Articles Posted in Public Benefits

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Michigan’s Medicaid waiver program provides individuals with developmental disabilities community-based services. Washtenaw County changed its budgeting method in 2015. Notices sent to recipients acknowledged that recipients would have to pay service-providers less in order to maintain their approved hours of service. The Association, a nonprofit community organization assisting individuals with developmental disabilities, joined with three individual plaintiffs to filed suit, alleging due process violations and seeking a preliminary injunction. The Association’s CEO testified that 169 individuals, including the three named plaintiffs, had received notices and that the three were Association members. The district court concluded that the Association lacked associational standing because the 169 people for whom it claimed associational standing were not shown to be members; the named members, in their individual capacities, were not entitled to injunctive relief because they had appealed the reductions and received favorable decisions so “there can be no irreparable harm suffered by the named Plaintiffs as a result of the inadequate notice.” The Sixth Circuit affirmed, noting that “standing is not dispensed in gross.” An individual must demonstrate standing for each claim he seeks to press and for each form of relief sought; an association that relies upon an individual member for standing purposes must do the same. The Association has not shown that any named member had standing to seek fresh notices and hearing rights when it filed its complaint.. View "Waskul v. Washtenaw County Community Mental Health" on Justia Law

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Cardew, a wheelchair-bound quadriplegic, had a summer internship with Lear Corporation thanks to his cousin, a Lear vice president. Over about three months, Cardew earned $5,502.75. Lear allowed Cardew a 30-hour work week, rather than the typical 40-hour week; exempted him from tasks typically assigned interns that involved traveling and from clerical tasks because of his difficulty with typing; and allowed more frequent breaks to adjust his position to avoid skin ulcers and use the restroom. Lear also paid $4,0000 to modify doors to be wheelchair-accessible. After the internship, Cardew applied for child disability benefits retroactive to age 15, when an accident rendered him, quadriplegic. Having applied after his eighteenth birthday, he had to prove that he has lived with a continuous disability since the accident. An ALJ denied Cardew’s application based on the income he received from Lear, reasoning that because Cardew’s earnings over three months exceeded a “bright line” threshold in the regulations, he had been “able to work at the substantial gainful activity level.” The Sixth Circuit vacated, finding the legal analysis incomplete and more rigid than the regulations require. Even assuming Cardew engaged in “gainful” activity, the ALJ failed to consider all the special conditions attendant to Cardew’s internship that could rebut the presumption, created by his income, that he had engaged in “substantial” activity. View "Cardew v. Commissioner of Social Security" on Justia Law

Posted in: Public Benefits

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In November 2010, Hayes engaged Cybriwsky to represent him related to the denial of Hayes’s application for Social Security disability benefits. In February 2011, the case was remanded for further administrative hearings (42 U.S.C. 405(g)) because faulty recordings of the hearings rendered the record inaudible. On remand, the Administrative Law Judge entered a fully favorable decision for Hayes in August 2011. The district court affirmed in April 2012. The next month Cybriwsky sought attorney’s fees under the Equal Access to Justice Act, 28 U.S.C. 2414. The court granted attorney’s fees of $2,225 in August 2012. In April 2017, Cybriwsky moved, under 42 U.S.C. 406(b), seeking more than $11,000. in fees. He subsequently provided documentation of the fee arrangement, benefits paid to Hayes, and an itemized description of the work performed. By the time Cybriwsky filed his 2017 motion, the SSA had released the 25% of past-due benefits normally reserved to pay attorney’s fees; $5,300 was awarded to Hayes’s attorney at the administrative level and the remainder was released to Hayes. Any fees awarded to Cybriwsky would have to be recovered from Hayes, either directly or by having fees taken from Hayes’s monthly disability payments. The Sixth Circuit affirmed denial of the motion as untimely and determined that the circumstances did not merit the exercise of equitable tolling. View "Hayes v. Commissioner of Social Security" on Justia Law

