Justia Public Benefits Opinion Summaries

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.

Plaintiff appealed the district court's grant of summary judgment dismissing claims of wrongful termination against her former employer, its president and chief executive officer, and its principal owner (collectively, defendants). At issue was whether plaintiff's claim of wrongful termination violated Iowa public policy. The court held that, in these circumstances, the district court correctly concluded that plaintiff's discharge did not undermine clearly defined public policy as a matter of law where plaintiff was discharged based on an at-will employment contract and where there was no false reimbursement claim submitted and no acts of fraud occurring on the part of defendants. Accordingly, the judgment of the district court was affirmed and the court denied as moot plaintiff's motion to strike portions of defendants' briefs.

Plaintiff appealed the district court's grant of summary judgment dismissing claims of wrongful termination against her former employer, its president and chief executive officer, and its principal owner (collectively, defendants). At issue was whether plaintiff's claim of wrongful termination violated Iowa public policy. The court held that, in these circumstances, the district court correctly concluded that plaintiff's discharge did not undermine clearly defined public policy as a matter of law where plaintiff was discharged based on an at-will employment contract and where there was no false reimbursement claim submitted and no acts of fraud occurring on the part of defendants. Accordingly, the judgment of the district court was affirmed and the court denied as moot plaintiff's motion to strike portions of defendants' briefs.

The former governor and former financial director of the Tribe were convicted for conspiracy to defraud the United States (18 U.S.C. 371), and of violations of 18 U.S.C. 287, 666 and 669, involving misuse of federal grant and tribal monies at the Passamaquoddy Tribe Indian Township Reservation in Maine. The First Circuit vacated the conviction of the financial director for making material misstatements about how grant money intended for HIV and substance abuse prevention was spent, but otherwise affirmed. The evidence that the director knew that his statements were false was insufficient. The district court had jurisdiction; several counts involved mismanagement of federal grants and contracts, which are subject to regulations that the Tribe is not free to ignore, and do not constitute internal tribal matters.

Plaintiff brought a Federal Tort Claims Act (FTCA), 28 U.S.C. 2671-2680, action on behalf of her minor son against the government for injuries allegedly related to his exposure to potentially dangerous, high levels of formaldehyde in their Federal Emergency Management Agency (FEMA) provided emergency housing unit (EHU). At issue was whether the district court properly dismissed plaintiff's claim for lack of subject matter jurisdiction because the claim was time-barred. The court held that neither the discovery rule, equitable estoppel, or the continuing tort doctrine applied in this case and therefore, plaintiff's FTCA claim accrued in May 2006 and her July 2008 administrative filing was untimely. Accordingly, the court affirmed the district court's dismissal of the case for lack of subject matter jurisdiction.

Plaintiff appealed from an order of the district court that reduced by two-thirds the attorney's fees award she requested for successfully appealing from the administrative denial of her application for disability benefits. The district court, attributing gaps in the administrative record to plaintiff's counsel, concluded that the alleged deficiency constituted "special circumstances" justifying a reduction in the attorney's fees awarded under the Equal Access to Justice Act, 28 U.S.C. 2412(d)(1)(A). The court held that the failure of a claimant's attorney to develop the administrative record on issues collateral to the disability determination did not constitute a "special circumstance" warranting a reduction in attorney's fees. The court also held that the district court abused its discretion in reducing the fee award based on its sua sponte critique of counsel's billing records and its conclusion that the time billed was excessive because no novel issues were raised. Accordingly, the judgment was reversed and remanded.