Justia Public Benefits Opinion Summaries

Plaintiffs-appellees Ronda Owens, Darryl Hubbard, Selena Freymiller, Shanika Crowley, Valerie Killman, Michael Lee Pitts, Ebony Warrior, John Ball, Michelle Bullock, Logan Bellew, Sondia Bell, Tumeeka Baker, and Jay Reid (collectively "Citizens") filed the underlying lawsuit seeking declaratory and injunctive relief. Citizens claimed that Oklahoma Governor J. Kevin Stitt and Defendant-appellant Shelley Zumwalt, in her official capacity as Executive Director of the Oklahoma Employment Security Commission, acted without authority and violated 40 O.S.2011 section 4-313 of the Oklahoma Employment Security Act by terminating agreements with the U.S. Department of Labor to administer COVID-related unemployment programs. The trial court entered a preliminary injunction ordering Zumwalt to immediately reinstate and administer the programs. Zumwalt appealed, and the Oklahoma Supreme Court stayed the trial court's order pending appeal. The Supreme Court found 40 O.S. 4-313 did not create a private right of action and, therefore, the trial court abused its discretion by granting a preliminary injunction. View "Owens, et al. v. Zumwalt" on Justia Law

Reynolds, born in 1992, graduated from high school and previously worked part-time in retail. Reynolds suffers from migraines, vertigo, and “major depressive disorder, recurrent moderate with anxious distress.” She applied for Social Security disability benefits in 2017. Reynolds testified that she suffers from back pain, vertigo, and migraines, and she cannot stand for more than 10 minutes. Her parents handle household chores. She has migraines every day. She stopped taking some prescription medications for her migraines because of the side effects. Reynolds quit her job at Walmart because of her migraines. Reynolds testified has never gone to an emergency room or crisis center for mental health treatment but suffers from anxiety around “more than five people.” She was taking medication for her mental health conditions.The ALJ concluded that Reynolds was not disabled under the Social Security Administration’s five-step method and that Reynolds had the residual functional capacity to perform a full range of work with certain non-exertional limitations. The Seventh Circuit affirmed the denial as supported by substantial evidence. The court rejected an argument that the ALJ erred by failing to include a qualitative interaction limitation in the residual functional capacity determination. No medical evidence called for a qualitative interaction limitation; the ALJ was not required to intuit such a limitation from the administrative record. View "Reynolds v. Kijakazi" on Justia Law

The issue this case presented for the New Jersey Supreme Court's review in this appeal was who bore the primary responsibility for the payment of Dale Mecouch’s medical bills arising from an automobile accident that took place before December 5, 1980: the issuer of an automobile insurance policy or Medicare. In 2016, Mecouch was hospitalized for approximately two months at Cooper Hospital University Medical Center (Cooper) due to complications arising from a 1977 automobile accident that left him paralyzed from the waist down. At the time of his accident, Mecouch had a no-fault automobile insurance policy with Selective Insurance Company of America (Selective), which provided Mecouch with unlimited personal-injury-protection (PIP) benefits. Sometime after 1979 but before 2016, Mecouch was enrolled in Medicare. Selective continued to pay Mecouch’s medical expenses related to the 1977 accident until December 11, 2015, when it notified Mecouch by letter that, going forward, “Medicare is the appropriate primary payer for any treatment related to” the 1977 accident. After Mecouch’s 2016 hospital stay, Cooper forwarded to Selective a bill for over $850,000 for medical services rendered to Mecouch. Instead of paying that bill, Selective directed Cooper to seek reimbursement from Medicare. Cooper was a participating Medicare provider, and, at that time, Mecouch was a Medicare enrollee. Cooper then billed Medicare, which issued a payment of under $85,000. Selective eventually agreed to reimburse Cooper for Mecouch’s co-payments and deductibles. Cooper filed a complaint against Selective, seeking the total cost of Mecouch’s care. The trial court granted summary judgment in favor of Cooper, awarding Cooper the cost of Mecouch’s care minus the amount covered by Medicare. The Appellate Division reversed, concluding Medicare was the “primary payer” for Mecouch's medical bills at Cooper. The Supreme Court concluded that because Mecouch was a Medicare enrollee in 2016, Cooper was required to bill and accept payment from Medicare, which promptly covered Mecouch’s medical expenses in accordance with its fee schedule. Cooper could not seek payment from Selective other than for reimbursement of the Medicare co-payments and deductibles. View "Cooper Hospital University Medical Center v. Selective Insurance Company of America" on Justia Law

