Justia Public Benefits Opinion Summaries

Following multiple surgeries for back injuries and multiple, unsuccessful, claims for disability benefits, the applicant asserted, in a 2008 hearing, that she had been disabled since 2004 and was still disabled but had returned to work because she needed the money. An ALJ found that she had been disabled by chronic back pain but after four years showed "medical improvement." and returned to full-time work.The ALJ awarded benefits for a closed period. The Seventh Circuit reversed and remanded. The ALJ never evaluated whether that work constituted an authorized, and encouraged, trial work period and, therefore, could not be labeled as substantial gainful activity. View "Tumminaro v. Astrue" on Justia Law

From 2007 to 2008, Dorothy Rogers received Medicare benefits through Pacificare's federally-approved Medicare Advantage Plan, Secure Horizons. Rogers and Pacificare entered into separate contracts each year providing the terms and conditions of coverage. After receiving treatment from the Endoscopy Center of Southern Nevada (ECSN), a facility approved by Pacificare for use by its Secure Horizons plan members, Rogers tested positive for hepatitis C. Rogers sued Pacificare, alleging that Pacificare should be held responsible for her injuries because it failed to adopt and implement an appropriate quality assurance program. Pacificare moved to dismiss her claims and compel arbitration based on a provision in the parties' 2007 contract. The district court determined that the 2007 contract governed, but held that the arbitration provision was unconscionable and, thus, unenforceable. The Supreme Court reversed, holding (1) because the parties in this case did not expressly rescind the arbitration provision at issue, the provision survived the 2007 contract's expiration and was properly invoked; and (2) as the Medicare Act expressly preempts any state laws or regulations with respect to the Medicare plan at issue in this case, Nevada's unconscionability doctrine was preempted to the extent that it would regulate federally-approved Medicare plans. View "Pacificare of Nevada v. Rogers" on Justia Law

The Cabinet for Health and Family Services filed a motion to hold Renee Ivy in contempt after Ivy fell behind in her child support payments. At the hearing on the motion, Ivy presented evidence that her sole source of income was a federal benefit under the Supplemental Security Income program (SSI). The trial court reduced Ivy's support obligation and held her in contempt for having failed to pay the past due amount. The court of appeals reversed, holding that the contempt finding and the order to pay even reduced child support could not stand because evidence showed Ivy did not have the ability to pay. The Supreme Court (1) reversed the court of appeals' decision to the extent that it suggested that a SSI recipient-parent's present inability to pay precludes even the assessment of child support; (2) vacated the existing order and remanded for the family court to determine if the guidelines-based amount would be unjust or inappropriate pursuant to Ky. Rev. Stat. 403.211(2); and (3) affirmed the holding that a contempt finding was inappropriate here where there was essentially uncontroverted evidence that Ivy's failure to provide child support stemmed only from her inability to do so. View "Cabinet for Health & Family Servs. v. Ivy" on Justia Law

Plaintiff Cynthia Anderson appealed a district court's grant of summary judgment in favor of Defendant Cato Corporation on her claim of discrimination under the Pregnancy Discrimination Act. A month or two after Cato terminated her employment, Plaintiff asked for a letter stating the reasons for her termination so that she could apply for public health benefits. A Cato supervisor wrote that Plaintiff "was terminated due to pregnancy related illnesses. [Plaintiff] needed off three weeks for bed rest required by a doctor. However, according to Cato policy a part time sales associate has to be release[d] if she/he needs off for longer than seven days unless she/he has been employed for 365 days. [Plaintiff] did not apply to the guidelines; therefore she was forced to be terminated." The supervisor's undisputed testimony was that Plaintiff "told me that she needed me to put on [the letter] it was because of her pregnancy." After Plaintiff filed suit, Cato moved for summary judgment. The district court determined that the letter was not direct evidence of discrimination. The court considered it "significant" that Plaintiff asked for the letter and told her supervisors what the letter should state as reasons for her termination. The court concluded that Plaintiff could establish a prima facie case for discrimination but that the evidence did not raise a disputed issue of material fact. Upon review, the Tenth Circuit concluded that the letter was indeed not direct evidence of discrimination, and agreed with the district court's reasoning that Plaintiff could make a prima facie case but that summary judgment was appropriate. View "Anderson v. Cato Corporation" on Justia Law

Plaintiff appealed the denial of his application for disability insurance benefits under Title II of the Social Security Act, 42 U.S.C. 401-34. Plaintiff claimed he was disabled by thoracic spine and lumbar spine degenerative disc disease, a muscle disorder, a pain disorder with agoraphobia, and a personality disorder. The court held that because plaintiff's physician's psychiatric evaluation and medical source statement were not considered by the Appeals Council or the ALJ, the court remanded to the ALJ for further consideration. The court also noted that the ALJ's previous five-step sequential analysis also contained several errors. View "Taylor v. Commissioner, SSA" on Justia Law

