Justia Public Benefits Opinion Summaries

The Ninth Circuit affirmed in part and reversed in part the district court's order affirming the Commissioner's denial of plaintiff's application for social security disability insurance (SSDI) benefits. The panel held that the ALJ erred in its assessment by not calling a medical advisor at the hearing; by giving too little weight to the observations of plaintiff's fiancé; and by finding that plaintiff was only partially credible. The panel reversed on these grounds and remanded. In a separately filed memorandum disposition, the panel rejected plaintiff's other challenges and affirmed that portion of the ALJ's decision. View "Diedrich v. Berryhill" on Justia Law

The Ninth Circuit reversed the district court's order affirming the denial of supplemental security income and disability insurance benefits. Plaintiff suffers from fibromyalgia. In July 2012, the SSA issued Social Security Ruling (SSR) 12-2P, a ruling that establishes that fibromyalgia may be a severe medical impairment for purposes of determining disability, and provided guidelines for the proper evaluation of the disease. The panel held that the ALJ, SSA Appeals Council, and the district court failed to heed the instructions of those rulings, and instead analyzed plaintiff's symptoms and rejected her claim without considering the unique characteristics of fibromyalgia, the principal source of her disability. The panel remanded with instructions for the district court to remand the case to the agency for the calculation and award of benefits. View "Revels v. Berryhill" on Justia Law

The issue presented for the Oregon Supreme Court’s review was whether an adult foster care provider claiming unjust enrichment may recover the reasonable value of its services from a defendant who, through fraud, obtained a lower rate from the provider for the services. Plaintiff owned two adult foster homes for the elderly. Plaintiff had contracted with the Oregon Department of Human Services to provide services in a home-like setting to patients who qualified for Medicaid. For those patients, the rates charged would be those set by the department. Isabel Pritchard resided and received care in one of plaintiff’s adult foster homes until her death in November 2008. Because Prichard had been approved to receive Medicaid benefits, plaintiff charged Prichard the rate for Medicaid-qualified patients: approximately $2,000 per month, with approximately $1,200 of that being paid by the department. Plaintiff’s Medicaid rates were substantially below the rates paid by plaintiff’s “private pay” patients. Prichard’s application for Medicaid benefits, as with her other affairs, was handled by her son, Richard Gardner. Gardner had for years been transferring Prichard’s assets, mostly to himself (or using those funds for his personal benefit). Gardner’s misconduct was discovered by another of Prichard’s children: defendant Karen Nichols-Shields, who was appointed the personal representative for Prichard’s estate. In 2009, defendant contacted the police and reported her brother for theft. Ultimately, Gardner pleaded guilty to three counts of criminal mistreatment in the first degree. Gardner’s sentence included an obligation to pay a compensatory fine to Prichard’s estate, to which he complied. After defendant, in her capacity as personal representative, denied plaintiff Larisa’s Home Care, LLC’s claim against Prichard’s estate, plaintiff filed this action, essentially asserting Prichard had been qualified for Medicaid through fraud and that Prichard should have been charged as a private pay patient. The Oregon Supreme Court concluded that, generally, a defendant who obtains discounted services as a result of fraud is unjustly enriched to the extent of the reasonable value of the services. The Court therefore reversed the contrary holding by the Court of Appeals. Because the fraud here occurred in the context of a person being certified as eligible for Medicaid benefits, however, the Court remanded for the Court of Appeals to consider whether certain provisions of Medicaid law may specifically prohibit plaintiff from recovering in this action. View "Larisa's Home Care, LLC v. Nichols-Shields" on Justia Law

The Hayes family is a low-income family whose rent is subsidized by enhanced voucher assistance under the Housing Act of 1937, 42 U.S.C. 1437f(t) (Section 8). Because an ordinary voucher does not cover a tenant’s rent to the extent that it exceeds the applicable payment standard, and, following a valid opt-out, property owners are no longer subject to limitations on what they may charge for rent, enhanced vouchers exist to enable residents to “choose” to continue renting the “dwelling unit in which they currently reside.” The Hayes family's eligibility to receive enhanced vouchers is contingent upon their continued tenancy in a unit currently owned by Harvey. Toward the end of their most recent lease term, Harvey notified the Hayes family that he would not renew their lease. The Hayes family refused to vacate the premises, arguing that as enhanced-voucher tenants, they have an enforceable “right to remain” in their unit as long as it is offered for rental housing. The district court granted Harvey summary judgment. The Third Circuit affirmed. The Act does not obligate property owners to renew enhanced-voucher tenancies after the initial lease term. View "Hayes v. Harvey" on Justia Law

In 2011, Cosenza sought disability benefits on behalf of her minor son. An ALJ determined that J.M.F. was not disabled. The Appeals Council denied her request for review. Cosenza argued that the ALJ improperly found that her son’s autism and Asperger’s syndrome were not “medically determinable” impairments. The district judge granted Cosenza summary judgment and remanded under 42 U.S.C. 405(g); 5), terminating the case in the district court. On remand, another ALJ conducted a hearing in March 2016. In June Cosenza filed a motion in the closed federal case to hold the Commissioner in contempt “for not following court-ordered remand.” In July the ALJ ruled against Cosenza. Cosenza did not wait for the decision to become final but moved for summary judgment in the closed federal case and filed a letter with the Appeals Council requesting review. The district court granted the agency’s motion to strike, reasoning that it had relinquished jurisdiction over Cosenza’s first case; as to most recent decision, the administrative appeals process had not finished so no final decision existed for judicial review. Cosenza had not shown that the Commissioner violated the court’s remand order. The Seventh Circuit affirmed. A district court lacks jurisdiction under the Social Security Act to review an ALJ’s unfavorable decision until the agency’s decision is final; the Appeals Council has not yet decided whether to review the ALJ’s decision. View "Cosenza v. Berryhill" on Justia Law

