Justia Public Benefits Opinion Summaries

Donovan Donald (Don) was incapacitated in an accident and received several treatment in Kalispell Regional Medical Center (KRMC). Later, a dispute arose between Don's estate and KRMC over KRMC's acceptance or rejection of Medicaid's payments for Don's care. KRMC filed liens against the Estate. The Estate, in turn, sued KRMC and MASH, a company that had provided Medicaid application forms to the Estate, under several theories of liability. The district court granted Defendants' motions for summary judgment. The Supreme Court affirmed, holding the district court (1) did not err in granting summary judgment to KRMC and MASH; (2) correctly interpreted and applied the Montana Medicaid Act; (3) correctly awarded KRMC prejudgment interest but incorrectly included interest KRMC received from its interest-bearing account; and (4) did not abuse its discretion by awarding KRMC attorney fees and costs. Remanded with instructions to offset the prejudgment interest award by the amount of interest KRMC received from the interest-bearing account.

Petitioner Maria Willits appealed the decision of the Job Service North Dakota ("Job Service") that denied her application for unemployment benefits after Job Service found she voluntarily left her employment without showing good cause attributable to her employer. In October 2003, Petitioner began working full time as a licensed practical nurse (LPN) for Circle of Nations School, a boarding school for Native American children located on federal property in Wahpeton. According to Petitioner, she became concerned that one staff member she had trained was not proficient in English. After a different staff member committed a medications error in late October 2009, Petitioner met with the dean of students of the school and expressed concerns about training the two staff members to administer medications because she did not believe they were qualified and would pose a risk to the student population. Petitioner told the dean that she would not re-certify the two staff members but would train others. Petitioner subsequently contacted the State Board of Nursing and inquired whether she could conduct medication administration training as an LPN. She was informed that she was not authorized to train staff to administer medications and that she needed to be supervised by a registered nurse or licensed practitioner. According to Petitioner, she concluded her work at the school was outside the scope of her nursing license. Petitioner's concerns were discussed with the school's administrators. In November 2009, Petitioner informed the school through a phone message that she quit her employment. By then, the school had obtained the services of a doctor to oversee nursing activities. The Supreme Court affirmed Job Service's decision, concluding "a reasoning mind reasonably could have determined that [Petitioner] did not make a reasonable effort to preserve her employment relationship and, consequently, that she left her employment without good cause attributable to her employer."

Plaintiff was in a work-related vehicle accident that injured his back in 1994. He worked on and off until 2000 when back pain prevented him from continuing as a truck driver. A 2001 claim for social security disability benefits was denied. Plaintiff had some relief following surgery in 2001 and was released to work in 2002. When the pain increased he began mental health treatment. In 2004 an ALJ found that plaintiff was not disabled. In 2007, following remand, an ALJ again denied benefits. The appeals council denied jurisdiction. The district court affirmed. The Sixth Circuit reversed and remanded, finding that the decision was not supported by substantial evidence because the ALJ failed to properly apply the treating physician rule and the good reasons rule in disregarding the conclusion of a treating psychiatrist and testimony of a treating counselor. Agency procedural rules require that the ALJ balance factors to determine what weight to give a treating source and to give good reasons for the weight actually assigned.

Petitioner worked as an underground surveyor for a coal company for more than 22 years. He filed an unsuccessful claim for black lung benefits (30 U.S.C. 901) about a year after being laid off. He filed a second claim 10 years later, accompanied by medical opinions and x-ray interpretations. The DOL provided a pulmonary examination for each claim. The first diagnosed shortness of breath of unknown etiology but opined that petitioner suffered no impairment. The second resulted in diagnosis of restrictive lung disease, right mid lung density, bilateral hilar adenopathy and concluded that there was no impairment. An ALJ rejected the second claim. The Benefits Review Board affirmed. The Sixth Circuit vacated for consideration under an amendment to the Act, under which a miner who worked underground for at least 15 years and who demonstrates that he suffers from a total respiratory disability is presumed to be totally disabled due to pneumoconiosis (30 U.S.C. 921(c)(4)). Rebuttal requires an affirmative showing; it is not enough to show that medical evidence does not include a well documented opinion of pneumoconiosis. The ALJ failed to consider all evidence relevant to the issue of disability.

