Justia Public Benefits Opinion Summaries

Philpot, former Clerk of Lake County, Indiana, took $25,000 in incentive payments from a federally funded child‐support fund (42 U.S.C. 658a(a)) without the required approval of the county fiscal body. The Indiana Department of Child Services disburses those federal funds to the counties, Ind. Code 31‐25‐4‐23(a), which have a relatively free hand in directing the money, although “amounts received as incentive payments may not, without the approval of the county fiscal body, be used to increase or supplement the salary of an elected official.” Philpot had used the funds to provide himself and staff members with bonuses. Convicted of mail fraud, 18 U.S.C. 1341, and theft from a federally funded program 18 U.S. 666(a)1A, he was sentenced to 18 months in prison. The Seventh Circuit affirmed, despite claims concerning whether Philpot “knowingly” violated the statute and the fact that Philpot had voluntarily returned the funds. View "United States v. Philpot" on Justia Law

Southern Rehabilitation Group and its medical director sued the Secretary of Health and Human Services and past and present Medicare contractors, seeking review of the Secretary’s final decision on 6,200 claims for Medicare reimbursement. The district court remanded so that the Secretary could pay the disputed amount. After payment, the case returned to the district court, which concluded that the claims for payment were moot and dismissed remaining constitutional and statutory claims as barred by jurisdictional provisions of the Medicare Act. The court also held that plaintiffs did not show that they were eligible to collect interest on their claims and that it did not have jurisdiction over 8,900 other claims that plaintiffs alleged were still in the administrative process. The Sixth Circuit affirmed summary judgment to defendants on plaintiffs’ federal and state law claims and on the 8,900 claims still in the administrative process, but reversed summary judgment on plaintiffs’ claims for interest. The Secretary could not rely on her unreasonable interpretation of the “clean-claims” statute as a basis for summary judgment concerning interest. View "S. Rehab. Grp. v. Sec'y of Health & Human Servs." on Justia Law

In 1998, the Board of Veterans’ Appeals rejected a claim by Tyrues, a Persion Gulf veteran, for benefits under 38 U.S.C. 1110, because his lung condition lacked the required service connection, but remanded to the VA Regional Office for further consideration of whether his chronic symptoms manifested Persian Gulf Syndrome, which might have entitled him to benefits under standards later enacted as 38 U.S.C. 1117. In 2004, on remand, the Board decided that Tyrues was not entitled to benefits under section 1117. Tyrues asked the Veterans Court to review both the 2004 denial under section 1117 and the 1998 denial under section 1110. The Veterans Court dismissed with respect to the 1998 decision, ruling that Tyrues missed the 120-day deadline, 38 U.S.C. 7266(a), and presented no basis for equitable tolling. The Federal Circuit affirmed. View "Tyrues v. Shinseki" on Justia Law

Burris worked in coal mines for 23 years. He twice sought benefits under the Black Lung Benefits Act, 30 U.S.C. 901, abandoning his first claim in 2001, and pursuing a second claim in 2006. After a hearing on the second claim, an Administrative Law Judge determined that Burris was totally disabled by pneumoconiosis arising from his coal mining employment and that he qualified for benefits. The Benefits Review Board affirmed. The Seventh Circuit denied a petition for review, rejecting arguments that the ALJ erred in finding that Burris established a material change in condition following his first, abandoned claim; in concluding that Burris proved 15 years of surface mine employment in conditions substantially similar to those that exist in underground mines; and in rejecting evidence rebutting a presumption of pneumoconiosis. View "Consolidation Coal Co. v. Dir., Office of Workers' Comp. Programs" on Justia Law

Schomas, 54 years old, suffers from scoliosis and degenerative disc disease. Following a hearing, the Social Security Administration denied his application for Disability Insurance Benefits. The district court and the Seventh Circuit upheld the denial, rejecting a challenge to the ALJ’s credibility finding and assessment of his residual functional capacity. The court acknowledged that the ALJ’s decision was “problematic,” but concluded that Schomas waived most of his arguments, and that the rest were unfocused or undeveloped. View "Schomas v. Astrue" on Justia Law

