Justia U.S. 6th Circuit Court of Appeals Opinion Summaries

Forester was awarded benefits under the Black Lung Benefits Act, 30 U.S.C. 901-944, as amended by the Patient Protection and Affordable Care Act, 124 Stat. 119, after the ALJ determined that Forester’s five years of private coal mine employment with Navistar’s predecessor, combined with his16 years of employment as a mine inspector with the U.S. Department of Labor’s Mine Safety and Health Administration , rendered him eligible for the rebuttable presumption that, having been employed for at least 15 years in underground coal mines, and having a totally disabling respiratory or pulmonary impairment, he was totally disabled due to pneumoconiosis, commonly known as black lung disease. The Benefits Review Board upheld the award. The Sixth Circuit vacated, holding that a federal mine inspector is not a “miner” for purposes of the BLBA, and remanding for determination of whether Forester is entitled to an award of BLBA benefits without the benefit of the 15-year presumption. View "Navistar, Inc. v. Forester" on Justia Law

Groups of hospitals in the Cincinnati area and in rural Iowa, challenged the Secretary of Health and Human Services’ calculation of how much to pay those hospitals for inpatient services under Medicare Part A. The hospitals objected to the agency’s decision to include in the calculation the hours associated with a short-term disability program paid from a hospital’s general funds through its payroll system and a program offering a full-time salary for part-time weekend work. The district court entered summary judgment for the Secretary. The Sixth Circuit affirmed, finding the agency’s interpretation was not arbitrary or capricious and referring to “the most completely impenetrable texts within human experience,” statutes and regulations that “one approaches ... at the level of specificity herein demanded with dread.” View "Atrium Medical Ctr. v. U.S. Dep't of Health & Human Servs." on Justia Law

The Randolph-Sheppard Act, 20 U.S.C. 107–107e, gives blind persons a priority in winning contracts to operate vending facilities on federal properties. Fort Campbell, Kentucky, operates a cafeteria for its soldiers. For about 20 years, Kentucky’s Office for the Blind (OFB) has helped blind vendors apply for and win the base’s contracts for various services. In 2012, the Army, the federal entity that operates Fort Campbell, published a solicitation, asking for bids to provide dining-facility-attendant services. Rather than doing so under the Act, as it had before, the Army issued this solicitation as a set aside for Small Business Administration Historically Underutilized Business Zones. OFB, representing its blind vendor, filed for arbitration under the Act, and, days later, filed suit, seeking to prevent the Army from awarding the contract. The district court held that it lacked jurisdiction to consider a request for a preliminary injunction. The Sixth Circuit vacated. OFB’s failure to seek and complete arbitration does not deprive the federal courts of jurisdiction. View "Commonwealth of Kentucky v. United States" on Justia Law

Warner, insured by State Farm, was involved in an automobile accident. Following the accident, Michigan Spine provided Warner with about $26,000 of neurological treatment. State Farm denied coverage, stating that Warner’s condition was the result of a preexisting condition. Michigan Spine submitted the claim to Medicare, which approved a conditional payment of $5,000 under the Medicare Secondary Payer Act, 42 U.S.C. 1395y. Michigan Spine sued State Farm under Michigan’s No-Fault Act and the Medicare Secondary Payer Act, which permits private causes of action against primary plans that fail to pay medical expenses for which they are responsible. The district court dismissed, holding that a private party can recover under the Secondary Payer Act only if a “primary plan” has failed to provide appropriate reimbursement only because the planholder is entitled to Medicare benefits, and State Farm did not deny coverage on that basis. The Sixth Circuit reversed and remanded. Although the text of the Secondary Payer Act is unclear as to whether a private cause of action is available against a non-group health plan that denies coverage on a basis other than Medicare eligibility, accompanying regulations and congressional intent indicate that the requirement applies only to group health plans and not to non-group health plans. Michigan Spine may pursue its claim under the Secondary Payer Act. View "MI Spine & Brain Surgeons, PLLC v. State Farm Mut. Auto Ins Co" on Justia Law

