Justia Public Benefits Opinion Summaries

Locane, born in 1983, was adopted and does not know her family medical history. She suffered her first symptoms within two weeks of being vaccinated in 1997 and was diagnosed with Crohn’s Disease. She sought compensation under the National Childhood Vaccine Injury Act, 42 U.S.C. 300aa-1 to -34, alleging that she suffered Crohn’s disease as a result of hepatitis B vaccination. A special master denied the claim, finding Locane’s disease began before her vaccination and that Locane failed to prove by a preponderance of the evidence that the vaccine caused or significantly aggravated her disease. The Federal Circuit affirmed. View "Locane v. Sec'y of Health & Human Servs." on Justia Law

Petitioners Leroy and Glenda Morris brought suit under 42 U.S.C. 1983 and the Supremacy Clause to challenge the Oklahoma Department of Human Services' ("OKDHS") denial of Mrs. Morris' application for Medicaid benefits as inconsistent with federal law. After calculating the couple's resources and the Community Spouse Resource Allowance (CSRA), OKDHS determined that the Morrises were ineligible for benefits. In an effort to "spend down" their excess resources, the Morrises purchased an actuarially sound annuity payable to Mr. Morris. Despite this purchase, OKDHS determined that Mrs. Morris remained ineligible. The district court granted summary judgment in favor of OKDHS, upholding the agency's application of the Medicaid statutes. Upon review, the Tenth Circuit reversed and remanded the case for further proceedings. A couple may convert joint resources (which may affect Medicaid eligibility) into income for the community spouse (which does not impact eligibility) by purchasing certain types of annuities. In other words, a couple may purchase a qualifying annuity payable to the community spouse in addition to the community spouse's retention of the CSRA. View "Morris v. Oklahoma Dept. of Human Svcs." on Justia Law

Howard Back filed this suit alleging that Secretary of Heath and Human Services Kathleen Sebelius violated her duties under the Medicare Act and the Due Process Clause by failing to provide an administrative process for beneficiaries of hospice care to appeal a hospice provider's refusal to provide a drug prescribed by their attending physician. The district court granted the Secretary's motion for judgment on the pleadings because Back had not exhausted his administrative remedies. The Ninth Circuit Court of Appeals vacated the district court's judgment and dismissed the appeal as moot, holding that although the government led Back to believe there was no appeal process, such a process did exist. Accordingly, no controversy existed and the appeal was moot. View "Back v. Sebelius" on Justia Law

Frederick, previously married to World War II veteran Hill, upon Hill's death became entitled to Dependency and Indemnity Compensation as surviving spouse of a veteran whose death resulted from service-related injury or disease, 38 U.S.C. 1310-1318. In 1986 she remarried at age 57. Until January 1, 2004, the law provided that a surviving spouse receiving DIC benefits lost entitlement to those benefits upon remarriage. The Veterans Benefits, Act of 2003, amending 38 U.S.C. 103(d)(2)(B), added language that “remarriage after age 57 of the surviving spouse of a veteran shall not bar the furnishing of DIC.” Congress also provided new DIC eligibility for surviving spouses who remarried after the age of 57, but before the date of enactment of the Act. The Regional VA Office denied Mrs. Frederick’s 2007 application for reinstatement as untimely. The Board of Appeals rejected her notice argument. The Veterans Court held that she was entitled to benefits. The Federal Circuit reversed, rejecting an argument that she is simply not covered by one-year limitation in subsection (e). View "Frederick v. Shinseki" on Justia Law

Plaintiff-Appellant Valinda Kornhauser filed suit to challenge the decision of the Commissioner of Social Security that denied her claim for disability benefits. The District Court referred the case to a Magistrate Judge for a report and recommendation ("R&R"). After receiving and considering memoranda on the matter, the Magistrate Judge issued an R&R recommending that the District Court vacate the Commissioner's decision and remand the case to the Commissioner for further proceedings. In his R&R, the Magistrate Judge, in addition to explaining why Plaintiff was entitled to a vacatur, observed that the memorandum her attorney had submitted failed to comply with Middle District of Florida Local Rule 1.05(a). The non-compliance, according to the Magistrate Judge, consisted of "smaller margins than authorized" by the rule and "footnotes . . . smaller than ten-point type." In a footnote to this observation, he stated: "These intentional violations would justify striking the memorandum. However, this sanction would unfairly punish the plaintiff. Consequently, I propose that, when plaintiff's counsel seeks attorney's fees, that the typical request for a cost-of-living increase be denied." Following the entry of judgment, Plaintiff petitioned the District Court for an award of attorney's fees under the Equal Access to Justice Act ("EAJA"). The parties stipulated to the amount of attorney fees, but after its consideration of the petition, the Magistrate Judge issue an R&R recommending that the district court award a lower amount in fees as have been stipulated because of Plaintiff's brief being submitted with small margins and unacceptable font sizing. Plaintiff's attorney filed an objection to the R&R, asking the district court not to adopt it because she did not intend to violate the local rule. Finding that the sanction was a reasonable exercise of the Magistrate Judge's disciplinary authority, the district court adopted the R&R with the sanction. Plaintiff appealed the imposition of the sanction. Upon review, the Eleventh Circuit vacated the sanction, finding "no procedural rule that sanctions the conduct involved" in this case. View "Kornhauser v. Comm'r of Social Security" on Justia Law