The Second Circuit reversed the district court's denial in part of the law firm's motion for attorney's fees in a Social Security disability case. The court held that for a court to find an attorney's agreed-upon contingency fee unreasonable under 42 U.S.C. 406(b) on the sole ground that it constitutes a windfall, it must be truly clear that the high fee represents a sum unearned by counsel. In this case, the requested fee was not such a windfall and there is no other reason to think that the fee requested is unreasonable. Therefore, the court remanded with instructions to order the Social Security Administration to release the requested fee to the law firm. View "Fields v. Kijakazi" on Justia Law

The State redesigned the dental insurance plan offered to public retirees in 2014, narrowing coverage but also decreasing premiums paid by retirees. The Retired Public Employees of Alaska challenged the redesign. After a bench trial the superior court concluded that the new plan unconstitutionally diminished retirees’ accrued benefits. The State appealed, arguing that the superior court erred by determining the dental plan was a constitutionally protected “accrued benefit” and by refusing to consider premium rates for retirees as relevant to the diminishment analysis. The Alaska Supreme Court agreed with the State on the second point only: "The Alaska Constitution does protect public retirees’ option to purchase dental insurance as an accrued benefit, but both coverage for retirees and price to retirees influence the value of this option." The Court therefore vacated and remanded for the superior court to reevaluate the plan changes and incorporate premium pricing into its analysis. View "Tshibaka v. Retired Public Employees of Alaska, Inc." on Justia Law

Gurley served in the Army, 1972-1974 (a period of war) and the National Guard, 1975-1982. As of 1997, VA was paying him service-connected disability compensation benefits at the 100 percent disability level based on individual unemployability. In 2011, Gurley was convicted of a felony and was incarcerated for nearly six months. When a veteran is incarcerated for a felony conviction, the veteran “shall not be paid” the full amount of awarded compensation benefits “for the period beginning on the sixty-first day of such incarceration and ending on the day such incarceration ends,” 38 U.S.C. 5313(a)(1). Gurley’s payment should have been reduced to the 10% disability level. Gurley, however, received his full benefits because VA did not learn of his incarceration until six days after his release.The VA notified Gurley that he had been overpaid by $10,461 and that it would reduce its payment of Gurley’s current benefits “until the amount . . . overpaid is recouped.” Gurley unsuccessfully requested a waiver under 38 U.S.C. 5302 and disputed the debt. The Board of Veterans’ Appeals, Veterans Court, and Federal Circuit affirmed. The retroactive benefit reduction and recoupment of the overpayment through the withholding of continuing benefit payments were proper. View "Gurley v. McDonough" on Justia Law

Magnolia, a managed care organization that contracted with the State to provide Medicaid services, applied what it saw as a statutory five percent reduction in Medicaid rates to Mississippi’s fourteen regional mental health providers. The regional providers responded by filing a complaint against Magnolia in which they sought injunctive relief and monetary damages. On February 18, 2020, Magnolia Health Plan, Inc., and Cenpatico Behavioral Health, LLC (collectively, “Magnolia”), filed a timely notice of appeal after a circuit court denied Magnolia’s motion to compel arbitration, and granted a preliminary injunction against it in favor of Defendants, Mississippi’s fourteen regional health commissions. The notice of appeal included both orders. As to the first, the order denying Magnolia’s motion to compel arbitration, at oral argument before the Mississippi Supreme Court panel, Magnolia abandoned the issue. As to the second, the order granting Magnolia’s request for a permanent injunction, the order was not a final, appealable judgment. Accordingly, the Supreme Court concluded it did not have jurisdiction for further review. View "Magnolia Health Plan, Inc. et al. v. Mississippi's Community Mental Health Commissions, et al." on Justia Law

