Justia Public Benefits Opinion Summaries

Appellant Billy J. Bringman appealed an Idaho Industrial Commission decision in favor of Respondents New Albertsons, Inc. and the Idaho Department of Labor. The Commission determined Bringman willfully made a false statement or failed to report a material fact regarding his separation from Albertsons to obtain unemployment benefits from the Department and ordered Bringman to repay the benefits he received and pay a civil penalty. Finding no reversible error with that decision, the Supreme Court affirmed. View "Bringman v. New Albertsons, Inc." on Justia Law

Melvin Peterson died in 2007. Prior to his death, he owned some residential real property. In 2001, Peterson executed a Gift Deed of his real property to his daughter, Cathie Peterson, retaining for himself a life estate in the property. Shortly thereafter, he applied for Medicaid and began receiving Medicaid benefits in March 2003. At the time of his death, Melvin Peterson had received a total of $171,386.94 in Medicaid benefits. Cathie was appointed personal representative. IDHW filed a timely Claim Against Estate and later an Amended Claim Against Estate in the amount of $171,386.94. Cathie disallowed the claims without stating a reason. In response, IDHW filed a Petition for Allowance of Amended Claim. After a hearing, the court granted IDHW's petition. After receiving no response to its claim against the estate, IDHW filed a Petition to Require Payment of Claim, setting forth its demand for payment of the value of Melvin Peterson's life estate. After a hearing, the magistrate court entered an order requiring payment of IDHW's claim. The Order held that the life estate was an asset of the estate for purposes of Medicaid recovery and ordered the personal representative to add the life estate interest to the estate's inventory and assign it an appropriate value. However, the personal representative instead filed and was granted a motion to hire an appraiser to determine the fee simple value of the residential real property. After the personal representative failed to file an appraisal, IDHW filed various motions relative to the appraisal, sale of the property, and payment of its claim. The magistrate court granted IDHW's motions to compel appraisal, sale of the property, and payment of the Medicaid claim, which the personal representative subsequently appealed. The district court vacated the magistrate's Order and remanded the matter for additional findings of fact and conclusions of law. Shortly after the ruling on appeal was entered, Cathie Peterson sought permission from the magistrate court to sell the property, liquidate an escrow account, and pay counsel for the personal representative of the estate. On the same day, she also filed an Amended Personal Representative's Inventory assigning the life estate zero value. Attorney Brent Featherston filed a Demand for Notice and Special Appearance on behalf of "Cathie Peterson, individually,"stating that he was seeking to vacate and dismiss all orders entered by the magistrate court regarding her real property. IDHW responded by filing a petition to remove Cathie Peterson as personal representative of the estate, which the magistrate court granted. Following a court trial, the magistrate court held that the life estate remainder interest was an estate asset of value for purposes of Medicaid reimbursement and that its value was to be determined in accordance with IDAPA 16.03.05.837.01. On appeal, the district court affirmed the magistrate court. Cathie Peterson appealed. The Supreme Court found that both the magistrate court and the district court had subject matter jurisdiction over this case and personal jurisdiction over Cathie Peterson individually, and that the entire residential property that Cathie Peterson received from her father was an asset of his estate and subject to Medicaid recovery. Thus, the district court erred to the extent it held that only the remainder interest in the estate was subject to Medicaid recovery. Furthermore, the Court held that Cathie Peterson failed to show that the district court's decision denying her claim for offsets was unsupported by the evidence. View "Dept. of Health & Welfare v. Peterson" on Justia Law

