Justia Public Benefits Opinion Summaries

Plaintiff (relator) filed a qui tam complaint under the False Claims Act (FCA), 31 U.S.C. 3730, against defendants, alleging that they participated in a fraudulent scheme where the durable medical equipment (DME) supplier allowed the nursing home to keep a portion of the reimbursement from Medicare in return for a guarantee that the nursing home would buy all of its DME from that supplier. The district court subsequently dismissed relator's action on the ground that it violated the public disclosure provisions of the FCA. Relator appealed, arguing that this suit was not based on public disclosures and that he was an original source of the information on which his suit was based. The court held that because relator's action included no allegations specific to defendants, but merely repeated a general description of fraud easily available in several government documents, the court affirmed the judgment of the district court.

Appellant challenged a judgment of the district court affirming the Social Security Administration's (SSA) denial of his application for disability benefits. Appellant contended that the ALJ did not properly apply the "treating physician rule" in evaluating his application and further argued that new evidence had come to light that warranted a remand to the agency. The court held that the ALJ did not, as required by the treating physician rule, explain his reasons for rejecting the opinion of appellant's treating physician. The court also held that a letter from the Board of Medicine validating appellant's complaint, as well as a judicial determination that a physician's report contained a false representation, qualified as new evidence within the meaning of 42. U.S.C. 405(g). Therefore, the court reversed the judgment of the district court and remanded for further proceedings.

After prevailing in a suit for social security disability benefits, plaintiff asked for an award of attorney’s fees of $25,200 under the Equal Access to Justice Act, 28 U.S.C. 2412(d)(2)(A)(ii). The district judge cut the amount to $6,625, adopting objections made by the Social Security Administration’s lawyer to hours spent on tasks and hourly rate. The Seventh Circuit reversed and remanded, rejecting both the attorney's attempt to justify the fee and the court's reasoning.

Appellant alleged that he was disabled as a result of Post Traumatic Stress Disorder, Parkinson's disease, Attention Deficit Disorder, and peripheral neuropathy and that these mental and physical limitations he had as a result of these conditions, combined with his advanced age and limited job skills, rendered him unable to perform any work available in the national economy. Appellant challenged the district court's affirmance of the Social Security Administration's (SSA) denial of his claim for disability benefits. The court affirmed the judgment and held that the ALJ's findings were supported by substantial evidence.

Plaintiff, an eleven-year-old special education student, lived in the Minnesota Independent School District No. 15 (district). An ALJ for the Minnesota Department of Education determined that the district had denied plaintiff a free appropriate public education (FAPE) within the meaning of the Individuals with Disabilities Education Act (IDEA), 20 U.S.C. 1400-1482. After plaintiff filed an action in federal court seeking attorney fees and costs, both parties filed cross-motions for judgment on the administrative record. The district court reversed the ALJ's decision and denied plaintiff's motion for fees and costs and plaintiff appealed. The court affirmed the district court's judgment and held that plaintiff was not denied a FAPE where the district court did not fail to give "due weight" to the results of the administrative hearing; where the district court did not commit procedural violations of the IDEA; and where the district court did not violate the IDEA's substantive requirements.

The applicant sought disability insurance benefits and supplemental security income, claiming that she is disabled by bipolar disorder and numerous physical impairments. The Social Security Administration denied the application; a magistrate judge affirmed. The Seventh Circuit vacated and remanded. The ALJ erred in discounting the testimony of the treating physician and in finding that the applicant exaggerated her difficulties.

In 2003, Joshua Micone applied for Medicaid benefits for himself and his family. In his applications, Joshua did not report his wife Jennifer's interest in a family limited partnership. The Department of Public Health and Human Services approved Joshua's application, and the Micone family received Medicaid benefits from 2003 to 2006. Subsequently, the Department notified Joshua that his household was ineligible for benefits paid over the past three years because of Jennifer's interest in the partnership and demanded repayment. Joshua contested the demand of benefits paid. The State Board of Public Assistance upheld a hearing officer's findings that Jennifer's interest in the partnership was a countable and available resource. The district court affirmed. On appeal, the Supreme Court affirmed, holding (1) the district court correctly concluded that that the hearing officer did not violate Mont. Code Ann. 2-4-623 when he did not issue a decision within ninety days after the case was deemed submitted; and (2) the district court correctly determined that substantial credible evidence supported the Department's finding that Jennifer's interest in the partnership was an available resource.

