Justia Public Benefits Opinion Summaries

In 2007, Chavez, then 21, was diagnosed with a brain tumor and underwent five surgeries. Chavez experienced depression and anxiety. She struggled to maintain concentration to complete simple household tasks and suffered from migraine headaches, back pain (caused by degenerative disc disease), and numbness in her feet and hands. Chavez had no prior work experience. In 2010 Chavez applied for Social Security supplemental security income. Chavez could perform only simple, routine tasks with significant restrictions on how much she could lift. The vocational expert enlisted by the agency to estimate the number of jobs suitable for Chavez testified that for one particular job there were either 800 or 108,000 existing positions but preferred the larger estimate. The administrative law judge agreed and denied Chavez’s claim. The district court affirmed. The Seventh Circuit vacated. The decision was not supported by substantial evidence; the ALJ failed to ensure that the vocational expert’s job estimates were reliable. The vocational expert offered no explanation for why his estimates (or his method) were reliable, instead reaching a conclusion by determining that the estimates yielded by an alternative method seemed too low. By affording such broad deference to the vocational expert’s chosen estimates, the ALJ relieved the agency of its evidentiary burden at the final step of the analysis, impermissibly shifting the burden to Chavez. View "Chavez v. Berryhill" on Justia Law

Three disabled individuals who formerly received cash general assistance benefits from the Pennsylvania Department of Public Welfare filed a complaint alleging that the manner in which the Pennsylvania General Assembly enacted Act 80 of 2012, a piece of legislation which, inter alia, made sweeping changes to the administration of the state's human services programs, violated Article III, Sections 1, 3 and 4 of the Pennsylvania Constitution. The Pennsylvania Supreme Court determined the Act was in violation of Section 4. The provisions of H.B 1261, P.N. 1385 were entirely removed from the bill by the Senate, inasmuch as they had been enacted by another piece of legislation, Act 22 of 2011. Since the original provisions were gone when the new provisions were added by the Senate, it was factually and legally impossible for the new provisions to work together with the deleted provisions to accomplish a single purpose. The Court held the amendments "to such enfeebled legislation" were not germane as a matter of law. Consequently, the Senate amendments were not germane to the provisions of H.B. 1261, P.N. 1385, and, accordingly, the three times that H.B. 1261, P.N. 1385 was passed by the House in 2011 could not count towards the requirements of Article III, Section 4. View "Washington, et al. v. Dept. of Pub. Welfare" on Justia Law

In an issue of first impression, the Court of Appeals addressed whether Family Code section 4504(b) required derivative benefits received by the child of a disabled parent to be credited against a noncustodial obligor's child support. In this case, the Social Security Administration (SSA) took six years to approve Father's application. In 2015, it made a lump-sum payment for past-due derivative benefits to custodial parent Y.H. (Mother), as Daughter's representative payee. In the intervening six years, Father had continued to pay child support and was not in arrears. The Court of Appeals held section 4504 (b) indeed permitted retroactive child support credit from Daughter's lump-sum payment where there was no child support arrearage. View "Y.H. v. M.H." on Justia Law

Jason Lillie appeals the Employment Security Board’s denial of his claim for unemployment benefits. In July 2014, Lillie was an employee of Amerigas Propane, Inc. and suffered an injury while working. He reported the injury to his employer, which in turn reported it to its worker’s compensation insurer. He sought medical attention for his injury shortly after being hurt but was able to continue working for several weeks, most of it on modified or light duty. In October, Amerigas fired Lillie for an alleged safety violation. A few days later, Lillie’s doctor indicated he was medically unable to work. Lillie expressed concern that he was ineligible for unemployment benefits because he was not able to work but was told he must apply in order to receive economic benefits. Lillie then sought workers’ compensation temporary disability benefits, which were initially denied by the insurer. Without any income or compensation disability benefits for several weeks, Lillie sought economic assistance from the Vermont Economic Services Division of the Department for Children and Families. Lillie was told by Economic Services that in order to be eligible for economic assistance he would have to file for unemployment benefits, even if he felt he would not qualify for them. With his workers’ compensation claim still in dispute, and based upon the information he had received from Economic Services, Lillie filed a claim for unemployment benefits. The Unemployment Division found him to be monetarily eligible for unemployment benefits when he sought them in December 2014. While he had the necessary base period wages to make him monetarily eligible for benefits, Lillie was not able to work and available for work, as required by 21 V.S.A. 1343(a)(3), because he was medically unable to work. He was, therefore, denied unemployment compensation. "At a minimum, coordination of the important information between the Unemployment Division and Economic Services concerning monetary eligibility, the establishment of a benefit year, and the use of wages and the use of wages prior to disability in connection therewith in the case of a worker injured on the job may have avoided this quagmire. Following the advice given by Economic Services, which we do not doubt was provided in good faith to Lillie, resulted in the unintended consequence of his loss of unemployment benefits once he regained his ability to work in 2017." The Vermont Supreme Court affirmed the denial of unemployment benefits; the Unemployment Division applied the law properly, and the Court was "not at liberty to rewrite the applicable statutes to obtain a different outcome." View "Lillie v. Department of Labor" on Justia Law

