Justia Public Benefits Opinion Summaries

Since 1996, retired employees of the City and County of San Francisco) have been eligible for a supplemental cost of living allowance (COLA) as part of their pension benefits when the retirement fund’s earnings from the previous year exceeded projected earnings. In 2011, voters passed Proposition C, an initiative measure that conditioned payment of the supplemental COLA on the retirement fund being “fully funded” based on the market value of the assets for the previous year. POB, a political action committee representing the interests of retired city employees, challenged the amendment as an impairment of a vested contractual pension right under the contract clauses of the federal and state Constitutions. The court of appeal held that, with respect to current employees and employees who retired after the supplemental COLA went into effect, the full funding requirement cannot stand. Employees who retired before November 6, 1996 had no vested contractual right in the supplemental COLA; the 2011 amendment may be applied to their pensions. The court rejected POB’s claim that the full funding requirement must be set aside because the Board of Supervisors failed to obtain an adequate actuarial report before placing Proposition C on the ballot. View "Protect Our Benefits v. City & Co. of San Francisco" on Justia Law

Pomianowski was 19 years old when she was in an automobile accident which left her a ventilator-dependent quadriplegic. She required total care in all aspects of daily living. A lawsuit filed against the County of Santa Cruz and Ford Motor Company, resulted in a settlement for $3,175,000.00. The court directed that the funds be deposited in a special needs trust (Probate Code sections 3600-3605). At age 23, Pomianowski died, with $1,294,453.23 left in the trust, which was ordered to reimburse the Department of Health Care Services for medical expenses paid on her behalf before her death. The trustee argued that the assets were exempt from reimbursement rights because the beneficiary was under 55 years of age when the services were provided. The court of appeal affirmed, holding that the Department was entitled to reimbursement under both the Medicaid statute, 42 U.S.C. 1396a, and the statutes and regulations implementing Medicaid through California’s Medi-Cal program. The statutes and regulations do not exempt beneficiaries under age 55, nor is there a public policy reason to shield the trust assets from recovery so that $417, 812.43 spent by the public can pass to the beneficiary’s parents along with the rest of the trust assets. View "Herting v. Cal. Dep;t of Health Care Servs." on Justia Law

The plaintiff, then age 40, applied to the Social Security Commission in 2009 for benefits, claiming to be disabled from gainful employment as a result of psychiatric disorders (depression and bipolar disorder), chronic back and hip pain, and an anal fissure. He had been trained as a machinist and, until 2002, had worked intermittently as a machinist and an assembly line worker. The administrative law judge denied his claim on the ground that he was capable of performing unskilled sedentary work. The district court upheld the denial of benefits. The Seventh Circuit reversed, noting contradictions and gaps in the ALJ’s reasoning. The court did “not say that Voigt is in fact totally disabled from gainful employment, however— only that he’s entitled to a more careful analysis of his claim by the Social Security Administration.” View "Voigt v. Colvin" on Justia Law

Shirley Bleick appealed a district court order affirming a Department of Human Services' decision denying her application for Medicaid benefits. The Supreme Court affirmed, concluding a preponderance of the evidence supported the Department's finding that the income stream from Shirley Bleick's life estate exceeded asset limits for Medicaid eligibility. View "Bleick v. N.D. Dep't of Human Services" on Justia Law

Robinson worked for Concentra as a medical assistant from 2003 until she was terminated in 2010. Robinson applied for Social Security disability benefits four days after being terminated, claiming that she had multiple sclerosis that rendered her unable to work. The initial application was denied. An ALJ reversed, summarizing Robinson’s statements that: she must use a cane to walk because of leg numbness; she has poor vision; her hands frequently cramp and she has difficulty holding objects; and she needs help with all household chores. Robinson then filed suit against Concentra under Title VII, 42 U.S.C. 1981, and the Family and Medical Leave Act, claiming that she had been terminated on the basis of her race and color and in retaliation for filing a complaint with the EEOC and taking FMLA leave and that Concentra had interfered with her ability to take FMLA leave. The court entered summary judgment, finding that Robinson was estopped from showing that she was qualified for her position when she was terminated in September 2010, because she received disability benefits based on her statement that she was fully disabled as of June 2010. The Second Circuit affirmed, noting that Robinson failed to “proffer a sufficient explanation” for the contradictory statements. View "Robinson v. Concentra Health Servs.,Inc." on Justia Law

