Justia Public Benefits Opinion Summaries

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

Plaintiff was a registered sex offender when he was admitted to the state rental assistance program. Thereafter, the legislature promulgated section 17b-812-13(9) of the Regulations of Connecticut States Agencies, which makes sex offender registration a ground for termination or denial of rental program assistance. The Commissioner of Housing (Commissioner) subsequently terminated Plaintiff’s rental program benefits. Plaintiff took an administrative appeal of the Commissioner’s decision to the trial court, which concluded that the Commissioner’s application of section 17b-812-13(9) was not retroactive and therefore did not exceed the authority granted to the Commissioner by the legislature. The Supreme Court reversed, holding (1) the Commissioner applied section 17b-812-13(9) of the regulations retroactively in this case by imposing a new obligation on Plaintiff’s sex offender status that terminated his rental program assistance; and (2) such retroactive application of the regulation was not statutorily authorized, and therefore, the trial court erred in dismissing Plaintiff’s administrative appeal. View "Shannon v. Comm’r of Housing" 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

After plaintiff suffered a serious knee injury while deployed by the Army in Iraq combat, he underwent surgery and the VA awarded him benefits for service-connected disability. Plaintiff then applied for Social Security disability insurance benefits for post-traumatic stress disorder (PTSD), back pain, right knee pain, and facial twitching. On appeal, plaintiff challenged the denial of disability benefits. The court concluded that substantial evidence on the administrative record supports the ALJ's conclusion that defendant retained the residual functioning capacity (RFC) to perform certain sedentary work during the relevant period at issue; the ALJ could reasonably conclude that plaintiff's repeated failure to attend a prescribed course of treatment was evidence that his mental impairment was less disabling than defendant claimed; and the ALJ explicitly acknowledged the VA’s disability finding, and correctly noted that the disability finding of another agency like the VA was not binding on the Social Security Administration. Accordingly, the court affirmed the judgment. View "Hensley v. Colvin" on Justia Law

Plaintiff Clifton Arbuckle sustained a work-related back injury while working for General Motors Corporation (GM), and in May 1993 began receiving a disability pension. He retired that month and was subsequently awarded workers’ compensation benefits. Later, he also received Social Security Disability Insurance (SSDI) benefits. GM and the International Union, United Automobile, Aerospace and Agricultural Implement Workers of America (UAW) had executed a letter of agreement in 1990 in which GM agreed not to coordinate workers’ compensation and disability pension benefits for its employees under MCL 418.354. This letter of agreement was incorporated into the 1990 collective-bargaining agreement (CBA) between GM and the UAW and was intended to remain in place until termination or amendment of the CBA, which expired in November 1993. When the CBA expired, however, the provision against coordination was continued in subsequent letters of agreement and incorporated into subsequent CBAs. In 2009, GM and the UAW adopted a formula (incorporated into the 2009 CBA) by which GM would coordinate benefits, using disability pension benefits to reduce the amount of workers’ compensation benefits for all workers and retirees, regardless of when they had retired. GM advised Arbuckle that effective January 1, 2010, his benefits would be reduced using the formula in the 2009 agreement. Arbuckle appealed to the Workers’ Compensation Agency, which ultimately concluded that GM was improperly using Arbuckle’s SSDI benefits to offset his workers’ compensation benefits, in violation of MCL 418.354(11). A workers’ compensation magistrate reversed the director’s ruling but nevertheless concluded that GM was prohibited from reducing Arbuckle’s workers’ compensation benefits by his disability pension benefits because Arbuckle had never agreed to coordination of benefits and no evidence established that the UAW had the authority to bargain on Arbuckle’s behalf after his retirement. The Michigan Compensation Appellate Commission (MCAC) reversed in part, holding that irrespective of the UAW’s authority to bind retirees, GM was permitted to coordinate Arbuckle’s disability pension benefits. Arbuckle sought leave to appeal, but after the Court of Appeals granted his application, he died. Robert Arbuckle, the personal representative of the estate, was substituted as plaintiff. The Court of Appeals reversed in an unpublished opinion per curiam and remanded the case for further proceedings. GM then appealed. The Supreme Court concluded after its review that the Court of Appeals erred in holding that GM lacked the authority to coordinate Arbuckle’s benefits under the 2009 CBA. The Court reversed and reinstated MCAC's order. View "Arbuckle v. General Motors, LLC" on Justia Law

