Justia Public Benefits Opinion Summaries

Wilder, born in 1970, has a high school education. She previously worked as a motor vehicle quality worker and a sales clerk. She has not worked since October 2015. Wilder applied for Social Security disability benefits in 2016, alleging a disability onset date in October 2015. She alleged hip pain, difficulty walking, lower back pain, and balance issues. Her claim was administratively denied. An ALJ concluded that Wilder’s impairments, while severe, did not meet or equal one of the impairments listed in 20 C.F.R. Part 404, Subpart P, App’x 1, that Wilder had the residual functional capacity to perform sedentary work with limitations, and that suitable jobs existed in significant numbers in the national economy. The Appeals Council denied Wilder’s request for review.The district court and Seventh Circuit held that substantial evidence supported the ALJ’s decision. The court rejected Wilder’s arguments that the ALJ erred by failing to consider whether she met or equaled Listing 11.17(a), even though her attorney did not argue to the ALJ that she met or equaled that Listing (or any Listing) and by failing to request the opinion of a medical expert, and that the ALJ’s evaluation of her subjective symptoms was patently wrong. View "Wilder v. Kijakazi" on Justia Law

D&G, a Medicare service provider for nursing homes and homebound individuals, filed suit against the H.H.S. Secretary in federal court seeking repayment of recouped funds, which then amounted to $4,136,258.19 in principal and $593,294.54 in accrued interest. The district court dismissed D&G's case for lack of subject matter jurisdiction, holding that there was no federal court jurisdiction pursuant to 42 U.S.C. 405(g), as applied to Medicare appeals by 42 U.S.C. 1395ff(b)(1)(A).The Fifth Circuit held that "effectuations" of final agency decisions when sought to liquidate the amount of repayment owed, are reviewable under 42 U.S.C. 405(g) as continuous aspects of the initial, properly exhausted, administrative decision. The court concluded that the district court had jurisdiction under section 405(g) to resolve this dispute because "effectuations" are inextricably intertwined with the initial exhausted agency action. Therefore, the district court committed reversible error when it granted the Secretary' motion to dismiss. Furthermore, the Secretary's attempted reopening of the "effectuation" was untimely and the purported reopening was void ab initio. The court reversed and remanded for further proceedings. View "D&G Holdings, LLC v. Becerra" on Justia Law

Colgan, a teacher at a special education high school, attempted to break up a fight between students but either fell or was pushed into a wall, leading to serious injuries. Colgan’s injuries and symptoms persisted despite treatment from several medical sources. Her treating physician, Dr. Ward, a concussion specialist, found that Colgan satisfied the medical criteria for mild traumatic brain injury and post-concussion syndrome with persistent cognitive defects and fatigue, chronic post-traumatic headaches, sleep disturbance, and dizziness; Colgan's debilitating headaches severely hampered her ability to carry out activities of daily living and basic job-related functions.Colgan successfully applied for workers’ compensation benefits. In 2016, Colgan sought social security disability insurance benefits. An ALJ denied Colgan’s claim, concluding that she had the residual functional capacity (RFC) to perform sedentary work, subject to physical and cognitive limitations (42 U.S.C. 423(d)(1)(A)). The district court affirmed. The Second Circuit vacated. The ALJ’s factual determination with respect to Colgan’s RFC was not supported by substantial evidence. The ALJ misapplied the treating physician rule to Dr. Ward’s “check-box” medical opinion, which was supported by voluminous treatment notes gathered over almost three years of clinical treatment View "Colgan v. Kijakazi" on Justia Law

The Ninth Circuit affirmed the district court's grant of summary judgment in favor of the SSA in a putative class action alleging that reducing the Social Security benefits of class members based on the receipt of a foreign social security pension violated the Windfall Elimination Program (WEP), its implementing regulation, and the Agreement Between the Government of the United States of America and the Government of Canada with Respect to Social Security.The panel concluded that the WEP applies to a Social Security beneficiary who receives benefits under the Canada Pension Plan. Therefore, the SSA and the district court properly interpreted the WEP and the U.S.-Canada Agreement. In this case, Plaintiff Rosell's Canadian pension was based at least in part on his earnings for noncovered service, and thus the agency correctly reduced the couple's Social Security benefits. View "Michener v. Kijakazi" on Justia Law

The Ninth Circuit affirmed the district court's judgment affirming in part and reversing in part an ALJ's decision in favor of student B.W. The panel held that goals (as opposed to services) in B.W.'s first grade Individualized Education Program (IEP) were not inadequate; Capistrano did not have to file for due process to defend the first grade IEP; and Capistrano did not have to have an IEP in place for the second grade. The panel remanded for the limited purpose of considering attorneys' fees. The panel addressed other issues in a concurrently filed memorandum disposition. View "Capistrano Unified School District v. S.W." on Justia Law

