Justia Public Benefits Opinion Summaries

Ken Lick Coal Company employed Bob Reed from 1973 to 1986, during which he was exposed to coal dust. Reed later worked for Green Valley Hydro Seeding & Reclamation and JPR, where he continued to be exposed to coal dust. Reed developed breathing problems and filed three claims for black-lung benefits. His first claim in 1986 was denied. His second claim in 2007 was initially granted but later denied by an administrative law judge who found Reed did not have pneumoconiosis. Reed's third claim in 2018 was pursued by his widow after his death.The district director awarded benefits and designated Ken Lick as the responsible operator. An administrative law judge upheld this decision, finding Reed had over 15 years of coal-mine employment, including his work with Green Valley and JPR. The judge also found that Ken Lick had stipulated to being the responsible operator during Reed's second claim, which the judge deemed binding in the third claim.The United States Court of Appeals for the Sixth Circuit reviewed the case. The court held that the administrative law judge erred in treating Ken Lick's prior stipulation as binding. The court found that the stipulation was a legal conclusion rather than a factual one, and thus, the judge had the authority to disregard it. The court noted that the administrative law judge would not have required Ken Lick to pay the benefits but for the stipulation. Consequently, the Sixth Circuit granted Ken Lick's petition for review and transferred the liability for Reed's claim to the Black Lung Disability Trust Fund. View "Ken Lick Coal Co. v. OWCP" on Justia Law

Donald Hunter, a former coal miner, applied for benefits under the Black Lung Benefits Act (BLBA) in 2019, claiming that he was totally disabled due to chronic obstructive pulmonary disease (COPD) caused by his coal mine employment. Southern Ohio Coal Company, his former employer, contested his claim, arguing that Hunter's COPD was caused by his significant history of smoking cigarettes rather than coal mine dust exposure.An Administrative Law Judge (ALJ) reviewed the case and awarded benefits to Hunter, finding that his COPD constituted legal pneumoconiosis and that it was a substantially contributing cause of his total disability. Southern Ohio Coal appealed to the Benefits Review Board (BRB), arguing that the ALJ erred in discrediting its evidence and in crediting Hunter's evidence. The BRB affirmed the ALJ's decision, holding that the ALJ had properly considered and weighed the evidence.The United States Court of Appeals for the Sixth Circuit reviewed the case. Southern Ohio Coal argued that the ALJ erred by relying on a pulmonary function test (PFT) that did not comply with regulatory quality standards and by relieving Hunter of his burden to establish entitlement to benefits. The court found that the ALJ acted within his discretion in determining that the PFT was compliant and supported Hunter's entitlement to benefits. The court also held that the ALJ did not improperly rely on regulatory guidance or flip the burden of proof to Southern Ohio Coal. The ALJ's decision was supported by substantial evidence, including expert opinions and Hunter's testimony.The Sixth Circuit denied the petition for review, affirming the ALJ's decision to award benefits to Hunter. The court held that the ALJ correctly applied the law and that his decision was supported by substantial evidence. View "Southern Ohio Coal Co. v. Office of Workers' Compensation Programs" on Justia Law

Edna Napier, a former cashier and certified nursing assistant, applied for disability insurance benefits due to severe physical conditions and mental impairments, including depression and anxiety. Her initial application was denied by the Social Security Administration (SSA) in 2018. Napier filed a new application in December 2019, claiming she had been unable to work since December 2018. An administrative law judge (ALJ) held an evidentiary hearing and concluded that Napier was not disabled under the Social Security Act, finding that her mental impairments were mild and her physical impairments did not prevent her from performing her past work as a cashier.The United States District Court for the Eastern District of Kentucky affirmed the ALJ's decision. Napier appealed, arguing that the ALJ erred in assessing the severity of her mental impairments and failed to account for them in her residual functional capacity (RFC) analysis.The United States Court of Appeals for the Sixth Circuit reviewed the case. The court held that the ALJ's decision was supported by substantial evidence and complied with proper legal standards. The ALJ had considered Napier's testimony, her limited treatment history for mental impairments, and the opinions of several psychologists. The ALJ found that Napier's mental impairments were not severe and that her physical impairments did not preclude her from performing her past work. The court also found that the ALJ adequately accounted for Napier's mental impairments in the RFC analysis.The Sixth Circuit affirmed the district court's judgment, concluding that the ALJ's findings were supported by substantial evidence and that the ALJ had followed the appropriate procedures in evaluating Napier's claims. View "Napier v. Commissioner of Social Security" on Justia Law

