Justia Public Benefits Opinion Summaries

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A1 learned that government auditors thought that the company had overcharged a federal agency by several million dollars for services provided to Medicare beneficiaries. A1 challenged the auditors’ decisions at two levels of the Medicare appeals process but changed the auditors’ minds only in a few minor ways. The government tried to start collecting the money, as the regulatory regime allows, 42 U.S.C. 1395ff(a)(5), (c)(3)(E). Fearing bankruptcy from the government’s recoupment efforts, A1 obtained a preliminary injunction, barring the government from recouping the money until A1 received a hearing before an administrative law judge. The Sixth Circuit vacated the injunction, first holding that although A1 did not proceed to the third and fourth levels of the administrative appeal, the district court had jurisdiction over A1’s constitutional claims. On the merits, the court identified unanswered questions regarding the statistics concerning the relief likely to be obtained at the third level of administrative review; details about A1’s choice not to take advantage of an option to escalate its claim to the fourth and final level of administrative review; and the parties’ awareness of a recoupment option that might have allowed A1 to obtain an ALJ hearing before making most or even all of its recoupment payments. View "A1 Diabetes & Medical Supply v. Alex Azar II" on Justia Law

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The Eighth Circuit affirmed the denial of social security disability insurance benefits and supplemental security income to plaintiff. The court held that substantial evidence supported the ALJ's conclusion that plaintiff's work as a receptionist constituted "substantial gainful activity." In this case, she worked predominately as a receptionist, was paid for the work, and performed work that plainly involved significant physical or mental activities. The court held that plaintiff performed activities beyond her core duties as a receptionist only occasionally, and her responsibilities as a receptionist alone constituted substantial gainful activity. View "Sloan v. Saul" on Justia Law

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In February 2015, Johnson’s landlord under the Housing and Community Development Act Section 8 housing assistance program (42 U.S.C. 1437f(o)) served a “lease violation notice” informing Johnson that she had violated her lease by following another tenant to his apartment and using profanity. In June 2015, Landlord issued a “notice to cease” stating that management had received a complaint from a resident alleging that she had used pepper spray against him. On February 29, 2016, Landlord served a “ninety-day notice of termination of tenancy.” In June, when Johnson failed to vacate, Landlord filed an unlawful detainer action. In August, the action was settled by a stipulation; Landlord agreed to reinstate Johnson’s tenancy on the condition that she conform her conduct to the lease. Landlord retained the right to apply for entry of judgment based on specified evidence of breach. In October, Landlord applied for entry of judgment, claiming that Johnson violated the stipulation. Johnson was evicted in January 2017. In February, the Oakland Housing Authority, which administers the Section 8 program, terminated Johnson's benefits. The court of appeal found no violation of Johnson’s procedural due process rights in terminating her from the program. Johnson was given sufficient notice of the grounds for termination: she failed to supply the Authority with required eviction documentation; she committed and was evicted for serious repeated lease violations. The hearing officer did not abuse its discretion in refusing to excuse the violation. View "Johnson v. Housing Authority of City of Oakland" on Justia Law

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California State Teachers’ Retirement System (CalSTRS) manages contributions made by employees and member school districts to the State Teachers’ Retirement Fund. (Ed. Code 22000.) In 2014, the Baxter petitioners, formerly employed by the Salinas Unified High School District sought to prevent CalSTRS from continuing to reduce their monthly retirement benefit payments and to restore prior monies they claimed CalSTRS had wrongfully withheld to recoup overpayments made as a result of a years-long miscalculation by the District. The trial court held that a three-year limitations period barred CalSTRS from recouping the prior overpayments. The court of appeal reversed, finding that the continuous accrual theory applied. A second suit challenged the reductions. Before the court of appeal addressed Baxter, the trial court granted relief in the second suit, finding CalSTRS’s claims time-barred. The court of appeal followed Baxter, holding that the continuous accrual theory applies. CalSTRS was time-barred from pursuing any claim against teachers as to pension benefit overpayments made more than three years before CalSTRS commenced an action but is not time-barred from pursuing any claim concerning periodic overpayments to teachers and adjustments to teachers’ future monthly benefits, where the payment accrued not more than three years prior to commencement of an action. The reduction in benefits made by CalSTRS did not constitute the commencement of an “action.” CalSTRS constructively commenced an “action” when these teachers filed their verified petition and complaint in the superior court on February 1, 2016. View "Blaser v. State Teachers' Retirement System" on Justia Law

