Justia Government & Administrative Law Opinion Summaries
Articles Posted in Public Benefits
Sea "B" Mining Co. v. Addison
An ALJ found that Jerry Addison was entitled to benefits under the Black Lung Benefits Act, 30 U.S.C. 901-944, because he had established the existence of clinical and legal pneumoconiosis that resulted in a total respiratory disability. Sea-B, Addison's former employer, filed a petition for review of the ALJ's decision. The court concluded that the ALJ’s decision to exclude the additional CT scan evidence was not harmless. This error affects the determination of both clinical and legal pneumoconiosis and impacts the ALJ’s consideration of the other evidence in this case. The omitted CT scan evidence is unquestionably probative of the central issue in dispute: whether Addison suffered from pneumoconiosis. Furthermore, the court could not determine from the ALJ’s sparse explanation how, or if, he weighed the x-ray readings in light of the readers’ qualifications. Finally, because the proffered explanation for elevating Dr. Forehand’s diagnosis is not supported, the ALJ must reevaluate that opinion to determine the proper weight it should be given. Accordingly, the court granted the petition for review, vacated the order, and remanded for further proceedings. View "Sea "B" Mining Co. v. Addison" on Justia Law
Shannon v. Comm’r of Housing
Plaintiff was a registered sex offender when he was admitted to the state rental assistance program. Thereafter, the legislature promulgated section 17b-812-13(9) of the Regulations of Connecticut States Agencies, which makes sex offender registration a ground for termination or denial of rental program assistance. The Commissioner of Housing (Commissioner) subsequently terminated Plaintiff’s rental program benefits. Plaintiff took an administrative appeal of the Commissioner’s decision to the trial court, which concluded that the Commissioner’s application of section 17b-812-13(9) was not retroactive and therefore did not exceed the authority granted to the Commissioner by the legislature. The Supreme Court reversed, holding (1) the Commissioner applied section 17b-812-13(9) of the regulations retroactively in this case by imposing a new obligation on Plaintiff’s sex offender status that terminated his rental program assistance; and (2) such retroactive application of the regulation was not statutorily authorized, and therefore, the trial court erred in dismissing Plaintiff’s administrative appeal. View "Shannon v. Comm’r of Housing" on Justia Law
Commonwealth of Virginia ex rel. Hunter Labs. v. Commonwealth of Virginia
Relators filed suit against medical laboratory businesses in 2007 in state court, alleging that the labs had submitted false claims to the Commonwealth for Medicaid reimbursement. Defendants removed to federal court. After the Commonwealth entered into a settlement agreement with defendants, the district court awarded relators a share of the settlement proceeds. Relators appealed, contending that the district court's award was insufficient under state law. The court vacated and remanded to the state court, concluding that the district court lacked subject matter jurisdiction over the qui tam action. In this case, by the plain terms of the complaint, relators could have prevailed on their state law claims by proving that defendants contravened the Commonwealth’s Medicaid regulations, without showing any violation of federal law. View "Commonwealth of Virginia ex rel. Hunter Labs. v. Commonwealth of Virginia" on Justia Law
Thomas v. Colvin
Thomas applied for Supplemental Security Income in 2010 when she was 55 years old. An administrative law judge identified her medically determinable impairments as degenerative changes in her back and left shoulder, Graves’ disease, and dysthymic disorder (a form of chronic depression), but concluded that the impairments did not impose more than minimal limitations on Thomas’s ability to work and denied her application. The Seventh Circuit reversed and remanded. The ALJ’s omission of fibromyalgia from Thomas’s medically determinable impairments and his conclusion that she has no severe impairments were not supported by substantial evidence. Thomas’s doctors’ lack of specialization in rheumatology was not an acceptable basis for discounting their assessments. View "Thomas v. Colvin" on Justia Law
Berg v. Christie
The issue before the New Jersey Supreme Court in this case was whether the 2011 suspension of State pension cost-of-living adjustments (COLAs) contravened a term of the contract right granted under the earlier enacted non-forfeitable right statute, L.1997, c.113 (codified as N.J.S.A.43:3C-9.5). Qualifying members of the State's public pension systems or funds were granted a non-forfeitable right to receive benefits as provided under the laws governing the retirement system or fund. By codifying that non-forfeitable right to receive benefits, the Legislature provided that the benefits program, for any employee for whom the right has attached, could not be reduced. Whether COLAs were part of the benefits program protected by N.J.S.A. 43:3C-9.5 depended on whether the Legislature, in enacting N.J.S.A. 43:3C-9.5(a) and (b), intended to create a contractual right to COLAs. The Supreme Court found in this instance, proof of unequivocal intent to create a non-forfeitable right to yet-unreceived COLAs was lacking. Although both plaintiff retirees and the State advanced plausible arguments on that question, "the lack of such unmistakable legislative intent dooms plaintiffs' position." The Court concluded that the Legislature retained its inherent sovereign right to act in its best judgment of the public interest and to pass legislation suspending further COLAs. Having determined that there was no contract violation, and because the additional arguments advanced by plaintiffs were not meritorious, the Court reversed the Appellate Division's judgment holding to the contrary. View "Berg v. Christie" on Justia Law
Caring Hearts v. Burwell
Caring Hearts Personal Home Services, Inc. provided physical therapy and skilled nursing services to “homebound” Medicare patients. It sought reimbursement from Medicare for services provided. The definition of who qualified as "homebound" or what services qualified as "reasonable and necessary" was unclear, even to the Centers for Medicare & Medicaid Services (CMS). CMS has developed its own rules on both subjects that had been repeatedly revised and expanded over time. In an audit, CMS purported to find that Caring Hearts provided services to at least a handful of patients who didn’t qualify as “homebound” or for whom the services rendered weren’t “reasonable and necessary.” As a result, CMS ordered Caring Hearts to repay the government over $800,000. It was later found that in reaching its conclusions CMS applied the wrong law: the agency did not apply the regulations in force in 2008 when Caring Hearts provided the services in dispute. Instead, it applied considerably more onerous regulations the agency adopted years later, "[r]egulations that Caring Hearts couldn’t have known about at the time it provided its services." The Tenth Circuit found that Caring Hearts "[made] out a pretty good case that its services were entirely consistent with the law as it was at the time they were rendered" when CMS denied Caring Hearts' request for reconsideration. The Tenth Circuit reversed the district court's judgment affirming CMS' denial to Caring Hearts for reimbursement, and remanded for further proceedings. View "Caring Hearts v. Burwell" on Justia Law
Gerdon v. Con Paulos, Inc.