While implementing changes required by the Patient Protection and Affordable Care Act of 2010, Michigan experienced a systemic computer problem that erroneously assigned thousands of non-citizens, who may have been eligible for comprehensive Medicaid coverage, to Emergency Services Only (ESO) Medicaid. Plaintiffs, two eligible noncitizen residents of Michigan who were erroneously assigned ESO coverage, filed a class action complaint against the Director of the Michigan Department of Health and Human Services, alleging violations of the Medicaid statute and the Due Process Clause. The district court found that actions taken by the state since the complaint was filed had resolved all systemic errors, so that plaintiffs’ claims were moot. The Sixth Circuit reversed the summary judgment, noting that not one of the individuals identified as a named plaintiff or potential named plaintiff was granted relief on the basis of a systemic fix and that that it is not “absolutely clear the allegedly wrongful behavior could not reasonably be expected to recur.” Material questions of fact remain regarding claims that the state failed to provide comprehensive Medicaid coverage and a reasonable opportunity to verify immigration status, precluding summary judgment. View "Unan v. Lyon" on Justia Law

Kentucky’s Health and Family Services commenced a Dependency, Neglect, and Abuse proceeding. The mother stipulated to neglecting her children. Kentucky placed both boys in foster care. R.O., the mother’s aunt, sought custody of the children. The state conducted a standard home evaluation and criminal background check on R.O. and eventually both children were placed in her home by court order. The family court closed the action and granted joint custody to the mother and R.O., though the boys remained living with R.O., who sought foster care maintenance payments. The family court declined to rule on the issue, “indicating that permanency had been achieved.” R.O. then sued the state, arguing that the federal Child Welfare Act, 42 U.S.C. 672(a), required the state to provide maintenance payments, and that the failure to make payments violated the Equal Protection and Due Process Clauses. The state removed the case to federal court. The district court dismissed, reasoning that the Child Welfare Act provides no privately enforceable rights, that the family lacked a property interest in the payments, and that Kentucky’s scheme rationally distinguished between relative and non-relative foster care providers. The Sixth Circuit reversed, finding that the Act creates a private right of action. View "D.O. v. Glisson" on Justia Law

Clark sought attorney fees under the Equal Access to Justice Act (EAJA), 28 U.S.C. 2412(d)(2)(A): $6,790.52 in fees for 34.75 attorney hours at an hourly rate of $176.13, plus 6.70 paralegal hours at an hourly rate of $100. The rate exceeded the $125 rate set by the EAJA. Clark argued that her counsel should receive a cost of living adjustment, based on the U.S. Bureau of Labor Statistics Consumer Price Index (CPI) for “Midwest Urban Consumers.” The agency requested that the court award fees at no more than $140, "the current reasonable and customary rate for experienced Social Security practitioners in the Western District of Kentucky." In her reply, Clark attached a declaration from her attorney, stating that he had practiced disability law from his Syracuse, New York, office for several years and provided his firm’s non-contingent hourly rate. Clark cited 2014 Sixth Circuit precedent, concluding that the requested rate of $176.13 was modest and appeared to be reasonable; she argued that other courts have held that the CPI alone was sufficient to justify a rate above the statutory cap. The district court awarded fees at an hourly rate of $140. The Sixth Circuit affirmed; there must be some understanding of the rates charged locally before a court can adjust for cost of living or other factors. View "Clark v. Commissioner of Social Security" on Justia Law

The Sixth Circuit declined to stay a preliminary injunction requiring the delivery of bottled water households served by the Flint water system that lack properly installed water filters. For many homes without a proper filter, safe drinking water is inaccessible due to the limited hours of the points of distribution and transportation issues. The cost of verifying and maintaining water filters and delivering bottled water to residents that are not part of the allegedly 96% of homes that have a functioning filter is "nowhere near $10.5 million" claimed by the defendants. There is still $100 million left of the $212 million that Michigan allocated to respond to the Flint water crisis. The court rejected an argument that delivering bottled water will slow down the recovery of Flint’s water system by decreasing the amount of water moving through the delivery lines. The defendants did not demonstrate a strong likelihood of success on their arguments, nor have they shown that portions of the preliminary injunction, including the provisions requiring the delivery of bottled water to non-exempt households, are overbroad. A stay would not support the public interest. Flint residents continue to suffer irreparable harm from the lack of reliable access to safe drinking water. View "Concerned Pastors for Social Action v. Khouri" on Justia Law

