Justia Public Benefits Opinion Summaries

Plaintiff applied for Supplemental Security Income disability benefits alleging disability due to a combination of impairments. At issue was whether plaintiff's hearing before the administrative law judge ("ALJ") was invalid where plaintiff waived his right to representation at his hearing. The court held that there was no agency error where there was no disclosure required other than the disclosure in 42 U.S.C. 406(c) and that section 406(c)'s disclosure requirements were met.

Plaintiff-Appellant Carl Sheppard appealed the district courtâs order which denied his applications for disability insurance and supplemental security income benefits under the Social Security Act. The Administrative Law Judge (ALJ) denied Plaintiffâs applications for benefits in January, 2008 because the part-time work Plaintiff was doing at the time of his application was âsubstantial gainful activity.â The Tenth Circuit found that the ALJ failed to apply the correct legal standards in arriving at his conclusion. Accordingly, the Court reversed the lower court and remanded the case for further proceedings.

Plaintiff applied at age 51 for supplemental security income based on disability. At issue was whether the administrative law judge ("ALJ") erred by failing to develop the record adequately and should have requested more explanation from two of plaintiff's treating physicians at the Department of Veterans Affairs ("VA"). The court held that the ALJ's failure to assist plaintiff in developing the record by getting his disability determination into the record was probably likely to have been prejudicial because the court gave VA disability determinations great weight. Therefore, the court remanded under sentence four of 42 U.S.C. 405(g), concluding that "the agency erred in some respect in reaching a decision to deny benefits."

Josephine Centorbi died intestate in 2007. At the time of her death, Ms. Centorbi received Medicaid benefits. Ms. Centorbiâs sister, Dianne Fiorille administered the estate, and acting without counsel, applied to relieve the estate from administration. When she filed the application, Ms. Fiorille did not check the box on the form to attest that the decedent was over 55 years old and received Medicaid assistance. In addition, as administrator, Ms. Fiorille failed to file some other forms necessary to notify both the probate court and the Ohio Department of Jobs and Family Services (ODJFS) of the decedentâs death. The probate court granted Ms. Fiorilleâs application to relieve the estate from administration on the same day it was filed. Two years later, ODJFS learned of Ms. Centorbiâs death. It filed an application to vacate the probate courtâs order, but its application was denied. The probate court held that because Ms. Fiorille indicated that no notice was required (in the form of the omitted check box), ODJFSâs application was time barred. The appellate court affirmed the probate courtâs decision. The Supreme Court found that failing to check the box on the initial relief-from-administration form tolled the statute of limitations. Without the check, the Medicaid program had not been officially notified of the decedentâs death. The Court reversed the appellate courtâs decision and remanded the case to the probate court for further proceedings.

A.S., a California minor, filed a request for a special education due process hearing where he was eligible for special education services under the Individuals with Disabilities Education Act ("IDEA"), 20 U.S.C. 1400 et seq., as an emotionally disturbed child. At issue was which California agency was responsible for funding a special education student's placement in an out-of-state residential treatment facility. The court requested the California Supreme Court exercise its discretion and decide the following certified question, "Whether under California law the school district responsible for the costs of a special education student's education while the student is placed at an out-of-state residential treatment facility is the district in which the student's de facto parent, who is authorized to make educational decisions on behalf of the student, resides."

The Nebraska Department of Health and Human Services (DHSS) determined that Darline Liddell-Toney was required to participate in a self-sufficiency program in order to receive benefits under the Welfare Reform Act, despite her documented disability. The district court affirmed the DHSSâ determination. Ms. Liddell-Toney appealed, arguing that the district court erred in finding that the DHSS provided sufficient evidence to prove she was not entitled to an exemption from participating in the program. The Supreme Court found that the evidence clearly indicated that Ms. Liddell-Toney was prevented from working for a substantial period due to her disability. The Court held that the district court erred when it affirmed DHSSâs determination that Ms. Liddell-Toney did not qualify for an exemption from participating in the self-sufficiency program. The Court reversed the judgment of the district court, and remanded the case for further proceedings.

