Justia Public Benefits Opinion Summaries

Articles Posted in US Court of Appeals for the Ninth Circuit
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An Administrative Law Judge (“ALJ”) denied Plaintiff benefits based on the testimony of a vocational expert (“VE”) that there were an estimated 72,000 “Table worker,” 65,000 “Assembler,” and 32,000 “Film touch up inspector” jobs in the national economy that claimant could perform. After the ALJ issued her decision, claimant’s attorney submitted to the Social Security Administration (“SSA”) Appeals Council different estimates for those same jobs, allegedly using the same software program used by the VE. The Appeals Council considered the new evidence but denied claimant’s request for review.The Ninth Circuit reversed the district court’s decision granting summary judgment to the Commissioner of Social Security and affirming the denial of Plaintiff’s claim for Supplemental Security Income (“SSI”) benefits, and remanded to the district court with directions that the case be remanded to the agency for further proceedings. The court held that under Buck v. Berryhill, 869 F.3d 1040 (9th Cir. 2017), remand was required to allow the ALJ to address claimant’s evidence of widely discrepant job number estimates.The claimant estimated—using SkillTRAN Job Browser Pro and the same DOT codes the VE had used—that there were 2,957 table worker, 0 assembler, and 1,333 film tough-up inspector jobs in the national economy. The discrepancy between the VE and the claimant’s estimates was comparable to the discrepancy in Buck. View "TYRONE WHITE V. KILOLO KIJAKAZI" on Justia Law

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Plaintiff hospices exceeded their aggregate caps in the 2013 fiscal year, and three Silverado hospices also exceeded their aggregate caps in the 2014 fiscal year. Plaintiffs appealed their cap determinations to the Provider Reimbursement Review Board (“PRRB”), arguing that their MAC had failed to calculate the aggregate cap using the “actual net amount of payment received by the hospice provider.” The Ninth Circuit affirmed the district court’s summary judgment in favor of the government.   The court held that CMS correctly concluded that the Budget Control Act required it to reduce the total annual amounts paid to hospices, not only the periodic reimbursements, and that the agency’s chosen method for implementing sequestration was consistent with the Medicare statute. The court further held that the agency was not required to undertake notice-and-comment rulemaking before implementing the Budget Control Act’s sequestration mandate. The agency’s sequestration method, as reflected in the TDL and the PRRB’s decisions, did not amount to the “establish[ment]” or “change[]” of a substantive legal standard governing payment for services under Medicare, within the meaning of 42 U.S.C. Section 1395hh. Rather, Congress enacted the Budget Control Act’s sequestration requirements, and the President implemented sequestration when the statutory conditions were triggered. View "SILVERADO HOSPICE, INC. V. XAVIER BECERRA" on Justia Law

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Appellants, Medicaid providers and former members of public-sector unions, challenge the district courts’ dismissals of two cases, consolidated on appeal. When Appellants joined the unions, they authorized the California State Controller to deduct union dues from their Medicaid reimbursements. Appellants now contend that, when the Controller made these deductions, she violated the “anti-reassignment” provision of the Medicaid Act, which prohibits state Medicaid programs from paying anyone other than the providers or recipients of covered services.   The Ninth Circuit affirmed the district court’s dismissal. The court explained that California uses some of its Medicaid funding to provide assistance with daily activities to elderly and disabled beneficiaries under a program called In-Home Support Services (IHSS). The recipients of these services are responsible for employing and overseeing the work of their IHSS providers, who are often family members. The Controller makes a variety of standard payroll deductions, including for federal and state income tax, unemployment compensation, and retirement savings. California law also authorizes the Controller to deduct union dues from the paychecks of IHSS providers.   Thus, the court held that the Medicaid Act’s anti-reassignment provision, 42 U.S.C. Section 1396a(a)(32), does not confer a right on Medicaid providers enforceable under Section 1983. The text and legislative history of the anti-reassignment provision make clear that Congress was focused on preventing fraud and abuse in state Medicaid programs rather than on serving the needs of Medicaid providers. Because Congress did not intend to benefit Medicaid providers, the anti-reassignment provision did not confer a right as enforceable under Section 1983. View "DELORES POLK V. BETTY YEE" on Justia Law

