Justia Public Benefits Opinion Summaries

Plaintiff appealed the denial of her application for supplemental security income (SSI) where she alleged that she was disabled due to back pain, scoliosis, and other conditions. The court concluded that the Commissioner did not err in affording little weight to plaintiff's treating physician's opinion because it was inconsistent with the treatment records and the objective medical evidence as a whole, and was not supported by the physician's own physical examination of plaintiff and the objective test results. Therefore, the court concluded that substantial evidence in the record as a whole supported the Commissioner's decision that plaintiff was not disabled. Accordingly, the court affirmed the denial of benefits. View "Cline v. Colvin" on Justia Law

For more than twenty years, the Maine Department of Health and Human Services (DHHS) provided Medicaid coverage for nineteen- and twenty-year-old children whose families met low-income requirements. In 2012, Maine DHHS submitted a state plan amendment to the federal DHHS plan seeking to drop that coverage. The federal DHHS Secretary declined to approve the amendment because it did not comply with 42 U.S.C. 1396a(gg), which requires states accepting Medicaid funds to maintain their Medicaid eligibility standards for children until October 1, 2019. Maine DHHS petitioned for review, contending that the statute is unconstitutional under the Spending Clause and violates the doctrine of equal sovereignty as articulated in Shelby County v. Holder. The First Circuit affirmed, holding that the statute is constitutional as applied in this case, as (1) application of section 1396a(gg) in these circumstances does not exceed Congress’s power under the Spending Clause; and (2) the equal sovereignty doctrine of Shelby County is not applicable in this case, and any disparate treatment caused by section 1396a(gg) is sufficiently related to the problem the statute was designed to address. View "Mayhew v. Burwell" on Justia Law

Respondent Kimberly Legette was employed by Appellant Nucor Corporation from 1998, through 2010. Nucor terminated Legette's employment after she failed a random on-site drug test in violation of Nucor's drug policy. Although Legette obtained an independent drug test, which tested negative for drugs, she was fired from her job at Nucor based on the two positive drug test results. Legette subsequently applied for unemployment benefits. Nucor requested that Legette be denied unemployment benefits, contending she was statutorily ineligible to receive them because she was fired for violating Nucor's drug policy by testing positive for drugs. This direct appeal from the Administrative Law Court (ALC) presented for the Supreme Court's review a threshold procedural challenge to appealability, and substantively, to the awarding of unemployment benefits to an employee terminated for failing a drug test administered by a laboratory that was not properly certified. Because this appeal arose from a final resolution of all issues, the Court found the matter is appealable. The Court affirmed the ALC. View "Nucor v. SCDEW" on Justia Law

Thulin was a Shopko pharmacist. During his tenure, Thulin observed what he believed to be a scheme in which Shopko submitted inflated claims for prescription drugs to the Medicaid program. Thulin filed a qui tam complaint, claiming violation of the federal False Claims Act by overbilling Medicaid, alleging that Shopko is a “sophisticated,” “multi-regional” business that developed and programmed the PDX system and should have been aware of federal law governing submission of claims, and bringing claims under the laws of eight states. The district court dismissed the federal claim under FRCP 9(b) and 12(b)(6). The Seventh Circuit affirmed. To be liable under the Act, Shopko must have acted with “actual knowledge,” or “deliberate ignorance” or “reckless disregard” of the possibility that its claims were false. Thulin’s allegations were not sufficient to satisfy that requirement even if Shopko’s practices were contrary to the Federal Assignment Law. Although malice, intent, and other conditions of the mind may be alleged generally, vague allegations that a corporation acted with reckless disregard or with reason to know of facts that would lead a reasonable person to realize that it was submitting false claims, simply because of its size or sophistication do not clear even this lower pleading threshold. View "Thulin v. Shopko Stores Operating Co., LLC" on Justia Law