The parents of E.M., a bilingual student, brought an action to challenge the Pajaro Valley Unified School District's (District) determination that E.M. did not qualify for special education under the Individuals with Disabilities Education Act (IDEA), 20 U.S.C. 1400 et seq. The Special Education Division of the California Office of Administrative Hearings (OAH) upheld the District's assessment and the district court affirmed the OAH's decision. The court disagreed with the district court's assessment only to the extent that it found one claim not addressed and one report not measured for its relevance. Accordingly, the court affirmed the judgment of the district court in part and reversed in part. The court remanded for the district court to consider whether the report was relevant to the determination of whether the district met its obligations to E.M. under the IDEA and whether an auditory processing disorder could qualify as an other health impairment, and if so, whether the district met its obligations to assess E.M. and identify him as a child with an other health impairment.

The parents of E.M., a bilingual student, brought an action to challenge the Pajaro Valley Unified School District's (District) determination that E.M. did not qualify for special education under the Individuals with Disabilities Education Act (IDEA), 20 U.S.C. 1400 et seq. The Special Education Division of the California Office of Administrative Hearings (OAH) upheld the District's assessment and the district court affirmed the OAH's decision. The court disagreed with the district court's assessment only to the extent that it found one claim not addressed and one report not measured for its relevance. Accordingly, the court affirmed the judgment of the district court in part and reversed in part. The court remanded for the district court to consider whether the report was relevant to the determination of whether the district met its obligations to E.M. under the IDEA and whether an auditory processing disorder could qualify as an other health impairment, and if so, whether the district met its obligations to assess E.M. and identify him as a child with an other health impairment.

Plaintiff Donna Butterick appealed a district court order that affirmed the Social Security Commissioner's denial of her application for disability insurance. Plaintiff argued on appeal that the Administrative Law Judge (ALJ) committed reversible error in denying her application because he failed to follow the Commission's own procedure in examining and admitting testimony of the medical expert that testified at her hearing. Upon review of the hearing record, the Tenth Circuit concluded that the alleged procedural errors at Plaintiff's hearing were "harmless." Because Plaintiff failed to show any prejudice, the Court affirmed the ALJ's decision to deny Plaintiff disability benefits.

Ernestine Girod, Una Favorite Brown, and Melinda Langley were each indicted on one count of conspiracy and multiple counts of healthcare fraud, and Brown and Girod were charged with three counts each of making false statements to law enforcement officers, all in relation to fraudulent Medicaid reimbursement claims made through A New Beginning of New Orleans, a Medicaid Early Periodic Screening Diagnosis and Treatment organization that provided minor, disabled Medicaid recipients with Personal Care Services. A jury convicted defendants on all but three of Langley's healthcare fraud counts. Brown, Girod, and Langley separately appealed their convictions and sentences on various grounds. The court discussed Brown's motion to dismiss the indictment due to prosecutorial misconduct; the sufficiency of the evidence supporting Girod's convictions; Girod's sentencing enhancements; and testimony of Langley's other acts. Accordingly, the court held that all the convictions and sentences were affirmed.

Plaintiff Melissa Qualls appealed a district Court's order that affirmed the Social Security Administration's decision to deny her application for disability insurance benefits. Plaintiff alleged she became disabled in 2004. Her "date last insured" was December 31, 2008, "thus she had the burden of proving that she was totally disabled on that date or before." Though Plaintiff suffered from multiple sclerosis, the Administrative Law Judge (ALJ) found that she was not disabled because "she could make a successful adjustment to other light and sedentary work that exists in significant numbers in the national economy." On appeal, Plaintiff argued that the ALJ failed to perform a proper credibility determination prior to rendering his judgment. Upon review of the Administration's record, the Tenth Circuit found that the Commissioner's decision was supported by substantial evidence, and the the law was properly applied. The Court affirmed the Commission's decision to deny Plaintiff further insurance benefits.

Plaintiff, the mother of a developmentally disabled high school student, alleged that the several sexual encounters her daughter had with another developmentally disabled student in a school bathroom were the result of the school's failure to properly supervise her daughter. At issue was whether plaintiff, individually and on behalf of her daughter, had a cognizable Fourteenth Amendment due process claim against the daughter's special education teacher. The court held that the district court properly dismissed plaintiff's 42 U.S.C. 1983 civil rights claim at summary judgment where the special-relationship exception and the state-created danger exception did not apply in this case. The court held that whatever liability the special education teacher faced, that liability must come from state tort law, not the Fourteenth Amendment. Accordingly, the judgment of the district court was affirmed.