Justia Public Benefits Opinion Summaries

Petitioner Toni Weeks appealed a district court judgment that affirmed a decision by Workforce Safety and Insurance (WSI) that reduced her disability benefits. Petitioner was injured at work after being exposed to anhydrous ammonia while employed by Dakota Gasification Company, in Beulah, North Dakota. In 2009, WSI received confirmation that on November 1, 2009, Weeks' social security disability benefits would convert to social security retirement benefits. WSI issued a notice of intention to discontinue or reduce benefits, in which Petitioner was informed that her permanent total disability benefits would end on October 31, 2009, and she would receive an "additional benefit payable" beginning November 1, 2009. Petitioner requested reconsideration. In November 2009, WSI issued an order denying Petitioner further disability benefits after October 31, 2009. Upon review, the Supreme Court found that because Petitioner failed to adequately brief her argument that WSI's reduction of her wage loss benefits violated equal protection under the federal and state constitutions, the Supreme Court declined to address her argument and otherwise affirmed the judgment.

Parents requested that the Anchorage School District evaluate their child for eligibility for special education services. While awaiting the results of the eligibility assessment, the parents arranged for private tutoring. The school district did not assess the child’s eligibility within the statutorily-required time, and the parents requested a due process hearing. They also arranged for their child to be privately evaluated to determine whether he was eligible for special education services. The school district subsequently completed its evaluation and determined the child to be ineligible for services. At the due process hearing, the parents alleged that the school district committed procedural violations under the federal Individuals with Disabilities Education Act (IDEA), including impermissibly delaying the evaluation. They sought reimbursement for the cost of their child’s private evaluation and tutoring. An independent hearing officer presided over the due process hearing and ultimately agreed with the district that the child was ineligible for services. The hearing officer ordered the school district to pay the cost of the private eligibility assessment and to partially pay the cost of the tutoring. The superior court upheld the award of the private eligibility assessment, but reversed the award of the private tutoring cost. On appeal to the Supreme Court, the school district argued that the parents should not be reimbursed for the evaluation or the tutoring; the parents argued they are entitled to full reimbursement for both expenses. The central question the Court addressed was: where a child is ultimately determined to be ineligible for special education services, does the IDEA provide relief for procedural violations that occur during the process of evaluating the child’s eligibility for services? The Court affirmed the superior court’s decision, upholding the independent hearing officer’s award of the private assessment cost, but reversing the hearing officer’s award of the private tutoring expenses.

In a 2008 administrative appeal, the Secretary of Health and Human Services ruled that a Medicare beneficiary enrolled in Medicare Part C still qualified as a person "entitled to benefits" under Medicare Part A. As a result, Beverly Hospital received a smaller reimbursement from the Secretary for services it provided to low-income Medicare beneficiaries during fiscal years 1999-2002. The district court granted summary judgment for Beverly Hospital on the ground that the Secretary's interpretation violated the plain language of the Medicare statute. The court held that the statute did not unambiguously foreclose the Secretary's intepretation. The court, nonetheless, affirmed the district court on the alternative ground that the Secretary must be held to the interpretation that guided her approach to reimbursement calculations during fiscal years 1999-2002, an interpretation that differed from the view she now advanced. Under her previous approach, the hospital would have prevailed on its claim for a larger reimbursement.

This case stemmed from a dispute regarding the individualized education program (IEP) of C.C., a child with a disability. At issue was whether a school district, after being declared in compliance with the Individuals with Disabilities Education Act (IDEA), 20 U.S.C. 1400-1490, in respect to a disabled child's entitlements, by an administrative hearing officer, could bring a civil action in court for attorneys' fees as a prevailing party against the child's parents on the grounds that their IDEA administrative complaint was brought for an "improper purpose, such as to harass, to cause unnecessary delay, or to needlessly increase the cost of litigation," although the parents had voluntarily dismissed their administrative complaint without prejudice. The court held that, under the plain meaning of the IDEA and its implementing regulations, the administrative proceeding through which the school district sought a declaratory ruling was a proceeding under section 1415. The court also held that the declaratory ruling favorably altered the school district's legal relationship with the parents. Therefore, the court reversed the district court's legal relationship dismissing the school district's civil action and remanded the case for determination of whether the parents' administrative complaint "was delay or to needlessly increase the cost of litigation," and if so, whether the district court should, within its discretion, award attorneys' fees to the school district.

