Justia Public Benefits Opinion Summaries

The Board appealed the district court's grant of summary judgment in favor of plaintiffs, mother and son, requiring the Board to reimburse the mother for the cost of the placement of her son, who was diagnosed with autism, in a private school. A hearing officer later found that the Board failed to offer a free appropriate public education to the son before his third birthday, as required by the Individuals with Disabilities Education Act, 20 U.S.C. 1412(a)(1)(A), and that the Board instead consented to the son's placement at Mitchell's Place, a preschool that provided services and education to autistic children. The district court affirmed. The court concluded that the district court did not abuse its discretion when it weighed the equities and concluded that the County must reimburse plaintiffs. Accordingly, the court affirmed the judgment of the district court. View "Blount Cty. Bd. of Educ., et al. v. Bowens, et al." on Justia Law

Plaintiff appealed the denial of her applications for disability insurance benefits (DIB) and supplemental security income (SSI). Plaintiff argued that the ALJ failed to give adequate weight to her treating physician's opinions regarding her disability. The court concluded that the ALJ had reason to discredit the physician's evaluation given the conclusory nature of his opinion and the court affirmed the judgment. View "Toland v. Colvin" on Justia Law

Martin, an Army veteran, applied for educational-assistance benefits under 38 U.S.C. 3011. The Board of Veterans’ Appeals denied the application, concluding that Mr. Martin was ineligible for benefits because the basis for his honorable discharge in 1990 constituted “willful misconduct.” The Court of Appeals for Veterans Claims affirmed. The officially declared reason for Martin’s discharge was “alcohol rehabilitation failure.” The Federal Circuit vacated, stating that “alcohol rehabilitation failure” cannot be said always to constitute or result from willful misconduct, regardless of circumstances. Neither the Board nor the Veterans Court made any determination of what particular conduct constituted misconduct, engaged in with the state of mind required for willfulness, that led to the rehabilitation-failure determination.View "Martin v. Shinseki" on Justia Law

Boley sought Social Security disability benefits. The agency denied her request initially and on reconsideration. A person dissatisfied with such a decision has 60 days to request a hearing. Boley took about nine months because SSA had notified Boley but not her lawyer (as required by 20 C.F.R.404.1715(a)). Boley was ill at the time, preparing for a double mastectomy, and did not know, until it was too late, that her lawyer was unaware of the decision. An ALJ dismissed an untimely hearing request, finding that Boley lacked “good cause” because she had received notice and could have filed a request herself. A district judge dismissed her petition for judicial review, based on 42 U.S.C. 05(g), which authorizes review of the agency’s final decisions made “after a hearing.” The Seventh Circuit vacated and remanded, with instructions to decide whether substantial evidence, and appropriate procedures, underlie the decision that Boley lacks “good cause” for her delay in seeking intra-agency review. In doing so, the court overruled its own precedent and noted a divide among the circuits. View "Boley v. Colvin" on Justia Law

Kathy Inwards was injured while employed as an assembler by Bobcat. WSI accepted liability for her claim and awarded Inwards vocational rehabilitation benefits to assist her in returning to work. In early June 2011, WSI issued a notice of intention to discontinue benefits ("NOID") stating her disability benefits would end then convert to retraining benefits. She had 30 days to request reconsideration of the decision. WSI issued a formal order requiring Inwards to "enter into training at Hutchinson Community College, Hutchinson, Kansas, in the Business Management & Entrepreneurship AAS program." Inwards requested reconsideration of the vocational rehabilitation plan, but attended two college courses during the summer of 2011 in accordance with the plan. Inwards complained to her physician that she was having increased pain as a result of her course work. Although Inwards registered for fall courses at the college, she withdrew from them. In October 2011, WSI issued a NOID to Inwards stating "[t]here is no medical evidence that supports your professed inability to attend the classes as outlined in the administrative order dated June 27, 2011. You are now considered to be in non-compliance with vocational rehab." Inwards timely requested reconsideration of this NOID, and on January 13, 2012, WSI issued a formal order suspending Inwards' rehabilitation benefits based on her noncompliance with the rehabilitation plan. Inwards timely requested a hearing to challenge WSI's finding of noncompliance and suspension of benefits. The ALJ reversed WSI's January 13, 2012 order suspending benefits for noncompliance with the vocational rehabilitation plan. WSI appealed to district court and Inwards moved to dismiss the appeal, claiming the court lacked subject matter jurisdiction because WSI failed to serve the notice of appeal and specification of errors on Inwards and her employer. The court denied the motion to dismiss, concluding Inwards had no standing to object to defective service on her employer and there was good cause to excuse WSI's mistake about recently mandated court electronic filing requirements. The court reversed the ALJ's decision, concluding the finding of good cause was "not supported by law," and reinstated WSI's January 13, 2012 order of noncompliance. The Supreme Court concluded the ALJ erred as a matter of law in ruling Inwards had good cause for failing to comply with a retraining program because WSI's previous order requiring Inwards to participate in the retraining program had been appealed and had not been finally resolved at the time she withdrew from the retraining program. The Court affirmed the district court judgment reversing the ALJ's decision and reinstating WSI's order of noncompliance. View "Inwards v. WSI" on Justia Law

