Justia Government & Administrative Law Opinion Summaries

Articles Posted in Public Benefits
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Josephine Centorbi died intestate in 2007. At the time of her death, Ms. Centorbi received Medicaid benefits. Ms. Centorbiâs sister, Dianne Fiorille administered the estate, and acting without counsel, applied to relieve the estate from administration. When she filed the application, Ms. Fiorille did not check the box on the form to attest that the decedent was over 55 years old and received Medicaid assistance. In addition, as administrator, Ms. Fiorille failed to file some other forms necessary to notify both the probate court and the Ohio Department of Jobs and Family Services (ODJFS) of the decedentâs death. The probate court granted Ms. Fiorilleâs application to relieve the estate from administration on the same day it was filed. Two years later, ODJFS learned of Ms. Centorbiâs death. It filed an application to vacate the probate courtâs order, but its application was denied. The probate court held that because Ms. Fiorille indicated that no notice was required (in the form of the omitted check box), ODJFSâs application was time barred. The appellate court affirmed the probate courtâs decision. The Supreme Court found that failing to check the box on the initial relief-from-administration form tolled the statute of limitations. Without the check, the Medicaid program had not been officially notified of the decedentâs death. The Court reversed the appellate courtâs decision and remanded the case to the probate court for further proceedings.

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The Nebraska Department of Health and Human Services (DHSS) determined that Darline Liddell-Toney was required to participate in a self-sufficiency program in order to receive benefits under the Welfare Reform Act, despite her documented disability. The district court affirmed the DHSSâ determination. Ms. Liddell-Toney appealed, arguing that the district court erred in finding that the DHSS provided sufficient evidence to prove she was not entitled to an exemption from participating in the program. The Supreme Court found that the evidence clearly indicated that Ms. Liddell-Toney was prevented from working for a substantial period due to her disability. The Court held that the district court erred when it affirmed DHSSâs determination that Ms. Liddell-Toney did not qualify for an exemption from participating in the self-sufficiency program. The Court reversed the judgment of the district court, and remanded the case for further proceedings.

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To provide relief in the aftermath of Hurricanes Katrina and Rita, Congress appropriated funds to Louisiana which distributed some of those funds through the "Road Home" program. The State required more than 150,000 Road Home grant recipients to execute a "Limited Subrogation/Assignment Agreement." The Road Home program created "perverse incentives" for insurance companies and their insured homeowners: some insurers inadequately adjusted and paid grant-eligible claims, and some grant-eligible homeowners had little motivation for file insurance claims. As a result, Road Home applications skyrocketed and created a $1 billion shortfall in the program. The State filed suit against more than 200 insurance companies, seeking to recover the funds spent and yet to be spent on claims under the Road Home program. The Insurance Companies successfully removed the case to the federal district court. The Insurance Companies then sought to dismiss the State's case, arguing that as a matter of law, anti-assignment clauses in the homeowners' policies invalidated the subrogation/assignment to the State. The federal district court denied the Companies' motion to dismiss. The Companies appealed to the Fifth Circuit. Because interpretation of the policy provisions at issue was a matter of State law, the Court certified interpretation to the Louisiana Supreme Court. The Supreme Court found that there is no public policy in Louisiana that precludes anti-assignment claims from applying to post-loss assignments. The Court commented that the language of the anti-assignment clause must clearly and unambiguously express that it applies to post-loss assignments, and as such must be evaluated on a policy-by-policy basis.

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Plaintiff-Appellant Jessica Cohon sought funding through New Mexicoâs Medicaid program. She qualified for the âMi Via Waiverâ program, and submitted budget requests which were partly granted, partly denied. After an unsuccessful administrative appeal, she filed suit, alleging that the administration of the Mi Via Waiver program discriminated against severely disabled persons like herself. The State moved to dismiss Plaintiffâs complaint, arguing that not only was it the wrong entity being sued, but that Plaintiff had no statutory basis to support her suit. The district court dismissed Plaintiffâs claims based on federal law, but remanded her state-law claims to the administrative agency for further proceedings. Plaintiff appealed the dismissal of her federal law claims to the Tenth Circuit. Upon review, the Tenth Circuit found Plaintiffâs federal claims âinsufficient in substance,â and affirmed the judgment of the district court that dismissed her claims.

