Justia Government & Administrative Law Opinion Summaries

Alohacare, a health maintenance organization (HMO), submitted a proposal to the Department of Human Services to bid for a Quest Expanded Access contract to provide healthcare services for participants in the state's Medicaid program. The Department of Human Services awarded Quest contracts to United HealthCare Insurance (United) and WellCare Health Insurance (Ohana) but not to Alohacare. Alohacare petitioned the Insurance Commissioner of the Department of Commerce and Consumer Affairs for declaratory relief that the Quest contracts required the accident and health insurers to carry an HMO license. The Commissioner concluded that the license was not required to offer the Quest managed care product because the services required under the contracts were not services that could be provided only by an HMO. The circuit court affirmed. The Supreme Court affirmed, holding (1) AlohaCare had standing to appeal the Commissioner's decision; (2) both accident and health insurers and HMOs were authorized to offer the model of care required by the Quest contracts; and (3) this holding did not nullify the Health Maintenance Organization Act.

Defendant filed a due process hearing complaint with California's Office of Administrative Hearings (OAH), alleging that he was being denied the free appropriate public education (FAPE) that he was entitled to under the Individuals with Disabilities Education Act (IDEA), 20 U.S.C. 1400 et seq. The court certified the following question to the California Supreme Court: Does California Education Code 56041 - which provided generally that for qualifying children ages eighteen to twenty-two, the school district where the child's parent resides is responsible for providing special education services - apply to children who are incarcerated in county jails? The case was withdrawn from submission and further proceedings were stayed pending final action by the Supreme Court of California.

In 2008, Chrysler offered a buyout program to employees in Kokomo, Indiana. Those employees then applied for unemployment benefits under Indiana's Unemployment Compensation Act. The Indiana Department of Workforce Development denied the claims. The Review Board of the Indiana Department of Workforce Development ultimately awarded benefits under a narrow provision of the Act. The court of appeals reversed, holding that the Board's application of the provision was erroneous and inconsistent with the statute. The Supreme Court granted transfer and vacated the court of appeals. The Court then affirmed the decision of the Board, holding that the Board properly applied the law to its findings of fact, and the Board's conclusion that the employees were eligible for benefits was reasonable in light of the evidence before it.

Respondent-Appellant Pneumotech, Inc. appealed the Industrial Commission's determination that its former employee, Petitioner-Appellee Angela Hopkins, was eligible for unemployment benefits. Pneumotech hired Petitioner as a bookkeeper and receptionist on July 3, 1995. She worked at Pneumotech until June 22, 2010, when her supervisor fired her. The same month, Petitioner filed a claim for unemployment benefits with the Idaho Department of Labor. At the hearing, Pneumotech presented testimony that Petitioner was discharged because: (1) for two years she had been habitually late for work; (2) she took time off without supervisor permission; (3) she took sick time off but went to the water park instead; (4) she spent time at work playing video games and talking on her cell phone; and (5) she failed to help train a new employee when asked. Petitioner denied all of these accusations, including that her supervisor had repeatedly warned her that her conduct was unacceptable. In fact, the supervisor testified that Petitioner never received a written warning or suspension, and in January 2009, she received a $2-per-hour raise. Upon review, the Supreme Court found that the Commission did not abuse its discretion or violate Pneumotech's right to procedural due process in denying the company's request for a new hearing. Furthermore, substantial and competent evidence supported the Commission's decision to uphold Petitioner's award of unemployment benefits. Accordingly, the Court affirmed.

This case involved Commonwealth Care, a state-initiated program that provided structured premium assistance for low-income Massachusetts residents. In 2009, the Legislature made certain changes to the eligibility requirements of Commonwealth Care, enacted in a two-part supplemental appropriation for fiscal year 2010. Section 31(a) of the appropriation excluded all aliens who were federally ineligible under the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA), 8 U.S.C. 1601-1646, from participation in Commonwealth Care. Plaintiffs were individuals who either have been terminated from Commonwealth Care or have been denied eligibility solely as a result of their alienage. The court held that section 31(a) could not pass strict scrutiny and that the discrimination against legal immigrants that its limiting language embodied violated their rights to equal protection under the Massachusetts Constitution.

Plaintiff appealed the district court's order affirming the Commissioner's denial of her application for supplemental security income (SSI). The court found that substantial evidence supported the ALJ's conclusion that plaintiff was not disabled within the meaning of the Social Security Act, 42 U.S.C. 301 et seq. Accordingly, the court affirmed the district court's grant of judgment on the pleadings in favor of the Commissioner.

