Justia Public Benefits Opinion Summaries

Meuser, 46 years old, was diagnosed with schizophrenia in 1996. For 15 years managed his symptoms with the antipsychotic drug Zyprexa. From 1995-2012, Meuser worked in a mailroom. Meuser’s health began deteriorating in late 2011 after his pharmacist gave him the generic version of Zyprexa. Meuser started having insomnia; he could not focus at work. Hoping that a break would improve his symptoms, Meuser took a leave of absence from his job. He was and is living with his parents.His new psychiatrist rediagnosed Meuser’s schizophrenia from “undifferentiated” to “paranoid type,” which involves “prominent delusions or auditory hallucinations,” switched Meuser back to the brand‐name Zyprexa, and increased his dosage. Meuser said he still did not feel well enough to return to work. Faced with the choice of returning to work or being fired, Meuser quit his job. An ALJ denied his application for Social Security Disability Insurance Benefits, finding that Meuser’s schizophrenia was not a severe impairment. The Seventh Circuit reversed, holding that the ALJ misunderstood the medical evidence and improperly rejected the treating psychiatrist’s opinion, so the conclusion that Meuser did not have a severe impairment was not supported by substantial evidence View "Meuser v. Colvin" on Justia Law

Pursuant to 8 U.S.C. 1157(a)(2), the President authorized entry of 85,000 refugees for fiscal 2016; at least 10,000 were to come from Syria. Since 2001, all persons seeking to enter the U.S. as refugees are required to undergo screening by the U.N. High Commissioner for Refugees, followed by multiple layers of screening by the federal government, which can take two years. Indiana has an approved refugee resettlement plan (8 U.S.C. 1522) and receives federal funds to contract with private agencies for the provision of services, “without regard to race, religion, nationality, sex, or political opinion.” Indiana’s governor refused to pay for services to any refugee whose “‘country of origin” is Syria. The Seventh Circuit affirmed entry of a preliminary injunction. Regulation of immigration is a federal function. The state’s brief provided no evidence that Syrian terrorists are posing as refugees or have ever committed acts of terrorism in the U.S. The court characterized the governor’s argument as “the equivalent of his saying . . . that he wants to forbid black people to settle in Indiana not because they’re black but because he’s afraid of them, and since race is therefore not his motive he isn’t discriminating.” Indiana is free to withdraw from the refugee assistance program, but withdrawal might not interrupt the flow of Syrian refugees; the Wilson/Fish program distributes federal aid to refugees without the involvement of the state government. View "Exodus Refugee Immigration, Inc. v. Pence" on Justia Law

O.B., two years old, has Down Syndrome, lung disease, and cardiac abnormalities. He is ventilator‐dependent and cannot digest take oral nutrition. O.B. is the named plaintiff in a class action against the Illinois Department of Healthcare and Family Services, alleging violation of the Medicaid Act. The Act defines “medical assistance” as including “early and periodic screening, diagnostic, and treatment services [EPSDT] … for individuals … under the age of 21,” 42 U.S.C. 1396d(a)(4)(B), and requires "reasonable promptness." EPSDT services include “private duty nursing services,” so that the child lives at home. When he was nine months old, the Department approved $19,718 monthly to pay nurses for up to 18 hours a day to care for O.B. at home. It took his parents almost a year to obtain home‐nursing staff so that O.B. could go home. The district judge certified a class of Illinois children who have been approved for home nursing but who have not been able to hire nurses. The judge ordered the Department to “take immediate and affirmative steps to arrange directly or through referral . . . in‐home shift nursing services.” The Seventh Circuit affirmed, noting that Congress has clarified that where the Act refers to the provision of services, a participating state is required to provide (or ensure the provision of) services, not merely pay for them and that O.B.’s in-hospital care cost four times what home nursing would cost. View "O. B. v. Norwood" on Justia Law

In 2010, Ghiselli applied for disability insurance benefits under the Social Security Act, claiming that she was unable to work due to a combination of health problems that included degenerative disc disease, asthma, and obesity. She asserted that she had been employed as a retail customer service manager and was disabled by injuries she suffered at her job on August 6, 2007, when a customer struck her in the back with a shopping cart. After her initial application and her request for reconsideration were denied, an administrative law judge found that she was not disabled despite her impairments. The district court, reviewing the ALJ’s decision under 42 U.S.C. 405(g), held that the decision was supported by substantial evidence, and affirmed. The Seventh Circuit reversed, reasoning that the ALJ erred in finding that she lacked credibility based on certain purportedly inconsistent statements. View "Ghiselli v. Colvin" on Justia Law

Presser, who has 20 years of experience as a Wisconsin nurse and a nurse practitioner, began working with Acacia in 2011, providing psychiatric evaluations, managing patient medication, and providing other medical services. Presser alleges that Acacia and its owner, Freund, engaged in “upcoding,” provided unnecessary medical procedures, and then charged the federal and state governments for those expenses. The district court dismissed Presser’s qui tam action under the False Claims Act, 31 U.S.C. 3729 and the Wisconsin False Claims Act. Citing the need for particularity in pleading, the court noted Presser did not allege that the defendants actually sent any of the alleged claims or made any of the alleged statements to the state or federal governments. The Seventh Circuit affirmed that judgment except with respect to the claims regarding the use of an improper billing code, which were stated with sufficient particularity. Presser otherwise provided no medical, technical, or scientific context which would enable a reader of the complaint to understand why Acacia’s alleged actions amount to unnecessary care forbidden by the statute. View "Presser v. Acacia Mental Health Clinic, LLC" on Justia Law