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The VA determined that West, a Viet Nam veteran, was eligible for a disability pension. Two days later West died. Four days later—without knowing that West had died—the government sent West a check for $8,660--his pension benefit retroactive to June 2013. In March 2014, a Kentucky probate court appointed West’s ex-wife, Brenda, as the Estate's executor. Brenda endorsed the VA check, the estate’s only cash asset, and deposited it into an escrow account. After three months, the VA determined that West’s estate was not entitled to the money, 38 U.S.C. 5121(a), and directed the bank to wire the $8,660 back to the U.S. Treasury. The bank complied. The Estate did not learn until later that its account had been drained of funds. More than 18 months later, the Estate obtained a Kentucky probate court order requiring the government to return the funds. The government removed the matter to the district court, which remanded the matter back because the $8,660 was already subject to the probate court’s jurisdiction. The Estate unsuccessfully sought attorneys’ fees. The Sixth Circuit reversed the remand order; the dispute can be litigated only under the procedure set forth in the Veterans’ Judicial Review Act, 102 Stat 4105. The court noted “concerns about the government’s expropriation of the Estate’s funds without any advance notice or process.” View "Estate of West v. United States Department of Veterans Affairs" on Justia Law

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In 2010, Earley applied for disability benefits, 42 U.S.C. 423(d)(2)(A), 1382c(a)(3)(B) . In 2012, an ALJ rejected the application on the ground that Earley, who suffered from fibromyalgia, mild carpal tunnel syndrome, panic disorder, degenerative disk disease, and major depression, did not have a covered disability. She applied again for a new period of time. The same ALJ denied her benefits, citing Sixth Circuit precedent (Drummond) as requiring him to give preclusive effect to the work-capacity finding he had made during the first proceeding absent “new and material evidence documenting a significant change in the claimant’s condition.” The district court reversed, concluding that the Drummond “principles of res judicata” apply only when they favor an individual applicant, not the government. The Sixth Circuit disagreed. The key principles protected by Drummond—consistency between proceedings and finality with respect to resolved applications—apply to individuals and the government but do not prevent the agency from giving a fresh look to a new application containing new evidence or satisfying a new regulatory threshold that covers a new period of alleged disability while being mindful of past rulings and the record in prior proceedings. View "Earley v. Commissioner of Social Security" on Justia Law

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Raymond, a veteran of the U.S. Air Force, was born in 1947 and was a long-term resident of Middlesboro, Kentucky. He worked in the coal-mining industry for over 20 years and developed severe respiratory issues. Raymond, a non-smoker, sought benefits under the Black Lung Benefits Act, 30 U.S.C. 901, but died while his claim was pending. Raymond’s claim was consolidated with a claim for survivor’s benefits submitted by his widow, Joanna. The ALJ awarded benefits to Joanna, on both Raymond’s behalf, and as his surviving spouse. The Benefits Review Board affirmed. Zurich, the insurer of Straight Creek Coal, sought review. The Sixth Circuit denied Zurich’s petition, upholding the ALJ’s conclusions that Zurich failed to rebut the presumption of timeliness, that Raymond had worked for at least 15 years in qualifying employment, and that Raymond had a total respiratory disability. Raymond worked only in surface mines or coal-preparation plants during his career; the ALJ properly relied on 20 C.F.R. 718.305(b)(2) and determined whether Raymond’s mining employment was “substantially similar” to underground mining. View "Zurich American Insurance Group v. Duncan" on Justia Law

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In 1990, an Ohio state court ordered Jacobs to pay Collin $13,800 in child-support payments. Jacobs subsequently began to receive social security benefits, but, by January 2014, Jacobs’s arrearage totaled $45,356. The state court directed the Commissioner to garnish Jacobs’s social-security payments, 42 U.S.C. 659. In October 2015, the Commissioner mistakenly terminated the garnishment. A year later Collin asked the court to order the Commissioner to resume the garnishment and to pay a lump sum equal to the amount the Commissioner had failed to garnish. The Commissioner voluntarily resumed the garnishment. The Sixth Circuit affirmed dismissal, holding that Collin’s demand was for “money damages,” so the United States was immune from suit. Section 659(a) provides that moneys payable by[] the United States . . . to any individual . . . shall be subject, in like manner and to the same extent as if the United States . . . were a private person, to withholding . . . to enforce the legal obligation ... to provide child support"; but 5 C.F.R. 581.305(e)(2) states “Neither the United States ... nor any governmental entity shall be liable ... to pay money damages for failure to comply with legal process.” The relief Collin seeks is not enforcement of “the statutory mandate itself” but instead damages for the failure to withhold, for which the government has not waived its immunity. View "Collin v. Commissioner of Social Security" on Justia Law