Plaintiff first applied for social security disability insurance (SSI) benefits ten years ago. When the benefits were denied, plaintiff requested a hearing but the SSA ruled that her request was untimely and denied a subsequent application on the ground of res judicata. The SSA never explained why it rejected plaintiff's facially valid excuse for the delay in her hearing request. The district court then dismissed her action for lack of subject matter jurisdiction. The court reversed and remanded, concluding that the ALJ failed to consider whether plaintiff's facially valid reasons constituted good cause excusing the delay, and deprived plaintiff of her due process right to a meaningful opportunity to be heard and to seek reconsideration of an adverse benefits determination. View "Dexter v. Astrue" on Justia Law

Veterans sought disability compensation for post-traumatic stress disorder (PTSD) allegedly caused by sexual assaults that occurred during service. Their service records do not reflect any reports of the alleged sexual assaults. The VA Regional Office, Board of Veterans’ Claims, and the Court of Appeals for Veterans Claims rejected the claims in part on the ground that the service records did not include reports of the alleged assaults, and because the veterans stated that the assaults were never reported to military authorities. The Federal Circuit vacated and remanded, holding that the absence of a service record documenting an unreported sexual assault is not pertinent evidence that the sexual assault did not occur; the Board and Veterans Court may not rely on failure to report an in-service sexual assault to military authorities as pertinent evidence that the sexual assault did not occur. View "AZ v. Shinseki" on Justia Law

The federal government holds, in trust for three Indian communities, certain Minnesota land acquired in the late 1800s, with federal funds appropriated for a statutorily identified group of Indians. That beneficiary group and the three present-day communities that grew on the land overlapped but diverged. Many beneficiaries were part of the communities, but many were not; the communities included many outside the beneficiary group. In 1980 Congress addressed resulting land use problems by putting the land into trust for the three communities that had long occupied them. Since then, proceeds earned from the land, including profits from gaming, have gone to the three communities. Descendants of the Indians designated in the original appropriations acts allege that they, rather than the communities, are entitled to benefits. In earlier litigation the Federal Circuit rejected a claim that the appropriations acts created a trust for the benefit of statutorily designated Indians and their descendants. On remand, the Court of Federal Claims rejected several new claims, but found the government liable on a claim for pre-1980 revenues from the lands acquired under the 1888-1890 Acts. The Federal Circuit reversed in part, finding that the descendants had no valid claim. View "Wolfchild v. United States" on Justia Law

Plaintiffs, employees of Coca-Cola, suffered work-related injuries and applied for workers’ compensation benefits through Sedgwick, Coca-Cola’s third-party benefit claims administrator. Sedgwick disputed the claims. Plaintiffs claim that Coca-Cola and Sedgwick “engaged in a fraudulent scheme involving the mail . . . to avoid paying benefits to injured employees,” and filed suit under the civil remedies provision of the Racketeer Influenced and Corrupt Organizations Act (RICO), 18 U.S.C. 1962(c). The district court dismissed. On rehearing, en banc, the Sixth Circuit affirmed, holding that the plaintiffs did not plead an injury to their “business or property” that is compensable under RICO. The RICO theory advanced in this case would throw the viability of workers’ compensation schemes into doubt; RICO “does not purport to afford remedies for all torts committed by or against persons engaged in interstate commerce.” The Michigan workers’ compensation scheme provides ample mechanisms by which the employee can contest denials. View "Jackson. Segwick Claims Mgmt. Servs." on Justia Law

Plaintiffs filed suit against defendant, in her official capacity as Interim Secretary for the Florida Agency for Health Care Administration (AHCA), alleging that defendant violated the Medicaid Act, 42 U.S.C. 1396 et seq., by denying Medicaid coverage of applied behavioral analysis (ABA) to treat plaintiffs' autism spectrum disorders. The court concluded that the district court did not abuse its discretion in issuing a permanent injunction that overruled AHCA's determination that ABA was experimental and required Medicaid coverage of this treatment. However, because the language in the injunction's final sections was out of step with the district court's analysis and what was actually decided, the court vacated the injunction in part and remanded to the district court to modify Paragraphs 2 and 6. View "Garrido, et al. v. Interim Secretary, FL Agency for Health Care Admin." on Justia Law