Husband worked as a miner from 1970 to 1987. In 2000, he was found to be totally disabled by coal workers' pneumoconiosis and was awarded benefits under the Black Lung Benefits Act, 30 U.S.C. 901. He died in 2005. His widow sought survivor’s benefits. At the time, she was required to prove that pneumoconiosis caused, contributed to, or hastened husband's death. An ALJ denied the claim. The Board vacated. On remand, the ALJ again denied benefits. While appeal was pending, Congress amended the Act, retroactively applicable to claims filed after January 1, 2005. The Board reversed and remanded for an order awarding survivor's benefits, holding that section 932(l), as amended, entitled the widow to benefits because husband was receiving black lung benefits at the time of his death and her claim was filed after January 1, 2005. The First Circuit denied the company's petition for review. Under the amendment, the widow is entitled to benefits without having to file a new claim or otherwise revalidate husband's claim because she filed her claim after January 1, 2005. The company's claim that she failed to establish the cause of death is irrelevant. Section 932(l) as amended does not violate the Due Process Clause or Takings Clause. View "B&G Constr. Co Inc. v. Dir., Office of Workers Comp. Programs" on Justia Law

Petitioners-Appellants Donald and Paula Thompson appealed a district court's decision that affirmed the Board of the Public Employees Retirement System's ruling to forfeit Mr. Thompson's retirement benefits earned in his state retirement account. The district court determined that Mr. Thompson's state retirement benefits had to be forfeited after he was convicted of felonies that violated his oath of office as a district court judge. The court determined that Mrs. Thompson did not have standing in the administrative proceedings and was not a proper party therein. On appeal to the Supreme Court, Mr. Thompson alleged the Board violated the Oklahoma Administrative Procedures Act when it forced him to forfeit his retirement benefits without proper notice. In addition, he argued he did not receive an individual proceeding to provide him an opportunity to proffer evidence and present witnesses pursuant to the Act. Furthermore, Mr. Thompson alleged that the strict construction of the applicable forfeiture statute requires that it apply only to the last oath of office he took. According to this logic, Mr. Thompson argued he should have only been forced to forfeit the benefits he would have earned from his last term in office. Upon review, the Supreme Court found none of Mr. Thompson's arguments persuasive, and affirmed the district court's decision. View "Thompson v. Oklahoma Public Employees Retirement System" on Justia Law

Plaintiff appealed the district court's decision affirming the Social Security Administration's (SSA) denial of her applications for disability insurance benefits and supplemental security income. The court held that because the SSA took nearly two years to investigate whether to reopen a favorable determination on one of plaintiff's applications, much longer than the presumptive time of six months, and because the record did not show that the investigation was diligently pursued, the court reversed.

A worker was involved in a fight in a logging camp bunkhouse. He did not file a report of injury related to the fight for over a year. When he finally filed a report of injury, he alleged that he had injured his hip, lower back, and ear in the fight. His employer denied the worker benefits because he did not give timely notice of the injury. The worker then alleged that he had verbally informed his supervisor of the injuries. After a hearing, the Alaska Workers’ Compensation Board determined that the worker’s claim was barred because he did not give his employer timely notice of the injury. The Board performed an alternative analysis assuming the worker had given timely notice and decided that the claim was not compensable. The Alaska Workers’ Compensation Appeals Commission affirmed the Board’s decision. Because the Commission correctly determined that substantial evidence in the record supports the Board’s decision on the compensability of the claim, the Supreme Court affirmed the Commission’s decision.

Petitioner Wanda Gottus appealed a district court judgment that affirmed a decision of Job Service North Dakota denying her unemployment benefits and concluding she was discharged for actions constituting misconduct. In January 2008, Petitioner began working as a cashier for Service Oil Inc. d/b/a Stamart. In addition to acting as a cashier, Petitioner's job duties included attending to the store's shelves, light cleaning, and other similar tasks. Petitioner's employment with Stamart ended in August 2010 when she was discharged for poor job performance. Petitioner subsequently filed for unemployment insurance benefits. Job Service initially approved Petitioner for unemployment benefits indicating she was not discharged for misconduct. Stamart appealed this decision, and a telephone hearing was held before an appeals referee. Testimony and evidence presented during the hearing revealed there were at least sixteen instances when Petitioner's job performance fell below the level expected of Stamart employees. The Job Service reviewed the record and affirmed the referee's decision. Petitioner argued on appeal her job performance was merely unsatisfactory but did not constitute misconduct. The district court rejected her argument and affirmed Job Service's decision. The Supreme Court concluded Job Service's findings of fact were supported by a preponderance of the evidence, and its conclusion that Petitioner's actions constituted disqualifying misconduct was supported by the findings.