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Plaintiff Richard Krauser appealed the district courtâs order that denied him social security and supplemental security income benefits. The Administrative Law Judge (ALJ) denied Plaintiffâs benefits on the last step of a five-step process for determining his eligibility. Among other things, the ALJ found that Plaintiffâs ailments had not met the âper seâ disabling impairments that would have made him eligible, and considering his age, education and transferable work skills, Plaintiff could go back to work. The appeals council denied review, making the ALJâs decision ripe for the Tenth Circuit to review. Plaintiff argued that the ALJ did not properly consider all of his impairments and came to the wrong conclusion after the five-step process. The Tenth Circuit found that the ALJ did not review all evidence Plaintiff submitted, particularly statements from Plaintiffâs treating physician. The Court reversed the ALJâs holding and remanded the case for further review.

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Plaintiff sought disability insurance benefits under the Social Security Act, alleging that migraine headaches, affective mood disorder, and mayofascial back pain left her unable to work. At issue was whether the administrative law judge's ("ALJ") decision was supported by substantial evidence and whether the ALJ properly weighed physicians' opinions in determining plaintiff's residual functional capacity. The court concluded that substantial evidence supported the ALJ's decision to discredit plaintiff's subjective complaints where none of her doctors reported functional or work related limitations due to her headaches and where there was no basis for her creditability. The court also held that the ALJ properly weighed the physicians' opinions in determining plaintiff's residual functional capacity.

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Plaintiffs sued defendants, Nassau County, New York and/or MTA Long Island Bus ("MTA"), asserting claims under the Americans with Disabilities Act ("ADA"), 42 U.S.C. 12101 et seq., and the Rehabilitation Act of 1973, 29 U.S.C. 701 et seq., where the gravamen of the lawsuits was that defendants implemented substantial reductions in paratransit services without allowing for the public participation of users of the services required by the ADA regulations and failed to make reasonable modifications to existing services so as to ameliorate the effect of the service reductions. At issue was whether the district court properly dismissed plaintiffs' cases on the grounds that the regulations did not apply to the service cuts in question and that the Department of Justice's ("DOJ") reasonable modifications requirement did not apply to paratransit services. The court held that 49 C.F.R. 37.137(c) of the ADA could not be enforced in a private right of action based on 49 C.F.R. 12143 where the failure to permit public participation did not constitute discrimination under section 12143. The court also read section 12134 to mean that the DOJ's reasonable modifications regulations did not apply to public entities providing paratransit services outside the ADA service area. Therefore, the court affirmed the district court's dismissal of plaintiffs' cases.

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The plaintiff was an "excepted" (not in the competitive service or the Senior Executive Service) employee of the Veterans Canteen Service and was not preference-eligible (as a veteran or close relative). She appealed a notice of termination for misconduct. The Merit Systems Protection Board dismissed for lack of jurisdiction because she had been hired under 38 U.S.C. 7802(e). The Federal Circuit affirmed, holding that the plain language of the statute allows removal of such employees without regard to other civil service laws. Civil Service Due Process Amendments in 1990 did not extend protections to excepted, non-preference eligible employees.

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Petitioner, a New York City police officer, retired in 2004 and was awarded disability benefits. In the following years, the police department received information indicating that petitioner was not disabled; that he made false representations to the Police Pension Fund ("Fund"); and that he had ingested cocaine, thus becoming ineligible to return to duty. At issue was whether the city should continue to pay petitioner a pension. The court affirmed the Appellate Division's order annulling the termination of petitioner's pension benefits and held that the benefits can only be terminated by the trustee of the Fund, who has not taken necessary action.

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Plaintiff appealed the administrative law judge's ("ALJ") denial of his application for supplemental security income alleging that he became disabled beginning in March 20, 2005 due to depression, post-traumatic stress disorder, and schizoaffective disorder. At issue was whether the factual findings were supported by substantial evidence and whether the correct legal standards were applied. The court held that the ALJ did not follow the law in evaluating all the medical evidence from a licensed clinical psychologist, a licensed professional counselor, and a physician who diagnosed plaintiff with schizoaffective disorder. The court also held that the ALJ failed to apply the correct legal standards in assessing plaintiff's credibility, and alternatively, the ALJ's adverse credibility determination was not supported by substantial evidence.