Justia Public Benefits Opinion Summaries

Plaintiff-appellant Laurie Smith sought review when her Social Security disability benefit claims were denied. She alleged disability based in part on: impingement of her left shoulder; restrictions on her ability to: (1) reach and (2) handle and finger objects; and moderate nonexertional limitations. The administrative law judge concluded that Smith could work as a telequotation clerk, surveillance systems monitor, or call-out operator. As a result, the judge concluded that Smith was not disabled. Ms. Smith appealed to the district court, which upheld the administrative law judge’s determination. After its review, the Tenth Circuit found no reason to disturb the ALJ's or the district court's judgments and affirmed. View "Smith v. Colvin" on Justia Law

Plaintiff, the beneficiary of a testamentary trust, entered a long-term care facility in 2012, at which time she applied for financial and medical assistance under Medicaid. The Department of Social Services denied the application for Medical benefits, finding that Plaintiff’s assets, including the trust, exceeded the relevant asset limits. A hearing officer upheld the department’s denial. Plaintiff appealed, arguing that the trust was not an asset available to her as defined by relevant Medicaid regulations. The trial court dismissed Plaintiff’s appeal. The Supreme Court reversed, holding that the testator intended to create a discretionary, supplemental needs trust and, therefore, the trust corpus and income may not be considered to be available to Plaintiff for the purpose of determining eligibility for Medicaid benefits. View "Pikula v. Dep’t of Social Servs." on Justia Law

Via Christi seeks an upward adjustment of the capital-asset depreciation reimbursement paid to its predecessor hospitals under a since curtailed Medicare regulation. Via Christi argues that it received St. Francis’s and St. Joseph’s assets at a lower value, i.e., more depreciated, than was reflected in the Secretary’s earlier depreciation reimbursements. As the hospitals’ successor-in-interest, Via Christi thus seeks additional reimbursements to cover the proportional Medicare share of the depreciation. The court concluded that the Secretary reasonably interpreted the bona fide sale requirement as limited to arm’s length transactions between economically self-interested parties. The Secretary concluded that St. Francis’s transfer of its assets to Via Christi was not an arm’s-length transaction in which each party sought to maximize its economic benefit. The court concluded that the Secretary's determination was supported by substantial evidence, and was not arbitrary, capricious or otherwise unlawful. In this case, Via Christi is not entitled to additional depreciation reimbursement in the absence of a qualifying transaction. View "Via Christi Hosp. Wichita v. Burwell" on Justia Law

VRC filed suit against HHS and the Secretary, seeking the recoupment of payments VRC returned to Medicare after it was issued notice of an overpayment. At issue is the reimbursement rate of the intravitreal injection of Lucentis. VRC did not follow the Lucentis label’s instructions limiting dosage to one per vial. Instead, VRC treated up to three patients from a single vial. Because VRC was extracting up to three doses from a single vial, it was reimbursed for three times the average cost of the vial and three times the amount it would have received had it administered the drug according to the label. The court affirmed the denial of recoupment, concluding that VRC's charge to Medicare did not reflect its expense and was not medically reasonable; the Secretary's decision was supported by substantial evidence; and VRC is liable for the overpayment. View "Vitreo Retinal Consultants v. U.S. Dep't of Health & Human Servs." on Justia Law

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

Plaintiff, complaining chiefly of neck pain, appealed the denial of his application for disability benefits. The court concluded that the newly submitted evidence - namely, updated treatment records - was not so significant as to require remand to the ALJ for additional consideration; substantial evidence supports the ALJ's determination at step three of the evaluation process that plaintiff did not meet or medically equal Listing 1.04(A); and the ALJ's residual functioning capacity (RFC) finding is supported by substantial evidence where the ALJ found that plaintiff was capable of performing light work with certain limitations. The court agreed with the ALJ's ultimate determination that plaintiff was not disabled and affirmed the judgment. View "Whitehead v. Colvin" on Justia Law

