Justia Public Benefits Opinion Summaries

Brault applied for Disability Insurance Benefits in 2007, claiming that he became disabled in 2006 because of nerve damage in his left arm and a cervical spine injury he sustained in a motor-vehicle accident. After his application was denied initially and on reconsideration, he requested an administrative hearing. Brault’s counsel asserted a Daubert-like objection to the vocational expert’s testimony, contending it was unreliable. The ALJ never directly responded to the objections, but issued a ruling which relied on the VE’s testimony, agreed that positions existed in the eight DOT positions the VE had identified at the numbers the VE had given, and denied Brault’s application for benefits. The district court affirmed the denial. The Second Circuit affirmed, finding that the denial was supported by substantial evidence. The administrative law judge was not required to state expressly his reasons for accepting a vocational expert’s challenged testimony.View "Brault v. Soc. Sec. Admin." on Justia Law

Heino, a veteran, is prescribed a daily dose of 12.5 milligrams of Atenolol. The lowest strength available for the prescription is a 25 milligram tablet, so his physician instructed him to split each tablet in half. Heino paid a $7 copayment for a 30-day supply of 15 tablets, which he claimed was excessive in light of the fact that some veterans paid the same co-payment for twice the medication. The VA refused his request for adjustment. The Veterans Court affirmed, rejecting arguments that the regulation the VA uses to calculate his copayment amount, 38 C.F.R. 17.110, conflicts with 38 U.S.C. 1722A(a)(2), which prohibits the VA from charging a copayment “in excess of the cost to the Secretary for medication,” because the actual cost of his Atenolol prescription was well below $7.3, and that his copayment was excessive. The Federal Circuit affirmed. View "Heino v. Shinseki" on Justia Law

Humana sued, alleging that Glaxo was obligated to reimburse Humana for expenses Humana had incurred treating its insureds’ injuries resulting from Glaxo’s drug, Avandia. Humana runs a Medicare Advantage plan. Its complaint asserts that, pursuant to the Medicare Act, Glaxo is in this instance a “primary payer” obligated to reimburse Humana as a “secondary payer.” The district court dismissed, agreeing with Glaxo that the Medicare Act did not provide Medicare Advantage organizations with a private cause of action to seek such reimbursement. The Third Circuit reversed and remanded. The Medicare Secondary Payer Act, in 42 U.S.C. 1395y(b)(3)(A), provides Humana with a private cause of action against Glaxo. Even if the provision is ambiguous, regulations issued by the Centers for Medicare and Medicaid Services make clear that the provision extends the private cause of action to MAOs. View "Humana Med. Plan Inc. v. GlaxoSmithKline LLC" on Justia Law

Plaintiff and his mother lived in public housing. His mother was arrested and charged with possession of cocaine and resisting law enforcement officers; she later pleaded guilty. Less than one month later she received notice that her arrest violated her lease agreement, that she had 30 days to vacate, and that she could contest termination of her lease during the eviction procedure. The Housing Authority subsequently filed an eviction action in Indiana state court. Before that hearing, plaintiff sought a preliminary injunction. The district judge conducted a telephonic hearing and denied the motion, based mainly on the Anti-Injunction Act, 28 U.S.C. 2283, and in consideration of "the principles of equity, comity, and federalism that restrain a federal court, while recognizing the respect due the courts of a sovereign state." The state court ruled in favor of the Housing Authority, issuing an order for immediate possession of the property and eviction. The Seventh Circuit dismissed, as moot, an appeal from the denial of an injunction. View "A.B. v. Hous. Auth. of South Bend" on Justia Law

Plaintiff Lisa R. Chapo appealed a district court's order upholding the Commissioner of Social Security's denial of her application for disability and supplemental security income benefits. The Administrative Law Judge (ALJ) denied benefits at the last step of the five-step process for determining disability. At step five the ALJ found Plaintiff not disabled because, "[c]onsidering [her] age, education [high school], work experience, and residual functional capacity, there are jobs that exist in significant numbers in the national economy that [she] can perform," namely the jobs of appointment clerk, escort vehicle driver, and office helper identified by the vocational expert (VE) who testified at the evidentiary hearing. On appeal to the Appeals Council, Plaintiff challenged the ALJ’s decision in several respects, in particular the ALJ’s treatment of the opinion evidence in the record. Upon review of the record, the Tenth Circuit concluded that ALJ’s handling of a testifying doctor's findings was erroneous and, as a result, the dispositive hypothetical inquiry put to the VE was fatally defective. "Indeed, that hypothetical did not even include a restriction (to 'simple' work) that the ALJ himself recognized in his decision." The Court concluded that this matter be remanded for further proceedings, "wherein the ALJ must either obtain a mental RFC determination from an examining source to oppose [the doctor], articulate some other adequate basis for discounting [his] findings, or come back to the VE with a proper hypothetical including those limitations (and his own restriction to 'simple' work, should the ALJ find it appropriate to re-impose such a restriction in the RFC determined on remand)." View "Chapo v. Astrue" on Justia Law