Appellants Phillip Grimsley and Roger Mowers were retired and later rehired employees of the South Carolina Law Enforcement Division (SLED). As employees, they were members of the Police Officers Retirement System. As part of the rehire process, SLED required Appellants to sign a form which provided that they would take a pay cut in the amount it would cost SLED to pay "the employer portion" of retirement. According to their suit, Appellants claimed that provision was contrary to state law, which assigned the responsibility for the employer portion of the retirement to the employer. On behalf of themselves and others similarly situated, Appellants brought suit against SLED and the State, seeking a declaratory judgment and asserting causes of action for a violation of S.C. Code Ann. section 9-11-90 and for unlawful takings. The trial court dismissed the complaint for failure to exhaust administrative remedies under the South Carolina Retirement Contribution Procedures Act (Retirement Act), which Appellants challenged on appeal to the Supreme Court. Appellants additionally appealed the trial court's alternative ruling dismissing their unlawful takings claim. Upon review, the Supreme Court agreed with Appellants and found the trial court erred in dismissing their complaint: "Appellants have asserted a cognizable property interest rooted in state law sufficient to survive the motion to dismiss. In so finding, [the Court] also [held] the trial court erred in dismissing Appellants' unlawful takings claim."

Plaintiff-Appellant John Conger appealed the Commissioner's denial of his application for supplemental social security income benefits. Plaintiff applied for benefits in 2005 alleging he was unable to work because of degenerative disk disease, spondylosis, arthritis, depression, and problems sleeping. His application was denied at the administrative level after a hearing before an administrative law judge (ALJ). The ALJ further found that Plaintiff had the residual functional capacity (RFC) to perform simple and routine medium exertional work that required no more than occasional stooping and no contact with the public. After the Appeals Council denied his request for review, Plaintiff filed his complaint in the district court. The district court adopted the report and affirmed the Commissioner's denial of benefits. Upon review, the Tenth Circuit found no error in the ALJ's RFC finding and that the decision was supported by substantial evidence. The Court affirmed the district court and Commissioner's rulings.

Plaintiff-Appellant Kathryn Johns appealed the district court’s denial of her motion for attorneys' fees under the Equal Access to Justice Act (EAJA) which followed the court's remand to the Commissioner of her claims for Social Security disability benefits. In denying Plaintiff's application for disability benefits, the administrative law judge (ALJ) concluded that her diagnosed mental impairments were not severe apart from alcohol abuse. Plaintiff argued before the district court that the ALJ had failed to apply the correct analysis in assessing her alcoholism. Specifically, the ALJ did not first find that she was disabled, and only then could the ALJ determine whether she would still be disabled if she stopped using alcohol. The government admitted that the ALJ did not follow the specified procedure, but argued that the error was harmless because the dispositive question was the same. Ultimately the district court remanded the case back to the Commissioner. Plaintiff then moved for fees under the EAJA. The government responded by arguing that a fee award was inappropriate because it believed the error by the ALJ was harmless. The district court denied Plaintiff's motion for fees. Finding that the district court believed that application of harmless error in this case was a close call, the Tenth Circuit concluded that under those circumstances, the district court did not "cross the bounds of the rationally available choices available to it when it concluded that the Commissioner's position was substantially justified." Accordingly, the Court affirmed the denial of fees.

The primary question in this case was whether a workplace injury that Plaintiff Nancy Petock characterized as an aggravation or worsening of an earlier compensable injury can give rise to a new three-year period in which she could demand reinstatement or reemployment. The trial court held that it could not and granted Defendant Asante's (dba Asante Health System) summary judgment motion. Although the Court of Appeals agreed with the trial court that an aggravation of an earlier injury cannot give rise to new reinstatement rights, it concluded that there was a disputed issue of fact as to whether Plaintiff had sustained a "new and separate injury" in 2005 that would give rise to those rights, and remanded the case. On review, Plaintiff argued that the Court of Appeals erred in holding that an aggravation of an earlier injury cannot give rise to a right to reinstatement under ORS 659A.043 or a right to reemployment under ORS 659A.046. Though the Supreme Court disagreed with some of the appellate court's reasoning, it affirmed the decision to reverse the trial court for further proceedings: "Even if defendant were correct that the same facts cannot give rise to an aggravation claim and a compensable injury claim (a proposition with which [the Court] noted our disagreement), [the Court] fail[ed] to see the relevance of that proposition in the context of defendant's summary judgment motion. On this record, Plaintiff was free to argue that her 2005 injury was a compensable injury."