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After appellant successfully litigated her claim to supplemental social security income, she challenged the district court's denial of her application for attorney's fees under 42 U.S.C. 406(b). The Second Circuit affirmed the denial of appellant's attorney's fee application as untimely, because she filed well beyond the 14 days prescribed by Federal Rule of Civil Procedure 54(d)(2)(B). Assuming the court would entertain appellant's argument, it failed on the merits because she provided no factual basis to support a claim that it was reasonable to delay the filing of her section 406(b) application for more than six months after she received notice of the benefits calculation on remand. View "Sinkler v. Berryhill" on Justia Law

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Crump applied for social security disability benefits based on her long history of numerous mental health impairments, including bipolar disorder and polysubstance abuse disorder. An administrative law judge denied benefits, finding that Crump, despite her severe impairments, could perform work limited to simple and repetitive tasks. The district court affirmed. The Seventh Circuit vacated. The ALJ did not adequately account for Crump’s difficulties with concentration, persistence, or pace in the workplace. An ALJ generally may not rely merely on catch-all terms like “’simple, repetitive tasks’” because there is no basis to conclude that they account for problems of concentration, persistence or pace. In addition, observing that a person can perform simple and repetitive tasks says nothing about whether the individual can do so on a sustained basis. Beyond disregarding the Vocational Expert’s opinion in response to a second hypothetical, the ALJ gave short shrift to the medical opinions of Crump’s treating psychiatrist. View "Crump v. Saul" on Justia Law

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The ALJ who ruled on Hess’s application for social security disability benefits concluded that Hess had “moderate difficulties” in “concentration, persistence or pace,” but offered a detailed explanation for why she believed those difficulties were not serious and why Hess was capable of performing simple tasks. She found that Hess was “limited to jobs requiring understanding, remembering, and carrying out only simple instructions and making only simple work-related decisions[.]” In a series of hypothetical questions meant to include Hess’s limitations, she asked a vocational expert whether there were jobs in the national economy available to someone with those limitations. The expert said there were. The ALJ decided that Hess was not disabled and rejected his claim. The district court determined that the ALJ had erred because, in her hypothetical questions to the vocational expert, she failed to include or account for her finding that Hess had “moderate” difficulties in “concentration, persistence, or pace.” The Third Circuit reversed, refusing to elevate “form over substance.” An ALJ’s statement of a limitation confining a person to “simple tasks” is permissible after a finding of “moderate” difficulties in “concentration, persistence, or pace,” if the ALJ offers a “valid explanation” for it. The explanation given by the ALJ was “valid.” View "Hess v. Commissioner of Social Security" on Justia Law

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The Eighth Circuit affirmed the denial of social security disability benefits to plaintiff. The court held that plaintiff clearly suffered from back pain, but substantial evidence supported the ALJ's finding that plaintiff had the residual functional capacity to perform light work. Furthermore, the ALJ did not err by failing to order a consultative examination, because the evidence in the record provided a sufficient basis for the ALJ's decision, and substantial evidence supported the ALJ's credibility determination on the record as a whole. View "Swink v. Saul" on Justia Law

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The Eighth Circuit affirmed the denial of plaintiff's application for supplemental security income, holding that substantial evidence supported the ALJ's determination that plaintiff had only a moderate restriction on his activities of daily living. In this case, while the ALJ could have weighed the evidence differently, substantial evidence supported the ALJ's determination that the psychological expert's review of all the evidence should be credited over the counselor's observations as a non-medical, other source. View "Dols v. Saul" on Justia Law

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A 1941 Executive Order, ordered into the service of the U.S. armed forces all of the organized military forces of the Philippines, a U.S. territory. Various Filipino military organizations and more than 100,000 members of the Philippine Commonwealth Army served the U.S. during World War II. After the war, Congress passed Surplus Appropriation Rescission Acts, 38 U.S.C. 107, providing that service in these Filipino military organizations “shall not be deemed to have been active military, naval, or air service.” Filipino veterans were not eligible for the same benefits as U.S. veterans. The American Recovery and Reinvestment Act of 2009, 123 Stat. 115, 200–02, established a $198 million fund to provide one-time payments to Filipino veterans: $15,000 for U.S. citizens and $9,000 for non-citizens. The statute required Filipino veterans to apply for this payment within one year of the statute’s enactment. The VA required that the relevant service department verify the veteran’s service. The VA treats the service department’s decision as conclusive, regardless of other evidence documenting service. The VA denied Cruz’s application because the Army certified that Cruz did not have service as a member of the Philippine Commonwealth Army, including recognized guerillas, as “he was not listed in the Reconstructed Guerilla Roster” The Federal Circuit reversed in part. The VA can generally rely on the service department’s determination in deciding eligibility for payment but, in this context, must give the veteran a meaningful opportunity to challenge his service record through the Army Board for Correction of Military Records. View "Dela Cruz v. Wilkie" on Justia Law