Justia Public Benefits Opinion Summaries

Demyanovich, an employee of Cadon for more than 20 years, was terminated after he requested leave under the Family and Medical Leave Act to treat his congestive heart failure. He had previously taken leave and his condition had gotten worse over the course of about 10 years. He claimed that Cadon and his direct supervisor, Ensign, interfered with his exercise of his FMLA rights, retaliated against him for seeking FMLA leave, and discriminated against him on the basis of disability. Ensign denied the FMLA request because he believed that Cadon did not have enough employees to be subject to the Act, but referred to Demyanovich as a “liability” immediately after the request for FMLA leave. The district court entered summary judgment in favor of Cadon. The Sixth Circuit reversed, noting evidence that establishs a genuine factual dispute as to whether Demyanovich was permanently incapable of working at the time that he was terminated. View "Demyanovich v. Cadon Plating & Coating, L.L.C." on Justia Law

Gentry has psoriasis, a chronic autoimmune condition causing patches of raised skin covered with flaky buildup of dead skin cells that crack and bleed and can interfere with sleeping, walking, sitting, standing, and using one’s hands. She also has psoriatic arthritis, an inflammatory disease that causes fatigue, stiffness and swelling in and around the joints, tenderness, pain and swelling in the tendons, swollen fingers and toes, and reduced range of motion. There is no cure for either condition. Gentry suffered severe injuries to her ankle, arm and wrist, and hip in a 1994 car accident and developed avascular necrosis and post-traumatic arthritis. She requires a brace on her leg to walk, has a limp and waddling gait, and has frequent pain in her leg and foot, back, neck, and hands. She also has deformities in her foot, ankylosing spondylitis cervical radiculopathy, cervical stenosis, lumbar spondylosis, possible sacroilitis or facet arthropathy in the low back, degenerative joint disease in the low back, chronic lumbar strain, possible herniated disc carpal tunnel syndrome, and lumbosacral/thoracic radiculopathy, among other things. In 2004, Gentry (age 29) applied for disability benefits under the Social Security Act, 42. U.S.C.401. She had worked 10 years as a pizza maker and delivery driver. She had most recently worked as a receptionist, but was discharged because her psoriasis bled on the paperwork. After Gentry’s application was denied, the case was remanded twice. The district court affirmed the denial of benefits. The Sixth Circuit reversed the denial as not supported by substantial evidence. View "Gentry v. Comm'r of Soc. Sec." on Justia Law

The former miner sued in 1992 and an administrative law judge determined that he was not medically qualified for benefits under the Black Lung Benefits Act, 30 U.S.C. 901 and indicated that Arkansas Coals was not the “responsible operator” required to pay benefits. About 17 years later, the miner filed a second claim. After finding that his medical condition had worsened and that he was now disabled, an ALJ awarded benefits and determined that Arkansas Coals was the responsible operator. The Benefits Review Board and the Sixth Circuit affirmed, rejecting the company’s finality, waiver, and collateral estoppel arguments; the miner was entitled to bring a second claim under 20 C.F.R. 725.309(d)(4) and the determination that Arkansas Coals was the responsible operator was not “necessary” to the resolution of the initial claim. Substantial evidence supports the determination that Arkansas Coals is the responsible operator. View "Arkansas Coals, Inc. v. Lawson" on Justia Law

Maynes, a miner who developed pneumoconiosis after working in Consolidated’s coal mine for 25 years, received benefits under the Black Lung Benefits Act, 30 U.S.C. 901-944, from 1997 until he died of respiratory failure in 2003. His widow sought survivors’ benefits. The then-current version of the BLBA conditioned her eligibility for benefits on proof that pneumoconiosis either caused or hastened her husband’s death. Her 2003 claim was denied. The Benefits Review Board and Sixth Circuit affirmed. In 2010, Congress passed the Affordable Care Act, which amended the law so that survivors are automatically entitled to benefits if the miner received BLBA benefits during his lifetime. Congress specified that the changes would apply to claims filed after January 2005, but did not address whether persons whose claims had been denied under the previous eligibility framework, could receive benefits by filing a subsequent claim. The issue was answered in the affirmative by the Benefits Review Board and affirmed by the Third and Fourth Circuits. Although the Department of Labor, an administrative law judge, and the Benefits Review Board agreed Maynes was entitled to benefits, they disagreed about the appropriate commencement date for benefits. The Sixth Circuit rejected Consolidated’s appeal, upholding the 2009 commencement date. View "Consolidation Coal Co. v. Maynes" on Justia Law

Ogle, born in 1954, worked in underground coal mines for 21 years, most recently in 1996 in Kentucky. Ogle smoked since age 12. He sought black lung benefits in 2007. After the record closed but before the ALJ issued a decision, Congress revived a rebuttable statutory presumption that a coal miner who worked in an underground mine for at least 15 years and suffers from a total respiratory or pulmonary disability is presumed to be totally disabled due to pneumoconiosis, 30 U.S.C. 921(c)(4). The ALJ awarded benefits, finding that Ogle suffered from totally disabling respiratory impairment, a conclusion with which all medical opinions agreed. The ALJ stated that the presumption shifts the burden to demonstrate by a preponderance of the evidence that either the miner’s disability does not, or did not, arise out of coal mine employment or the miner did not, suffer from pneumoconiosis. The Fund demonstrated that Ogle did not suffer from clinical pneumoconiosis, but failed to rebut the presumption that Ogle suffers from legal pneumoconiosis. The Board affirmed. The Sixth Circuit denied a petition for review, finding no evidence that the ALJ improperly restricted the Fund’s ability to rebut the 15-year presumption or that the ALJ applied the wrong standard. View "Big Branch Res., Inc. v. Ogle" on Justia Law

