Justia Government & Administrative Law Opinion Summaries

Boley sought Social Security disability benefits. The agency denied her request initially and on reconsideration. A person dissatisfied with such a decision has 60 days to request a hearing. Boley took about nine months because SSA had notified Boley but not her lawyer (as required by 20 C.F.R.404.1715(a)). Boley was ill at the time, preparing for a double mastectomy, and did not know, until it was too late, that her lawyer was unaware of the decision. An ALJ dismissed an untimely hearing request, finding that Boley lacked “good cause” because she had received notice and could have filed a request herself. A district judge dismissed her petition for judicial review, based on 42 U.S.C. 05(g), which authorizes review of the agency’s final decisions made “after a hearing.” The Seventh Circuit vacated and remanded, with instructions to decide whether substantial evidence, and appropriate procedures, underlie the decision that Boley lacks “good cause” for her delay in seeking intra-agency review. In doing so, the court overruled its own precedent and noted a divide among the circuits. View "Boley v. Colvin" on Justia Law

Kathy Inwards was injured while employed as an assembler by Bobcat. WSI accepted liability for her claim and awarded Inwards vocational rehabilitation benefits to assist her in returning to work. In early June 2011, WSI issued a notice of intention to discontinue benefits ("NOID") stating her disability benefits would end then convert to retraining benefits. She had 30 days to request reconsideration of the decision. WSI issued a formal order requiring Inwards to "enter into training at Hutchinson Community College, Hutchinson, Kansas, in the Business Management & Entrepreneurship AAS program." Inwards requested reconsideration of the vocational rehabilitation plan, but attended two college courses during the summer of 2011 in accordance with the plan. Inwards complained to her physician that she was having increased pain as a result of her course work. Although Inwards registered for fall courses at the college, she withdrew from them. In October 2011, WSI issued a NOID to Inwards stating "[t]here is no medical evidence that supports your professed inability to attend the classes as outlined in the administrative order dated June 27, 2011. You are now considered to be in non-compliance with vocational rehab." Inwards timely requested reconsideration of this NOID, and on January 13, 2012, WSI issued a formal order suspending Inwards' rehabilitation benefits based on her noncompliance with the rehabilitation plan. Inwards timely requested a hearing to challenge WSI's finding of noncompliance and suspension of benefits. The ALJ reversed WSI's January 13, 2012 order suspending benefits for noncompliance with the vocational rehabilitation plan. WSI appealed to district court and Inwards moved to dismiss the appeal, claiming the court lacked subject matter jurisdiction because WSI failed to serve the notice of appeal and specification of errors on Inwards and her employer. The court denied the motion to dismiss, concluding Inwards had no standing to object to defective service on her employer and there was good cause to excuse WSI's mistake about recently mandated court electronic filing requirements. The court reversed the ALJ's decision, concluding the finding of good cause was "not supported by law," and reinstated WSI's January 13, 2012 order of noncompliance. The Supreme Court concluded the ALJ erred as a matter of law in ruling Inwards had good cause for failing to comply with a retraining program because WSI's previous order requiring Inwards to participate in the retraining program had been appealed and had not been finally resolved at the time she withdrew from the retraining program. The Court affirmed the district court judgment reversing the ALJ's decision and reinstating WSI's order of noncompliance. View "Inwards v. WSI" on Justia Law

Plaintiff, a former laborer, applied for social security disability benefits, claiming he was unable to work a full 40-hour week because of acute lower back pain that radiates into his right leg. He has had various treatments and takes several medications such as oxycodone and percocet. His application was denied; the Appeals Council and district court affirmed. The Seventh Circuit reversed and remanded, reasoning that the administrative law judge was likely mistaken in believing that one physician’s report refuted the findings of the other physician. What was relevant was not the cause of the pain and numbness but the severity of these symptoms and whether they disabled plaintiff from working full time. Both physicians diagnosed radiculopathy. If the administrative law judge remains skeptical of the claim, he can order a further examination of the plaintiff by a qualified physician instructed to offer a medical opinion (if possible) on the plaintiff’s physical ability to engage in full-time work. The court stated references to the credibility of the applicant are “a recurrent feature of the government’s defense of denials of social security disability benefits” that constitutes “professional misconduct and if it continues we’ll have to impose sanctions.” View "Hanson v. Colvin" on Justia Law

