Justia Public Benefits Opinion Summaries

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

The seven consolidated cases in this appeal all involve attempts by assignees of a health maintenance organization (HMO) to recover conditional payments via the Medicare Secondary Payer Act's (MSP Act), 42 U.S.C. 1395y(b)(2)(B)(ii), (b)(3)(A), private cause of action. At issue is whether a contractual obligation, without more (specifically, without a judgment or settlement agreement from a separate proceeding), can satisfy the “demonstrated responsibility” requirement of the private cause of action provided for by the MSP Act. The court held that a plaintiff suing a primary plan under the private cause of action in the MSP Act may satisfy the demonstrated responsibility prerequisite by alleging the existence of a contractual obligation to pay. A judgment or settlement from a separate proceeding is not necessary. Therefore, the court vacated the district courts' judgments and remanded for further proceedings. View "MSP Recovery LLC v. AllState Ins. Co." on Justia Law

The Supplemental Nutrition Assistance Program (SNAP), overseen by the USDA, is administered by the states, 7 U.S.C. 2011–2036c. An individual is ineligible for SNAP benefits if he is “fleeing to avoid prosecution, or custody or confinement after conviction . . . for a crime, or attempt to commit a crime, that is a felony under the law of the place from which the individual is fleeing.” Michigan’s implementation barred assistance to anyone “subject to arrest under an outstanding warrant arising from a felony charge against that individual.” Michigan had an automated program that compared the list of public-assistance recipients with a list of outstanding felony warrants maintained by the Michigan State Police; when the program identified a match, it automatically closed the recipient’s file and generated a notice of the termination of benefits. In 2015 the Secretary of Agriculture promulgated 7 C.F.R. 273.11(n), clarifying disqualification of fugitive felons. Plaintiffs challenged Michigan's automatic disqualification and notice process. The court certified a class, held that Michigan policy violated the SNAP Act and the Constitution, and issued an injunction requiring Michigan to refrain from automatic disqualifications based solely on the existence of a felony warrant and to provide adequate notices of valid disqualification. The Sixth Circuit affirmed, rejecting claims that the plaintiffs lacked standing, of mootness, that there is no SNAP Act private right of action, and that Michigan's methods were valid. View "Barry v. Lyon" on Justia Law

Charles Wimberly filed an application for disability retirement benefits with the Kentucky Retirement Systems (KERS). A hearing officer recommended that Wimberly's application be denied and, before KERS could render a final decision, Wimberly filed a second application pursuant to Kentucky Revised Statute (KRS) 61.600(2). Following the recommendation of another hearing officer, KERS denied that application. Wimberly sought judicial review; the circuit court reversed KERS. KERS appealed to the Court of Appeals, which affirmed the circuit court. The Supreme Court granted discretionary review to address the parties' arguments regarding the application of the doctrine of res judicata and to determine whether the consumption of alcohol was or could be a pre-existing condition. Having reviewed the record and the arguments of the parties, the Supreme Court affirmed. View "Kentucky Retirement Systems v. Wimberly" on Justia Law

Dianne Carson first filed an application for retirement disability benefits in November 2007. Based on the recommendation of a hearing officer, the Kentucky Retirement Systems (KERS) denied Carson's claim. Carson did not seek judicial review of KERS's order, choosing instead to file a second application in October 2009. Based on a recommendation of a different hearing officer, KERS again denied Carson's claim. Carson sought judicial review and the circuit reversed and remanded with instructions for KERS to consider all of the medical evidence Carson submitted. The Court of Appeals affirmed. KERS argued that Carson's second application should have been dismissed under the doctrine of res judicata. "If res judicata applied to this action, Carson would have been barred from filing a second application that was based on the same claim as her first application. However, KRS 61.600(2) requires KERS to accept an employee's timely filed "reapplication based on the same claim of incapacity" and to reconsider the claim 'for disability if accompanied by new objective medical evidence.'" This case was remanded for KERS to undertake the correct review of the evidence. The Supreme Court affirmed the Court of Appeals. View "Kentycky Retirement Systems v. Carson" on Justia Law

Plaintiff appealed the denial of her Social Security benefits, arguing that the ALJ's determination that she is not disabled is not supported by substantial evidence on the record as a whole. Plaintiff claimed that she was unable to work due to osteoarthritis, lumbago, a congenital back defect, chronic stomach pain, and pulmonary restrictions. The court concluded that the Commissioner gave good reasons for discounting the opinion of plaintiff's treating physician and that substantial evidence in the record as a whole supports the Commissioner’s decision that plaintiff was not disabled. Accordingly, the court affirmed the denial of benefits. View "Reece v. Colvin" on Justia Law

In 1985-1986, Kerrigan was a Navy carpenter. He injured his back and was awarded workers’ compensation benefits by the Office of Workers Compensation (OWCP). In 1993, Kerrigan raised concerns regarding his benefits. Over several years, Kerrigan made multiple requests, some of which were denied. In 2001, Kerrigan contacted the Department of Labor Office of Inspector General (OIG) alleging that DOL employees had based one denial on a form that they falsified or destroyed. The OIG did not investigate, but forwarded the letter to OWCP. Kerrigan pursued, over several years, a suit against DOL for illegal termination of benefits and a suit against the physician who reviewed his medical records. Both were dismissed. In 2013, Kerrigan filed a complaint with the U.S. Office of Special Counsel, which chose not to investigate, but referred him to the Merit Systems Protection Board, where Kerrigan alleged retaliatory termination of benefits. The ALJ dismissed Kerrigan’s appeal, stating that the Whistleblower Protection Act only covers actions taken by an agency concerning its own employees. The Board stated that 5 U.S.C. 8128(b) provides that benefits determinations are within the exclusive jurisdiction of the DOL and are unreviewable and that Kerrigan failed to nonfrivolously allege that his protected disclosures were a contributing factor in the decision to terminate benefits. The Federal Circuit affirmed. While 5 U.S.C. 8128(b) does not bar review, Kerrigan failed to nonfrivolously allege that his protected disclosure was a contributing factor in the decision. View "Kerrigan v. Merit Sys. Protection Bd." on Justia Law

Plaintiff appealed the denial of her social security disability benefits. As a preliminary matter, the court concluded that neither the doctrine of collateral estoppel nor law of the case applies to plaintiff's claim. On the merits, the court concluded that there was substantial evidence in the record to support the current ALJ's decision where he considered and evaluated her treating physician's opinion (Dr. Kinney). The ALJ did discount some of the physician's opinion about plaintiff's marked limits on performing work at a consistent pace because it found the record did not support such conclusions. The court also concluded that the ALJ thoroughly considered the opinions of other treating sources (Dr. Heims and Dr. Stubblefield). Finally, substantial evidence supports the ALJ's adverse credibility finding where the ALJ discounted plaintiff's subjective complaints of pain. In this case, plaintiff had not sought treatment for some of the complained limitations, the objective medical evidence was inconsistent with several of her allegations, there was a general lack of consistent medical treatment, and she seemed to return to the doctors only when she needed disability forms filled out. Furthermore, plaintiff was noncompliant with suggestions by her own treating physician. Accordingly, the court affirmed the judgment. View "Aguiniga v. Colvin" on Justia Law

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

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