Justia Public Benefits Opinion Summaries

Articles Posted in U.S. Court of Appeals for the Sixth Circuit
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For more than 40 years, participants in the Tennessee Valley Authority Retirement System (TVARS) received cost-of-living adjustments on top of their investment returns, pension benefits, and supplemental benefits. In 2009, with the system’s financial health in jeopardy, the TVARS board amended the rules that govern the system to cap or eliminate cost-of-living adjustments for the years 2010–2013, increase the eligibility age for cost-of-living adjustments, and lower the interest rate on a savings fund. The participants sued. None of their claims survived summary judgment. According to the district court, the plaintiffs did not have a private right of action to enforce the board’s compliance with the TVARS rules, and a Takings claim failed on the merits. The Sixth Circuit affirmed in part; cost-of-living adjustments are not vested, the agencies were also entitled to summary judgment on the merits of the claim that the board violated TVARS rules by reducing vested benefits. The court remanded remaining claims alleging violations of the TVARS rules because those claims are judicially reviewable in the context of this case. View "Duncan v. Muzyn" on Justia Law

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Under the 2000 Energy Employees Occupational Illness Compensation Program Act a “covered employee” (or her survivor) is entitled to a lump sum payment of $150,000 “for the disability or death of that employee from that employee’s occupational illness,” 42 U.S.C. 7384s(a)(1). The claim adjudication process culminates in a final decision by the Final Adjudication Branch (FAB), which may be challenged in court. A claimant may request to reopen his claim after a final decision by submitting new evidence of covered employment or exposure to a toxic substance or identifying a change in medical guidelines. Berry sought benefits based on his father’s employment. After FAB denied his application for lack of proof that his father worked at a covered facility, Berry did not seek reconsideration or judicial review; 10 years later, Berry filed a request to reopen, stating that he had new evidence of employment. The request was denied. Berry sued under the Administrative Procedure Act. The district court dismissed, find the refusal to reopen “not a final agency action,” 5 U.S.C. 704. The Sixth Circuit affirmed. While the decision not to reopen satisfied the Supreme Court’s test for “final agency action,” and was not the type of decision that Court has recognized as “committed to agency discretion,” the court properly dismissed because the request was not actually based on new evidence, but alleged a material error in the initial decision. Under Supreme Court precedent, reopening requests based on material error are “committed to agency discretion” and unreviewable. View "Berry v. Dept. of Labor" on Justia Law

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The amount of additional Medicare reimbursements that a hospital is entitled to receive for serving a disproportionate share of low-income patients depends, in part, on the number of days that the hospital served patients who were “eligible for medical assistance under a State plan approved under [the Medicaid statute].” 42 U.S.C. 1395ww(d)(5)(F)(vi)(II). Kentucky hospitals contend that because Kentucky has chosen in its Medicaid plan to award additional Medicaid funds to hospitals based on how many days they treat patients who are eligible for the Kentucky Hospital Care Program (KHCP), a state program that provides medical coverage to low-income individuals who do not qualify for Medicaid, KHCP patient days should be counted in the calculation of the additional Medicare reimbursements. The Sixth Circuit affirmed rejection of the state’s argument on summary judgment, stating that the statutory term “eligible for medical assistance under a State plan approved under [the Medicaid statute]” is synonymous with “eligible for Medicaid” and KHCP patients are, by definition, not eligible for Medicaid. View "Owensboro Health, Inc. v. United States Dept. of Health & Human Servs." on Justia Law

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Minor suffers from migraine headaches, injuries from a serious car accident, fibromyalgia, and depression. Minor previously appealed the Social Security Commissioner’s decision to deny her disability claims; in 2013, the Sixth Circuit remanded with instructions to award benefits. The district court, calculating attorney fees under the Equal Access to Justice Act (EAJA), 28 U.S.C. 2412, substantially reduced Minor’s requested hourly rate and number of hours. While fees awarded under the Social Security Act, 42 U.S.C. 406(b) are deducted from a claimant’s award of past-due Social Security benefits, the government must pay fees awarded under the EAJA out of government funds, so the issue was, essentially, whether the government had to reimburse Minor for some or all of the attorney fees to be deducted from her benefit award. The Sixth Circuit vacated, stating that the district court provided little explanation for drastically reducing the requested EAJA fee award. View "Minor v. Comm'r of Social Sec." on Justia Law

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A class of Tennessee residents who applied for Medicaid sought declaratory and injunctive relief, alleging that the delays they have experienced in receiving eligibility determinations on their applications violate 42 U.S.C. 1396a(a)(8) of the Medicaid statute, and that the state’s failure to provide a fair hearing on their delayed applications violates that statute and the Due Process Clause. Regulations implementing the statute provide that “the determination of eligibility for any applicant may not exceed” 90 days for those “who apply for Medicaid on the basis of disability” and 45 days for all other applicants. The district court certified a class and granted a preliminary injunction, which requires the state to grant a fair hearing on delayed applications to class members who request one. The Sixth Circuit affirmed the preliminary injunction, holding that the matter is not moot and that the federal government is not a required party. The court noted that the federal government submitted an amicus brief, supporting plaintiffs’ position. Despite the passage of the Affordable Care Act, states remain ultimately responsible for ensuring their Medicaid programs comply with federal law. View "Wilson v.Gordon" on Justia Law