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Biestek, age 54, worked for most of his life as a carpenter and a construction laborer, frequently transporting scaffolding, panels, and other construction materials around work sites. He completed at least one year of college and received additional vocational training as a bricklayer and carpenter. He stopped working in June 2005, allegedly due to degenerative disc disease, Hepatitis C, and depression. Biestek applied for Supplemental Security Income and Disability Insurance Benefits in March 2010, alleging a disability onset of October 2009. A Social Security Administration ALJ denied Biestek’s application. The district court remanded because the ALJ had not obtained necessary medical-expert testimony and did not pose a sufficiently specific hypothetical to the vocational expert. The ALJ subsequently issued a partially favorable decision finding Biestek disabled starting in May 2013, on his fiftieth birthday, the point at which the Agency deems an applicant “closely approaching advanced age” and presumptively disabled under 20 C.F.R. 404. The ALJ found that Biestek was “not disabled” before that date. The Sixth Circuit affirmed. Substantial evidence supported the ALJ’s finding the that Biestek did not meet or medically equal the back-pain-related impairment listed at 20 C.F.R. 404. The ALJ properly evaluated the testimony of medical experts and a vocational expert. View "Biestek v. Commissioner of Social Security" on Justia Law

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Biestek, age 54, worked for most of his life as a carpenter and a construction laborer, frequently transporting scaffolding, panels, and other construction materials around work sites. He completed at least one year of college and received additional vocational training as a bricklayer and carpenter. He stopped working in June 2005, allegedly due to degenerative disc disease, Hepatitis C, and depression. Biestek applied for Supplemental Security Income and Disability Insurance Benefits in March 2010, alleging a disability onset of October 2009. A Social Security Administration ALJ denied Biestek’s application. The district court remanded because the ALJ had not obtained necessary medical-expert testimony and did not pose a sufficiently specific hypothetical to the vocational expert. The ALJ subsequently issued a partially favorable decision finding Biestek disabled starting in May 2013, on his fiftieth birthday, the point at which the Agency deems an applicant “closely approaching advanced age” and presumptively disabled under 20 C.F.R. 404. The ALJ found that Biestek was “not disabled” before that date. The Sixth Circuit affirmed. Substantial evidence supported the ALJ’s finding the that Biestek did not meet or medically equal the back-pain-related impairment listed at 20 C.F.R. 404. The ALJ properly evaluated the testimony of medical experts and a vocational expert. View "Biestek v. Commissioner of Social Security" on Justia Law

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In 1988, an ALJ awarded Smith supplemental security income (SSI). Smith received benefits until 2004 when he was found to be over the resource limit. Smith filed another SSI application in 2012, alleging additional medical conditions. The application was denied on March 26, 2014. Smith claims that he mailed a request for review on April 24, 2014. On September 21, Smith faxed a correspondence to the Social Security Administration, inquiring about the status of his appeal, with a copy of his request, dated April 24, 2014. A representative informed Smith that his request was not in the “electronic folder,” that if the Council had received the request, it would have mailed a receipt, and that his appeals request was filed as of October 1, 2014. The Council dismissed the request as untimely, finding no good cause to extend the deadline because Smith could not provide evidence that it was sent within the appropriate time. The district court determined that there was no judicial review available because the dismissal did not constitute a final decision and Smith made no colorable constitutional claims. The Sixth Circuit affirmed, rejecting arguments that Smith suffered due process violations because his request was timely submitted, different ALJs presided over his hearing and signed his decision, and the ALJ referenced the 1988 decision but failed to attach a copy as an exhibit. View "Smith v. Commissioner of Social Security" on Justia Law