Justia Public Benefits Opinion Summaries

Plaintiff, who receives two government pensions, one from noncovered employment and one from covered employment, alleged that the Government Pension Offset (“GPO”) should not apply to his benefits. During Plaintiff’s administrative proceedings, the Social Security Administration (“SSA” or the “agency”) agreed with Plaintiff and paid him spousal benefits without applying any offset. Ultimately, though, the agency decided that the GPO should apply. The agency then temporarily withheld Plaintiff’s spousal benefits to recoup approximately $15,000 in overpayments to him, and it reduced his spousal benefits going forward. On appeal, the parties disputed whether the GPO applies to Plaintiff’s spousal benefits and if it does apply, whether the agency was entitled to recoup the overpayment.   The Ninth Circuit held that the GPO applies to Plaintiff’s spousal benefits but that a remand to the agency is necessary to determine whether SSA was entitled to recoupment. The court reasoned that under both the old and new version of Social Security regulation 20 C.F.R. Sec 404.408a, the existence of Plaintiff’s pension earned through noncovered employment triggered the GPO’s application to his spousal benefits notwithstanding his later covered employment in a job with a different pension plan.  Further, the court held that the ALJ’s finding of Plaintiff’s fault for the overpayment was not supported by substantial evidence and that on remand the agency could consider whether any evidence in the record beyond that relied on by the ALJ supported the proposition that Plaintiff was at fault for the overpayment and, if so, whether recoupment would be appropriate. View "PAUL MISKEY V. KILOLO KIJAKAZI" on Justia Law

In July 2019, the Appeals Council denied Claimant’s appeal without elaboration. Claimant challenged, among other rulings, the ALJ’s analysis of her testimony. Claimant did not assert any constitutional challenges to the district court. The district court entered a judgment reversing the ALJ’s denial of benefits and remanded the matter to the agency for further proceedings. The Commissioner filed a motion pursuant to Federal Rule of Civil Procedure 59(e) to amend or alter the judgment, arguing that the court had clearly erred by overlooking the ALJ’s explanation for rejecting Claimant’s testimony. The district court agreed with the Commissioner and entered an order granting the Rule 59(e) motion   The Ninth Circuit affirmed the amended judgment in favor of the Commissioner.  The court upheld the Commissioner’s decision denying her application for benefits because claimant did not show that the removal provision caused her any actual harm. Further, Federal Rule of Civil Procedure 59(e) allows a district court to alter or amend a judgment if the court determines that its original judgment was clearly erroneous. Because the district court properly concluded that it had clearly erred in its original ruling in favor of Claimant, the court’s granting of the Commissioner’s Rule 59(e) motion fell within the court’s considerable discretion View "JODY KAUFMANN V. KILOLO KIJAKAZI" on Justia Law

Plaintiff sought benefits under the Social Security Act based on various physical and mental impairments. An administrative law judge (“ALJ”) found that she was not disabled and denied her claim. The district court affirmed.The Ninth Circuit affirmed the district court’s decision affirming the Commissioner of Social Security’s denial of claimant’s application for benefits under the Social Security Act based on various physical and mental impairments.The court decided that recent changes to the Social Security Administration’s regulations displaced case law requiring an administrative law judge (“ALJ”) to provide “specific and legitimate” reasons for rejecting an examining doctor’s opinion. The “relationship factors”, such as length and purpose of the treatment relationship, frequency of visits, and extent of examinations the medical source has performed are still relevant. However, the ALJ no longer needs to make specific findings regarding those factors. Under the new regulations, an ALJ cannot reject an examining or treating doctor’s opinion without providing an explanation supported by substantial evidence.In this case, the ALJ acknowledged the doctor’s opinion that the claimant had marked and extreme limitations in various cognitive areas; but the ALJ found this opinion unpersuasive because it was inconsistent with the overall notes in the record. The court held that substantial evidence supported the ALJ’s finding. View "LESLIE WOODS V. KILOLO KIJAKAZI" on Justia Law