In 2008, Joseph Gerdon was seriously injured in a motor vehicle accident that arose out of and in the course of his employment. He was a passenger in a vehicle being driven by a coworker, who drove off the road. The Industrial Commission awarded Gerdon benefits. Gerdon requested a hearing to determine whether he was also entitled to benefits for a compensable psychological injury. That issue was heard before a referee, who issued proposed findings of fact, conclusions of law, and a recommendation that Gerdon had failed to prove that he was entitled to additional psychological care. The Commission adopted the referee’s proposed findings of fact and conclusions of law and issued an order. Gerdon appealed to the Idaho Supreme Court. Because the Commission’s decision was based upon its constitutional right to weigh the evidence and determine the credibility of conflicting expert opinions, the Supreme Court affirmed the Commission's order. View "Gerdon v. Con Paulos, Inc." on Justia Law
Altman-Bates v. Pub. Emps. Retirement Bd.
Attorneys employed by the Franklin County Public Defender sought membership and service credit in the Ohio Public Employees Retirement System for their years of service prior to January 1999, and challenged a decision the Ohio Public Employees Retirement Board’s denial of service credit. Persons hired by the Franklin County Public Defender on or before December 31, 1984, are public employees entitled to PERS benefits; effective January 1, 1999, the Franklin County Public Defender’s employees have been enrolled in and considered to be members of PERS. During the intervening years, pursuant to the Ohio Public Defender Act (R.C. Chapter 120), the Franklin County Public Defender Commission and its employees paid Social Security taxes on wages and did not consider the office to be a county agency. The Court of Appeals denied relief. The Supreme Court of Ohio granted a writ of mandamus to compel the board to award service credit, rejecting an argument that “there was no person holding the office of Franklin County Public Defender between 1985 and 1999 because a person was appointed as the ‘Director’ of the corporation. The plain language in R.C. 120.14(A)(1) indicates that the attorneys were employed by a public official, and hence, were public employees. View "Altman-Bates v. Pub. Emps. Retirement Bd." on Justia Law
Wilson v.Gordon
A class of Tennessee residents who applied for Medicaid sought declaratory and injunctive relief, alleging that the delays they have experienced in receiving eligibility determinations on their applications violate 42 U.S.C. 1396a(a)(8) of the Medicaid statute, and that the state’s failure to provide a fair hearing on their delayed applications violates that statute and the Due Process Clause. Regulations implementing the statute provide that “the determination of eligibility for any applicant may not exceed” 90 days for those “who apply for Medicaid on the basis of disability” and 45 days for all other applicants. The district court certified a class and granted a preliminary injunction, which requires the state to grant a fair hearing on delayed applications to class members who request one. The Sixth Circuit affirmed the preliminary injunction, holding that the matter is not moot and that the federal government is not a required party. The court noted that the federal government submitted an amicus brief, supporting plaintiffs’ position. Despite the passage of the Affordable Care Act, states remain ultimately responsible for ensuring their Medicaid programs comply with federal law. View "Wilson v.Gordon" on Justia Law
Smith v. Colvin
Plaintiff-appellant Laurie Smith sought review when her Social Security disability benefit claims were denied. She alleged disability based in part on: impingement of her left shoulder; restrictions on her ability to: (1) reach and (2) handle and finger objects; and moderate nonexertional limitations. The administrative law judge concluded that Smith could work as a telequotation clerk, surveillance systems monitor, or call-out operator. As a result, the judge concluded that Smith was not disabled. Ms. Smith appealed to the district court, which upheld the administrative law judge’s determination. After its review, the Tenth Circuit found no reason to disturb the ALJ's or the district court's judgments and affirmed. View "Smith v. Colvin" on Justia Law