Justia Government & Administrative Law Opinion Summaries

Out-of-work residents of Michigan may claim unemployment benefits if they meet certain eligibility criteria. The State’s Unemployment Insurance Agency oversees the benefits system. In 2011, with the help of private contractors, the Agency began to develop software to administer the unemployment system. The Agency sought to equip the software to auto-adjudicate as many parts of the claims process as possible. The Agency programmed software that used logic trees to help process cases and identify fraud. A claimant’s failure to return the fact-finding questionnaire, for example, led to a fraud finding, as did the claimant’s selection of certain multiple-choice responses. In August 2015, problems arose with some features of the system, prompting the Agency to turn off the auto-adjudication feature for fraud claims.Plaintiffs are four individuals who obtained unemployment benefits, which were terminated after the Agency flagged their claims for fraud. Plaintiffs filed a putative class action against three government contractors and nineteen Agency staffers, raising claims under the Fourth, Fifth, and Fourteenth Amendments, 26 U.S.C. Sec. 6402(f), and Michigan tort law. In a previous proceeding, the court held that plaintiffs’ due process rights clearly existed because they had alleged a deprivation of their property interests without adequate notice and without an opportunity for a pre-deprivation hearing.At this stage, because the remaining plaintiffs have failed to show that these procedures violate any clearly established law, the supervisors of the unemployment insurance agency are entitled to judgment as a matter of law. The court also found that an intervening plaintiff was properly prevented from joining the case, based on her untimely filing. View "Patti Cahoo v. SAS Institute, Inc." on Justia Law

Claimant appealed the district court’s judgment upholding the denial of social security benefits by an administrative law judge (“ALJ”). Reviewing de novo the district court’s decision, Farlow v. Kijakazi, 53 F.4th 485, 487 (9th Cir. 2022), the Ninth Circuit reversed The ALJ materially mischaracterized Claimant’s functional capacity when posing a question to a vocational expert, so the vocational expert’s testimony lacked evidentiary value with respect to jobs that Claimant could perform. Here, Claimant argued that the ALJ’s question posed to the vocational expert inaccurately described her actual limitations. First, the hypothetical posed to the expert did not provide that claimant was limited to jobs with “little or no judgment.” The panel concluded that the error was harmless because the vocational expert identified only jobs with that limitation. Second, the hypothetical did not provide that Claimant could “follow short, simple instructions” only. Third, in the question posed to the vocational expert, the ALJ described a hypothetical person who “can work in an environment with occasional changes to the work setting.” The panel concluded that the ALJ materially mischaracterized Claimant’s functional capacity when posing a question to a vocational expert, so the vocational expert’s testimony lacked evidentiary value with respect to jobs that Claimant could perform. View "CAROLINE LEACH V. KILOLO KIJAKAZI" on Justia Law

Plaintiff sought disability benefits from the Social Security Administration in 2018. He primarily based his application on pain in his lower back, hips, legs, knees, and feet, as well as on hypertension. Throughout the administrative process and upon review in federal district court, Plaintiff was denied benefits. He appealed.   The Fourth Circuit reversed and remanded the district court’s ruling affirming the ALJ’s final decision denying Plaintiff’s application for disability benefits. The court explained that nothing in the record expressly reconciles the differing mobility conclusions between 2018 and 2019, but it seems reasonable to believe that perhaps Plaintiff’s objective ailments worsened during that time, thereby impacting his mobility. To be sure, neither this Court nor an ALJ may infer a medical diagnosis—like symptom progression. But when insufficient evidence prevents an ALJ from soundly determining whether providers’ opinions are consistent, a Section 404.1520b(b)(2) inquiry by the ALJ could remedy the uncertainty with relative ease. Second, the court held that the ALJ improperly considered Plaintiff’s subjective complaints. Third, the court found that the ALJ improperly considered whether Plaintiff’s daily activities were inconsistent with his claim of disability. View "Renard Oakes v. Kilolo Kijakazi" on Justia Law

Combs suffers from several physical and mental impairments. An ALJ found that she suffers from lumbar spondylosis, asthma, migraines/headaches, chronic pain syndrome, diabetes with diabetic polyneuropathy, obesity, attention deficit hyperactivity disorder, schizoaffective disorder, bipolar type, posttraumatic stress disorder, social anxiety disorder, generalized anxiety disorder, and borderline personality disorder. Combs sought treatment for lower back pain in March 2018 at PPG, where she received various tests, treatments, and prescriptions through 2020.Combs applied for Disability Insurance Benefits in August 2019, alleging an onset of disability on December 24, 2015. The claim was denied initially and upon reconsideration. The district court concluded the ALJ’s determination was supported by substantial evidence. The Seventh Circuit affirmed, rejecting an argument that the ALJ should have concluded that Combs suffered a closed period of disability from June 2019 to July 2020 due to her back impairment, pain, and multiple invasive procedures that would have rendered her off task or absent beyond employer tolerances. The record amply supports the ALJ’s conclusion that Combs was not disabled at any time, including during that period. View "Combs v. Kijakazi" on Justia Law

The Supreme Court dismissed this direct appeal brought by the Iowa Department of Human Services (HDS) from a district court ruling requiring Iowa's Medicaid program to pay for sex reassignment surgery for two transgender adults and affirmed the denial of fees on cross-appeal, holding that the appeal was moot.Petitioners, adult transgender Iowans who were denied preauthorization for sex reassignment surgeries through the Medicaid program, appealed their managed care organization's denial of coverage to DHS. DHS affirmed the denials. The district court reversed, concluding that Iowa Code 216.7(3), an amendment to the Iowa Civil Rights Act (ICRA) violated the guarantee of equal protection under the Iowa Constitution. DHS appealed, but, thereafter, agreed to pay for Petitioners' surgeries. The Supreme Court dismissed the direct appeal as moot and affirmed the district court's order denying any fee award, holding that the court erred in denying Petitioners' request for attorney fees. View "Vasquez v. Iowa Dep't of Human Services" on Justia Law