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In denying Plaintiff’s request for Social Security disability benefits, an Administrative Law Judge (ALJ) relied on the testimony of a vocational expert to conclude that a person with Plaintiff’s limitations, age, education, and work experience could still perform jobs that exist in significant numbers in the national economy. On appeal, Plaintiff claimed that the ALJ erred in not addressing competing job numbers that her counsel provided using his own methodology.   The Ninth Circuit affirmed the district court’s judgment upholding the Commissioner of Social Security’s denial of a claimant’s application. The court held in the context of similar challenges to ALJ decisions that an ALJ need only explain his rejection of significant probative evidence. The court reasoned that in accordance with Social Security Act regulations, an administrative law judge (“ALJ”) is entitled to rely on a vocational expert’s testimony to support a finding that the claimant can perform occupations that exist in significant numbers in the national economy.     The court reasoned that to engage in a meaningful review of a disability claim, an ALJ may not ignore significant probative evidence that bears on the disability analysis, but an ALJ need not discuss all evidence that was presented.  Here, Plaintiff’s attorney did not replicate the VE’s methodology, and Plaintiff’s different approach led to different numbers. There is no basis to conclude that these results qualified as significant probative evidence that the ALJ was required to address. View "SARAHROSE KILPATRICK V. KILOLO KIJAKAZI" on Justia Law

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Plaintiff filed a lawsuit alleging state law claims arising from SelectHealth’s administration of her deceased husband’s MA plan and his death. Under Part C of the Medicare Act, beneficiaries can enroll in an MA plan and receive Medicare benefits through private MA organizations instead of the government. SelectHealth removed the action to federal court on the basis of diversity jurisdiction.   The Ninth Circuit affirmed the district court’s summary judgment in favor of SelectHealth, Inc. because the Medicare Act’s express preemption provision, 42 U.S.C. Section 1395w-26(b)(3), barred Plaintiff’s state law claims.   The court held that Section 1872 of Title XVIII of the SSA provides that Section 205(h) is applicable to cases under the Medicare Act to the same extent as in cases under Title II. The court concluded that enrollees in an MA plan must likewise first exhaust their administrative remedies before seeking judicial review of a claim for benefits.   Next, the court concluded that Plaintiff’s claims were not subject to the SSA’s exhaustion requirement because the dispute was not whether Plaintiff’s husband received a favorable outcome from the internal benefits determination process but rather whether he should have received the services earlier.   Further, the court held that Plaintiff’s claim that SelectHealth breached a duty to process timely her husband’s October 7, 2016, appeal was expressly preempted. Because the standards established under Part C supersede any state law duty that would impose obligations of MA plans on the same subject. View "NAOMI AYLWARD V. SELECTHEALTH, INC." on Justia Law

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Plaintiff was civilly confined by court order pursuant to California’s Sexually Violent Predator Act (“SVPA”), after a probable cause hearing, but before a full civil commitment trial. While confined by court order in a state hospital, Plaintiff applied for Social Security disability benefits. The Social Security Administration (SSA) approved his application, and he received benefits.   In May 2014, the SSA notified Plaintiff that these benefits had been issued in error, and required him to refund the benefits previously paid. Plaintiff challenged that determination and requested a hearing before an Administrative Law Judge (ALJ). After a hearing, the ALJ determined that Section 402(x)(1)(A)(iii) made Plaintiff ineligible for benefits, and ordered him to repay the benefits to the SSA. Plaintiff sought judicial review of the ALJ’s decision and the district court concluded that Plaintiff was not eligible for disability benefits   The Ninth Circuit affirmed and held that the Commissioner did not err in concluding that Plaintiff was not eligible for benefits. The court reasoned the Social Security Act provides that no monthly benefits shall be paid to individuals who are confined at public expense, including someone who “immediately upon completion of confinement” for a criminal sexual offense “is confined in an institution at public expense pursuant to a finding that the individual is a sexually dangerous person or a sexual predator or a similar finding.”  Here, the state trial court’s confinement order in Plaintiff’s case was pursuant to a finding that he was a sexually dangerous person or a sexual predator or a similar finding. View "GEORGE ALLEN V. KILOLO KIJAKAZI" on Justia Law