The court agreed to rehear this case en banc to clarify under what circumstances the exhaustion requirement of the Individuals with Disabilities Education Act (IDEA), 20 U.S.C. 1415(l), barred non-IDEA federal or state law claims. Plaintiff, on behalf of herself and her son, appealed the district court's grant of summary judgment to defendants where the district court dismissed her claims for lack of subject matter jurisdiction because plaintiff did not initially seek relief in a due process hearing and therefore, failed to comply with one of the exhaustion-of-remedies requirement of the IDEA. The court held that the IDEA's exhaustion requirement was not jurisdictional and that plaintiff's non-IDEA federal and state-law claims were not subject to the IDEA's exhaustion requirement. Therefore, the court reversed the judgment.

Claimant Katrina Blue appealed an Employment Security Board decision that denied her claim for unemployment compensation benefits.  Claimant contended the Board erred in: (1) finding that she was disqualified from receiving benefits because she left her employment voluntarily; and (2) assigning her the burden of proof.  Claimant worked for about four years for Hickok & Boardman Realty.  In the early summer of 2010, claimant left her employment to participate in a three-month cross-country bicycle ride for multiple sclerosis. Claimant acknowledged that she did not submit a written request for leave, as required in the company's personnel policy, which stated that employees who apply for unpaid personal leave, "must apply in writing" and that, "reinstatement is not guaranteed" but rather, "at the Company's sole discretion."  While conceding that her leave arrangement "was not typical," Claimant maintained that her supervisor had agreed, "that an exception would be made in this instance." In its ruling, the ALJ's findings indicated that Claimant "requested a three-month leave of absence" but do not state whether the request was granted or, if so, on what terms.   Its key conclusion, however, was that, "[w]hile the claimant maintain[ed] that she was fired when the employer would not allow her to come back from a personal leave of absence, it was the claimant who initiated the separation from employment by requesting the leave of absence . . . thus making this a voluntary separation from employment."  Since there was no claim that the separation was for "good cause attributable" to the employer, the ALJ concluded that claimant was disqualified from receiving benefits. In a divided ruling, the Employment Security Board adopted the ALJ's findings and conclusions and sustained its decision.  The dissenting member of the Board would have found that claimant's "departure for her cross-country ride was . . . not a voluntary abandonment of her employment, but a temporary unpaid leave of absence," that claimant was let go upon her return in late August, and therefore that she was entitled to unemployment compensation benefits from that time forward.  This appeal followed. Upon review of the record, the Supreme Court reversed and remanded the case to the Department of Labor's ALJ: "[m]indful that our unemployment compensation scheme must be broadly construed so that no claimant is "excluded unless the law clearly intends" it … we direct the ALJ on remand to enter additional findings and conclusions on the material issues presented, and to award unemployment compensation benefits to claimant in the event it is determined that she  did not leave her employment voluntarily."

Plaintiff Duane Barber (Barber) appealed the Commissioner of Social Security's denial of benefits claiming that an Administrative Law Judge (ALJ) failed to properly consider the evidence he presented in support of his claim. Plaintiff claimed he was disabled by schizophrenia, anti-social personality disorder, depression, anxiety and bipolar disorder. Barber eventually applied for Supplemental Security Income but the ALJ concluded at step five of the five-step evaluation process that Plaintiff was not disabled. The Appeals Council denied review, and a magistrate judge, acting on the parties' consent, affirmed. Plaintiff then brought his appeal to the Tenth Circuit. Upon review of the administrative record, the Tenth Circuit found that the ALJ properly explained his findings throughout. Because the record supported the ALJ's decision in this case, the Tenth Circuit affirmed the ALJ's decision to deny Plaintiff's application for benefits.