Brault applied for Disability Insurance Benefits in 2007, claiming that he became disabled in 2006 because of nerve damage in his left arm and a cervical spine injury he sustained in a motor-vehicle accident. After his application was denied initially and on reconsideration, he requested an administrative hearing. Brault’s counsel asserted a Daubert-like objection to the vocational expert’s testimony, contending it was unreliable. The ALJ never directly responded to the objections, but issued a ruling which relied on the VE’s testimony, agreed that positions existed in the eight DOT positions the VE had identified at the numbers the VE had given, and denied Brault’s application for benefits. The district court affirmed the denial. The Second Circuit affirmed, finding that the denial was supported by substantial evidence. The administrative law judge was not required to state expressly his reasons for accepting a vocational expert’s challenged testimony.View "Brault v. Soc. Sec. Admin." on Justia Law

Heino, a veteran, is prescribed a daily dose of 12.5 milligrams of Atenolol. The lowest strength available for the prescription is a 25 milligram tablet, so his physician instructed him to split each tablet in half. Heino paid a $7 copayment for a 30-day supply of 15 tablets, which he claimed was excessive in light of the fact that some veterans paid the same co-payment for twice the medication. The VA refused his request for adjustment. The Veterans Court affirmed, rejecting arguments that the regulation the VA uses to calculate his copayment amount, 38 C.F.R. 17.110, conflicts with 38 U.S.C. 1722A(a)(2), which prohibits the VA from charging a copayment “in excess of the cost to the Secretary for medication,” because the actual cost of his Atenolol prescription was well below $7.3, and that his copayment was excessive. The Federal Circuit affirmed. View "Heino v. Shinseki" on Justia Law

Humana sued, alleging that Glaxo was obligated to reimburse Humana for expenses Humana had incurred treating its insureds’ injuries resulting from Glaxo’s drug, Avandia. Humana runs a Medicare Advantage plan. Its complaint asserts that, pursuant to the Medicare Act, Glaxo is in this instance a “primary payer” obligated to reimburse Humana as a “secondary payer.” The district court dismissed, agreeing with Glaxo that the Medicare Act did not provide Medicare Advantage organizations with a private cause of action to seek such reimbursement. The Third Circuit reversed and remanded. The Medicare Secondary Payer Act, in 42 U.S.C. 1395y(b)(3)(A), provides Humana with a private cause of action against Glaxo. Even if the provision is ambiguous, regulations issued by the Centers for Medicare and Medicaid Services make clear that the provision extends the private cause of action to MAOs. View "Humana Med. Plan Inc. v. GlaxoSmithKline LLC" on Justia Law

Plaintiff and his mother lived in public housing. His mother was arrested and charged with possession of cocaine and resisting law enforcement officers; she later pleaded guilty. Less than one month later she received notice that her arrest violated her lease agreement, that she had 30 days to vacate, and that she could contest termination of her lease during the eviction procedure. The Housing Authority subsequently filed an eviction action in Indiana state court. Before that hearing, plaintiff sought a preliminary injunction. The district judge conducted a telephonic hearing and denied the motion, based mainly on the Anti-Injunction Act, 28 U.S.C. 2283, and in consideration of "the principles of equity, comity, and federalism that restrain a federal court, while recognizing the respect due the courts of a sovereign state." The state court ruled in favor of the Housing Authority, issuing an order for immediate possession of the property and eviction. The Seventh Circuit dismissed, as moot, an appeal from the denial of an injunction. View "A.B. v. Hous. Auth. of South Bend" on Justia Law

Plaintiff Lisa R. Chapo appealed a district court's order upholding the Commissioner of Social Security's denial of her application for disability and supplemental security income benefits. The Administrative Law Judge (ALJ) denied benefits at the last step of the five-step process for determining disability. At step five the ALJ found Plaintiff not disabled because, "[c]onsidering [her] age, education [high school], work experience, and residual functional capacity, there are jobs that exist in significant numbers in the national economy that [she] can perform," namely the jobs of appointment clerk, escort vehicle driver, and office helper identified by the vocational expert (VE) who testified at the evidentiary hearing. On appeal to the Appeals Council, Plaintiff challenged the ALJ’s decision in several respects, in particular the ALJ’s treatment of the opinion evidence in the record. Upon review of the record, the Tenth Circuit concluded that ALJ’s handling of a testifying doctor's findings was erroneous and, as a result, the dispositive hypothetical inquiry put to the VE was fatally defective. "Indeed, that hypothetical did not even include a restriction (to 'simple' work) that the ALJ himself recognized in his decision." The Court concluded that this matter be remanded for further proceedings, "wherein the ALJ must either obtain a mental RFC determination from an examining source to oppose [the doctor], articulate some other adequate basis for discounting [his] findings, or come back to the VE with a proper hypothetical including those limitations (and his own restriction to 'simple' work, should the ALJ find it appropriate to re-impose such a restriction in the RFC determined on remand)." View "Chapo v. Astrue" on Justia Law