Justia Public Benefits Opinion Summaries

The Ninth Circuit affirmed the district court's grant of summary judgment for the Department in an action brought by private ambulance companies challenging the reimbursement rate for their transportation of patients covered by Medi-Cal. The panel held that plaintiffs failed to carry their burden of producing evidence upon which a reasonable jury could return a verdict in their favor and thus the district court did not err in entering judgment in the Department's favor on the Takings Clause claim. The panel reasoned that the ambulance companies lacked a constitutionally protected property interest in a particular reimbursement rate, but the mandatory-care provision of Cal. Health & Safety Code 1317(d) implicated a constitutionally protected property right. The panel held that section 1317(d) did not effect a regulatory taking under the Penn Central test. The panel also held that the ambulance companies did not establish a due process claim regarding DHCS's failure to ensure that Medi-Cal reimbursement rates kept pace with their costs because they lacked a constitutionally protected interest in any particular reimbursement rate. View "Sierra Medical Services Alliance v. Kent" on Justia Law

The trial court did not err in dismissing Plaintiffs’ action for lack of subject matter jurisdiction due to Plaintiffs’ failure to exhaust administrative remedies in seeking damages for denied Medicaid reimbursement claims.The court of appeals reversed the trial court’s order, ruling that the trial court erred in dismissing Plaintiffs’ complaint without resolving certain factual issues and that Plaintiffs sufficiently demonstrated that it would be futile to pursue administrative remedies. The Supreme Court reversed, holding that the court of appeals erred in reversing the dismissal of Plaintiffs’ claims where Plaintiffs failed to exhaust their administrative remedies prior to filing suit and failed to demonstrate futility of the available remedies at this time. View "Abrons Family Practice & Urgent Care, PA v. North Carolina Department of Human Services" on Justia Law

In November 2014, the Board of Veterans’ Appeals denied Bly’s request for service connection for bilateral hearing loss. Bly appealed to the Veterans Court. After his opening brief was filed, Bly and the government filed a joint motion for partial remand. The Veterans Court granted the motion, citing to Rule 41(b) of the Veterans Court’s Rules of Practice and Procedure, and noting that “this order is the mandate of the Court.” Bly applied for attorneys’ fees and expenses under the Equal Access to Justice Act (EAJA), 28 U.S.C. 2412, 31 days later. Remand orders from the Veterans Court may entitle veterans to EAJA fees and expenses. Under 28 U.S.C. 2412(d)(1)(B), such EAJA applications must be made “within thirty days of final judgment in the action.” The Veterans Court reasoned that its judgment became final immediately because the order remanded the case on consent and stated that it was the mandate of the court. The Federal Circuit vacated the denial of his application, reasoning that the consent judgment at issue became “not appealable” 60 days after the entry of the remand order under 38 U.S.C. 7292(a). View "Bly v. Shulkin" on Justia Law

Brown worked for BCP for 10 years. BCP had permitted Brown to wear shirts with BCP patches, rather than a uniform shirt. After discovering that it could order larger-size uniform shirts, BCP purchased such shirts for Brown in 2011. He was fired in January 2012 for wearing the wrong shirt. The Employment Development Department (EDD) denied his application for unemployment benefits. The trial court granted Brown’s writ petition, concluding that Brown had not engaged in misconduct sufficient to disqualify him from benefits because he had offered to go home and change shirts and was terminated on his first violation. In August 2013, EDD responded that EDD had paid Brown “all the benefits for which he has been found eligible,” noting that it was requiring Brown to submit certification forms and that an eligibility issue would need to be resolved before further benefits could be paid. in October 2014, Brown sought enforcement, claiming that EDD had imposed improper conditions, caused extended delays, and continued to withhold benefits. The court found EDD’s failure to comply “without good cause,” levied a $1,000 fine, awarded attorney fees, and determined that the rate of interest for wrongfully withheld unemployment benefits was seven percent, the judgment interest rate (Government Code 965.5(a), (d)). The court of appeal reversed, remanding for calculation of interest at 10 percent under Civil Code 3289(b). EDD’s statutory obligations are like contractual promises, subject to the statutory contractual rate of prejudgment interest. Brown’s right to prejudgment interest gave way to his entitlement to post-judgment interest with the trial court’s order. View "Brown v. California Unemployment Insurance Appeals Board" on Justia Law

Brown worked for BCP for 10 years. BCP had permitted Brown to wear shirts with BCP patches, rather than a uniform shirt. After discovering that it could order larger-size uniform shirts, BCP purchased such shirts for Brown in 2011. He was fired in January 2012 for wearing the wrong shirt. The Employment Development Department (EDD) denied his application for unemployment benefits. The trial court granted Brown’s writ petition, concluding that Brown had not engaged in misconduct sufficient to disqualify him from benefits because he had offered to go home and change shirts and was terminated on his first violation. In August 2013, EDD responded that EDD had paid Brown “all the benefits for which he has been found eligible,” noting that it was requiring Brown to submit certification forms and that an eligibility issue would need to be resolved before further benefits could be paid. in October 2014, Brown sought enforcement, claiming that EDD had imposed improper conditions, caused extended delays, and continued to withhold benefits. The court found EDD’s failure to comply “without good cause,” levied a $1,000 fine, awarded attorney fees, and determined that the rate of interest for wrongfully withheld unemployment benefits was seven percent, the judgment interest rate (Government Code 965.5(a), (d)). The court of appeal reversed, remanding for calculation of interest at 10 percent under Civil Code 3289(b). EDD’s statutory obligations are like contractual promises, subject to the statutory contractual rate of prejudgment interest. Brown’s right to prejudgment interest gave way to his entitlement to post-judgment interest with the trial court’s order. View "Brown v. California Unemployment Insurance Appeals Board" on Justia Law