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Hensley, born in 1949, was employed as a coal miner for 13 years, before leaving in 1988 after seriously injuring his hand and arm in an accident. He has not worked since. Hensley also smoked cigarettes for 10-12 years, averaging half a pack a day before quitting 29 years ago. Hensley first noticed issues with his breathing in 1987. In 1990, he filed an unsuccessful claim for benefits under the Black Lung Benefits Act, 30 U.S.C. 901. He filed a second claim in 2003. The claim was denied, despite a finding of pneumoconiosis, because Hensley did not prove that he was totally disabled by the disease. Hensley filed another claim 2006. The Department of Labor recommended awarding benefits.The evidence, which consisted of chest x-rays, biopsy results, CT scans, pulmonary function studies, arterial blood-gas studies, treatment records and several medical opinions, was forwarded to the ALJ, who awarded benefits in 2010, initially holding that Hensley’s x-ray evidence alone was sufficient to establish the existence of pneumoconiosis.. On remand, the ALJ again concluded that Hensley was entitled to benefits. The Sixth Circuit upheld the award as supported by substantial evidence. View "Dixie Fuel Co. v. Office Workers' Comp. Progams" on Justia Law

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Taskila, age 37, has several health issues. She was involved in serious car accidents in 1996, 2006, and 2010; underwent successful treatment in 2011 for a mass in her breast; and sought treatment for knee pain. She claims, the injuries have led to unremitting pain in her neck and back, to anxiety and depression, to memory problems, to incontinence, to carpal tunnel syndrome, to an inability to work. Taskila sought Social Security disability insurance and supplemental security income. An initial disability examiner denied her applications. After a hearing, an ALJ did the same. The appeals council denied review. The district court and Sixth Circuit affirmed, finding the denial supported by substantial evidence that Taskila could perform a significant number of jobs in the national economy. View "Taskila v. Comm'r of Social Sec." on Justia Law

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Cadillac Place (former General Motors Building), a Detroit office complex, is home to state offices, a court of appeals, a restaurant, a gift store, and even a barber shop. It is owned by Michigan Strategic Fund, a public entity, and leased by the state. Babcock, an attorney, s disabled due to Friedreich’s Ataxia, a degenerative neuromuscular disorder that impairs her ability to walk. She worked in Cadillac Place. Babcock alleged that its design features denied her equal access to her place of employment in violation of the Americans with Disabilities Act , 42 U.S.C. 12132, and Section 504 of the Rehabilitation Act of 1973, 29 U.S.C. 794(a). The Sixth Circuit affirmed dismissal. Babcock did not identify a service, program, or activity of a public entity from which she was excluded or denied a benefit. The court noted the dispositive distinction between access to a facility and access to programs or activities. Babcock only identified facilities-related issues. View "Babcock v. State of Mich." on Justia Law

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Miller is a single father who, before his alleged disability, held positions as a security guard, machine operator, material handler, and night-club bouncer. In 2006, Miller visited a hospital emergency department with an injured knee. He did not return to work but applied for disability insurance benefits, and supplemental security income. On remand from the Appeals Council, an ALJ determined that Miller was not disabled within the meaning of the Social Security Act and did not qualify for benefits. The Appeals Council declined another review. The district court granted summary judgment, affirming the denial of benefits. Miller’s timely appeal followed. The Sixth Circuit vacated, finding the decision not supported by substantial evidence. A determination concerning Miller’s residual functional capacity (particularly his ability to stand) did not comport with the ALJ’s determination that a doctor’s assessment should be accorded significant weight; the limited discussion of Miller’s obesity arguably did not comply with SSR 02- 1p; the ALJ’s focus on isolated, often stale, portions of the record was an insufficient basis to determine that Miller could conduct work activities on a sustained basis, especially in light of the Appeals Council’s original decision to remand for failure to adequately evaluate Miller’s mental impairments. View "Miller v. Comm'r of Social Sec." on Justia Law

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Plaintiffs, 194 employees who were terminated by Vanderbilt University on July 1, 2013, sued, claiming violation of the Worker Adjustment and Retraining Notification Act (WARN), 29 U.S.C. 2101, which requires certain employers to provide at least 60 days’ written notice to affected employees before a mass layoff. The plaintiffs’ class is insufficient to constitute a “mass layoff” (of 500 workers during a 30-day period) as defined by WARN; they cited the Act’s aggregation provision, which allows for separate layoffs within a 90-day period to be counted togetherf. They alleged that a second group of Vanderbilt employees was notified on September 17, 2013, that their jobs would be eliminated 60 days later, on November 16. Although they were no longer permitted to report for work, they continued to receive wages and accrue benefits after the notice was given. They were not eligible for state unemployment benefits until November 16, when they no longer received wages and accrued benefits. The Sixth Circuit ruled in favor of Vanderbilt. The employment relationship between Vanderbilt and the September employees did not end until November 16; they suffered an employment loss more than 90 days after the plaintiffs were terminated and thus cannot be counted under the aggregation provision. View "Morton v. Vanderbilt Univ." on Justia Law