Christensen, an applicant for aid under the California Work Opportunity and Responsibility to Kids Act (CalWORKs) program, Welf. & Inst. Code, 11200, lives with her husband and her children. Her husband is the noncustodial parent of additional children, and court-ordered child support is garnished from his income for the benefit of these children who do not live in the applicant’s home. Counting the garnished amounts as nonexempt income to the applicant’s family, San Mateo County determined the family’s income was too high to qualify for CalWORKs cash aid and denied the application. The California Department of Social Services affirmed the denial. The trial court granted Christensen’s petition for writ of administrative mandate and request for declaratory relief, finding the Department’s policy of counting child support payments as nonexempt income was invalid on the grounds it was contrary to regulation, and it resulted in improper “double counting” of income among recipients of aid. The court of appeal reversed. No statute or regulation requires the exemption of the husband’s garnished child support from the income of applicant’s family, so the Department properly treated such amounts as income in determining the applicant’s family’s eligibility for CalWORKs cash aid. View "Christensen v. Lightbourne" on Justia Law

McGann, who is blind and deaf, requested from Cinemark an American Sign Language (ASL) tactile interpreter so that he could experience a movie in his local Cinemark theater during one of its regular showings. Cinemark denied his request. McGann filed suit under the Americans with Disabilities Act (ADA), 42 U.S.C. 12101 ADA. After a bench trial in which the parties stipulated to all relevant facts, the district court entered Judgment in favor of Cinemark. It reasoned that McGann’s requested tactile interpreter was not an auxiliary aid or service under the ADA and that the ADA did not require movie theaters to change the content of their services or offer “special” services for disabled patrons. The Third Circuit vacated. The tactile interpreter McGann requested is an “auxiliary aid or service.” A a public accommodation may avoid ADA liability for failure to provide an auxiliary aid or service only if it shows that the aid or service in question “fundamentally alter[s] the nature” of its goods or services, or “would result in an undue burden, i.e., significant difficulty or expense.” The court remanded for consideration of CInemark’s possible defense. View "McGann v. Cinemark USA Inc" on Justia Law

Bowling worked as a coal miner for 29 years, most recently for Island Fork. In 2002, Bowling unsuccessfully sought Black Lung Benefits Act (BLBA) benefits. In 2010, Bowling filed the current claim. In the meantime, the Affordable Care Act amended the BLBA to reinstate a rebuttable presumption that claimants with respiratory disabilities and 15 years or more of underground coal-mining work experienced those disabilities as a result of pneumoconiosis, 30 U.S.C. 921(c)(4). The District Director designated Island Fork as the responsible operator and awarded benefits. At a hearing, the ALJ learned that Island Fork and its insurer, Frontier were insolvent. Frontier declared insolvency after the Proposed Order issued. At the initial stages, if the District Director determines that an operator is not financially capable, the Director can select another operator—such as a previous employer—to be the responsible operator; once the claim reaches the ALJ, there is no mechanism to designate a different responsible operator. The Trust Fund, created by the BLBA, provides benefits when there are no responsible operators available, including when an operator is deemed at the ALJ stage not to be financially capable. KIGA, created by the Kentucky Insurance Guaranty Association Act, provides benefits when a member insurance company is insolvent. The ALJ decided that Island Fork was still the responsible operator because benefits could be paid by KIGA. The Sixth Circuit affirmed. The exclusions in the Guaranty Act do not apply; KIGA is liable. View "Island Fork Construction v. Bowling" on Justia Law

The Fourth Circuit vacated the district court's judgment affirming the denial of disability benefits to plaintiff. The court agreed with plaintiff and held that the ALJ improperly assessed the medical opinion evidence and disregarded the treating physician rule in rendering his residual functioning capacity (RFC) determination and finding that plaintiff could persist through an eight-hour workday. Accordingly, the court remanded for further proceedings. View "Brown v. Commissioner Social Security Administration" on Justia Law

Goodman served in the U.S. Army, 1972-1992, with service in Southwest Asia during the Persian Gulf War. During his service and at his discharge, Goodman underwent medical examinations that returned negative for rheumatoid arthritis; he denied having pain in his joints or arthritis. In 2007, Goodman sought treatment at a VA medical center for hand stiffness and knee pain, which he said had begun during service. He sought VA benefits for rheumatoid arthritis. The Board sought an independent medical advisory opinion from the Veterans Health Administration, which was conducted by a VA medical center Director of Rheumatology in 2014 and concluded that “it is less likely than not” that Goodman’s rheumatoid arthritis can be characterized as a medically unexplained chronic multi-symptom illness (MUCMI) under 38 C.F.R. 3.317, and that it “is less likely than not that his rheumatoid arthritis is related to a specific exposure event experienced … during service. The Board concluded that Goodman was not entitled to a presumptive service connection for a MUCMI; the Federal Circuit affirmed. The VA adjudicator may consider evidence of medical expert opinions and all other facts of record to make the final determination of whether a claimant has proven, based on the claimant’s unique symptoms, the existence of a MUCMI. View "Goodman v. Shulkin" on Justia Law