Bonnilyn Mascio filed an application with the Social Security Administration for supplemental security income benefits, alleging that she was disabled from degenerative disc disease, carpal tunnel syndrome, and adjustment disorder. An administrative law judge (ALJ) found that Mascio was not disabled. The district court reversed. On remand, a second ALJ found that Mascio was not disabled and denied her application. The district court upheld the denial of benefits. The Fourth Circuit reversed, holding that the ALJ erred (1) in assessing Mascio’s residual functional capacity because he did not conduct a function-by-function analysis; (2) by not considering Mascio’s moderate limitation in her ability to maintain her concentration, persistence, or pace; and (3) by determining Mascio’s residual functional capacity before assessing her credibility. Remanded. View "Mascio v. Colvin" on Justia Law

Relators’ daughter was being treated by counselors at Arbour Counseling Services in Lawrence, Massachusetts when she was prescribed a medication for her purported bipolar disorder. The daughter experienced an adverse reaction to the drug and eventually suffered a fatal seizure. Relators filed this action against Defendant Universal Health Services, Inc., Arbour’s owner and operator, under both the federal and Massachusetts False Claims Acts, alleging that Arbour, in submitting reimbursement claims to the state Medicaid agency for services rendered by the staff members who treated their daughter, fraudulently misrepresented that those staff members were properly licensed and supervised, as required by law. Specifically, Relators alleged that Arbour’s alleged noncompliance with supervision and licensure requirements rendered its reimbursement claims actionably false. The district four dismissed the complaint for failure to state a claim. The First Circuit reversed the dismissal of the complaint with one limited exception, holding (1) a healthcare provider’s noncompliance with conditions of payment is sufficient to establish the falsity of a claim for reimbursement; and (2) Relators appropriately stated a claim with particularity under the False Claims Act. View "United States, ex rel. Escobar v. Universal Health Servs., Inc." on Justia Law

Wingard, a 20-year veteran, died in 2005, from causes unrelated to his military service. His daughter sought a burial-plot or interment allowance (38 U.S.C. 2303) and burial benefits (38 U.S.C. 2302(a)(1)), which provides for burial benefits only in the case of a deceased veteran “who at the time of death was in receipt of compensation . . . or was in receipt of pension.”. The Board of Veterans Appeals granted an interment allowance, but denied burial benefits. In 1989, the Department had assigned Wingard a 0% disability rating for a service-connected hernia that had been treated and showed no sign of recurrence. Wingard’s disability rating remained at 0%l. He never received disability compensation, had no claims pending, and never received a Veterans-related pension. The Veterans Court held that 8 U.S.C. 7252(b) did not preclude review and that sections 1110 and 1155 allowed the Department to find some disabilities noncompensable and assign a 0% rating. The court did not address whether “in receipt of compensation,” included “entitled to receive compensation.” The Federal Circuit vacated, holding that Congress has barred the Veterans Court and Federal Circuit from conducting such review, which must be conducted through a direct review of rulemaking determinations under 38 U.S.C. 502. View "Wingard v. McDonald" on Justia Law

Three former New Mexico State employees were denied unemployment compensation benefits by the Department of Workforce Solutions because they were in positions designated as "a major nontenured policy-making or advisory position." The Supreme Court reversed the Department's decision, because after review, it concluded that the three positions in questions in these cases were not indeed designated as major nontentured policy-making or advisory positions. View "Perez v. N.M. Dep't of Workforce Solutions" on Justia Law

This action began in 1993 when Plaintiffs, representatives of a class of over 1.5 million Texas children eligible for Medicaid’s Early and Periodic Screening, Diagnosis, and Treatment program ("EPSDT"), sued various Texas state officials under 42 U.S.C. 1983 for violations of federal Medicaid law in the state’s implementation of the Program. The parties concluded a consent decree in 1996 in which Defendants promised to implement a number of changes, among which was a training program for participating health care providers. A few years later, after little progress had been made, the district court found Defendants in violation of the Decree. The Fifth Circuit reversed solely on Defendants' challenge to the Decree's validity under the Eleventh Amendment. In 2007, the parties agreed on a corrective action order to resolve Plaintiffs’ concerns with one part of the Decree. Defendants, believing their obligations to be satisfied, moved to dissolve that order and the associated Decree provisions under Rule 60(b)(5). The district court granted their motion. Plaintiffs appealed the district court’s termination of several provisions of the Decree decree and the dissolution of a related corrective action order pursuant to the first clause of Federal Rule of Civil Procedure 60(b)(5), that the judgment has been “satisfied, released, or discharged.” Finding no reversible error, the Fifth Circuit affirmed. View "Frew v. Suehs" on Justia Law