Justia Public Benefits Opinion Summaries

Philbrook served in the Army, 2000-2004, then was awarded disability compensation for PTSD. In 2011, Philbrook stipulated to a judgment of “guilty except for insanity” in connection with a felony. He was ordered into the custody of the Oregon State Hospital “under the jurisdiction of the Psychiatric Security Review Board . . . for care, custody, and treatment for a maximum period not to exceed 20 years.” Philbrook then applied for total disability based on individual unemployability (TDIU).A VA regional office concluded that Philbrook’s PTSD did not entitle him to TDIU because it did not preclude gainful employment. The Board of Veterans’ Appeals denied TDIU “as a matter of law”; 38 U.S.C. 5313(c), precludes the assignment of a TDIU rating for any period “during which the veteran is incarcerated in a Federal, State, local, or other penal institution or correctional facility for conviction of a felony.” The Veterans Court affirmed.The Federal Circuit reversed. Philbrook was not confined in a “penal institution or correctional facility”; he was committed to a mental institution, “a hospital for people with mental or emotional problems.” The term “correctional facility” cannot encompass a hospital that treats civil patients, and a hospital cannot be a correctional facility for some patients and not others. View "Philbrook v. McDonough" on Justia Law

The Ninth Circuit reversed the district court's decision affirming the ALJ's 2019 decision denying claimant's application for social security disability benefits. The panel concluded that, although the ALJ's conclusion that claimant was not disabled at the time of the hearing was supported by substantial evidence, the ALJ did not adequately consider claimant's symptoms over time. The panel explained that the ALJ's failure to consider these changes over time impacted both her assessment of claimant's credibility and her analysis of the medical opinions. Therefore, on remand, the ALJ shall consider whether claimant was disabled and thus entitled to benefits, for some qualifying, earlier portion of his alleged disability period. View "Smith v. Kijakazi" on Justia Law

This case arose from the cancellation of long-term-care Medicaid benefits for two claimants when an Oklahoma agency concluded that the claimants’ resources exceeded the regulatory cap for eligibility. One claimant, Idabelle Schnoebelen died, mooting her claim. The eligibility of the other claimant, Nelta Rose, turned on whether her resources included a 2018 promissory note. In 2017 and 2018, Rose loaned money to her daughter-in-law in exchange for three promissory notes. The daughter-in-law provided the first two promissory notes in 2017 (before Rose applied for Medicaid benefits). The Oklahoma Department of Human Services initially approved Rose for Medicaid, declining to regard the 2017 promissory notes as resources. In 2018, the daughter-in-law provided the third promissory note. But the Department of Human Services concluded that the 2018 promissory note: (1) was a resource because the payment to the daughter-in-law did not constitute a bona fide loan; and (2) was a deferral that turned the 2017 promissory notes into resources. The extra resources put Rose over the eligibility limit for Medicaid, so the Department of Human Services cancelled Rose’s benefits. A district court concluded that the agency’s conclusion did not conflict with federal law. In the Tenth Circuit's view, however, a reasonable factfinder could disagree. Summary judgment was reversed and the matter remanded for further proceedings. View "Baker, et al. v. Brown, et al." on Justia Law

Wade filed her claim for Social Security Disability Insurance benefits and Supplemental Security Income in 2015. An ALJ denied Wade’s claim in 2017, finding her not disabled. Following an unsuccessful administrative appeal, Wade filed suit, seeking leave to proceed in forma pauperis (IFP). The district court granted Wade’s IFP motion and, in 2020, entered judgment in the Commissioner’s favor. Wade proceeded IFP with her appeal. The Ninth Circuit found that the ALJ erred, reversed the order affirming the denial of benefits, and remanded for further administrative review. Wade then submitted a bill of appellate costs, seeking $169.65 from the government for copies of briefs and excerpts of record.The Ninth Circuit denied the request. A party who proceeds IFP and prevails on appeal is not entitled to recover taxable costs from the United States, 28 U.S.C. 1915(f)(1); “judgment may be rendered for costs at the conclusion of the suit or action as in other proceedings, but the United States shall not be liable for any of the costs thus incurred.” View "Wade v. Kijakazi" on Justia Law