Alvarado was born in 1967. In 1993 he was granted childhood disability benefits and Supplemental Security Income. The Social Security Act requires the Social Security Administration to periodically review whether a recipient remains disabled. Alvarado’s eligibility was reviewed and affirmed in 1999. In a 2004 review, the Administration determined that his disability had ended, so his benefits were discontinued. After a remand, a hearing officer and ALJ each upheld the decision, finding that Alvarado continued to suffer from a severe learning disorder, which prevented him from performing many jobs, but which did not prevent him from doing simple jobs that did not require interaction with the public and that a significant number of such jobs exist in Illinois,. The Appeals Council denied review. The district judge and Third Circuit affirmed, finding the denial supported by substantial evidence. The court noted evidence evidence that Alvarado: had a driver’s license and drove regularly, including long trips; used public transportation; had obtained an associate’s degree and was only a few credits short of a bachelor’s degree; had lived alone, in a different state from his family; assisted at his mother’s flower shop; performed chores at home; and used the internet. View "Alvarado v. Colvin" on Justia Law

O’Connor-Spinner, age 47, suffers from depression and several physical impairments, including degenerative disk disease, bilateral carpal tunnel syndrome, sleep apnea, “restrictive lung disease,” and obesity. Several times since 2001 she has applied for Disability Insurance Benefits and Supplemental Security Income. In 2010, the Seventh Circuit invalidated the Social Security Administration’s denial of her 2004 request for benefits, noting that the ALJ had not asked a testifying vocational expert to assess how O’Connor-Spinner’s employment prospects would be affected by her moderate limitation on concentration, persistence, and pace, and had ignored a psychologist’s opinion that O’Connor-Spinner also faces a moderate limitation on her ability to accept instructions from, and respond appropriately to, supervisors. On remand, a different ALJ contradicted his colleague and declared that O’Connor-Spinner’s depression is not, and never was a severe impairment. The Seventh Circuit again vacated and remanded, stating that the medical evidence contradicts the ALJ’s assertion. The court noted symptoms including recurring agitation, impulsivity, fatigue, crying spells, and two or three “explosive episodes” weekly involving violent behavior and memory blackouts. View "O'Connor-Spinner v. Colvin" on Justia Law

In 2000, while working as a welder, Cole (then in his 20s) broke his left arm and wrist, requiring insertion of a metal plate and screws in his arm. He experienced pain that has still not gone away. In 2008, employed as a factory foreman, he fell off a 10‐foot ladder, landing on his right elbow. He received physical and occupational therapy, but the pain has persisted. An orthopedic surgeon diagnosed cubital tunnel syndrome and performed an anterior ulnar nerve transposition. Cole’s pain increased. Another orthopedic surgeon diagnosed posterolateral rotatory instability and replaced the ligament in Cole’s elbow with a graft from Cole’s arm. Cole’s pain became constant. Another orthopedic surgeon noted his “chronic pain” but said that Cole could return to work “without restrictions.” Cole settled his worker’s compensation claim and obtained unemployment benefits. When they ran out, Cole unsuccessfully applied for social security disability benefits. The Seventh Circuit reversed, stating that the ALJ “appears to have thought Cole a malingerer,” and “cherry-picked” the medical record. View "Cole v. Colvin" on Justia Law

Taylor has an IQ of 70-75. In her twenties, living with her mother, and never having worked, Taylor needs help to get dressed, wash her hair, and take her medications. She can do simple household chores, very slowly and only if reminded, sometimes repeatedly. She cannot drive and cries when she feels overwhelmed. She has poor depth perception and is clumsy. She has seizures and debilitating headaches that require her to sleep during the day. She has a history of kidney problems. A social security field officer interviewed her regarding her application for Supplemental Security Income benefits and reported that her “capability [of working] is questionable.” A psychologist found her verbal comprehension to be particularly low and deemed her “incapable of managing her funds independently.” Taylor had volunteered an hour a week at the public library folding brochures, cutting slips and notices, and affixing labels. The librarian reported that Taylor “completes her tasks well” but “has problems following procedures unless she has a list to follow, which her mother created.” The librarian said she “would hesitate in giving [Taylor] any more responsibilities” The Seventh Circuit reversed the denial of benefits, stating “there is no evidence to support the administrative law judge’s conjecture” that Taylor could work full-time. View "Taylor v. Colvin" on Justia Law

Baptist began working at Ford’s assembly plant, operating a forklift. Less than three months later, Baptist inadvertently hit a pillar, injuring his left wrist. He visited Ford’s medical department and submitted an injury report. An investigator and Ford’s physician doubted Baptist’s account of his injury; Baptist did not report the incident properly and refused to release medical records from a prior workers’ compensation case against another employer involving an injury to his other wrist. Ford paid for Baptist’s initial visit to an orthopedic surgeon, Dr. Heller. The parties are litigating Baptist’s workers’ compensation claim. After working two months, Baptist again sought medical attention. Dr. Heller diagnosed him with a complete ligament tear, recommended surgery, indicated that Baptist was not able to perform the essential function of his job, and cleared him to return to work if he did not lift or grip over five pounds with his left hand. Disagreeing with Ford's doctor, Baptist believed that this prevented him from operating the forklift and asked for another position. He did not work for several days. Ford suspended him for one month. When Baptist returned, he was told that the only available work was as a forklift driver. Baptist later testified that he was told that he would be fired unless he agreed to state that his injury did not happen at work. The company denied this assertion. Baptist was discharged for having three consecutive absences without justification. In a suit alleging retaliation for exercising his workers’ compensation rights, the court granted Ford summary judgment. The Seventh Circuit vacated. A triable issue exists regarding whether Baptist was put to the impracticable choice between keeping his job or giving up a key argument for workers’ compensation. View "James Baptist v. Ford Motor Company" on Justia Law