Justia Public Benefits Opinion Summaries

The Eighth Circuit reversed the district court's decision upholding the Social Security Commission's denial of plaintiff's applications for child insurance benefits and supplemental security income. The court held that the ALJ did not elicit a reasonable explanation to resolve an apparent conflict between testimony from the vocational expert and the Dictionary of Occupational Titles (DOT) when it determined that plaintiff's limitations did not prevent him from performing certain jobs in the national economy. In this case, the conflict was in regard to the DOT's listing related to the level of reasoning required for the job of hospital or industrial cleaner. Accordingly, the court remanded for further proceedings. View "Stanton v. Commissioner" on Justia Law

The Supreme Court affirmed the judgment of the trial court in this qui tam case filed by Relators alleging that several laboratories illegally inflated the bills they submitted to Virginia’s Medicaid program, holding that the trial court did not err in concluding that Relators were entitled to twenty-eight percent of the proceeds of the gross proceeds of the settlement in this case.After the parties settled, the parties disagreed with respect to whether Relators were entitled to twenty-eight percent of the gross proceeds of the settlement or whether the twenty-eight percent share should come out of the Commonwealth’s net share of the proceeds. At issue was the provision in Va. Code 8.01-216.7(B) that the relator is entitled to a share “of the proceeds of the award or settlement.” The Supreme Court held that the proceeds of settlement means the gross proceeds and, accordingly, affirmed the judgment of the court below. View "Commonwealth v. Hunter Laboratories, LLC" on Justia Law

Spicher suffers from osteoarthritis, degenerative disc disease, chronic obstructive pulmonary disease, fibromyalgia, and morbid obesity. In 2010, Spicher applied for Social Security Disability Insurance Benefits and Supplemental Security Income dating back to 2003. After a 2012 hearing, an ALJ found that Spicher was not disabled from 2003-2012. The district court remanded because the ALJ had not properly considered the limitations imposed by Spicher’s obesity, independently and in combination with her other impediments. On remand, Spicher focused on whether she had been disabled since December 2008, when her insured status expired. The ALJ consulted a second doctor who essentially adopted the findings of the medical reports already in the record. The ALJ stated that further consideration of Spicher’s obesity had not motivated her to change her conclusion, finding that Spicher could hold a sedentary position and perform three jobs identified by a vocational expert, and could occasionally crouch, crawl, balance, stoop, and kneel. The Seventh Circuit reversed, finding that the decision was not supported by substantial evidence. The ALJ did not address contradictory medical evidence when determining the types of sedentary jobs that Spicher could hold and failed to consider the interaction between her obesity and her non‐severe impairments. The court rejected a claim that the ALJ displayed antagonism toward Spicher in violation of her due process rights. View "Spicher v. Berryhill" on Justia Law

The Eighth Circuit affirmed the district court's denial of social security disability benefits to plaintiff. The court held that the ALJ properly relied on testimony from the vocational expert's testimony that a certain needed modification is part of the functional workplace. In this case, the vocational expert testified based on her expertise that bariatric chairs were commonly provided to individuals in the workplace and identified jobs that an individual who, like plaintiff, needs a bariatric chair, could perform. Therefore, substantial evidence supported the ALJ's finding that jobs exist in the national economy that plaintiff could adjust to, and that finding did not result from an error of law. View "Higgins v. Commissioner" on Justia Law

The California Legislature reduced Medicaid hospital payments 10 percent between 2008-2011; the federal agency administering the Medicaid program approved the rate reductions. Hospitals alleged the reductions violated the Medicaid Act (42 U.S.C. 1396), which sets out procedural and substantive requirements the state must follow when establishing reimbursement rates. Hospitals unsuccessfully sought to have the rates declared void and almost $100 million in recalculated rates. The court of appeal affirmed, concluding that healthcare providers alleging a violation of section 1396a(a)(30)(A) may not obtain a writ of mandate against state officials to contest Medicaid rates approved by the federal agency that administers the program. Their recourse is an administrative action against the federal agency that approved the rates. While plaintiffs may obtain a writ of mandate for violations of the procedural requirements of section 13(A), no such violation occurred here. View "Santa Rosa Memorial Hospital v. Kent" on Justia Law

The Fourth Circuit affirmed the district court's grant of summary judgment to the school district in an action under the Individuals with Disabilities Education Act (IDEA), alleging that the school district failed to provide plaintiff, a former student, with a free appropriate public education (FAPE). The court held that the school district committed a procedural violation of the IDEA by failing to respond to parents' requests and conduct a timely evaluation of whether the student was eligible for special education or related services. Nonetheless, plaintiff failed to show that this defect in the process had an adverse effect on his education. Therefore, plaintiff was not actually deprived of a FAPE. View "T.B. v. Prince George's County Board of Education" on Justia Law

Memorial Hospital at Gulfport and Singing River Health System (“Hospitals”) sought judicial review of a June 24, 2016 administrative decision which found the Division of Medicaid’s (“DOM’s”) 2014 Fiscal Year Methodology “correctly interprets statutes and regulations and is neither arbitrary or capricious.” The chancellor affirmed the decision of DOM. Finding no evidence in the record before it that DOM failed to comply with Sections 43-13-117 and 43-13-145 in allocating and distributing supplemental payments to Mississippi hospitals, the Mississippi Supreme Court affirmed. View "Memorial Hospital at Gulfport v. Dzielak" on Justia Law