The Department of Human Services for Arapahoe County (“the Department”) sued Monica Velarde and Michael Moore to enforce a final order it had issued against them to recover Medicaid overpayments. But the Department did so only after undertaking extensive efforts on its own to recoup the fraudulently obtained benefits. The district court dismissed the Department’s suit, finding that section 24-4-106(4), C.R.S. (2021), which was part of the State Administrative Procedure Act (“APA”), required an agency seeking judicial enforcement of one of its final orders to do so within thirty-five days of the order’s effective date. The Colorado Supreme Court determined district court and the court of appeals incorrectly relied on an inapplicable statutory deadline in ruling that the complaint was untimely filed. Each court was called upon to determine whether a thirty-five-day deadline governing proceedings initiated by an adversely affected or aggrieved person seeking judicial review of an agency’s action also applied to proceedings initiated by an agency seeking judicial enforcement of one of its final orders. Both courts answered yes. The Supreme Court, however, answered no. Judgment was reversed and the case remanded for further proceedings. View "Arapahoe County v. Velarde & Moore" on Justia Law

Plaintiff filed a claim for Social Security benefits. In support of her disability claims, she presented the opinions of two of her treating physicians. After a hearing, an ALJ assigned partial weight to the treating physicians’ opinions, ultimately concluding that the plaintiff was not disabled. Congress has authorized federal courts to engage in a limited review of final SSA disability benefit decisions.Plaintiff argued that the ALF’s residual functional capacity (“RFC”) finding was not supported by substantial evidence. The court reasoned that in this instance, the ALJ had complete records such as medical opinions, treatment notes, and relevant test results. The court found that the plaintiff failed to identify any missing medical records, and therefore the ALJ did not err in failing to supplement the administrative record. Similarly, the ALJ found notable inconsistencies between the plaintiff's treating doctors' conclusions and the longitudinal records of the plaintiff’s physical health.Thus, the court concluded that substantial evidence supports the ALJ’s ultimate RFC determination. Finally, although the ALJ committed procedural error by failing to explicitly apply each of the factors listed in 20 C.F.R. Sec. 404.1527(c), the error was harmless because substantial evidence supported the ALJ's determinations. View "Schillo v. Saul" on Justia Law

The Supreme Court reversed the judgment of the trial court denying ResCare Health Service's request for a declaratory judgment, holding that ResCare sufficiently pleaded its declaratory judgment request.ResCare, which operates intermediate care facilities in Indiana for individuals with intellectual disabilities, petitioned for administrative reconsideration after an auditor with the Indiana Family & Social Services Administration’s Office of Medicaid Policy and Planning (FSSA) adjusted cost reports to prevent ResCare from recovering costs for over-the-counter medicines under Medicaid. An ALJ granted summary judgment for ResCare. The trial court affirmed the agency's final decision. The Supreme Court reversed, holding (1) ResCare did not need to file a separate complaint for a declaratory judgment; (2) ResCare sufficiently pleaded its declaratory judgment claim; and (3) ResCare's patients did not have to be joined to the litigation before the declaratory judgment request could be considered. View "ResCare Health Services Inc. v. Indiana Family & Social Services Administration" on Justia Law

Slaughter served on active duty in the Navy, 1975-1995. In 2008, a VA Regional Office determined that Slaughter, who is righthanded, suffered right ulnar nerve entrapment as a result of his service and awarded a 10% disability rating under 38 C.F.R. 4.124a, Diagnostic Code (DC) 8516. Slaughter pursued a higher rating. VA examiners eventually additionally diagnosed Slaughter with a median nerve injury, not service-connected. In 2018, the Board of Veterans’ Appeals increased Slaughter’s rating for right ulnar nerve entrapment to 40%, finding that it could not distinguish the symptoms of his service-connected ulnar nerve entrapment from those of his non-service-connected median nerve injury and attributing the entirety of the disability to the service-connected injury. The Board determined that it would be inappropriate to rate Slaughter under DC 8512, which provides ratings for injuries to the lower radicular group, because only the ulnar nerve entrapment was service-connected.The Veterans Court and Federal Circuit affirmed. While the Veterans Court placed too heavy a burden on Slaughter to show prejudice, that error was harmless because the Board correctly interpreted section 4.124a. The section provides that “[c]ombined nerve injuries should be rated by reference to the major involvement, or if sufficient in extent, consider radicular group ratings” and refers to service-connected injuries, not to a combination of service-connected and non-service-connected injuries. View "Slaughter v. McDonough" on Justia Law