The Eleventh Circuit sua sponte vacated its prior decision and substituted the following decision, which again affirmed the district court's denial of plaintiff's application for disability insurance benefits and supplemental security income. This decision added a discussion about the 2015 physical capacities form completed by Dr. Jane Teschner and explained why that form did not warrant a remand to the Social Security Administration. View "Hargress v. Social Security Administration" on Justia Law

Johnson worked successively as a firefighter for South San Francisco (CSSF) and Pacifica. He developed nasopharyngeal cancer. Labor Code section 3212.11 establishes a presumption that cancer manifesting during and for a specified period following employment in certain public safety positions, including firefighters, arose out of and in the course of that employment. Section 5500.5(a) limits employer liability for a cumulative injury to the employer who employed the applicant during the one year preceding the earliest of the date of injury or the last date of injurious exposure to the hazards that caused the injury, so either CSSF or Pacifica would be potentially responsible for compensation for the entire injury. CSSF settled Johnson's workers’ compensation claim and sought contribution from Pacifica. An arbitrator denied the petition, ruling that evidence of the latency period for Johnson's cancer showed the injurious exposure occurred during Johnson’s earlier employment with CSSF. The Workers’ Compensation Appeals Board adopted the order. CSSF argued the Board erroneously utilized a more lenient preponderance evidentiary standard in applying section 5500.5(a), rather than the more stringent cancer presumption rebuttal standard of section 3212.1. The court of appeal affirmed; the evidence supports the award. Worker protection policies embodied in section 3212.1 are not implicated in the allocation of liability between employers. View "City of South San Francisco v. Workers' Compensation Appeals Board" on Justia Law

Johnson worked successively as a firefighter for South San Francisco (CSSF) and Pacifica. He developed nasopharyngeal cancer. Labor Code section 3212.11 establishes a presumption that cancer manifesting during and for a specified period following employment in certain public safety positions, including firefighters, arose out of and in the course of that employment. Section 5500.5(a) limits employer liability for a cumulative injury to the employer who employed the applicant during the one year preceding the earliest of the date of injury or the last date of injurious exposure to the hazards that caused the injury, so either CSSF or Pacifica would be potentially responsible for compensation for the entire injury. CSSF settled Johnson's workers’ compensation claim and sought contribution from Pacifica. An arbitrator denied the petition, ruling that evidence of the latency period for Johnson's cancer showed the injurious exposure occurred during Johnson’s earlier employment with CSSF. The Workers’ Compensation Appeals Board adopted the order. CSSF argued the Board erroneously utilized a more lenient preponderance evidentiary standard in applying section 5500.5(a), rather than the more stringent cancer presumption rebuttal standard of section 3212.1. The court of appeal affirmed; the evidence supports the award. Worker protection policies embodied in section 3212.1 are not implicated in the allocation of liability between employers. View "City of South San Francisco v. Workers' Compensation Appeals Board" on Justia Law

Guzman was operating a soil compactor on a hillside with a 45-degree slope when the compactor hit a rock. The compactor rose in the air, causing Guzman to fall backward, and then fell on top of him. The workers’ compensation judge determined that Guzman sustained an injury to his back and psyche and that the psychiatric injury was caused by a “sudden and extraordinary employment condition,” Lab. Code, 3208.3(d). The workers’ compensation carrier for Guzman’s employer unsuccessfully sought reconsideration by the Workers’ Compensation Appeals Board, arguing that Guzman failed to meet his burden of proving that his psychiatric injury was caused by a “sudden and extraordinary employment condition.” The court of appeal annulled the Board’s order denying reconsideration. Guzman did not provide any evidence establishing that it is “uncommon, unusual, and totally unexpected” for a rock to be in soil, for a compactor to rise when striking a rock, or for an operator to become unbalanced and to fall when the compactor rises on a 45-degree hillside. He did not introduce any evidence regarding what regularly or routinely happens if a compactor hits a rock on a slope. Guzman admitted that he had previously worked on flat surfaces only. View "State Compensation Insurance Fund v. Workers’ Compensation Appeals Board" on Justia Law

Shamrock Psychiatric Clinic, P.A., a Medicaid provider, was entitled to a contested-case hearing on the merits of the State’s claim to recoup alleged overpayments.Texas law directs the Inspector General to recover from a Medicaid provider any “overpayment” identified in a fraud or abuse investigation. Here, Shamrock received a “Notice of Payment Hold." Shamrock requested an expedited administrative hearing. Shamrock later received a “Final Notice of Overpayment.” The parties agreed to consolidate the payment hold and overpayment issues into one proceeding. The administrative law judge (ALJ) dismissed the overpayment and payment-hold cases due to Shamrock’s failure to submit a timely written request for an appeal. Shamrock filed suit. The trial court granted the Inspector General’s plea to the jurisdiction on sovereign immunity grounds. Shamrock appealed, arguing that the ALJ and Inspector General had a ministerial duty to abide by a Rule 11 agreement created by the parties’ communications and the Inspector General’s written representations. The court of appeals affirmed. The Supreme Court reversed, holding (1) the parties agreed that Shamrock would defend itself against the overpayment claims in a contested-cse hearing; (2) the ALJ failed to perform the purely ministerial act of enforcing the Rule 11 agreement; and (3) therefore, the ultra vires exception to sovereign immunity applied to Shamrock’s suit. View "Shamrock Psychiatric Clinic, P.A. v. Texas Department of Health & Human Services" on Justia Law