Justia Public Benefits Opinion Summaries

The court agreed to rehear this case en banc to clarify under what circumstances the exhaustion requirement of the Individuals with Disabilities Education Act (IDEA), 20 U.S.C. 1415(l), barred non-IDEA federal or state law claims. Plaintiff, on behalf of herself and her son, appealed the district court's grant of summary judgment to defendants where the district court dismissed her claims for lack of subject matter jurisdiction because plaintiff did not initially seek relief in a due process hearing and therefore, failed to comply with one of the exhaustion-of-remedies requirement of the IDEA. The court held that the IDEA's exhaustion requirement was not jurisdictional and that plaintiff's non-IDEA federal and state-law claims were not subject to the IDEA's exhaustion requirement. Therefore, the court reversed the judgment.

The parents of E.M., a bilingual student, brought an action to challenge the Pajaro Valley Unified School District's (District) determination that E.M. did not qualify for special education under the Individuals with Disabilities Education Act (IDEA), 20 U.S.C. 1400 et seq. The Special Education Division of the California Office of Administrative Hearings (OAH) upheld the District's assessment and the district court affirmed the OAH's decision. The court disagreed with the district court's assessment only to the extent that it found one claim not addressed and one report not measured for its relevance. Accordingly, the court affirmed the judgment of the district court in part and reversed in part. The court remanded for the district court to consider whether the report was relevant to the determination of whether the district met its obligations to E.M. under the IDEA and whether an auditory processing disorder could qualify as an other health impairment, and if so, whether the district met its obligations to assess E.M. and identify him as a child with an other health impairment.

The parents of E.M., a bilingual student, brought an action to challenge the Pajaro Valley Unified School District's (District) determination that E.M. did not qualify for special education under the Individuals with Disabilities Education Act (IDEA), 20 U.S.C. 1400 et seq. The Special Education Division of the California Office of Administrative Hearings (OAH) upheld the District's assessment and the district court affirmed the OAH's decision. The court disagreed with the district court's assessment only to the extent that it found one claim not addressed and one report not measured for its relevance. Accordingly, the court affirmed the judgment of the district court in part and reversed in part. The court remanded for the district court to consider whether the report was relevant to the determination of whether the district met its obligations to E.M. under the IDEA and whether an auditory processing disorder could qualify as an other health impairment, and if so, whether the district met its obligations to assess E.M. and identify him as a child with an other health impairment.

Plaintiff, the mother of a developmentally disabled high school student, alleged that the several sexual encounters her daughter had with another developmentally disabled student in a school bathroom were the result of the school's failure to properly supervise her daughter. At issue was whether plaintiff, individually and on behalf of her daughter, had a cognizable Fourteenth Amendment due process claim against the daughter's special education teacher. The court held that the district court properly dismissed plaintiff's 42 U.S.C. 1983 civil rights claim at summary judgment where the special-relationship exception and the state-created danger exception did not apply in this case. The court held that whatever liability the special education teacher faced, that liability must come from state tort law, not the Fourteenth Amendment. Accordingly, the judgment of the district court was affirmed.

Plaintiffs, married couples who worked as house parents to children who were "severely emotionally disturbed" in defendants' homes, sued defendants for overtime pay under the Fair Labor Standards Act ("FLSA"), 29 U.S.C. 203(r)(2)(A). The children attended local public schools and participated in other activities away from the homes. Although, the children participated in group therapy conducted by clinicians in the homes, they received most of their medical and psychological treatment outside the homes. Plaintiffs were not licensed medical or social service professionals. Defendants filed an interlocutory appeal challenging the district court's conclusion that defendants' homes were covered by the FLSA and were subject to its overtime provisions. The court held that defendants' homes were not covered by the FLSA because they were not an "institution primarily engaged in the care of the sick, the aged, mentally ill or defective who resided on the premises of such institution." Accordingly, the court reversed and remanded for further proceedings.

Appellant, a medicare provider, appealed its notice of program reimbursement for the fiscal year ending in 2001 to the Provider Reimbursement Review Board ("Board"), which dismissed the appeal because appellant missed its deadline to file a preliminary position paper. After the Board denied appellant's motion for reinstatement of its appeal, appellant filed the current action and subsequently appealed from the district court's order granting summary judgment for appellee. The court affirmed summary judgment and held that the Board's Instructions requiring dismissal of claims due to failure to timely submit preliminary position papers did not violate the Medicare Act, 42 U.S.C. 1395, and the Board's dismissal of appellant's claim was neither arbitrary or capricious.

Plaintiff applied for disability benefits based on combined impairments including bullous emphysema, depression, anxiety, and bipolar disorder and alleged that her disability began when her right lung collapsed. Plaintiff appealed the district court's decision affirming the Commissioner of Social Security's denial of her application for disability insurance benefits and supplemental security income benefits under Titles II and XVI of the Social Security Act, 42 U.S.C. et seq. The court held that the administrative law judge ("ALJ") erred by failing to follow the requirements of 20 C.F.R. 404.1520(a) in determining whether plaintiff's mental impairments were severe and, if severe, whether they met or equaled a listed impairment. Accordingly, the court reversed the judgment of the district court with instructions to remand to the ALJ to conduct a proper review of plaintiff's mental impairments.

Plaintiffs, a class of indigent children who suffered from severe emotional and mental disabilities, sued Idaho state officials more than three decades ago, alleging that the officials were providing them with inadequate care in violation of their constitutional and statutory rights. The parties reached agreements intended to remedy deficiencies in care and those agreements were embodied in three consent decrees entered and monitored by the district court. Plaintiffs appealed the 2007 order of the district court finding that defendants had substantially complied with the remaining Action Items, which were specified in an Implementation Plan that resulted from the third consent decree, asserting that it was error for the district court to apply the standard for civil contempt in determining whether to vacate the decrees. Plaintiffs further contended that the district court committed errors in fact and law in issuing protective orders barring them from taking supplemental depositions of appellee and two non-parties. The court held that the district court's application of the contempt standard with the imposition of the burden of proof on plaintiffs was error where the district court accepted the Action Items as the entire measure of compliance with the consent decree. Accordingly, the court reversed the order of the district court. The court also held that the district court committed no errors in upholding the assertion of the deliberative process privilege to one non-party and appellee, as well as the legislative privilege to the second non-party. Accordingly, the court did not abuse its discretion in issuing the protective orders.

Plaintiff applied for Supplemental Security Income disability benefits alleging disability due to a combination of impairments. At issue was whether plaintiff's hearing before the administrative law judge ("ALJ") was invalid where plaintiff waived his right to representation at his hearing. The court held that there was no agency error where there was no disclosure required other than the disclosure in 42 U.S.C. 406(c) and that section 406(c)'s disclosure requirements were met.

Plaintiff applied at age 51 for supplemental security income based on disability. At issue was whether the administrative law judge ("ALJ") erred by failing to develop the record adequately and should have requested more explanation from two of plaintiff's treating physicians at the Department of Veterans Affairs ("VA"). The court held that the ALJ's failure to assist plaintiff in developing the record by getting his disability determination into the record was probably likely to have been prejudicial because the court gave VA disability determinations great weight. Therefore, the court remanded under sentence four of 42 U.S.C. 405(g), concluding that "the agency erred in some respect in reaching a decision to deny benefits."