The Supreme Court reversed the judgment of the district court concluding that the Iowa Department of Human Services (DHS) was entitled to a detailed accounting and all of the residual funds The Center for Special Needs Trust Administration, Inc. had retained from Steven Muller's trust subaccount, holding that the district court erred.The Center for Special Needs Trust Administration, Inc. acted as trustee over a pooled special needs trust subaccount for the benefit of Muller. After Muller died, the Center retained all residual funds in his trust subaccount. DHS sought judicial intervention to obtain a detailed accounting of the retained funds. The district court decided in favor of DHS and ordered the Center to pay DHS all of the funds it had retained from the subaccount. The Supreme Court reversed, holding that the Center provided an adequate accounting, and therefore, the district court lacked authority to grant the relief it provided to remedy the Center's alleged failure to account for the retained funds. View "In re Medical Assistance Pooled Special Needs Trust of Steven Muller" on Justia Law

The Supreme Court affirmed the judgment of the district court granting summary judgment for the Center for Special Needs Trust Administration, Inc., as trustee of a polled special needs trust held for the benefit of Scott Hewitt, and dismissing this action brought by the Iowa Department of Human Services (DHS) claiming it was entitled to a detailed accounting, holding that the trustee provided an adequate accounting.Title XIX of the Social Security Act required that the funds remaining in Hewitt's trust subaccount when he died must first be used to reimburse the state for its Medicaid expenditures. DHS filed a petition to invoke jurisdiction over the irrevocable trust, claiming that it was entitled to a detailed accounting to ensure that the funds retained by by the pooled special needs trust were used for a proper purpose. The district court granted summary judgment for the Center, concluding that no further accounting was required absent evidence that the Center breached its duties as trustee. The Supreme Court affirmed, holding that DHS was not entitled to relief on its claims of error. View "In re Medical Assistance Pooled Special Needs Trust Of Scott Hewitt" on Justia Law

Plaintiff, MSP Recovery Claims, Series LLC (“MSP”) appealed from the district court’s judgment dismissing for lack of standing its putative class action against Defendant Hereford Insurance Company (“Hereford”) and denying leave to amend. MSP has brought several lawsuits around the country seeking to recover from insurance companies that allegedly owe payments to Medicare Advantage Organizations (“MAOs”) under the Medicare Secondary Payer Act (the “MSP Act”). In the putative class action brought here, MSP charges Hereford with “deliberate and systematic avoidance” of Hereford’s reimbursement obligations under the MSP Act.   The Second Circuit affirmed. The court concluded that MSP lacked standing because its allegations do not support an inference that it has suffered a cognizable injury or that the injury it claims is traceable to Hereford. The court also concluded that the district court did not abuse its discretion when it denied MSP leave to amend based on MSP’s repeated failures to cure. The court explained that the plain language of Section 111 provides that when a no-fault insurance provider such as Hereford reports a claim pursuant to Section 111, it does not thereby admit that it is liable for the claim. The statutory context of the section’s reporting obligation and the purpose of the reporting obligation confirms the correctness of this interpretation. Because MSP’s argument that the payments made by EmblemHealth are reimbursable by Hereford rests entirely on its proposed interpretation of Section 111, MSP has not adequately alleged a “concrete” or “actual” injury or that the injury it alleges is fairly traceable to Hereford. View "MSP v. Hereford" on Justia Law

Appellants challenged the appointment of Social Security Administration Acting Commissioner Nancy Berryhill under the Federal Vacancies Reform Act (FVRA). They argue that no one may serve as an acting officer under 5 U.S.C. Section 3346(a)(2), which allows acting service while a nomination is pending in the Senate unless that nomination occurred during the initial 210-day period of acting service allowed by 5 U.S.C. Section 3346(a)(1). Appellants assert that Section 3346(a)(2) serves only to toll Section 3346(a)(1)’s time limit and does not authorize an independent period of acting service.   The Fourth Circuit affirmed. The court rejected Appellants’ argument because Section 3346(a)(1) and Section 3346(a)(2) are, by their plain text, disjunctive and independent. Because Berryhill was legally serving as Acting Commissioner, her appointments of the ALJs who decided Appellants’ cases were valid. The court explained that Appellants’ reading of the statute would shift the balance against the President. It would prevent him from designating anyone to serve as an acting officer if he submits a nomination after the 210-day period has elapsed, thus leaving the office vacant for as long as the Senate takes to consider it. View "Barbara Rush v. Kilolo Kijakazi" on Justia Law

Plaintiff filed a claim under 42 U.S.C 405(g), believing the Social Security Administration miscalculated his benefits. He filed his claim more than one year after the SSA verbally denied his request for review, and after he did not receive the requested written documentation of the SSA's denial.The SSA filed a motion to dismiss, arguing that the district court lacked subject matter jurisdiction because Sec. 405(g)’s waiver of sovereign immunity applied only with respect to judicial review of a “final decision of the Commissioner of Social Security” and that Plaintiff had not obtained a final decision, having refused to exhaust the four-step administrative process. The district court granted SSA’s motion.Finding that Sec. 405(g)’s exhaustion requirement is not jurisdictional, the Fourth Circuit nonetheless concluded that exhaustion is a mandatory requirement of the Social Security Act that may be excused only in a narrow set of circumstances, which were not present in this case. Accordingly, the court affirmed the district court’s dismissal. View "L.N.P. v. Kilolo Kijakazi" on Justia Law