Justia Public Benefits Opinion Summaries

Plaintiff challenged the denial of his application for disability insurance benefits. Plaintiff claims that he is disabled as a result of osteoarthritis and degenerative joint disease of the hips, degenerative disc disease of the lumbar and cervical spines, sensory and motor neuropathies, chronic shoulder pain and osteoarthritis, and carpal tunnel syndrome. The court concluded that the ALJ did not err in failing to find that plaintiff's impairments met or equaled the criteria of Listing 1.02A; substantial evidence in the record as a whole supports the ALJ’s finding that plaintiff had the residual functional capacity to perform his past relevant work as a receptionist and thus was not disabled; and the denial of disability insurance benefits is supported by substantial evidence on the record as a whole. Accordingly, the court affirmed the judgment. View "Igo v. Colvin" on Justia Law

The focus of this appeal centered on the validity of HB 2630; 2014 Okla. Sess. Laws c. 375 (effective November 1, 2014). HB 2630 created the Retirement Freedom Act (74 O.S. Supp. 2014, sec. 935.1 et seq.), with the stated purpose as creating a new defined contribution system within the Oklahoma Public Employees Retirement System (OPERS) for persons who initially became a member of OPERS on or after November 1, 2015 (this included most state employees hired on or after this date). Plaintiffs-appellants filed a Petition for Declaratory and Supplemental Relief challenging the validity of HB 2630, claiming HB 2630 was void because it was passed by the Legislature in violation of the Oklahoma Pension Legislation Actuarial Analysis Act (OPLAA). Both parties filed a motion for summary judgment. The trial court granted defendants-appellees' motion for summary judgment and the appellants appealed. Agreeing with the trial court that the OPLAA had not been violated, the Supreme Court affirmed the grant of summary judgment in defendants' favor. View "Stevens v. Fox" on Justia Law

Plaintiff appealed the denial of Social Security disability insurance benefits. The ALJ concluded that she suffered from severe but not listed impairments – mood disorder, anxiety disorder, residuals of brain tumor with surgical resection, degenerative disc disease of the thoracic and cervical spine, and scoliosis – but that plaintiff was not disabled because, while she could not perform her past relevant work, she retained the residual functional capacity (RFC) to perform a limited range of light work. In this case, the ALJ expressly incorporated into the RFC work-related limitations suggested by medical source opinions regarding plaintiff's slow pace; the cumulative evidence submitted did not undermine the ALJ's RFC determination; and the ALJ properly weighed and considered the extensive medical evidence in the record in making the RFC determination. Therefore, the court concluded that substantial evidence on the record as a whole supports the ALJ’s decision and the court affirmed the judgment. View "Harvey v. Colvin" on Justia Law

Meuser, 46 years old, was diagnosed with schizophrenia in 1996. For 15 years managed his symptoms with the antipsychotic drug Zyprexa. From 1995-2012, Meuser worked in a mailroom. Meuser’s health began deteriorating in late 2011 after his pharmacist gave him the generic version of Zyprexa. Meuser started having insomnia; he could not focus at work. Hoping that a break would improve his symptoms, Meuser took a leave of absence from his job. He was and is living with his parents.His new psychiatrist rediagnosed Meuser’s schizophrenia from “undifferentiated” to “paranoid type,” which involves “prominent delusions or auditory hallucinations,” switched Meuser back to the brand‐name Zyprexa, and increased his dosage. Meuser said he still did not feel well enough to return to work. Faced with the choice of returning to work or being fired, Meuser quit his job. An ALJ denied his application for Social Security Disability Insurance Benefits, finding that Meuser’s schizophrenia was not a severe impairment. The Seventh Circuit reversed, holding that the ALJ misunderstood the medical evidence and improperly rejected the treating psychiatrist’s opinion, so the conclusion that Meuser did not have a severe impairment was not supported by substantial evidence View "Meuser v. Colvin" on Justia Law

Pursuant to 8 U.S.C. 1157(a)(2), the President authorized entry of 85,000 refugees for fiscal 2016; at least 10,000 were to come from Syria. Since 2001, all persons seeking to enter the U.S. as refugees are required to undergo screening by the U.N. High Commissioner for Refugees, followed by multiple layers of screening by the federal government, which can take two years. Indiana has an approved refugee resettlement plan (8 U.S.C. 1522) and receives federal funds to contract with private agencies for the provision of services, “without regard to race, religion, nationality, sex, or political opinion.” Indiana’s governor refused to pay for services to any refugee whose “‘country of origin” is Syria. The Seventh Circuit affirmed entry of a preliminary injunction. Regulation of immigration is a federal function. The state’s brief provided no evidence that Syrian terrorists are posing as refugees or have ever committed acts of terrorism in the U.S. The court characterized the governor’s argument as “the equivalent of his saying . . . that he wants to forbid black people to settle in Indiana not because they’re black but because he’s afraid of them, and since race is therefore not his motive he isn’t discriminating.” Indiana is free to withdraw from the refugee assistance program, but withdrawal might not interrupt the flow of Syrian refugees; the Wilson/Fish program distributes federal aid to refugees without the involvement of the state government. View "Exodus Refugee Immigration, Inc. v. Pence" on Justia Law