Petitioner Richard Lister appealed the recommendation of the Family Division Master that modified his child support obligations, and that refused to grant him credit for Social Security benefits received by his adult son. The son lives with his mother, Marianne Lister, and receives Supplemental Social Security (SSI) income of approximately $450 per month. As a disabled adult, the son is eligible for child support so long as he remains dependent. The sonâs SSI is reduced by the amount of child support he receives. In 2010, Mrs. Lister requested an increase in child support from Mr. Lister. At that time, Mr. Lister argued that he should receive a dollar for dollar credit for the sonâs SSI benefits when considering how much more he should be obliged to pay. The case Mr. Lister relied on to make his âcreditâ argument depended on the parentâs status as either retired or disabled. In this case, the son receives SSI benefits because of his own disability. The family division modified the child support obligation and refused to give Mr. Lister âcreditâ in the amount of his sonâs SSI benefits. On appeal, Mr. Lister argues that the family division made a mistake in reaching its decision to modify his support obligation. The Supreme Court agreed with the family divisionâs analysis of Mr. Listerâs case, and affirmed the divisionâs decision.

To provide relief in the aftermath of Hurricanes Katrina and Rita, Congress appropriated funds to Louisiana which distributed some of those funds through the "Road Home" program. The State required more than 150,000 Road Home grant recipients to execute a "Limited Subrogation/Assignment Agreement." The Road Home program created "perverse incentives" for insurance companies and their insured homeowners: some insurers inadequately adjusted and paid grant-eligible claims, and some grant-eligible homeowners had little motivation for file insurance claims. As a result, Road Home applications skyrocketed and created a $1 billion shortfall in the program. The State filed suit against more than 200 insurance companies, seeking to recover the funds spent and yet to be spent on claims under the Road Home program. The Insurance Companies successfully removed the case to the federal district court. The Insurance Companies then sought to dismiss the State's case, arguing that as a matter of law, anti-assignment clauses in the homeowners' policies invalidated the subrogation/assignment to the State. The federal district court denied the Companies' motion to dismiss. The Companies appealed to the Fifth Circuit. Because interpretation of the policy provisions at issue was a matter of State law, the Court certified interpretation to the Louisiana Supreme Court. The Supreme Court found that there is no public policy in Louisiana that precludes anti-assignment claims from applying to post-loss assignments. The Court commented that the language of the anti-assignment clause must clearly and unambiguously express that it applies to post-loss assignments, and as such must be evaluated on a policy-by-policy basis.

Plaintiff-Appellant Jessica Cohon sought funding through New Mexicoâs Medicaid program. She qualified for the âMi Via Waiverâ program, and submitted budget requests which were partly granted, partly denied. After an unsuccessful administrative appeal, she filed suit, alleging that the administration of the Mi Via Waiver program discriminated against severely disabled persons like herself. The State moved to dismiss Plaintiffâs complaint, arguing that not only was it the wrong entity being sued, but that Plaintiff had no statutory basis to support her suit. The district court dismissed Plaintiffâs claims based on federal law, but remanded her state-law claims to the administrative agency for further proceedings. Plaintiff appealed the dismissal of her federal law claims to the Tenth Circuit. Upon review, the Tenth Circuit found Plaintiffâs federal claims âinsufficient in substance,â and affirmed the judgment of the district court that dismissed her claims.

Records indicate that the veteran's knee was injured in 1949 while he was playing football with a military team. Treatment at a field hospital in Germany included x-rays that revealed no bone or joint injury. The knee was not treated again until 1999, when the veteran claimed service-related disability. X-rays at a VA clinic showed minimal degeneration consistent with osteoarthritis. On remand, for the VA's failure to assist the veteran, instructions to the VA hospital stated "NO EXAM" and indicated a file review, but did state that an exam was allowable if necessary. The Veterans' Court upheld a second denial of benefits. The Federal Circuit affirmed; the Veterans Court acted correctly in not requiring the Board to state reasons why the medical examinersâ reports were competent and sufficiently informed. The court noted that the veteran did not raise his concerns about the instructions with the Board and that it cannot review a challenge to a law or regulation as applied to the facts of a particular case under 38 U.S.C. 7292.