Ruenger applied for Social Security Disability benefits in 2015, alleging that he had limited use of his left arm and mental impairments including anxiety and depression. At a hearing, the ALJ determined that Ruenger had not worked within the claim period, that his mental and physical impairments were severe but did not presumptively establish a disability, and that he had the capacity to perform light work with certain physical and social limitations. At the final step of the inquiry, the ALJ determined—based on a vocational expert’s testimony—that Ruenger could still perform jobs that exist nationwide in significant numbers and denied Ruenger’s application.The Seventh Circuit vacated and remanded. Substantial evidence does not support the ALJ’s decision. ALJs cannot afford complete discretion to vocational experts. When a claimant challenges a vocational expert’s job-number estimate, the ALJ must inquire whether the methodology used by the expert is reliable. In this case, the vocational expert enlisted by the agency to estimate the number of jobs suitable for Ruenger omitted crucial details about her methodology, such as the source of her job numbers and the reason she used the equal distribution method; the ALJ nevertheless relied on the expert’s testimony. View "Ruenger v. Kijakazi" on Justia Law

For almost 30 years, Prill worked for the Eau Claire, Wisconsin County Highway Department performing physically demanding work, including driving a dump truck and maintaining roads. She suffered from pain in her lower back and knees, which was exacerbated by a car accident and multiple work injuries. Prill retired in 2014 and later filed for Social Security disability benefits alleging she could no longer perform heavy or medium work. Several doctors examined Prill or reviewed her medical records but reached different conclusions about her physical limitations.An ALJ found Prill’s testimony only partially credible, concluding that her report about the severity of her symptoms and the extent of her limitations was inconsistent with other record evidence. The ALJ also weighed the competing medical evidence and gave greater weight to the opinions of consulting physicians who reviewed Prill’s medical records than to the opinion of Prill’s treating physician. The ALJ concluded that Prill had not been disabled since August 2014. The Appeals Council of the Social Security Administration denied her request for review. The district court and Seventh Circuit affirmed. Substantial evidence supported the ALJ’s decision. The court rejected arguments the ALJ wrongly discounted Prill’s subjective allegations and improperly weighed the differing medical opinions. View "Prill v. Kijakazi" on Justia Law

Social Security retirement benefits are calculated using a formula based on past earnings, 42 U.S.C. 415(a)(1)(A). Under the “windfall elimination” provision, benefits are reduced when a retiree receives a separate pension payment based on employment not subject to Social Security taxes. Pension payments exempt from the windfall reduction include those "based wholly on service as a member of a uniformed service.”A “military technician (dual status),” 10 U.S.C. 10216, is a “civilian employee” assisting the National Guard. Such technicians are required to maintain National Guard membership and must wear uniforms while working. For their work as full-time civilian technicians, they receive civil-service pay. If hired before 1984, they receive Civil Service Retirement System pension payments. As part-time National Guard members, they receive military pay and pension payments from a different arm of the government.The SSA applied the windfall elimination provision to the benefits calculation for Babcock, a dual-status technician. The district court and Sixth Circuit upheld that decision, declining to apply the uniformed-services exception.The Supreme Court affirmed. Civil Service Retirement System pensions generally trigger the windfall provision. Babcock’s technician work was not service “as” a National Guard member. A condition of employment is not the same as the capacity in which one serves. The statute states: “For purposes of this section and any other provision of law,” a technician “is” a “civilian employee,” “authorized and accounted for as” a “civilian.” While working in a civilian capacity, technicians are not subject to the Uniform Code of Military Justice. They possess characteristically civilian rights concerning employment discrimination, workers’ compensation, disability benefits, and overtime work; technicians hired before 1984 are “civil service” members, entitled to pensions as civil servants. Babcock’s civil-service pension payments are not based on his National Guard service, for which he received separate military pension payments. View "Babcock v. Kijakazi" on Justia Law