the claimed exemption, concluding that the value of the lease did not qualify as an exempt local public assistance benefit. The district court affirmed. Debtor appealed, arguing that the value of her lease was a local public assistance benefit that was exempted from her bankruptcy estate. The Second Circuit certified a question to the New York Court of Appeals regarding the issue. The Court of Appeals answered that section 282(2) exempts a debtor-tenant’s interest in a rent-stabilized lease. View "Matter of Santiago-Monteverde" on Justia Law

Plaintiff appealed the denial of her application for disability insurance benefits (DIB) and supplemental security income (SSI) benefits. The court vacated the district court's dismissal of plaintiff's complaint and remanded, holding that a rebuttable presumption against substantial gainful activity arises where a disability claimant's earnings are below the threshold set by the relevant statutory regulations. In this case, the Commissioner's failure to address plaintiff's earnings and apply the presumption is grounds for reversal. View "Copeland v. Colvin" on Justia Law