Justia Government & Administrative Law Opinion Summaries

Dianne Carson first filed an application for retirement disability benefits in November 2007. Based on the recommendation of a hearing officer, the Kentucky Retirement Systems (KERS) denied Carson's claim. Carson did not seek judicial review of KERS's order, choosing instead to file a second application in October 2009. Based on a recommendation of a different hearing officer, KERS again denied Carson's claim. Carson sought judicial review and the circuit reversed and remanded with instructions for KERS to consider all of the medical evidence Carson submitted. The Court of Appeals affirmed. KERS argued that Carson's second application should have been dismissed under the doctrine of res judicata. "If res judicata applied to this action, Carson would have been barred from filing a second application that was based on the same claim as her first application. However, KRS 61.600(2) requires KERS to accept an employee's timely filed "reapplication based on the same claim of incapacity" and to reconsider the claim 'for disability if accompanied by new objective medical evidence.'" This case was remanded for KERS to undertake the correct review of the evidence. The Supreme Court affirmed the Court of Appeals. View "Kentycky Retirement Systems v. Carson" on Justia Law

In 1985-1986, Kerrigan was a Navy carpenter. He injured his back and was awarded workers’ compensation benefits by the Office of Workers Compensation (OWCP). In 1993, Kerrigan raised concerns regarding his benefits. Over several years, Kerrigan made multiple requests, some of which were denied. In 2001, Kerrigan contacted the Department of Labor Office of Inspector General (OIG) alleging that DOL employees had based one denial on a form that they falsified or destroyed. The OIG did not investigate, but forwarded the letter to OWCP. Kerrigan pursued, over several years, a suit against DOL for illegal termination of benefits and a suit against the physician who reviewed his medical records. Both were dismissed. In 2013, Kerrigan filed a complaint with the U.S. Office of Special Counsel, which chose not to investigate, but referred him to the Merit Systems Protection Board, where Kerrigan alleged retaliatory termination of benefits. The ALJ dismissed Kerrigan’s appeal, stating that the Whistleblower Protection Act only covers actions taken by an agency concerning its own employees. The Board stated that 5 U.S.C. 8128(b) provides that benefits determinations are within the exclusive jurisdiction of the DOL and are unreviewable and that Kerrigan failed to nonfrivolously allege that his protected disclosures were a contributing factor in the decision to terminate benefits. The Federal Circuit affirmed. While 5 U.S.C. 8128(b) does not bar review, Kerrigan failed to nonfrivolously allege that his protected disclosure was a contributing factor in the decision. View "Kerrigan v. Merit Sys. Protection Bd." on Justia Law

For more than 40 years, participants in the Tennessee Valley Authority Retirement System (TVARS) received cost-of-living adjustments on top of their investment returns, pension benefits, and supplemental benefits. In 2009, with the system’s financial health in jeopardy, the TVARS board amended the rules that govern the system to cap or eliminate cost-of-living adjustments for the years 2010–2013, increase the eligibility age for cost-of-living adjustments, and lower the interest rate on a savings fund. The participants sued. None of their claims survived summary judgment. According to the district court, the plaintiffs did not have a private right of action to enforce the board’s compliance with the TVARS rules, and a Takings claim failed on the merits. The Sixth Circuit affirmed in part; cost-of-living adjustments are not vested, the agencies were also entitled to summary judgment on the merits of the claim that the board violated TVARS rules by reducing vested benefits. The court remanded remaining claims alleging violations of the TVARS rules because those claims are judicially reviewable in the context of this case. View "Duncan v. Muzyn" on Justia Law

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