The single mother of five children, 8 to 15 years old, struggled with abusive relationships, homelessness and unemployment. They lived primarily in Marin County from 2000 until they moved to Richmond in 2009. In 2015, Mother asked Contra Costa Children & Family Services to place the four youngest children in foster care. CFS did so and filed petitions alleging Mother’s failure to protect and inability to provide support. The court ordered supervised visitation and that CFS refer Mother to substance abuse treatment and parenting education. CFS's disposition report recommended that the court order family reunification services and transfer the case to Marin County. Mother was participating 12- step meetings and alcohol abuse education in Marin and expected to secure a Marin apartment. Marin County court accepted the transfer and continued the case. Later, Marin’s Health and Human Services Department asked the court to transfer the cases back to Contra Costa because it had discovered that a county employee had a familial relationship to the parties, rendering the Department unable to continue services. Mother opposed the transfer; there was no evidence that the proposed transfer served the children’s best interests. The court of appeal remanded the cases to Marin, noting that all of the parties conceded error. View "In re Nia A." on Justia Law

While claimant-appellant Judith Weible was employed by Safeway, Inc., she requested time off because she had to have surgery. Safeway granted her request and agreed to hold her job until she was able to return to work, which she intended to do. She was gone for approximately six weeks. While on leave, claimant applied for unemployment benefits. She was denied because during her leave of absence she was still employed, even though she was not working. An appeals examiner upheld the denial, and the Industrial Commission upheld the appeals examiner. Finding no reversible error, the Supreme Court affirmed the Industrial Commission. View "Weible v. Dept of Labor" on Justia Law

Dreher had been a maintenance supervisor at an Alliance apartment complex for 74 days when he slipped and fell on concrete walkway in the complex in the rain. Dreher sustained a fractured pelvis and injuries to his neck, shoulder, leg, and knee. He suffered gait derangement, a sleep disorder, and headaches. Dreher required surgery to repair pelvic fractures, another surgery to repair a torn meniscus, and another surgery to address issues with his foot and ankle. Dreher sought compensation for a psychiatric injury. An evaluation concluded that Dreher suffered a psychiatric disability as a result of the accident, including depression, difficulty sleeping, and panic attacks. The ALJ found that Dreher sustained an injury arising out of and in the course of his employment but denied his claim as barred by section 3208.3(d) because Dreher was employed by Alliance for less than six months and his psychiatric injury did not result from a sudden and extraordinary employment condition. On reconsideration, the Workers’ Compensation Appeals Board found that the injury was not barred. The court of appeal annulled the decision. Dreher’s testimony that he was surprised by the slick surface because the other walkways had a rough surface, and that the walkway was later resurfaced, did not demonstrate that his injury was caused by an uncommon, unusual, or totally unexpected event. View "Travelers Cas. & Surety Co. v. Workers' Comp. Appeals Bd." on Justia Law

Sneed, who served on active duty 1964-1968, suffered service-connected disabilities. In 2001, Sneed suffered a spinal cord contusion from a fall, leaving him quadriplegic. In 2003, he died of smoke inhalation while living in a home for paralyzed veterans. His widow sought dependency and indemnity compensation, 38 U.S.C. 1310, alleging that Sneed’s service-connected spondylosis and spinal stenosis contributed to quadriplegia and that his service-connected PTSD and hearing loss prevented him from exiting during the fire. The Board of Veterans’ Appeals affirmed denial,mailing notice on April 5. Sneed’s notice of appeal was due 120 days after that mailing. On April 13, Sneed contacted attorney Eagle, requesting representation. According to Sneed, at the request of Eagle’s secretary, she transmitted case materials to and had oral communications with that office. On August 2, Sneed received a letter from Eagle, stating that the claim “does not meet the criteria,” declining representation, and stating that notice of appeal was due "no later than August 5.” The correct deadline was August 3. Several lawyers declined her case. Sneed filed notice on September 1, explaining her circumstances. The Veterans Court dismissed the appeal as untimely. On remand, Sneed argued attorney abandonment, warranting equitable tolling. The Veterans Court held, and the Federal Circuit affirmed, that equitable tolling was not warranted absent an agreement between Eagle and Sneed and that Sneed did not act diligently. View "Sneed v. McDonald" on Justia Law