Justia Public Benefits Opinion Summaries

Plaintiff applied for disability benefits, listing eight impairments. The Social Security Administration denied Plaintiff’s application and did so again on reconsideration. The next year, Plaintiff testified before an Administrative Law Judge (ALJ). The ALJ disbelieved Plaintiff’s testimony that she could not sit, stand, or walk for extended periods of time and denied Plaintiff’s application for Disability Insurance Benefits and Supplemental Security Income. The Appeals Council denied review, making the ALJ’s decision the final decision of the Commissioner of Social Security. Plaintiff challenged the ALJ’s adverse credibility finding on appeal. The Seventh Circuit reversed, holding that the ALJ’s analysis was flawed in several respects, and the ALJ’s mistakes in evaluating Plaintiff’s credibility were not harmless. Remanded. View "Hill v. Colvin" on Justia Law

Plaintiff appealed the denial of his application for disability insurance benefits and supplemental security income. The court held that the Appeals Council committed legal error when it failed to consider materials from a psychologist who examined plaintiff. Accordingly, the court reversed and remanded with instructions. View "Washington v. SSA" on Justia Law

Beginning in 1989, Petitioner received public assistance from New York City Department of Social Services. Petitioner gave birth to a son, Michael, the next year. Michael was added to Petitioner’s public assistance case, and Petitioner assigned her right to child support for Michael. In January 2007, the Social Security Administration (SSA) determined that Michael was eligible to receive Supplemental Security Income (SSI), retroactive to September 2005. Because Michael’s eligibility for SSI made him ineligible for public assistance, the City removed him from Petitioner’s case in January 2007 but continued to collect child support arrears that had accrued prior to January 2007. In 2011, Petitioner requested a review from the City to determine whether she was owed any excess child support payments. The City determined that it owed no payments because it had not collected sufficient child support arrears to exceed the public assistance provided to Petitioner’s household. The State confirmed the City’s determination. Petitioner then commenced this N.Y. C.P.L.R. 78 proceeding challenging Respondents’ determinations as arbitrary, capricious and erroneous as a matter of law. Supreme Court denied the petition, and the Appellate Division affirmed. The Court of Appeals affirmed on the grounds that the City had not yet collected child support arrears that exceeded the unreimbursed benefits Petitioner’s family received. View "Hawkins v. Berlin" on Justia Law

For more than a decade, the Commissioner of the Social Security Administration (SSA) has paid directly to qualified attorneys who bring Supplemental Security Income (SSI) claims a fee of no more than twenty-five percent of the successful recovery of past-due benefits to clients. When a state chooses to administer its own payments, the amount of state payments are not included as “past-due benefits” for the purpose of attorney compensation. In 2012, Attorney represented a client in a claim for SSI benefits before the SSA. In 2013, Attorney’s client received a partially favorable decision. In 2012, however, Massachusetts changed its practice and began administering its own program of supplementary payments rather than rely on federal administration of its supplementary payments. Upon learning that the SSA attorney’s fee award did not include twenty-five percent of the Massachusetts state-administered state supplementary payments, Attorney filed a complaint for declaratory relief and petition for writ of mandamus in the federal district court. The district court granted summary judgment to the Commissioner. The First Circuit affirmed, holding that the Commissioner’s interpretation of 42 U.S.C. 1383(d)(2)(B) was reasonable. View "Moriarty v. Colvin" on Justia Law

California Education Code 56346(f) requires school districts to initiate a due process hearing if the school district determines that a portion of an Individualized Education Program (IEP) to which a parent does not consent is necessary to provide a child with a Free Appropriate Public Education (FAPE) under the Individuals with Disabilities Education Act (IDEA), 20 U.S.C. 1400–1450. The ALJ concluded that the district offered an appropriate placement but Mother's refusal to consent prevented the district from implementing and providing a FAPE. I.R. appealed, but the district court affirmed. The court concluded that the district court erred in concluding that the district could not initiate a due process hearing to address Mother's refusal to the IEP's recommended placement. In this case, the district waited a year and a half before initiating a hearing, which the court determined was too long a period of time. Therefore, to the extent that I.R. lost an educational opportunity and was deprived of educational benefits for an unreasonably prolonged period, the district can be held responsible for denying her a FAPE for that unreasonably prolonged period. The court reversed and remanded. View "I.R. v. L.A. U.S.D." on Justia Law