Thompson served in the Navy from October 1973 to January 1975. During active service, he was treated for psychiatric symptoms, attributed to immature personality disorder. Over the following years, he was hospitalized sporadically based upon complaints of a nervous disorder and an inability to get along with others. In 1984 he was diagnosed as a paranoid schizophrenic. He was hospitalized for schizophrenia several times between 1984 and 1991. In 2006, a VA Regional Office issued a rating decision finding no service connection with respect to any acquired psychiatric disorder. Before the Veterans Court reached the merits of an appeal, the parties filed a joint motion for partial remand citing a 2009 intervening decision. The motion was granted. Thompson then moved for attorneys’ fees and costs. The Veterans Court denied the motion, holding that he was not a prevailing party under the Equal Access to Justice Act, 28 U.S.C. 2412(d). The Federal Circuit affirmed. View "Thompson v. Shinseki" on Justia Law

Plaintiffs brought a putative class action challenging 62 Pa. Stat. 1414, which was enacted to regulate special needs trusts. The comprehensive Medicaid eligibility rules enacted by Congress generally mandate that trusts be counted as assets of those seeking Medicaid, but exempt special needs trusts, which are intended to provide disabled individuals with necessities and comforts not covered by Medicaid. Plaintiffs allege Section 1414 is preempted by 42 U.S.C. 1396p(d)(4). The district court held that all but one of the challenged provisions of Section 1414 was preempted, finding that plaintiffs had a private right of action under both Section 1983 and the Supremacy Clause. The court also held that Section 1414 was severable, certified a class, and appointed class counsel. The Third Circuit affirmed in part, agreeing that the case is justiciable and that plaintiffs have a private right of action. Section 1414's 50% repayment provision, "special needs" provision, expenditure provision, and age restriction are all preempted by federal law. The enforcement provision of Section 1414, however, when used to enforce provisions not otherwise preempted, is a reasonable exercise of the Commonwealth's retained authority to regulate trusts. View "Lewis v. Alexander" on Justia Law

Plaintiffs appealed from the district court's dismissal of their amended complaint against Florida government defendants, SBHD, AHCA, and DCF. Plaintiffs alleged that defendants' billing practice violated both 42 U.S.C. 1396a(a)(25)(C), the "balance billing" provision of the federal Medicaid Act, and a similar Florida statute. The court concluded that section 1396a(a)(25)(C) did not confer upon plaintiffs a federal right enforceable under 42 U.S.C. 1983 and therefore, affirmed the district court's decision to dismiss the amended complaint. View "Martes, et al. v. CEO of South Broward Hospital Dist., et al." on Justia Law

Plaintiff appealed an order of the district court affirming the Commissioner's final decision denying her disability benefits under Title II of the Social Security Act (SSA), 42 U.S.C. 401-434. At issue, among other things, was whether the district court should have considered evidence plaintiff did not submit to the ALJ but submitted for the first time to the Appeals Council, which accepted and considered the new evidence but declined to review the ALJ's decision. The court held that when a claimant submitted evidence for the first time to the Appeals Council, which considering that evidence in denying review of the ALJ's decision, the new evidence was part of the administrative record, which the district court must consider in determining whether the Commissioner's decision was supported by substantial evidence. Considering the record as a whole, the court concluded that the Commissioner's decision was not supported by substantial evidence. Accordingly, the court reversed and remanded for an immediate award of benefits. View "Brewes v. Commissioner of Social Security" on Justia Law

Reeves served as a heavy mortar crewman during combat offensives, 1942-1945, and was awarded three Bronze Stars. In 1981, Reeves filed a claim seeking service-connected disability benefits, with a medical opinion, stating that Reeves had bilateral, nerve-type hearing loss in 1962, attributable to noise exposure or to treatment with quinine for malaria. He also submitted records of an audiogram and statements from officers with whom he had served. The board denied the claim, stating that hearing loss documented in 1962 was too remote from active service. Reeves did not appeal. In 2004, the board granted an application to re-open, citing new evidence of treatment from 1946 to 1954, and awarded him service-connected disability benefits, effective 2002. In 2006, Reeves sought revision to an earlier effective date. The board denied the motion. The Veterans Court affirmed, rejecting an assertion that the evidence of record in 1983 was such that the board had no choice but to resolve in his favor that his hearing disability was incurred in service. Reeves died in 2011; the Federal Circuit substituted his widow and reversed. The Veterans Court misinterpreted 38 U.S.C. 1154(b) in rejecting the clear and unmistakeable error claim. View "Reeves v. Shinseki" on Justia Law