Plaintiff appealed the denial of his application for supplemental security income (SSI). The court concluded that substantial evidence supported the ALJ's decision denying plaintiff's application for SSI where the ALJ's decision in this case was not a broad rejection and was sufficient to enable the district court and this court to conclude that the ALJ considered plaintiff's medical condition as whole. The court held that the Appeals Council is not required to explain its rationale when denying a request for review and concluded that the new evidence plaintiff submitted did not render the Commissioner's denial of benefits erroneous. Accordingly, the court affirmed the judgment. View "Mitchell v. Commissioner, Social Security Administration" on Justia Law

Plaintiff appealed the denial of her application for disability insurance benefits, asserting that she had difficulty breathing and painful joints. The court concluded that the ALJ did not err in giving greater weight to a medical expert's testimony than to the testimony of other experts; the ALJ did not err in not seeking clarifications to plaintiff's expert's opinion where the ALJ expressly refused to give the expert opinion "great weight" and then explaining its reasons for doing so; the ALJ's decision was based on substantial evidence; the ALJ considered plaintiff's obesity and made findings about the demands of her prior work as a file clerk; and the ALJ did not err in relying on the vocational expert's testimony that plaintiff's mental and physical condition, age, and education support her ability to perform "unskilled occupations." Accordingly, the court affirmed the denial of benefits. View "Grable v. Colvin" on Justia Law

The district court awarded Naegel, counsel for a prevailing social security disability benefits applicant, significantly reduced attorneys’ fees under 42 U.S.C. 406(b). He claimed that the court should have approved his request for $26,049.73, the 25-percent contingency fee accepted by his client and permitted by statute. The Commissioner of Social Security, representing the interests of the claimant whose benefits pay for the fees, opposed that sum as a “windfall” in light of counsel’s 35.5 hours of work. The district court agreed and awarded $12,780. The Sixth Circuit affirmed, noting that: “Within the 25 percent boundary,” prevailing counsel bears the burden of “show[ing] that the fee sought is reasonable for the services rendered.” View "Lasley v. Comm'r of Soc. Sec." on Justia Law

Plaintiff appealed the denial of her application for social security disability insurance benefits, alleging total disability due to, among other things, depression, anxiety, joint deterioration, and swelling in her hands and feet. The court held that substantial evidence, including contemporaneous treatment notes, independent medical opinions, and plaintiff's own behavior, supported the ALJ's and the district court's determination that she could perform sedentary work. Accordingly, the court affirmed the judgment. View "Ponder v. Colvin" on Justia Law

Plaintiff appealed the denial of his applications for Social Security disability insurance benefits and supplemental security income. The court concluded that the ALJ's determination is supported by substantial evidence on the record that a person with plaintiff's residual functional capacity can perform a sufficient number of existing jobs based on the vocational expert's testimony. Accordingly, the court affirmed the judgment of the district court. View "Gieseke v. Colvin" on Justia Law

Plaintiffs had been firefighters for the city of Portland when they suffered disabling injuries. The city's charger required it to provide disability benefits to its police and fire employees who suffer injuries in the course of their employment that render them “unable to perform [their] required duties,” with a minimum disability benefit of 25 percent of the employee’s base pay, “regardless of the amount of wages earned in other employment.” The city originally determined that plaintiffs’ disabilities made them unable to perform their “required duties” and paid them disability benefits. Years later, however, the city created new job assignments that included some of the duties within the job classifications that plaintiffs had held when they were injured. Because the city gave the new job assignments the same job classifications that plaintiffs had previously held, the city maintained that plaintiffs were no longer disabled. The city therefore required plaintiffs to return to work and discontinued paying them the minimum disability benefit. Plaintiffs sued the city for breach of contract, and the circuit court granted summary judgment for the city. The Court of Appeals affirmed in part and reversed in part. After its review, the Supreme Court concluded the city charter’s use of the term “required duties” meant core duties. Because there was a genuine issue of material fact as to whether the duties of plaintiffs’ new job assignments were the “required duties” for the job classifications that plaintiffs previously held, the Court further concluded that the circuit court erred in granting summary judgment in favor of the city. View "Miller v. City of Portland" on Justia Law