The Fourth Circuit affirmed the district court's dismissal of an action brought by plaintiff, alleging that the school district had violated her daughters' rights under the Individuals with Disabilities Education Act (IDEA). The court held that plaintiff's withdrawal of the children from the school district system rendered moot her request for prospective relief. Furthermore, because the district court proceedings under the IDEA are original civil actions, the court held that plaintiff's failure to specify in her complaint that she was seeking compensatory education for her children, or to include allegations from which a request for compensatory education reasonably could be inferred, precludes her present assertion of a live controversy in the district court. View "Johnson v. Charlotte-Mecklenburg Schools Board of Education" on Justia Law

Wisconsin provides transportation to private-school students, limited to only one school “affiliated or operated by a single sponsoring group” within any given attendance area. The state superintendent decided that St. Augustine, a freestanding entity that describes itself as Catholic but independent of the church’s hierarchy, is “affiliated with or operated by” the same sponsoring group as St. Gabriel, which is run by the Catholic Archdiocese.In 2018, the Seventh Circuit rejected a suit by St. Augustine. The Supreme Court vacated and remanded for further consideration in light of intervening precedent. The Seventh Circuit then certified to the Wisconsin Supreme Court the question of how to determine “affiliation” under state law. That court responded: [I]n determining whether schools are “affiliated with the same religious denomination” [i.e., the same sponsoring group] pursuant to Wis. Stat. 121.51, the Superintendent is not limited to consideration of a school’s corporate documents exclusively. In conducting a neutral and secular inquiry, the Superintendent may also consider the professions of the school with regard to the school’s self-identification and affiliation, but the Superintendent may not conduct any investigation or surveillance with respect to the school’s religious beliefs, practices, or teachings.The Seventh Circuit then reversed. The Superintendent’s decision was not justified by neutral and secular considerations, but necessarily and exclusively rested on a doctrinal determination that both schools were part of a single sponsoring group—the Roman Catholic church—because their religious beliefs, practices, or teachings were similar enough. View "St. Augustine School v. Underly" on Justia Law

The Supreme Court held that Corpus Christi pharmacist John McNeill, who participated in a Medicaid drug program run by the Texas Health and Human Services Commission, was entitled to an administrative contested case hearing as to his challenge to the results of a program audit by the Commission.After the Commission audited McNeill, the auditor determined that McNeill had been overpaid by $69,911. McNeill requested a hearing, after which the Commission issued a final notice that reduced the overpayment amount to $64,549. McNeill thrice requested a contested case hearing before the State Office of Administrative Hearings. The Commission denied each request. McNeill sued the Commission, its commissioner, and its inspector general, seeking a declaration that he was entitled to a contested case hearing. The trial court granted the Commission's plea to the jurisdiction based on sovereign immunity and dismissed the complaint. The court of appeals reversed. The Supreme Court reversed, holding (1) McNeill's appeal was timely; and (2) the Commission's inspector general acted ultra vires in failing to perform her ministerial duty to provide McNeill a contested-case hearing under Tex. Gov't Code 531.1201, and the inspector general was not entitled to sovereign immunity. View "Phillips v. McNeill" on Justia Law

The Fifth Circuit affirmed the denial of social security disability benefits to plaintiff, concluding that the ALJ's residual function capacity (RFC) determination was supported by substantial evidence. The court also concluded that a consultive exam was not required where the ALJ's decision was based upon substantial evidence in a sufficiently developed record. Finally, the court concluded that plaintiff's remaining arguments were waived because he failed to raise them in the district court. View "Webster v. Kijakazi" on Justia Law

The Supreme Court affirmed in part and reversed in part the judgment of the trial court concluding that the Town of Fairfield may require James Gallagher and his wife to enroll in medicare but may also reimburse the costs of their Medicare Part B premiums, holding that the Town was not required to reimburse the Gallaghers for their Medicare premium costs.In 1985, when federal law did not permit municipal employees to participate in the Medicare system, the Town and its police union entered into a collective bargaining agreement providing that upon members who retired early, such as James, due to disability and their eligible dependents would be entitled to Town-paid private health insurance. An intervening change in federal law permitted retirees, such as James, to enroll in Medicare upon reaching the age of sixty-five. At issue was whether the Town was permitted to terminate James's private health insurance, provide him with comparable Town-paid Medicare supplemental insurance, and require that he bear the costs of his Medicare premium. The Supreme Court held that the trial court (1) properly concluded that the Town may require the Gallaghers to enroll in Medicare; but (2) erred in concluding that the Town must also reimburse the costs of the Gallaghers' Medicare premium costs. View "Gallagher v. Fairfield" on Justia Law