The 2010 Caregivers and Veterans Omnibus Health Services Act required the VA to establish two programs to help individuals who provide eligible veterans with personal care services. One program provided assistance to family caregivers, 38 U.S.C. 1720G(a); the other provided assistance to general caregivers, section 1720G(b). The VA promulgated implementing regulations, 38 C.F.R. 71 (2015). In 2018, Congress amended the Act.; the VA MISSION Act expanded the class of veterans who qualify as eligible under the family caregivers program. The program now applies to all veterans regardless of their service dates, and there are new avenues for a veteran to qualify as eligible for benefits. The VA overhauled its regulations that attempted to clarify, streamline, and regularize implementation of the Act.Objectors challenged six definitions in 38 C.F.R. 71.15 and a residency requirement imposed in 38 C.F.R. 71.10(b). The Federal Circuit addressed standing; rejected challenges to the definitions of “three or more activities of daily living,” “serious injury,” “inability to perform one or more activities of daily living,” and “monthly stipend rate”; and to the imposition of a geographic residence requirement. View "Veteran Warriors, Inc. v. Secretary of Veterans Affairs." on Justia Law

In 2012, United Healthcare of Mississippi (United) entered into provider agreements with Mississippi’s fourteen Community Mental Health Centers (CMHCs) to provide Medicaid services under the Division of Medicaid’s (DOM’s) managed care program. From 2012 until 2019, United paid the CMHCs an agreed upon amount for Medicaid services - 100 percent of the medicaid fee schedule rates. In July 2019, United unilaterally imposed a 5 percent rate cut, retroactive to January 1, 2019, and later demanded that the CMHCs refund 5 percent of all payments made from July 1, 2018, through December 31, 2018, all of which totaled more than $1 million. The CMCHs demanded that United immediately cease and desist from the 5 percent rate cut and recoupments. When United refused, the CMHCs filed a Complaint for Damages and Injunctive Relief, specifically requesting, inter alia, a preliminary injunction. United responded with a motion to compel arbitration and to stay the proceedings. After a two-day evidentiary hearing, the circuit court denied United’s motion to compel arbitration, granted the CMHCs’ request for injunctive relief, and issued a preliminary injunction. The limited issues presented to the Mississippi Supreme Court were whether the trial court properly enjoined United from imposing a 5 percent rate cut and whether the trial court erred by denying arbitration. After review, the Supreme Court affirmed the trial court’s decision to grant a preliminary injunction and to deny the motion to compel arbitration. View "United Healthcare of Mississippi Inc. et al. v. Mississippi's Community Mental Health Commissions, et al." on Justia Law

In response to economic conditions related to the spread of COVID-19, Congress established several programs that made additional federal funds available to the states for providing enhanced unemployment-compensation benefits to eligible individuals. Alabama elected to participate in the programs, and Shentel Hawkins, Ashlee Lindsey, Jimmie George, and Christina Fox, were among the Alabamians who received the enhanced benefits. As the spread of COVID-19 waned, Governor Kay Ivey announced that Alabama would be ending its participation in the programs. When Alabama did so, the claimants received reduced unemployment-compensation benefits or, depending on their particular circumstances, no benefits at all. Two months later, the claimants sued Governor Ivey and Secretary of the Alabama Department of Labor Fitzgerald Washington in their official capacities, alleging that Alabama law did not permit them to opt Alabama out of the programs. After a circuit court dismissed the claimants' lawsuit based on the doctrine of State immunity, the claimants appealed. Finding no reversible error, the Alabama Supreme Court affirmed the circuit court. View "Hawkins, et al. v. Ivey, et al." on Justia Law