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Plaintiff, who receives two government pensions, one from noncovered employment and one from covered employment, alleged that the Government Pension Offset (“GPO”) should not apply to his benefits. During Plaintiff’s administrative proceedings, the Social Security Administration (“SSA” or the “agency”) agreed with Plaintiff and paid him spousal benefits without applying any offset. Ultimately, though, the agency decided that the GPO should apply. The agency then temporarily withheld Plaintiff’s spousal benefits to recoup approximately $15,000 in overpayments to him, and it reduced his spousal benefits going forward. On appeal, the parties disputed whether the GPO applies to Plaintiff’s spousal benefits and if it does apply, whether the agency was entitled to recoup the overpayment.   The Ninth Circuit held that the GPO applies to Plaintiff’s spousal benefits but that a remand to the agency is necessary to determine whether SSA was entitled to recoupment. The court reasoned that under both the old and new version of Social Security regulation 20 C.F.R. Sec 404.408a, the existence of Plaintiff’s pension earned through noncovered employment triggered the GPO’s application to his spousal benefits notwithstanding his later covered employment in a job with a different pension plan.  Further, the court held that the ALJ’s finding of Plaintiff’s fault for the overpayment was not supported by substantial evidence and that on remand the agency could consider whether any evidence in the record beyond that relied on by the ALJ supported the proposition that Plaintiff was at fault for the overpayment and, if so, whether recoupment would be appropriate. View "PAUL MISKEY V. KILOLO KIJAKAZI" on Justia Law

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In July 2019, the Appeals Council denied Claimant’s appeal without elaboration. Claimant challenged, among other rulings, the ALJ’s analysis of her testimony. Claimant did not assert any constitutional challenges to the district court. The district court entered a judgment reversing the ALJ’s denial of benefits and remanded the matter to the agency for further proceedings. The Commissioner filed a motion pursuant to Federal Rule of Civil Procedure 59(e) to amend or alter the judgment, arguing that the court had clearly erred by overlooking the ALJ’s explanation for rejecting Claimant’s testimony. The district court agreed with the Commissioner and entered an order granting the Rule 59(e) motion   The Ninth Circuit affirmed the amended judgment in favor of the Commissioner.  The court upheld the Commissioner’s decision denying her application for benefits because claimant did not show that the removal provision caused her any actual harm. Further, Federal Rule of Civil Procedure 59(e) allows a district court to alter or amend a judgment if the court determines that its original judgment was clearly erroneous. Because the district court properly concluded that it had clearly erred in its original ruling in favor of Claimant, the court’s granting of the Commissioner’s Rule 59(e) motion fell within the court’s considerable discretion View "JODY KAUFMANN V. KILOLO KIJAKAZI" on Justia Law

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Plaintiff sought benefits under the Social Security Act based on various physical and mental impairments. An administrative law judge (“ALJ”) found that she was not disabled and denied her claim. The district court affirmed.The Ninth Circuit affirmed the district court’s decision affirming the Commissioner of Social Security’s denial of claimant’s application for benefits under the Social Security Act based on various physical and mental impairments.The court decided that recent changes to the Social Security Administration’s regulations displaced case law requiring an administrative law judge (“ALJ”) to provide “specific and legitimate” reasons for rejecting an examining doctor’s opinion. The “relationship factors”, such as length and purpose of the treatment relationship, frequency of visits, and extent of examinations the medical source has performed are still relevant. However, the ALJ no longer needs to make specific findings regarding those factors. Under the new regulations, an ALJ cannot reject an examining or treating doctor’s opinion without providing an explanation supported by substantial evidence.In this case, the ALJ acknowledged the doctor’s opinion that the claimant had marked and extreme limitations in various cognitive areas; but the ALJ found this opinion unpersuasive because it was inconsistent with the overall notes in the record. The court held that substantial evidence supported the ALJ’s finding. View "LESLIE WOODS V. KILOLO KIJAKAZI" on Justia Law

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The Ninth Circuit affirmed the district court's grant of summary judgment in favor of the SSA in a putative class action alleging that reducing the Social Security benefits of class members based on the receipt of a foreign social security pension violated the Windfall Elimination Program (WEP), its implementing regulation, and the Agreement Between the Government of the United States of America and the Government of Canada with Respect to Social Security.The panel concluded that the WEP applies to a Social Security beneficiary who receives benefits under the Canada Pension Plan. Therefore, the SSA and the district court properly interpreted the WEP and the U.S.-Canada Agreement. In this case, Plaintiff Rosell's Canadian pension was based at least in part on his earnings for noncovered service, and thus the agency correctly reduced the couple's Social Security benefits. View "Michener v. Kijakazi" on Justia Law