Mulder served in the Army for three separate periods between 1982 and 1994, accumulating about two years of honorable service. In 1998, the VA assigned Mulder a 50% disability rating for two service-connected conditions. Mulder was arrested and charged with felonies. Because Mulder was unable to post bail on July 11, 2005, he remained in custody pending trial. On May 19, 2006, Mulder pleaded no contest and a conviction was entered. On June 16, 2006, the court ordered that Mulder serve an initial term of confinement of eight years, six months, followed by six years of supervised release, with credit for the 384 days he had been in custody, specifying May 19, 2006, as the “Date(s) Convicted.” The VA must reduce benefits payments if the recipient is incarcerated for a period in excess of 60 days for conviction of a felony, 38 U.S.C. 5313(a)(1), beginning on the sixty-first day of such incarceration. In July 2007, the VA notified Mulder that his felony conviction and resulting incarceration required it to reduce his disability compensation, effective July 19, 2006. The Board, the Veterans Court, and the Federal Circuit agreed with the VA’s use of the date of the plea and conviction in calculating the reduction. View "Mulder v. McDonald" on Justia Law

Plaintiff appealed the denial of social security disability benefits, alleging that the Appeals Council erred by failing to provide an explanation for why it disregarded the treating physician’s opinion and that the ALJ’s decision is not supported by substantial evidence in light of a treating physician’s opinion. The court agreed and held that, based on the record, including the physician's opinion, the ALJ's determination is not supported by substantial evidence in the record. Accordingly, the court vacated the judgment and remanded for further proceedings. View "Lesterhuis v. Colvin" on Justia Law

Legislation, effective in 2004 requires that injured workers’ requests for medical treatment be evaluated through a process called utilization review (UR). Under the UR process, a request for treatment cannot be denied by a claims adjustor and must be approved unless a clinician determines that the treatment is medically unnecessary. Workers can challenge decisions denying requested treatment, but employers cannot challenge decisions approving it. The 2004 legislation called for administrative adoption of uniform standards for physicians to use in evaluating treatment. In 2013, additional reforms went into effect, establishing a new procedure, independent medical review (IMR), to resolve workers’ challenges to UR decisions. Stevens challenged the constitutionality of the IMR process, arguing that it violated the state Constitution’s separation of powers clause, its requirements that workers’ compensation decisions be subject to review and the system “accomplish substantial justice,” and principles of due process. The court of appeal rejected those claims, but remanded Stevens’s request for a home health aid. The Legislature has plenary powers over the workers’ compensation system under article XIV, section 4 of the state Constitution. California’s scheme for evaluating workers’ treatment requests is fundamentally fair and affords workers sufficient opportunities to present evidence and be heard. View "Stevens v. Workers' Comp. Appeals Bd," on Justia Law

A single mother of five children subject to dependency proceedings sought to reverse a court order denying her further reunification services with respect to her three oldest children and to stay a hearing under Welfare and Institutions Code 366.26 that had been set for September 16, 2015. She claims the court erred in denying her further reunification services because she has made and continues to make reasonable efforts to address the problems that led to the removal of her children, so denial of additional services is not in the children’s best interests. The court of appeal stayed the hearing, but ultimately denied the petition and lifted the stay. Mother has received extensive child welfare services and has taken advantage of them only sporadically. The children have been involved with the dependency system for 11 years, and have spent six years in out-of-home placement with multiple caregivers, not always in healthful circumstances. Mother’s drug abuse, mental instability, and abusive relationships with men, have exposed the children to a continuing risk of harm, delayed their educational development, and left them without a stable home. The court’s factual findings in determining to withhold further services were supported by substantial evidence. View "D.T. v. Superior Court" on Justia Law

Plantiff filed suit challenging the denial of his claim for disability benefits under Title II of the Social Security Act, 42 U.S.C. 423. Because the ALJ based his decision on a credibility assessment of plaintiff's testimony without holding an additional hearing as required by the Hearings, Appeals, and Litigation Law Manual (HALLEX), the court held that defendant was prejudiced by the HALLEX violation. Accordingly, the court reversed and remanded with instructions that the case be remanded to the Commissioner for further proceedings. View "Morgan, Jr. v. Colvin" on Justia Law