Alliance alleged that County and City policies and inaction have created a dangerous environment in the Skid Row area, claiming that the County violated its mandatory duty to provide medically necessary care and that the municipalities have facilitated public nuisance violations by failing to clear encampments, violated disability access laws by failing to clear sidewalks of encampments, and violated constitutional rights by providing disparate services to those within the Skid Row area and by enacting policies resulting in a state-created danger to area residents and businesses. The district court issued a preliminary injunction, ordering the escrow of $1 billion to address homelessness, offers of shelter to all unhoused individuals in Skid Row within 180 days, and numerous reports. The court found that structural racism was behind Los Angeles’s homelessness crisis and its disproportionate impact on the Black community.The Ninth Circuit vacated. The plaintiffs lacked standing on all but their ADA claim; no claims were based on racial discrimination. The district court impermissibly resorted to independent research and extra-record evidence. There was no allegation that any individual plaintiff was Black nor that there was a special relationship between the City and unhoused residents nor that any individual plaintiff was deprived of medically necessary care or general assistance. Two plaintiffs who use wheelchairs and cannot traverse Skid Row sidewalks because of homeless encampments had standing to bring ADA claims but had not shown a likelihood of success on the merits. View "LA Alliance for Human Rights v. County of Los Angeles" on Justia Law

Plaintiff appeals the district court's order affirming the ALJ's denial of his application for supplemental security income (SSI) benefits, pursuant to 42 U.S.C. 1383(c). Plaintiff contends that the ALJ erred by ruling that he could perform a job with level 3 reasoning after finding that his residual functional capacity limited him to simple, routine, and repetitive tasks, and by basing the number of available jobs on unreliable vocational expert testimony.The Eleventh Circuit joined the Fourth, Ninth, and Tenth Circuits and held that there is an apparent conflict between a limitation to simple, routine, and repetitive tasks and the demands of level 3 reasoning. Because the ALJ did not address that apparent conflict—as required by precedent—and because the court cannot say that the error was harmless, the court reversed and remanded for further proceedings. View "Viverette v. Commissioner of Social Security" on Justia Law

About 50 businesses that offer live adult entertainment (nude or nearly nude dancing) sought loans under the second round of the Paycheck Protection Program enacted to address the economic disruption caused by the Covid-19 pandemic. Congress excluded plaintiffs and other categories of businesses from the second round of the Program, 15 U.S.C. 636(a)(37)(A)(iv)(III)(aa), incorporating 13 C.F.R. 120.110. Plaintiffs asserted that their exclusion violated their rights under the Free Speech Clause of the First Amendment.The district court issued a preliminary injunction, prohibiting the Small Business Administration (SBA) from denying the plaintiffs eligibility for the loan program based on the statutory exclusion. The Seventh Circuit granted the government’s stay of the preliminary injunction and expedited briefing on the merits of the appeal. The SBA satisfied the demanding standard for a stay of an injunction pending appeal, having shown a strong likelihood of success on the merits. Congress is not trying to regulate or suppress plaintiffs’ adult entertainment. It has simply chosen not to subsidize it. Such selective, categorical exclusions from a government subsidy do not offend the First Amendment. Plaintiffs were not singled out for this exclusion, even among businesses primarily engaged in activity protected by the First Amendment. Congress also excluded businesses “primarily engaged in political or lobbying activities.” View "Camelot Banquet Rooms, Inc. v. United States Small Business Administration" on Justia Law