In this case, the Georgia Department of Human Services, Family and Children Services (DFCS) granted appellee Jerry Glover's application for Medicaid benefits but imposed a multi-month asset transfer penalty on him pursuant to section 2339 of DFCS's Georgia Economic Support Services Manual due to his refusal to name the State as the remainder beneficiary on an annuity. Glover appealed the penalty to an Office of State Administrative Hearings Administrative Law Judge (ALJ) who issued an initial decision reversing the penalty. DFCS then filed a request for agency review by the Georgia Department of Community Health (DCH). DCH issued a final decision upholding the penalty. Pursuant to OCGA 50-13-19 of the Administrative Procedures Act, Glover then sought judicial review from the Superior Court which affirmed the final agency decision. The Court of Appeals granted Glover’s application for discretionary appeal and reversed the superior court, concluding that section 2339 of the Eligibility Manual as applied to Glover was inconsistent with the plain language of the federal Medicaid statute and that pursuant to 42 U. S. C. sections 1396p (c) (1) (F) and (G), Glover's annuity was not an asset to which the asset transfer penalty would apply. Appellants, David Cook in his official capacity as Commissioner of DCH and Clyde Reese in his official capacity as Commissioner of DFCS, appealed to the Georgia Supreme Court arguing that the Court of Appeals improperly interpreted the annuity section of the Medicaid Act and erred in holding that sec. 2339 as applied to Glover violated federal law. Asserting that the statutory provisions at issue was ambiguous, appellants contended that the Court of Appeals was required to defer to CMS's interpretation of the federal statute. Because the Supreme Court found that the federal statutory provisions at issue were ambiguous and the relevant administrative agencies’ interpretations of them were based on a permissible construction of the statutory language, it reversed the Court of Appeals’ decision in this case. View "Cook v. Glover" on Justia Law

Beardsley was 49 years old when she fell and injured her knee. She had worked as a machine operator, assembler, inspector, and cashier. After the injury, she applied for disability insurance benefits and supplemental security income. Her doctors determined that she had meniscal tears and a ruptured ligament, compounded by obesity and worsening osteoarthritis. She declined surgery but received injections for the arthritis. Dr. Banyash examined her on behalf of the Social Security Administration and opined that pain and weakness restricted her ability to walk, stand, climb stairs, crouch, and kneel, but she was capable of sedentary work. Given Beardsley’s age and skills, a finding that she was capable of only sedentary work would have qualified her as disabled at the time under the grid SSA uses for making that determination. Another agency physician subsequently judged her able to stand or walk for about six hours of an eight-hour workday. The ALJ denied benefits, finding that she could still perform a range of light work. Beardsley argued that the ALJ gave too little weight to the opinion of the examining doctor and too much weight to an erroneous view of her daily activities, particularly care she provided for her elderly mother and that the ALJ improperly held against her the decision not to seek surgery. The district court affirmed the denial of benefits. The Seventh Circuit reversed and remanded, finding that errors undermined the “logical bridge” between evidence and conclusion. View "Beardsley v. Colvin" on Justia Law

Townsend applied for social security disability benefits and supplemental security income in 2003, at age 44, claiming that she had become incapable of full‐time gainful employment in May 2002 when she had stopped working as a result of multiple physical and psychiatric ailments, including fibromyalgia. In 2012 an ALJ decided that she had become totally disabled in November 2008. By the time that decision was rendered she had died (of pulmonary diseases apparently unrelated to the ailments alleged to have made her totally disabled). Her father was substituted for her. The district court upheld the decision. The Seventh Circuit reversed and remanded, noting multiple errors in determining the onset of total disability. View "Williams v. Colvin" on Justia Law

