Justia Government & Administrative Law Opinion Summaries

Under the 2000 Energy Employees Occupational Illness Compensation Program Act a “covered employee” (or her survivor) is entitled to a lump sum payment of $150,000 “for the disability or death of that employee from that employee’s occupational illness,” 42 U.S.C. 7384s(a)(1). The claim adjudication process culminates in a final decision by the Final Adjudication Branch (FAB), which may be challenged in court. A claimant may request to reopen his claim after a final decision by submitting new evidence of covered employment or exposure to a toxic substance or identifying a change in medical guidelines. Berry sought benefits based on his father’s employment. After FAB denied his application for lack of proof that his father worked at a covered facility, Berry did not seek reconsideration or judicial review; 10 years later, Berry filed a request to reopen, stating that he had new evidence of employment. The request was denied. Berry sued under the Administrative Procedure Act. The district court dismissed, find the refusal to reopen “not a final agency action,” 5 U.S.C. 704. The Sixth Circuit affirmed. While the decision not to reopen satisfied the Supreme Court’s test for “final agency action,” and was not the type of decision that Court has recognized as “committed to agency discretion,” the court properly dismissed because the request was not actually based on new evidence, but alleged a material error in the initial decision. Under Supreme Court precedent, reopening requests based on material error are “committed to agency discretion” and unreviewable. View "Berry v. Dept. of Labor" on Justia Law

The amount of additional Medicare reimbursements that a hospital is entitled to receive for serving a disproportionate share of low-income patients depends, in part, on the number of days that the hospital served patients who were “eligible for medical assistance under a State plan approved under [the Medicaid statute].” 42 U.S.C. 1395ww(d)(5)(F)(vi)(II). Kentucky hospitals contend that because Kentucky has chosen in its Medicaid plan to award additional Medicaid funds to hospitals based on how many days they treat patients who are eligible for the Kentucky Hospital Care Program (KHCP), a state program that provides medical coverage to low-income individuals who do not qualify for Medicaid, KHCP patient days should be counted in the calculation of the additional Medicare reimbursements. The Sixth Circuit affirmed rejection of the state’s argument on summary judgment, stating that the statutory term “eligible for medical assistance under a State plan approved under [the Medicaid statute]” is synonymous with “eligible for Medicaid” and KHCP patients are, by definition, not eligible for Medicaid. View "Owensboro Health, Inc. v. United States Dept. of Health & Human Servs." on Justia Law

In 42 U.S.C. 433, Congress authorized the President to enter into social security coordination agreements - known as totalization agreements - with other countries. This case involves a totalization agreement between the United States and France. At issue is whether or not two French taxes enacted into law after that totalization agreement was adopted amend or supplement the French social security laws covered by the agreement, and thus fall within the agreement’s ambit. The court concluded that the trial court committed legal error in declaring the status of those French laws not by analyzing the text of the totalization agreement or the understanding of the parties, but by resorting to American dictionaries. The court reversed and remanded because insufficient consideration was given to the text and the official views of the United States and French governments. View "Eshel v. Commissioner" on Justia Law

The issue this case presented for the New Hampshire Supreme Court's review called for the Court to determine the constitutionality of New Hampshire Administrative Rules, He-W 654.04(c). The rule required DHHS to include a child’s federal Supplemental Security Income (SSI) in the calculation of a family’s eligibility for benefits under the federal Temporary Assistance for Needy Families program (TANF), as administered by the State’s Financial Assistance to Needy Families program (FANF). Plaintiffs Carrie Hendrick and Jamie Birmingham were mothers whose children received SSI and FANF benefits, and whose benefits were ultimately cut by the Department of Health and Human Services (DHHS). Plaintiffs brought this lawsuit on behalf of themselves and their children, seeking a declaratory judgment that DHHS’s “inclusion of children’s SSI in FANF assistance group income is unlawful and void” pursuant to applicable federal law. In addition, plaintiffs sought a declaratory judgment that Rule He-W 654.04 “is invalid because it impairs [their] legal rights.” Plaintiffs sought a permanent injunction enjoining DHHS from including children’s SSI in FANF assistance group income and an award of attorney’s fees “because this litigation will result in a substantial benefit to the public.” After requesting that the Solicitor General of the United States file an amicus brief in this matter, and after reviewing that brief, the New Hampshire Supreme Court agreed with the Solicitor General that the Supremacy Clause did not permit the State to redirect federal benefits as required by Rule He-W 654.04(c). The rule, by counting a disabled child’s SSI benefits as income available to the child’s “assistance group,” treated the child’s benefits as a source of income for the entire household. The rule, thereby, reduced a household’s TANF benefit by one dollar for every dollar in SSI that was received by a disabled child in the household. Because the rule “stands as an obstacle to the accomplishment and execution of the full purposes and objectives of Congress,” the New Hampshire Court held that Rule He-W 654.04(c) was preempted by federal law and, thus, invalid to the extent that it required inclusion of children’s SSI as income to the TANF assistance group for the purpose of determining eligibility for TANF benefits. View "Hendrick v. New Hampshire Dept. of Health & Human Svcs." on Justia Law

In 2012, Plaintiff applied for disability insurance benefits under the Social Security Act, alleging a disability onset date of 1995. Plaintiff’s date last insured (DLI) was in 1998. An administrative law judge (ALJ) denied benefits, concluding that Plaintiff was not disabled prior to her DLI and was thus not eligible to receive benefits. The district court vacated the Commissioner’s decision and remanded for further proceedings, ruling that the ALJ failed to comply with Social Security Ruling (SSR) 83-20 and consult a medical advisor before drawing inferences as to whether Plaintiff’s onset date preceded the expiration of her insured status. In making its ruling, the district court relied upon Social Security Ruling (SSR) 83-20, which instructs an ALJ to consult a medical expert when the ALJ must infer a claimant’s date of disability onset on the basis of ambiguous medical evidence. The First Circuit vacated the judgment of the district court, holding that SSR 83-20 did not require the ALJ to consult a medical expert because the medical evidence was not ambiguous, and thus, the ALJ did not need to infer Plaintiff’s date of disability onset. Remanded for consideration of Plaintiff’s remaining claims. View "Fischer v. Colvin" on Justia Law

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

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

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 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

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