Hilleger, suffering from dementia, heart problems, and arthritis, moved into a Cincinnati assisted-living facility. For four years, Hilleger paid the center’s $4,300 monthly fee. When she ran out of money, her daughters paid the fee while Hilleger applied for Medicaid assistance through Ohio’s assisted-living waiver program. When the agency determined that Hilleger was financially eligible, Medicaid began paying for her care. Saunders suffered a fall. Her stress fractures and dementia prevented her from returning home. She moved to an Ironton assisted-living center and applied for Medicaid assistance The agency authorized benefits 18 days later. Saunders’s daughter paid the costs for those 18 days. Hilleger and Saunders filed a putative class action, alleging that Ohio’s omissions of Medicaid coverage for the first 18 days of Saunders’s assisted-living costs and for the first three months of Hilleger’s costs violated 42 U.S.C. 1396a(a)(34); violation of the notice requirements of 42 U.S.C. 1396a(a)(3) and failure to provide Medicaid assistance with reasonable promptness (42 U.S.C. 1396a(a)(8)). The district court certified the proposed class and granted plaintiffs summary judgment. The Sixth Circuit reversed. The plaintiffs had standing to pursue only their claim with respect to retroactive benefits; other claims could not be redressed by the relief sought. Section 1396n(c)(1) permits Medicaid funding only for assisted-living services that are authorized by a preceding service plan. View "Price v. Medicaid Dir." on Justia Law

Brookdale Senior Living hired Prather to review documentation related to thousands of Brookdale residents who had received home-health services from Brookdale. Medicare claims regarding those patients were on hold and Brookdale faced possible recoupment of payments it had received if it did not review and submit final Medicare claims. Prather noticed that the required certifications stating that the doctor had decided that the patient needed home-health services, established a plan of care, and met with the patient, were signed long after care was provided. Prather repeatedly raised this issue, but was rebuffed. Brookdale, facing financial disaster, began paying doctors to complete the paperwork months after treatment was provided. Prather thought that Brookdale was not just asking treating physicians to complete forgotten paperwork, but had provided the services without physician involvement and then found doctors willing to validate the care after-the-fact. Prather's suit under the False Claims Act, 31 U.S.C. 3729, was dismissed. The Sixth Circuit reversed as to unlawful retention of payments. Completing certifications months after the fact was not “as soon as possible” after the plan was established, as required by regulations. Prather provided a detailed description of the alleged fraudulent scheme and her personal knowledge. Affirming dismissal of her false-records claim, the court concluded that Prather failed to plead with particularity the use of government forms to certify falsely that care had been provided under a doctor’s orders, or that unnecessary care had been provided. View "Prather v. Brookdale Senior Living Communities, Inc." on Justia Law

O.B., two years old, has Down Syndrome, lung disease, and cardiac abnormalities. He is ventilator‐dependent and cannot digest take oral nutrition. O.B. is the named plaintiff in a class action against the Illinois Department of Healthcare and Family Services, alleging violation of the Medicaid Act. The Act defines “medical assistance” as including “early and periodic screening, diagnostic, and treatment services [EPSDT] … for individuals … under the age of 21,” 42 U.S.C. 1396d(a)(4)(B), and requires "reasonable promptness." EPSDT services include “private duty nursing services,” so that the child lives at home. When he was nine months old, the Department approved $19,718 monthly to pay nurses for up to 18 hours a day to care for O.B. at home. It took his parents almost a year to obtain home‐nursing staff so that O.B. could go home. The district judge certified a class of Illinois children who have been approved for home nursing but who have not been able to hire nurses. The judge ordered the Department to “take immediate and affirmative steps to arrange directly or through referral . . . in‐home shift nursing services.” The Seventh Circuit affirmed, noting that Congress has clarified that where the Act refers to the provision of services, a participating state is required to provide (or ensure the provision of) services, not merely pay for them and that O.B.’s in-hospital care cost four times what home nursing would cost. View "O. B. v. Norwood" on Justia Law

Plaintiff challenged the denial of disability insurance benefits, arguing that the ALJ erred by failing to ask a testifying vocational expert whether her testimony was consistent with the Dictionary of Occupational Titles (DOT), as required by an agency policy interpretation ruling, but nonetheless relying on that testimony. The court concluded that the ALJ's procedural error was harmless and does not warrant reversal. Because plaintiff does not raise any other grounds for reversal, the court affirmed the judgment. View "Graves v. Colvin" on Justia Law

In 2010, Ghiselli applied for disability insurance benefits under the Social Security Act, claiming that she was unable to work due to a combination of health problems that included degenerative disc disease, asthma, and obesity. She asserted that she had been employed as a retail customer service manager and was disabled by injuries she suffered at her job on August 6, 2007, when a customer struck her in the back with a shopping cart. After her initial application and her request for reconsideration were denied, an administrative law judge found that she was not disabled despite her impairments. The district court, reviewing the ALJ’s decision under 42 U.S.C. 405(g), held that the decision was supported by substantial evidence, and affirmed. The Seventh Circuit reversed, reasoning that the ALJ erred in finding that she lacked credibility based on certain purportedly inconsistent statements. View "Ghiselli v. Colvin" on Justia Law