The Ninth Circuit reversed the denial of disability insurance benefits and supplemental security income to plaintiff. The panel held that SR 82-41 obligates the ALJ to make transferability of skills findings where, unlike Bray v. Commissioner of Social Security Administration, 554 F.3d 1219, 1223–26 (9th Cir. 2009), no Grid rule states that a person with the claimant's age, education, and work experience is disabled absent transferable skills. Therefore, the panel remanded for further proceedings. View "Barnes v. Berryhill" on Justia Law

In November 2010, Hayes engaged Cybriwsky to represent him related to the denial of Hayes’s application for Social Security disability benefits. In February 2011, the case was remanded for further administrative hearings (42 U.S.C. 405(g)) because faulty recordings of the hearings rendered the record inaudible. On remand, the Administrative Law Judge entered a fully favorable decision for Hayes in August 2011. The district court affirmed in April 2012. The next month Cybriwsky sought attorney’s fees under the Equal Access to Justice Act, 28 U.S.C. 2414. The court granted attorney’s fees of $2,225 in August 2012. In April 2017, Cybriwsky moved, under 42 U.S.C. 406(b), seeking more than $11,000. in fees. He subsequently provided documentation of the fee arrangement, benefits paid to Hayes, and an itemized description of the work performed. By the time Cybriwsky filed his 2017 motion, the SSA had released the 25% of past-due benefits normally reserved to pay attorney’s fees; $5,300 was awarded to Hayes’s attorney at the administrative level and the remainder was released to Hayes. Any fees awarded to Cybriwsky would have to be recovered from Hayes, either directly or by having fees taken from Hayes’s monthly disability payments. The Sixth Circuit affirmed denial of the motion as untimely and determined that the circumstances did not merit the exercise of equitable tolling. View "Hayes v. Commissioner of Social Security" on Justia Law

The VA determined that West, a Viet Nam veteran, was eligible for a disability pension. Two days later West died. Four days later—without knowing that West had died—the government sent West a check for $8,660--his pension benefit retroactive to June 2013. In March 2014, a Kentucky probate court appointed West’s ex-wife, Brenda, as the Estate's executor. Brenda endorsed the VA check, the estate’s only cash asset, and deposited it into an escrow account. After three months, the VA determined that West’s estate was not entitled to the money, 38 U.S.C. 5121(a), and directed the bank to wire the $8,660 back to the U.S. Treasury. The bank complied. The Estate did not learn until later that its account had been drained of funds. More than 18 months later, the Estate obtained a Kentucky probate court order requiring the government to return the funds. The government removed the matter to the district court, which remanded the matter back because the $8,660 was already subject to the probate court’s jurisdiction. The Estate unsuccessfully sought attorneys’ fees. The Sixth Circuit reversed the remand order; the dispute can be litigated only under the procedure set forth in the Veterans’ Judicial Review Act, 102 Stat 4105. The court noted “concerns about the government’s expropriation of the Estate’s funds without any advance notice or process.” View "Estate of West v. United States Department of Veterans Affairs" on Justia Law

The Eighth Circuit affirmed the denial of plaintiff's claims for a period of disability, disability insurance benefits, and supplemental security income. The court held that Social Security Ruling (SSR) 00-4p makes clear that before relying on Vocation Expert (VE) evidence, adjudicators must identify and obtain a reasonable explanation for any conflicts between such evidence and the DOT. However, SSR 00-4p did not impose a duty on the ALJ to obtain a reasonable explanation when the VE simply testifies to information not found in the DOT—but that does not conflict with it. Therefore, the court agreed with the Commissioner that unless a VE's testimony appears to conflict with the DOT, there is no requirement that an ALJ inquire as to the precise basis for the expert's testimony regarding extra-DOT information. In this case, the ALJ described plaintiff's limitations to the VE, the VE responded with possible jobs, and the VE's testimony did not conflict with the DOT. Therefore, the ALJ was entitled to rely on the testimony and substantial evidence supported the agency's finding that plaintiff was not disabled. View "Courtney v. Commissioner" on Justia Law

In 2000, Kaminski fell down a flight of stairs, suffering a head wound that caused a traumatic brain injury and a seizure disorder. He applied under the Social Security Act for disability insurance benefits and supplemental security income 13 years later. The Social Security Administration denied his applications; the district court upheld the denial. The Seventh Circuit reversed, finding that the administrative law judge improperly rejected his treating physician’s opinions. The treating physician’s opinions and the testimony of the vocational expert together show that Kaminski is disabled. View "Kaminski v. Berryhill" on Justia Law

This case was a qui tam action alleging violations of the False Claims Act (“FCA”) involving fraudulent reimbursements under the Medicare Act. Plaintiff Gerald Polukoff, M.D., was a doctor who worked with Defendant Sherman Sorensen, M.D. After observing some of Sorensen’s medical practices, Polukoff brought this FCA action, on behalf of the United States, against Sorensen and the two hospitals where Sorensen worked (collectively, “Defendants”). Polukoff alleged Sorensen performed thousands of unnecessary heart surgeries and received reimbursement through the Medicare Act by fraudulently certifying that the surgeries were medically necessary. Polukoff further alleged the hospitals where Sorensen worked were complicit in and profited from Sorensen’s fraud. The district court granted Defendants’ motions to dismiss, reasoning that a medical judgment could not be false under the FCA. The Tenth Circuit reversed and remanded, holding that a doctor’s certification to the government that a procedure is “reasonable and necessary” is “false” under the FCA if the procedure was not reasonable and necessary under the government’s definition of the phrase. View "Polukoff v. St. Mark's Hospital" on Justia Law