Plaintiff appealed the denial of his application for disability insurance benefits and supplemental security income (SSI) benefits. The court concluded that the ALJ did not err in concluding that plaintiff did not have a severe impairment that met the criteria of listing 12.04 (Affective Disorders); substantial evidence supported the ALJ's conclusion that plaintiff did not meet all the criteria for the listed impairment; the ALJ's determination of plaintiff's residual functional capacity (RFC) was supported by substantial evidence, and the ALJ did not err in declining to give a nurse practitioner's assessment controlling weight; and the hypothetical posed by the ALJ to the vocational expert was not defective. Accordingly, the court affirmed the denial of benefits. View "Blackburn v. Colvin" on Justia Law

Groves worked as a strip miner for more than 20 years and a smoker who accumulated more than 50 pack-years. His first claim for black lung benefits, in 1998, was denied. Groves filed his current application in 2006. The ALJ awarded benefits in 2009. The Benefits Review Board vacated and remanded so that the ALJ could provide more detailed explanations. On remand, the ALJ again granted benefits after a careful review of the medical opinions of several different doctors who evaluated Groves’ lung disease, Chronic Obstructive Pulmonary Disease (COPD). The Board affirmed. The Sixth Circuit remanded. While substantial evidence supported the determination that Groves’s COPD arose at least in part out of coal mining employment, the ALJ apparently did not apply the correct standard in determining that his total disability was due to pneumoconiosis.View "Arch on the Green, Inc. v. Groves" on Justia Law

Plaintiff, a former laborer, applied for social security disability benefits, claiming he was unable to work a full 40-hour week because of acute lower back pain that radiates into his right leg. He has had various treatments and takes several medications such as oxycodone and percocet. His application was denied; the Appeals Council and district court affirmed. The Seventh Circuit reversed and remanded, reasoning that the administrative law judge was likely mistaken in believing that one physician’s report refuted the findings of the other physician. What was relevant was not the cause of the pain and numbness but the severity of these symptoms and whether they disabled plaintiff from working full time. Both physicians diagnosed radiculopathy. If the administrative law judge remains skeptical of the claim, he can order a further examination of the plaintiff by a qualified physician instructed to offer a medical opinion (if possible) on the plaintiff’s physical ability to engage in full-time work. The court stated references to the credibility of the applicant are “a recurrent feature of the government’s defense of denials of social security disability benefits” that constitutes “professional misconduct and if it continues we’ll have to impose sanctions.” View "Hanson v. Colvin" on Justia Law

The Medicare as a Secondary Payer Act, 42 U.S.C. 1395y(b)(2) precludes Medicare from providing benefits when a “primary plan” could be expected to pay. When the primary plan does not promptly pay medical expenses, Medicare makes conditional payments and is entitled to reimbursement. Under the New Jersey Collateral Source Statute (NJCSS), N.J. Stat. 2A:15–97, a tort plaintiff cannot recover damages from a defendant when she has already received funding from a different source. Taransky was injured when she fell at a shopping center. Medicare conditionally paid for her care. She sued the owner, seeking damages for bodily injury, disability, pain and suffering, emotional distress, economic loss, and medical expenses. She settled for $90,000, granting a full release, stating that liens or subrogation claims would be satisfied from settlement proceeds, and stating that Taransky would indemnify the owner with respect to such claims. Based on the NJCSS, Taransky then claimed that her Medicare expenses were not included in the settlement and obtained an order that the settlement was solely recovery for bodily injury, disability, pain and suffering, emotional distress, and non-economic, otherwise-uncompensated loss. A Medicare contractor demanded reimbursement of $10,121.15. Taransky refused to pay, arguing that a tortfeasor was not a “primary plan” and that reimbursement would be inequitable because she had not recovered medical expenses. An ALJ ruled against Taransky. The Medicare Appeals Council affirmed. The district court dismissed, holding that it lacked jurisdiction over proportionality and due process claims because she had not raised them before the agency; that the NJCSS did not apply to conditional Medicare benefits; and that the MSP Act authorized reimbursement from the settlement. The Third Circuit affirmed. View "Taransky v. Sec'y U.S. Dep't of Heath & Human Servs." on Justia Law

Plaintiff enrolled her son at a private school after she decided that the individualized education program (IEP) proposed by the DOE for the 2010-2011 school year failed to provide her son with a free appropriate public education (FAPE) under the Individuals with Disabilities Education Act (IDEA), 20 U.S.C. 1400 et seq. Plaintiff filed suit seeking tuition reimbursement, the IHO granted her relief, but the SRO reversed the decision, and the district court affirmed. The court deferred to the IHO's well-reasoned determination that the son required the services of a 1:1 paraprofessional for longer than the transitional three-month period afforded him by his IEP. Because the DOE failed to offer him a FAPE, the court reversed and remanded to the district court to consider the appropriateness of plaintiff's private placement and the balance of the equities. View "Reyes v. NYC Dept. of Educ." on Justia Law