Justia Public Benefits Opinion Summaries

In 2006 the claimant sought disability benefits, alleging injury in a construction accident. An ALJ denied the claim and the appeals council denied review. The district court upheld the denial. The Sixth Circuit vacated. The ALJ's decision was incomplete and improperly gave greatest weight to the opinion of a non-treating state agency physician, rather than to the opinion of a treating physician. The ALJ mischaracterized the treating physician's treatment notes.

Plaintiff filed several suits against healthcare groups on behalf of the United States, claiming violation of the Medicare Secondary Payer Act, 42 U.S.C. 1395y(b). No court has ever found that the MSP is a qui tam statute, permitting private attorneys general to sue on behalf of the United States. The Sixth Circuit found plaintiff was on notice of the frivolous nature of his filings from their inception in the Tennessee district courts and remanded for a show-cause hearing on why sanctions should not issue. The district court awarded sanctions to two defendants in amounts of $131,158.50 and $145,431.19. The Sixth Circuit affirmed, but denied an award for the appeal.

Petitioner was awarded disability insurance benefits for a period beginning in 1983. In 2002 the Social Security Administration produced evidence he had engaged in substantial gainful employment; the Appeals Council accordingly reopened and remanded to an administrative law judge, who determined that petitioner was not entitled to disability benefits. The district court and Sixth Circuit affirmed. Petitioner's subsequent application for supplemental security income benefits was denied; the district court and Sixth Circuit affirmed. The petitioner then sought a writ of mandamus to compel the SSA to reopen his case and reinstate benefits. The Sixth Circuit dismissed for lack of jurisdiction to issue a writ directly to the agency.