Justia Public Benefits Opinion Summaries

E.M., who has an auditory processing disorder or a central auditory processing disorder, through his parents, filed suit against the district alleging that E.M. had been denied a free and appropriate public education (FAPE) pursuant to the Individuals with Disabilities Education Improvement Act of 2004 (IDEA), 20 U.S.C. 1400 et seq. The court concluded that plaintiffs failed to show that the district acted unreasonably in determining in 2005 that E.M. did not qualify for special education services under the "specific learning disability" category; the Department of Education's position that a central auditory processing disorder is eligible for consideration for benefits under the "other health impairment" category merits deference; but plaintiffs failed to show that the district acted unreasonably in not considering E.M. for benefits under the "other health impairment" category in 2005. Accordingly, the court affirmed the district court's denial of relief to plaintiffs.View "E.M. v. Pajaro Valley U.S.D." on Justia Law

Plaintiff appealed the denial of Social Security benefits. The court concluded that the ALJ erred in rejecting medical opinions, that she misunderstood a state examiner's opinion of plaintiff's impairments, and that she failed to meet the requirement of offering specific, clear, and convincing reasons for discrediting plaintiff's symptom testimony. The court reversed the district court's decision to remand the case to the ALJ for further proceedings and, instead, remanded to the district court with instructions to remand to the ALJ for a calculation and award of appropriate benefits. Plaintiff unquestionably satisfies all three conditions of the credit-as-true rule and a careful review of the record disclosed no reason to seriously doubt that she is, in fact, disabled. View "Garrison v. Colvin" on Justia Law

Plaintiff, a mother with limited financial means raising a severely disabled child, withdrew her daughter from public school and enrolled her in a private learning center, alleging that the Department failed to provide her child with the free appropriate public education (FAPE) required by the Individuals with Disabilities Education Act (IDEA), 20 U.S.C. 1400 et seq. The court concluded that, in light of the contractual obligation to pay tuition, plaintiff had standing under Article III to pursue her challenge to the Individualized Education Program (IEP) and to seek direct retroactive tuition payment. The court also concluded that, in light of intervening authority, the district court erred in affirming the SRO's determination that the December 2008 IEP provided a FAPE. Because the court could not resolve the merits of plaintiff's challenge to the IEP, the court remanded for further proceedings.View "E.M. v. NYC Dept. of Educ." on Justia Law

In this case, the Georgia Department of Human Services, Family and Children Services (DFCS) granted appellee Jerry Glover's application for Medicaid benefits but imposed a multi-month asset transfer penalty on him pursuant to section 2339 of DFCS's Georgia Economic Support Services Manual due to his refusal to name the State as the remainder beneficiary on an annuity. Glover appealed the penalty to an Office of State Administrative Hearings Administrative Law Judge (ALJ) who issued an initial decision reversing the penalty. DFCS then filed a request for agency review by the Georgia Department of Community Health (DCH). DCH issued a final decision upholding the penalty. Pursuant to OCGA 50-13-19 of the Administrative Procedures Act, Glover then sought judicial review from the Superior Court which affirmed the final agency decision. The Court of Appeals granted Glover’s application for discretionary appeal and reversed the superior court, concluding that section 2339 of the Eligibility Manual as applied to Glover was inconsistent with the plain language of the federal Medicaid statute and that pursuant to 42 U. S. C. sections 1396p (c) (1) (F) and (G), Glover's annuity was not an asset to which the asset transfer penalty would apply. Appellants, David Cook in his official capacity as Commissioner of DCH and Clyde Reese in his official capacity as Commissioner of DFCS, appealed to the Georgia Supreme Court arguing that the Court of Appeals improperly interpreted the annuity section of the Medicaid Act and erred in holding that sec. 2339 as applied to Glover violated federal law. Asserting that the statutory provisions at issue was ambiguous, appellants contended that the Court of Appeals was required to defer to CMS's interpretation of the federal statute. Because the Supreme Court found that the federal statutory provisions at issue were ambiguous and the relevant administrative agencies’ interpretations of them were based on a permissible construction of the statutory language, it reversed the Court of Appeals’ decision in this case. View "Cook v. Glover" on Justia Law