Ramage, born in 1933, worked for Island Creek for 28 years, five years underground and 23 years on the surface. In 2007 he sought black lung benefits. While the claim was pending, Congress revived a statutory rebuttable presumption that a coal miner who worked in an underground coal mine for 15 years and suffers from a total respiratory or pulmonary disability is presumed to be totally disabled due to pneumoconiosis, 30 U.S.C. 921(c)(4), applicable to pending claims filed after January 1, 2005. The ALJ noted that x-rays did not show pneumoconiosis, that Ramage could not complete a pulmonary function test due to a tracheostomy, and that arterial blood-gas studies were qualifying under the federal standards. The ALJ summarized the medical opinions of five doctors, including one who emphasized that it was impossible to distinguish between the damage due to coal dust as opposed to the damage due to smoking. The ALJ awarded benefits and the Benefits Review Board affirmed. The Sixth Circuit denied a petition for review, holding that the ALJ’s determinations were reasoned and reasonable and that the legislative provisions creating the presumption are self-executing.View "Island Creek KY Mining v. Ramage" on Justia Law

A nursing home resident and her community spouse (husband) were penalized based on husband’s purchase of an annuity for himself using funds from his IRA. The district court granted summary judgment in favor of the director of the Ohio Department of Job and Family Services, holding that 42 U.S.C. 1396r-5(f)(1) precluded the transfer of assets because it exceeded husband’s community spouse resource allowance. Section 1396p(c) requires a state to impose a transfer penalty (a period of restricted coverage) if either spouse disposed of assets for less than fair market value during the look-back period. The Sixth Circuit reversed, reasoning that the transfer occurred before the Ohio agency determined that wife was eligible for Medicaid coverage and section 1396p(c)(2)(B)(i) permits an unlimited transfer of assets “to another for the sole benefit of the individual’s spouse.” View "Hughes v. Colbert" on Justia Law

Williams had worked at Marathon’s Ashland, Kentucky, facility for 25 years, most recently as a senior barge welder. Williams alleged that he sustained a long thoracic nerve injury to his right shoulder while replacing parts of a barge in 2003. His injury was likely the result of the cumulative effect of his heavy lifting. Williams has not returned to work and has been seen by several physicians, but they do not agree on a common diagnosis. Following a remand the Benefits Review Board of the U.S. Department of Labor affirmed an administrative law judge’s award of permanent and total disability benefits under the Longshore and Harbor Workers’ Compensation Act, 33 U.S.C. 901. On a second appeal, the Sixth Circuit affirmed, finding that Williams is permanently and totally disabled and is unable to perform the alternative employment identified by Marathon’s vocational expert. The court granted Williams leave to seek attorney fees under 33 U.S.C. 928(a). View "Marathon Ashland Petroleum v. Williams" on Justia Law

Southern Rehabilitation Group and its medical director sued the Secretary of Health and Human Services and past and present Medicare contractors, seeking review of the Secretary’s final decision on 6,200 claims for Medicare reimbursement. The district court remanded so that the Secretary could pay the disputed amount. After payment, the case returned to the district court, which concluded that the claims for payment were moot and dismissed remaining constitutional and statutory claims as barred by jurisdictional provisions of the Medicare Act. The court also held that plaintiffs did not show that they were eligible to collect interest on their claims and that it did not have jurisdiction over 8,900 other claims that plaintiffs alleged were still in the administrative process. The Sixth Circuit affirmed summary judgment to defendants on plaintiffs’ federal and state law claims and on the 8,900 claims still in the administrative process, but reversed summary judgment on plaintiffs’ claims for interest. The Secretary could not rely on her unreasonable interpretation of the “clean-claims” statute as a basis for summary judgment concerning interest. View "S. Rehab. Grp. v. Sec'y of Health & Human Servs." on Justia Law

Plaintiffs, employees of Coca-Cola, suffered work-related injuries and applied for workers’ compensation benefits through Sedgwick, Coca-Cola’s third-party benefit claims administrator. Sedgwick disputed the claims. Plaintiffs claim that Coca-Cola and Sedgwick “engaged in a fraudulent scheme involving the mail . . . to avoid paying benefits to injured employees,” and filed suit under the civil remedies provision of the Racketeer Influenced and Corrupt Organizations Act (RICO), 18 U.S.C. 1962(c). The district court dismissed. On rehearing, en banc, the Sixth Circuit affirmed, holding that the plaintiffs did not plead an injury to their “business or property” that is compensable under RICO. The RICO theory advanced in this case would throw the viability of workers’ compensation schemes into doubt; RICO “does not purport to afford remedies for all torts committed by or against persons engaged in interstate commerce.” The Michigan workers’ compensation scheme provides ample mechanisms by which the employee can contest denials. View "Jackson. Segwick Claims Mgmt. Servs." on Justia Law