Claimant DeAnne Muchow began working for Varsity Contractors, Inc in 2011 as a human resources assistant. During her employment, the claimant had an ongoing conflict with her supervisor and had lodged several complaints about her supervisor with the director of the department. In an effort to resolve the conflict, the director held a meeting with claimant and her supervisor. The claimant and her supervisor both stated that they had documentation outlining their complaints. The director told them to get their documentation and bring it back to his office. The claimant asked if they could do so the following day because she wanted time to look over her documentation, but the director denied that request because he was leaving the next day on a business trip. He did give the claimant a few minutes to look over her documentation. She returned to her desk and after a few minutes printed her documentation. She took the documents and walked toward the director, who was standing outside his office. The claimant waved the documents in the air, told the director she had them and was going to shred them, and walked past him toward the shredder. He told her not to shred them, but she continued to the shredder and shredded them. The director then discharged her for insubordination. The claimant applied for unemployment benefits, which were initially denied. She appealed, and an appeals examiner reversed the ruling that the claimant was not entitled to unemployment benefits. He held that as a matter of law there was no insubordination. The basis of his ruling was that the director’s order not to shred the documents was not a directive that the director was authorized to give and entitled to have obeyed, because the documents belonged to the claimant and contained her personal notations about issues and problems she was having with a coworker. The employer then appealed to the Industrial Commission. The commission adopted the findings of fact made by the appeals examiner. However, the commission disagreed with the conclusions of law made by the appeals examiner. The commission concluded that her conduct constituted employment-related misconduct, and it reversed the decision of the appeals examiner and held that the claimant was not eligible for unemployment benefits. Upon review of the matter, the Supreme Court found no reversible error in the Commission's decision and affirmed. View "Muchow v. Varsity Contractors, Inc." on Justia Law

To address economic conditions and projections demonstrating a severely underfunded plan, the Colorado General Assembly approved measured designed to protect present and future retirees by providing an adequately pension program. This appeal centered on changes made to the annual cost of living (COLA) that applied to increase each retiree's vested base retirement benefit. Plaintiffs in this case were retired public employees who contended that they had a contract with the State entitling each of them, upon retirement, to have their base pension benefit annually adjusted by the specific COLA formula in existence at the time they were eligible to retire, for the rest of their lives without change. The district court ruled they had no such contract right to an unchangeable COLA formula. The court of appeals disagreed, finding the retirees had a contract right to the formula in place at the time of eligibility for retirement or actual retirement based on the so-called "public policy exception," and remanded for further review to determine whether the legislature's act violated the Contract Clauses of the federal and state constitutions. The Colorado Supreme Court disagreed with the court of appeals, and agreed with the district court. The appellate court's judgment was reversed that the district court's judgment reinstated. View "Justus v. Colorado Public Employee's Retirement Association Pension Plan" on Justia Law

Plaintiff appealed the denial of his application for supplemental security income where the ALJ found that plaintiff was not disabled because he could perform jobs a vocational expert (VE) identified in response to a hypothetical posed by the ALJ. The court agreed with plaintiff that the ALJ failed to resolve an apparent conflict between the physical limitations described by the ALJ in his hypothetical and the requirements of the jobs the VE identified, as listed in the Dictionary of Occupational Titles. Accordingly, the court vacated and remanded for further proceedings. View "Moore, Jr. v. Colvin" on Justia Law

The issues this case presented for the Supreme Court were whether ORS 243.303(2) (which requires local governments to make available to retired employees, "insofar as and to the extent possible," the health care insurance coverage available to current officers and employees of the local government,) created a private right of action for the enforcement of that duty; or, if not, whether the Court should (under its common-law authority) provide such a right of action. The Court of Appeals held that the statute did not expressly or impliedly create a private right of action, and it considered that conclusion to be dispositive of plaintiffs' claim for relief. The Supreme Court also concluded that the statute did not expressly or impliedly create a private right of action for its enforcement. However, where a statute imposes a legal duty, but there is no indication that the legislature intended to create (or not to create) a private right of action for its enforcement, courts must (if such relief is sought) determine whether the judicial creation of a common-law right of action would be consistent with the legislative provision, appropriate for promoting its policy, and needed to ensure its effectiveness. Analyzing the duty imposed on local governments by ORS 243.303(2) under that standard, the Court declined to create an additional common-law right of action for its enforcement because: (1) plaintiffs failed to identify a cognizable common-law claim for relief whose creation is appropriate and necessary to effectuate the legislature's purpose; (2) a declaratory judgment and supplemental relief were adequate to enforce the statutory duty; and (3) a significant change in existing law would result from judicial creation of a tort claim permitting the recovery of noneconomic damages in the circumstances here, and there is no other need to create a common-law tort claim. View "Doyle v. City of Medford" on Justia Law