Petitioner Estate of Thea Braiterman filed a petition for writ of certiorari challenging a final decision of the Administrative Appeals Unit (AAU) of the New Hampshire Department of Health and Human Services (DHHS), that upheld the determination that applicant Thea Braiterman was ineligible for Medicaid-Old Age Assistance (Medicaid-OAA) benefits because her assets exceeded the eligibility threshold. On appeal, petitioner argued that the AAU erroneously found that the Thea G. Braiterman Irrevocable Trust (the Trust) was includable as an asset for the purpose of determining applicant’s eligibility for Medicaid-OAA benefits. Petitioner argued, and DHHS did not dispute, that petitioner’s challenge was not moot even though applicant had died prior to the conclusion of this matter. Given the facts of this case, the New Hampshire Supreme Court could not say that there were no circumstances under which payments from the Trust could be made “for the benefit” of the applicant. “Finally, we take this opportunity to stress that we have no doubt that self-settled, irrevocable trusts may, if so structured, so insulate trust assets that those assets will be deemed unavailable to the settlor.” The Trust in this case was not such a vehicle. In the Supreme Court's view, the Trust, as structured, allowed applicant “a degree of discretionary authority that would . . . permit [her] to enjoy her assets, preserve those assets for her heirs, and receive public assistance, to, in effect, have her cake and eat it too." As such, the Court denied certiorari. View "Petition of Estate of Thea Braiterman" on Justia Law

The Secretary determined that Bayou Shores was not in substantial compliance with the Medicare program participation requirements, and that conditions in its facility constituted an immediate jeopardy to residents’ health and safety. The bankruptcy court assumed authority over Medicare and Medicaid provider agreements as part of the debtor’s estate, enjoined the Secretary from terminating the provider agreements, determined for itself that Bayou Shores was qualified to participate in the provider agreements, required the Secretary to maintain the stream of monetary benefit under the agreements, reorganized the debtor’s estate, and finally issued its Confirmation Order. The district court upheld the Secretary’s jurisdictional challenge and reversed the Confirmation Order with respect to the assumption of the debtor’s Medicare and Medicaid provider agreements. The court concluded that the statutory revision in this case does not demonstrate Congress's clear intention to vest the bankruptcy courts with jurisdiction over Medicare claims. Therefore, the court agreed with the district court that the bankruptcy court erred as a matter of law when it exercised subject matter jurisdiction over the provider agreements in this case. The bankruptcy court was without 28 U.S.C. 1334 jurisdiction under the 42 U.S.C. 405(h) bar to issue orders enjoining the termination of the provider agreements and to further order the assumption of the provider agreements. Accordingly, the court affirmed the judgment. View "Florida Agency for Health Care Admin. v. Bayou Shores" on Justia Law

Relators filed suit against medical laboratory businesses in 2007 in state court, alleging that the labs had submitted false claims to the Commonwealth for Medicaid reimbursement. Defendants removed to federal court. After the Commonwealth entered into a settlement agreement with defendants, the district court awarded relators a share of the settlement proceeds. Relators appealed, contending that the district court's award was insufficient under state law. The court vacated and remanded to the state court, concluding that the district court lacked subject matter jurisdiction over the qui tam action. In this case, by the plain terms of the complaint, relators could have prevailed on their state law claims by proving that defendants contravened the Commonwealth’s Medicaid regulations, without showing any violation of federal law. View "Commonwealth of Virginia ex rel. Hunter Labs. v. Commonwealth of Virginia" on Justia Law

The False Claims Act (FCA) forbids private parties from bringing qui tam actions on the government’s behalf alleging fraud on government programs if the complaint rests on allegations that were already publicly disclosed through certain enumerated sources. In this case, Relators brought a qui tam action under the FCA challenging certain billing practices of CVS Caremark Corp. and affiliated companies (collectively, CVS). The district court dismissed the action, concluding that previous disclosures and controversies triggered the FCA’s public disclosure bar. The First Circuit affirmed, holding that the public disclosure bar forbade Relators’ suit. View "Winkelman v. CVS Caremark Corp." on Justia Law

Plaintiffs filed suit against the City, arguing that the City's pension reforms violate the Texas Constitution, Tex. Const. art. XVI 66(d). Two district courts ruled in favor of the City. In these consolidated appeals, the court concluded that Section 66 permits prospective changes to the pension plans of the public employees within its reach. In this case, the Pension Reform complies with Section 66 where Section 66 did not turn plaintiffs’ variable-rate cost-of-living adjustment into a one-way ratchet capable only of upward movement. The court rejected claims raised by plaintiffs of Case No. 15-10416, that only the Texas legislature has the City of Dallas v. Trammel "reserved power" to amend pension plans and thus abrogate contractual rights. The court concluded that this argument is foreclosed by Klumb v. Houston Mun. Employees Pension Sys. Finally, the court concluded that the Pension Reform does not violate the United States Constitution’s contracts clause and takings clause where neither clause create property rights and the right to public pension benefits in Texas is subject to legislative power. Accordingly, the court affirmed the district court's judgments. View "Houten, Jr. v. City of Fort Worth" on Justia Law