Coursey’s application for Social Security benefits was denied. He sought judicial review. The district court granted a joint motion to reverse the decision. Coursey sought attorney fees. Although the Equal Access to Justice Act (EAJA), 28 U.S.C. 2412, sets the presumptive maximum hourly rate an attorney may recover at $125. Coursey sought $185.18 per hour. Coursey submitted the Bureau of Labor Statistics’ Consumer Price Index (CPI), which documents that the statutory amount would, when adjusted for the cost of living in the Midwest in 2015, be the equivalent of $185.18. The court concluded that the CPI and the attorney's affidavit were insufficient to justify the requested rate and approved an award of $140 per hour, consistent with recent cases in the district awarding that amount for EAJA attorney-fee requests in Social Security cases. The Sixth Circuit affirmed. A plaintiff seeking an attorney’s fee of greater than $125 per hour must show by competent evidence that the cost of living justifies a higher rate and that the fee is “in line with those prevailing in the community for similar services by lawyers of reasonably comparable skill, experience, and reputation.” The court properly relied on evidence, judicial findings in previous cases, that the prevailing market rate for similar services within its venue was $140 per hour. View "Coursey v. Commissioner of Social Security" on Justia Law

In 2006, Congress amended 42 U.S.C. 1396p(c)(1)(F)(i), which permits individuals and married couples to dispose of their assets (to qualify for Medicaid) by purchasing an annuity, under which the state is named as the remainder beneficiary in the first position for the amount of medical assistance paid. The federal law initially contained a drafting error. It was subsequently amended. A corresponding Kentucky regulation, promulgated four months later, mistakenly included the pre-amendment language, stating that the state had to be the beneficiary for the amount of assistance paid on behalf of the annuitant, rather than the institutionalized spouse. The state agency enforced the corrected federal statute. The Singletons sought Medicaid benefits to support Claude’s full-time nursing home care; in purchasing an annuity, Mary wanted to name the state as a beneficiary for the value of care provided to her, rather than Claude, as the Kentucky regulation seemed to permit. Claude obtained Medicaid eligibility after the purchase of an annuity that complied with the federal regulation. The government paid $98,729.01 in medical expenses before Claude's death. Mary later died, leaving $118,238.41 in the annuity. In compliance with the federal rule, the government’s claim left $19,509.40 for the secondary beneficiaries. The Singleton children sued. The Sixth Circuit rejected their argument that the Medicaid statute gave the state discretion to be more generous concerning annuities and the general spend-down rules. The Kentucky regulation departed from the Medicaid statute’s clear instructions and was preempted. View "Singleton v. Commonwealth of Kentucky" on Justia Law

Fleming had a sporadic work history in the coal industry. Between 1970 and 1991, Fleming worked for 25 different employers. In 2010, Fleming sought Black Lung Benefits Act payments. The DOL Office of Workers’ Compensation calculated that Fleming was employed as a miner for nine and one-quarter years and that he had contracted pneumoconiosis as a result of that employment. Aberry was designated as the employer responsible for payment of benefits. On appeal, an ALJ determined that Fleming could show he had worked 273.50 weeks in the industry (about 5.25 years), but that Fleming was credible and established that he had either been paid under the table or without proper records having been kept. Based on that determination, the ALJ found that Fleming engaged in coal-mine employment “for at least 15 years,” which entitled Fleming to the presumption of total disability under 30 U.S.C. 921(c)(4). The Benefits Review Board remanded, stating that the ALJ had neither explained how he resolved the conflict between Fleming’s “not [being] a good historian” and the ALJ’s crediting of Fleming’s testimony, nor resolved the conflicting evidence. The ALJ's second Decision again awarded benefits. finding that Fleming worked more than 15 years in coal-mine employment. The Sixth Circuit vacated. The evidence was insufficient to establish that Fleming had 15 years of employment. View "Aberry Coal, Inc. v. Fleming" on Justia Law