Petitioner Becky Jean Willig appealed an opinion and order entered by a United States Magistrate Judge that affirmed the decision of the Commissioner of Social Security (Commissioner) denying her application for supplemental security income benefits. In this appeal, Petitioner raised the same issues she raised in the district court: (1) whether the ALJ failed to perform a proper evaluation of the opinion of her treating physician; (2) whether the ALJ failed to propound a proper hypothetical to the vocational expert; and (3) whether the ALJ improperly assessed her credibility. Upon review, the Tenth Circuit concluded that the magistrate judge’s opinion and order was "thorough, well-reasoned and persuasive on each point argued again by Ms. Willig in this court. We see no reason to repeat the same analysis, and we affirm for substantially the same reasons set forth in the opinion and order dated September 28, 2010."

Two administrative hearing panels (Panels) concluded that the school district failed to provide plaintiffs' twin sons with a free appropriate public education (FAPE) in 2005, pursuant to the Individuals with Disabilities Education Act (IDEA), 20 U.S.C. 1400 et seq., but did provide one in 2006. The district court upheld these decisions and later awarded attorney's fees to plaintiffs. Plaintiffs and the school district cross appealed. The court held that the school district offered the twins a FAPE in 2005 and therefore, reversed the award of a reduced attorney's fee. The court affirmed, however, the district court's ruling that plaintiffs waived or abandoned their appeal of the Panels' 2006 FAPE decision.

Plaintiffs brought this action for damages under 42 U.S.C. 1983 on behalf of their minor daughter, who allegedly was deprived of her constitutional rights when she was expelled from public school and refused alternative education benefits during the 2005-2006 academic school year by defendants. The district court granted summary judgment in favor of defendants dismissing all of plaintiffs' claims. The court affirmed the district court's summary judgment in principal part, but reversed summary judgment with respect to plaintiffs' claims that their daughter was deprived of her constitutional right to procedural due process when defendants denied her right under state law to continued public educational benefits through an alternative education program without some kind of notice and some kind of hearing. Accordingly, the court remanded the case to the district court for further proceedings.

Petitioner married in 2001. Her husband had retired unmarried under the Civil Service Retirement System and elected to receive an annuity payable during his lifetime with no survivor benefits. He died in 2003, and petitioner's application for survivor annuity benefits was denied. After considering evidence about a conversation that husband purportedly had with one of its employees, the Office of Personnel Management affirmed, stating that husband could have elected to receive a reduced lifetime annuity with survivor benefits for a new wife only by notifying OPM of his intentions in a signed writing within two years of his marriage, 5 U.S.C. 8339(k)(2)(A). An administrative judge upheld the decision, stating that the decision would become final on June 21, 2004, unless a petition for review was filed. Petitioner did not file until 2010, claiming disability made her unable to attend to the matter. The Board denied her petition for review as untimely filed, finding no credible medical evidence regarding her condition. The Federal Circuit affirmed.

Plaintiff, a minor with dyslexia, by and through her mother and Guardian Ad Litem, appealed from the district court's order affirming the Administrative Hearing Officer's conclusion that the Hawaii Department of Education (DOE) properly found plaintiff ineligible for services under the Individuals with Disabilities Education Act (IDEA), 20 U.S.C. 1400 et seq. The court held that the DOE procedurally violated the IDEA by applying regulations that required exclusive reliance on the "severe discrepancy model" at plaintiff's final eligibility meeting. This violation deprived plaintiff of a significant educational opportunity because it resulted in an erroneous eligibility determination. Accordingly, the court reversed the district court's order affirming the Hearing Officer's decision and remanded for further proceedings.

Patient, insured by defendant, diagnosed with end-stage renal disease, and received dialysis at plaintiff's center. Three months after diagnosis, she became entitled to Medicare benefits (42 U.S.C. 426-1). Her plan provided that coverage ceased at that time, because of her entitlement to Medicare, but the insurer continued to pay for two months. Under the 1980 Medicare Secondary Payer Act, a group health plan may not take into account that an individual is entitled to Medicare benefits due to end-stage renal disease during the first 30 months (42 U.S.C. 1395y(b)(1)(C)(i)), but the insurer terminated coverage. Plaintiff continued to treat and bill. The insurer declared that termination was retroactive and attempted to offset "overpayment" against amounts due on other patients' accounts. The outstanding balance after patient's death was $210,000. Medicare paid less than would have been received from the insurer. The center brought an ERISA claim, 29 U.S.C. 1132(a)(1)(B), and a claim for double damages under the 1980 Act. The district court granted plaintiff summary judgment on its ERISA claim but dismissed the other. The Sixth Circuit affirmed on the ERISA claim and reversed dismissal. A healthcare provider need not previously "demonstrate" a private insurer's responsibility to pay before bringing a lawsuit under the 1980 Act's private cause of action.