On July 11, 2013, the Idaho Department of Labor (“IDOL”) mailed an eligibility determination for unemployment benefits (the “2013 determination”) to William Wittkopf. This determination found Wittkopf underreported his wages for several weeks, which resulted in an overpayment in unemployment benefits. As a result, Wittkopf was: (1) ordered to repay the overpayment; (2) ineligible for any unemployment benefits for a fifty-two week period; and (3) assessed a civil penalty. Additionally, Wittkopf was told that he would remain ineligible for unemployment benefits until all amounts were repaid. Pursuant to Idaho Code section 72– 1368(3) the last day for Wittkopf to file a protest to the 2013 determination was July 25, 2013, which he failed to do. IDOL attempted to collect on the 2013 determination over the next year without success. Subsequently in early 2016, Wittkopf filed for Chapter 7 bankruptcy. The debt he owed to the state of Idaho was included in his bankruptcy and was discharged by order of the Bankruptcy Court. In September 2016, Wittkopf began filing new claims for unemployment benefits with IDOL because he worked a seasonal job and was not receiving any income in the winter months. After not receiving benefits for several weeks, Wittkopf called IDOL which informed him he was ineligible for unemployment benefits because he had failed to pay back his overpayment, civil penalty, and interest he owed IDOL, even though those amounts were discharged in bankruptcy. Wittkopf mailed a letter to IDOL protesting the denial of his unemployment benefits. Wittkopf claimed in this letter that he was eligible for unemployment benefits because his bankruptcy discharged any amount he owed to IDOL. An Appeals Examiner construed Wittkopf’s 2016 letter as a protest of the 2013 determination. Two days later the Appeals Examiner issued a written decision finding there was no jurisdiction to hear Wittkopf’s protest because it was not filed within fourteen days of when it was issued on July 25, 2013, as required by Idaho Code section 72-1368. On November 3, 2016, Wittkopf appealed the Appeals Examiner’s decision to the Industrial Commission. On January 27, 2017, the Industrial Commission affirmed the Appeals Examiner’s decision. The Idaho Supreme Court determined the Industrial Commission erred in affirming the examiner without having determined first whether: (1) the bankruptcy discharge voided IDOL's 2013 determination; (2) whether the discharge operated as an injunction against any effort to collect, recover or offset the 2013 debt; and if yes, (3) why the Department's denial of current benefits on the basis of the 2013 debt wasn't a violation of the injunction. The matter was remanded back to the Industrial Commission for further proceedings. View "Wittkopf v. Idaho Dept of Labor" on Justia Law

Cardew, a wheelchair-bound quadriplegic, had a summer internship with Lear Corporation thanks to his cousin, a Lear vice president. Over about three months, Cardew earned $5,502.75. Lear allowed Cardew a 30-hour work week, rather than the typical 40-hour week; exempted him from tasks typically assigned interns that involved traveling and from clerical tasks because of his difficulty with typing; and allowed more frequent breaks to adjust his position to avoid skin ulcers and use the restroom. Lear also paid $4,0000 to modify doors to be wheelchair-accessible. After the internship, Cardew applied for child disability benefits retroactive to age 15, when an accident rendered him, quadriplegic. Having applied after his eighteenth birthday, he had to prove that he has lived with a continuous disability since the accident. An ALJ denied Cardew’s application based on the income he received from Lear, reasoning that because Cardew’s earnings over three months exceeded a “bright line” threshold in the regulations, he had been “able to work at the substantial gainful activity level.” The Sixth Circuit vacated, finding the legal analysis incomplete and more rigid than the regulations require. Even assuming Cardew engaged in “gainful” activity, the ALJ failed to consider all the special conditions attendant to Cardew’s internship that could rebut the presumption, created by his income, that he had engaged in “substantial” activity. View "Cardew v. Commissioner of Social Security" on Justia Law

Lambert applied for Disability Insurance Benefits in 2012 at age 41 alleging disabling lower back pain. In 2004 discs in his lumbar spine had been surgically fused with a rod. In 2008 surgeons repaired the rod. In 2010 Lambert began experiencing back pain “most of the time” and had “intermittent” pain down his left leg that often caused him to fall. By late 2012 Lambert had tried steroid injections in his spine and pelvis, chiropractic care, medication, and physical therapy. Several neurosurgeons found the cause unclear; three said further surgery was not an option. In denying Lambert’s application, an ALJ concluded that Lambert suffers from degenerative disc disease that is severely impairing but not disabling, giving little weight to the most recent opinions of his treating neurosurgeon and discrediting Lambert’s own testimony about the severity of his pain and extent of his limitations. The Seventh Circuit reversed. The ALJ failed to explain why the treating neurosurgeon’s opinions were entitled to less weight than those of the agency physicians, rendered before some key medical evidence was compiled. The ALJ improperly relied on Lambert’s application for unemployment compensation to discount his credibility in seeking disability benefits; a claimant’s desire to work is not evidence that the claimant has embellished his limitations. View "Lambert v. Berryhill" on Justia Law