This case involved a petition for injunctive and declaratory relief brought by plaintiffs Harbor Homes, Inc. and Gary Dube, Thomas Taylor, Cynthia Washington, and Arthur Furber against defendants the New Hampshire Department of Health and Human Services (DHHS), the Commissioner of DHHS, the Associate Commissioner of DHHS, and the Administrator of the Bureau of Behavioral Health seeking, in part, to enjoin DHHS from denying the individual plaintiffs the right to obtain Medicaid-funded services from their chosen provider, Harbor Homes. The individual plaintiffs received Medicaid-funded rehabilitative services from Harbor Homes. Since 1991, Harbor Homes participated in New Hampshire's Medicaid program pursuant to a Medicaid Provider Enrollment Agreement. On June 23, 2008, Harbor Homes entered into an interagency agreement (IAA) with a community mental health program, Community Council of Nashua, NH, now known as Greater Nashua Mental Health Center (GNMHC), which authorized Harbor Homes to provide certain Medicaid-funded rehabilitative services to GNMHC patients. In February 2011, Harbor Homes learned that GNMHC did not intend to renew its IAA and that the Medicaid reimbursable services provided by Harbor Homes would be transitioned to GNMHC. This was done pursuant to Administrative Rule He-M 426.04(a)(2), which meant that Harbor Homes would no longer have an IAA with a community mental health provider, and it would no longer be permitted to provide Medicaid funded mental health services to approximately one hundred and forty of its clients, including the individual plaintiffs in this case. Plaintiffs filed a petition for injunctive and declaratory relief, seeking a court order enjoining DHHS from "terminating or limiting Harbor Homes' status as a qualified Medicaid provider" and to direct the State to allow the individual plaintiffs to obtain community mental health services from Harbor Homes, the provider of their choice. Following two hearings, the court denied the plaintiffs' request for a preliminary injunction. Thereafter, all parties moved for partial summary judgment on the plaintiffs' claim that DHHS's reliance upon the IAA requirement as a reason to terminate Harbor Homes' status as a qualified Medicaid provider was improper because the requirement was invalid both on its face and as applied in this case. Plaintiffs appealed rulings of the Superior Court that denied their summary judgment motions and granting the defendants' cross-motions for summary judgment on two counts in the plaintiffs' petition. Upon review of the matter, the Supreme Court reversed the Superior Court's ruling that New Hampshire Administrative Rules, He-M 426.04(a)(2) did not violate the federal Medicaid Act. The case was remanded for further proceedings. View "Dube v. New Hampshire Dept. of Health & Human Svcs." on Justia Law

Robert Campbell quit his job as a school teacher in anticipation of accompanying his wife to Finland on her Fulbright grant. Campbell applied for unemployment benefits for the months between his resignation in June 2010 and his family's planned departure in February 2011. His request was denied because the Department of Employment Security determined that Campbell did not qualify for benefits as claimed under RCW 50.20.050(2)(b)(iii), known as the "quit to follow" provision. On appeal, the superior court reversed, but the Court of Appeals reinstated the agency action. The Supreme Court affirmed the Court of Appeals and held that Campbell's resignation from his job seven months before the planned relocation was not reasonable as contemplated by the statute. View "Campbell v. Dep't of Emp't Sec." on Justia Law

Plaintiff’s spouse (Spouse) applied to the Commissioner of Social Services (Department) for Medicaid benefits. After a review of the combined assets of both Spouse and Plaintiff, the Department concluded that Spouse was not eligible to receive Medicaid benefits. A hearing officer denied Plaintiff’s appeal, as did the superior court. The Supreme Court affirmed, holding that the trial court correctly concluded that the Department did not act arbitrarily or abuse its discretion in finding that the Department applied the correct eligibility and availability of assets criteria when evaluating the application for Medicaid benefits submitted by Spouse. View "Palomba-Bourke v. Comm'r of Soc. Servs." on Justia Law

Plaintiffs, Medicaid beneficiaries with near total disabilities, filed suit after being denied coverage for ceiling lifts under a categorical exclusion in the state's implementing Medicaid regulations. The district court granted summary judgment for the state. The court concluded that, under binding precedent, plaintiffs have an implied private cause of action under the Supremacy Clause to pursue their challenge; the state must comply with the requirements of the Medicaid Act, 42 U.S.C. 1396 et seq., but the Act does not preempt the state's categorical exclusions; and therefore, the court affirmed the grant of summary judgment and denied the motion to vacate. View "Detgen, et al. v. Janek" on Justia Law