The Randolph-Sheppard Act, 20 U.S.C. 107–107e, gives blind persons a priority in winning contracts to operate vending facilities on federal properties. Fort Campbell, Kentucky, operates a cafeteria for its soldiers. For about 20 years, Kentucky’s Office for the Blind (OFB) has helped blind vendors apply for and win the base’s contracts for various services. In 2012, the Army, the federal entity that operates Fort Campbell, published a solicitation, asking for bids to provide dining-facility-attendant services. Rather than doing so under the Act, as it had before, the Army issued this solicitation as a set aside for Small Business Administration Historically Underutilized Business Zones. OFB, representing its blind vendor, filed for arbitration under the Act, and, days later, filed suit, seeking to prevent the Army from awarding the contract. The district court held that it lacked jurisdiction to consider a request for a preliminary injunction. The Sixth Circuit vacated. OFB’s failure to seek and complete arbitration does not deprive the federal courts of jurisdiction. View "Commonwealth of Kentucky v. United States" on Justia Law

Employer Maple Leaf Farm Association, Inc. appealed a decision of the Employment Security Board finding that its former employee Katherine Kelley was involuntarily terminated from her position and therefore eligible for unemployment compensation benefits. Employer operated an intensive inpatient drug and alcohol treatment program. Claimant worked for employer as a part-time treatment counselor for seven years. Due to a conflict with a supervisor, claimant resigned from her position in writing on August 29, 2013. She stated in her letter to employer that her last day would be September 19, 2013, and employer allowed her to continue working. Four days later, on September 3, employer terminated her employment and escorted her off the premises. Claimant applied for unemployment compensation. The claims adjudicator determined that she was not entitled to benefits for the first two weeks after her termination because the accrued vacation pay that employer paid her during that period was in excess of her weekly benefit amount. The claims adjudicator further determined that claimant was not entitled to benefits because she had left employment voluntarily without good cause attributable to her employer. Employer appealed the referee’s decision to the Employment Security Board, which adopted the referee’s findings and affirmed its conclusions. Finding no reversible error, the Supreme Court affirmed the Board's decision. View "Kelley v. Department of Labor" on Justia Law

UT filed suit against the United States, seeking refund of the Social Security component of FICA taxes it paid with respect to the service of medical residents in 2005. The court affirmed the district court's denial of UT's motion for summary judgment and grant of the United States' motion for summary judgment, concluding that UT's residents are not "students" within the meaning of the student exclusion in Texas's 42 U.S.C. 418 agreement. Section 418 allows states to voluntarily opt-in to the Social Security system by entering into an agreement with the Commissioner of Social Security.View "University of Texas System, et al. v. United States" on Justia Law

Warner, insured by State Farm, was involved in an automobile accident. Following the accident, Michigan Spine provided Warner with about $26,000 of neurological treatment. State Farm denied coverage, stating that Warner’s condition was the result of a preexisting condition. Michigan Spine submitted the claim to Medicare, which approved a conditional payment of $5,000 under the Medicare Secondary Payer Act, 42 U.S.C. 1395y. Michigan Spine sued State Farm under Michigan’s No-Fault Act and the Medicare Secondary Payer Act, which permits private causes of action against primary plans that fail to pay medical expenses for which they are responsible. The district court dismissed, holding that a private party can recover under the Secondary Payer Act only if a “primary plan” has failed to provide appropriate reimbursement only because the planholder is entitled to Medicare benefits, and State Farm did not deny coverage on that basis. The Sixth Circuit reversed and remanded. Although the text of the Secondary Payer Act is unclear as to whether a private cause of action is available against a non-group health plan that denies coverage on a basis other than Medicare eligibility, accompanying regulations and congressional intent indicate that the requirement applies only to group health plans and not to non-group health plans. Michigan Spine may pursue its claim under the Secondary Payer Act. View "MI Spine & Brain Surgeons, PLLC v. State Farm Mut. Auto Ins Co" on Justia Law