Peggy Harvey and Eileen Manzanares were injured in separate car accidents when their cars were struck by other drivers. Each was then taken to a Centura-affiliated hospital (along with Centura Health Corporation, “Centura”) for treatment. At the time they were treated by Centura, both women’s health insurance was solely through Medicare and Medicaid. And both women’s injuries resulted in hospital stays. In addition to Medicare and Medicaid, both women had automobile insurance whose policies included medical payment ("Med Pay") coverage for medical bills incurred as a result of a motor vehicle accident. In addition, the third-party tortfeasors who caused Harvey’s and Manzanares’s injuries also had automobile insurance. Both Harvey and Manzanares advised Centura of all of the available health and automobile insurance policies. Centura then assigned the women’s accounts to a collection agency, Avectus Healthcare Solutions, for processing; Avectus submitted Centura’s medical expenses to each of the automobile insurers involved, including the automobile insurers for Harvey, Manzanares, and the third-party tortfeasors. Within two weeks after submitting these charges to the various automobile insurers (and within two months of the women’s respective discharges from their hospital stays), Centura filed hospital liens against both of the women. Centura conceded it did not bill either Medicare or Medicaid before filing their respective liens. Both Harvey and Manzanares subsequently brought suit, alleging that Centura had violated the Lien Statute by not billing Medicare for the services provided to the women prior to filing the liens. The parties disputed whether when, as here, Medicare was a person’s principal source of health coverage, Medicare could be considered a “primary medical payer of benefits” under the Lien Statute (such that a hospital must bill Medicare before asserting a lien), or if such an interpretation was barred by the Medicare Secondary Payer statute, which designated Medicare as a “secondary payer.” The Colorado Supreme Court concluded that when Medicare was a patient’s primary health insurer, the Lien Statute required a hospital to bill Medicare for the medical services provided to the patient before asserting a lien against that patient. "Hospital liens are governed by state, not federal, law, and merely enforcing our Lien Statute does not make Medicare a primary payer of medical benefits in violation of the MSP Statute." View "Harvey v. Centura, No." on Justia Law

Compensatory education is not an automatic remedy for a child-find violation under the Individuals with Disabilities Education Act (IDEA). Compensatory educational services are designed to counteract whatever educational setbacks a child encounters because of IDEA violations—to bring her back where she would have been but for those violations. At minimum, a parent must offer evidence that a procedural violation—like the child-find violation asserted here—caused a substantive educational harm, and that compensatory educational services can remedy that past harm.The Eleventh Circuit concluded that the district court was well within its "broad discretion and equitable authority" when it concluded that plaintiff had not shown that the school board's child-find violation resulted in educational deficits for the child that could be remediated with prospective compensatory relief. Furthermore, because the school began its special education referral process before plaintiff filed suit, she cannot show that she is entitled to attorney's fees. Accordingly, the court affirmed the district court's judgment. View "J.N. v. Jefferson County Board of Education" on Justia Law

The Ninth Circuit affirmed the district court's grant of summary judgment in favor of the high school and school district in an action brought by plaintiff under Title II of the Americans with Disabilities Act (ADA) and section 504 of the Rehabilitation Act. Plaintiff, a student with attention deficit disorder, sought damages after he was assaulted and seriously injured by another student at a high school football game. Petitioner argues that guidance issued by the DOE in various Dear Colleague Letters should be binding, and that the school's failure to adopt all of the Letters' suggestions for preventing harassment of disabled students amounts to disability discrimination.The panel concluded that guidance issued by the DOE in the Letters was not binding and that plaintiff may not use the Letters to leapfrog over the statutory requirements to assert a cognizable claim under the ADA or the Rehabilitation Act. The panel explained that the Letters do not adjust the legal framework governing private party lawsuits brought under the ADA or Rehabilitation Act. Therefore, plaintiff's claims—which rely entirely on the enforceability of the Letters as distinct legal obligations—fail. In this case, the Letters did not make plaintiff's need for social accommodation "obvious," such that failure to enact their recommendations constituted a denial of a reasonable accommodation with deliberate indifference. Furthermore, no request for a social-related accommodation was ever made and no prior incidents of bullying or harassment involving plaintiff were observed or reported by the school prior to the assault during the football game. View "Csutoras v. Paradise High School" on Justia Law