Plaintiff was a Medicare beneficiary who received his Medicare benefits through a plan offered by Respondents, health insurance businesses that specialize in health maintenance and/or managed care and are engaged in the joint venture of providing insurance. As a result of his treatment at a clinic, which was a contracted provider for Respondents, Plaintiff became infected with hepatitis C. Plaintiff subsequently sued Respondents alleging negligence in selecting their health care providers. The district court dismissed the complaint, concluding that Plaintiff’s claim was preempted by the federal Medicare Act. The Supreme Court affirmed, holding that state common law negligence claims regarding the retention and investigation of contracted Medicare providers are expressly preempted by the Medicare Act. View "Morrison v. Health Plan of Nev., Inc." on Justia Law

Yurt suffers from a psychotic disorder which causes him to experience auditory hallucinations and bouts of uncontrollable rage. He also has obsessive compulsive disorder, moderately severe chronic obstructive pulmonary disease (COPD), and chronic bifrontal tension headaches. He has worked as a cook and a janitor, last working in May 2010, when he suffered a mental break and was terminated for threatening a coworker with a knife. He applied for Disability Insurance Benefits from the Social Security Administration, but an ALJ denied his application. The Appeals Council declined review. The district court affirmed. The Seventh Circuit reversed and remanded, agreeing that the ALJ erred by failing to include many of his medical limitations in the hypothetical that she posed to the vocational expert. View "Yurt v. Colvin" on Justia Law

Beardsley was 49 years old when she fell and injured her knee. She had worked as a machine operator, assembler, inspector, and cashier. After the injury, she applied for disability insurance benefits and supplemental security income. Her doctors determined that she had meniscal tears and a ruptured ligament, compounded by obesity and worsening osteoarthritis. She declined surgery but received injections for the arthritis. Dr. Banyash examined her on behalf of the Social Security Administration and opined that pain and weakness restricted her ability to walk, stand, climb stairs, crouch, and kneel, but she was capable of sedentary work. Given Beardsley’s age and skills, a finding that she was capable of only sedentary work would have qualified her as disabled at the time under the grid SSA uses for making that determination. Another agency physician subsequently judged her able to stand or walk for about six hours of an eight-hour workday. The ALJ denied benefits, finding that she could still perform a range of light work. Beardsley argued that the ALJ gave too little weight to the opinion of the examining doctor and too much weight to an erroneous view of her daily activities, particularly care she provided for her elderly mother and that the ALJ improperly held against her the decision not to seek surgery. The district court affirmed the denial of benefits. The Seventh Circuit reversed and remanded, finding that errors undermined the “logical bridge” between evidence and conclusion.View "Beardsley v. Colvin" on Justia Law

Plaintiff appealed the denial of her application for disability insurance benefits and supplemental security income. The district court granted the Commissioner's motion for judgment on the pleadings, finding that the ALJ's denial of benefits was supported by substantial evidence. The court concluded that, although the ALJ erred in posing an incomplete hypothetical question, the error was harmless because the hypothetical question posed to the vocational expert implicitly (and sufficiently) accounted for plaintiff's particular non-exertional limitations. Accordingly, the court affirmed the judgment of the district court.View "McIntyre v. Colvin" on Justia Law

Townsend applied for social security disability benefits and supplemental security income in 2003, at age 44, claiming that she had become incapable of full‐time gainful employment in May 2002 when she had stopped working as a result of multiple physical and psychiatric ailments, including fibromyalgia. In 2012 an ALJ decided that she had become totally disabled in November 2008. By the time that decision was rendered she had died (of pulmonary diseases apparently unrelated to the ailments alleged to have made her totally disabled). Her father was substituted for her. The district court upheld the decision. The Seventh Circuit reversed and remanded, noting multiple errors in determining the onset of total disability.View "Williams v. Colvin" on Justia Law

The Board challenged the district court's decision to award O.L.'s parents reimbursement for one-on-one instruction outside the school setting as well as some of their attorney's fees. The parents cross-appealed the district court's decision not to award O.L. compensatory education. The court concluded that the parents were eligible for reimbursement; the district court was right to find that the alternative program was proper under the standard set forth in Bd. of Educ. of Hendrick Hudson Centr. Sch. Dist., Westchester Cnty. v. Rowley; even if the alternative program has its shortcomings, it was reasonably calculated to permit the child to obtain some educational benefit; the district court's reimbursement award was appropriate; the district court did not abuse its discretion when it took the quality of the chosen alternative into consideration; it was clear on the record that the district court properly weighed the evidence and did not abuse its considerable discretion when it denied the request for compensatory education; and there was no need to reverse the attorney's fee award since the court affirmed the district court's decision in all respects.View "R.L., et al. v. Miami-Dade Cty. Sch. Bd." on Justia Law