In 2003 the Social Security Administration denied DeLong’s applications for Disability Insurance Benefits. After each of three hearings, the ALJ concluded that DeLong was not disabled. After the third determination, the Appeals Council declined further review. In 2010, DeLong challenged the denial under 42 U.S.C. 405(g) and 1383(c)(3). The district court vacated and remanded, concluding that the ALJ had failed to provide ‘good reasons’ for the weight he gave to the opinions of treating physicians,” but rejected two other claims, noting that credibility determinations are peculiarly within the province of the ALJ, that the ALJ had not mischaracterized underlying medical evidence, and no error in the consideration of lay opinion evidence. DeLong sought attorney fees under the Equal Access to Justice Act, 28 U.S.C. 2412, contending that the denial of benefits and defense of the denial had lacked substantial justification. The district court denied the motion, reasoning that the agency’s position was substantially justified because the court had rejected all but one argument; DeLong had improperly attempted to present evidence in court that she had not presented to the ALJ; the record did not “strongly establish” entitlement to benefits; and the reversal was on procedural, not substantive, grounds. The Sixth Circuit affirmed. View "DeLong v. Comm'r of Social Sec." on Justia Law

Demyanovich, an employee of Cadon for more than 20 years, was terminated after he requested leave under the Family and Medical Leave Act to treat his congestive heart failure. He had previously taken leave and his condition had gotten worse over the course of about 10 years. He claimed that Cadon and his direct supervisor, Ensign, interfered with his exercise of his FMLA rights, retaliated against him for seeking FMLA leave, and discriminated against him on the basis of disability. Ensign denied the FMLA request because he believed that Cadon did not have enough employees to be subject to the Act, but referred to Demyanovich as a “liability” immediately after the request for FMLA leave. The district court entered summary judgment in favor of Cadon. The Sixth Circuit reversed, noting evidence that establishs a genuine factual dispute as to whether Demyanovich was permanently incapable of working at the time that he was terminated. View "Demyanovich v. Cadon Plating & Coating, L.L.C." on Justia Law

Gentry has psoriasis, a chronic autoimmune condition causing patches of raised skin covered with flaky buildup of dead skin cells that crack and bleed and can interfere with sleeping, walking, sitting, standing, and using one’s hands. She also has psoriatic arthritis, an inflammatory disease that causes fatigue, stiffness and swelling in and around the joints, tenderness, pain and swelling in the tendons, swollen fingers and toes, and reduced range of motion. There is no cure for either condition. Gentry suffered severe injuries to her ankle, arm and wrist, and hip in a 1994 car accident and developed avascular necrosis and post-traumatic arthritis. She requires a brace on her leg to walk, has a limp and waddling gait, and has frequent pain in her leg and foot, back, neck, and hands. She also has deformities in her foot, ankylosing spondylitis cervical radiculopathy, cervical stenosis, lumbar spondylosis, possible sacroilitis or facet arthropathy in the low back, degenerative joint disease in the low back, chronic lumbar strain, possible herniated disc carpal tunnel syndrome, and lumbosacral/thoracic radiculopathy, among other things. In 2004, Gentry (age 29) applied for disability benefits under the Social Security Act, 42. U.S.C.401. She had worked 10 years as a pizza maker and delivery driver. She had most recently worked as a receptionist, but was discharged because her psoriasis bled on the paperwork. After Gentry’s application was denied, the case was remanded twice. The district court affirmed the denial of benefits. The Sixth Circuit reversed the denial as not supported by substantial evidence. View "Gentry v. Comm'r of Soc. Sec." on Justia Law

The former miner sued in 1992 and an administrative law judge determined that he was not medically qualified for benefits under the Black Lung Benefits Act, 30 U.S.C. 901 and indicated that Arkansas Coals was not the “responsible operator” required to pay benefits. About 17 years later, the miner filed a second claim. After finding that his medical condition had worsened and that he was now disabled, an ALJ awarded benefits and determined that Arkansas Coals was the responsible operator. The Benefits Review Board and the Sixth Circuit affirmed, rejecting the company’s finality, waiver, and collateral estoppel arguments; the miner was entitled to bring a second claim under 20 C.F.R. 725.309(d)(4) and the determination that Arkansas Coals was the responsible operator was not “necessary” to the resolution of the initial claim. Substantial evidence supports the determination that Arkansas Coals is the responsible operator. View "Arkansas Coals, Inc. v. Lawson" on Justia Law

Maynes, a miner who developed pneumoconiosis after working in Consolidated’s coal mine for 25 years, received benefits under the Black Lung Benefits Act, 30 U.S.C. 901-944, from 1997 until he died of respiratory failure in 2003. His widow sought survivors’ benefits. The then-current version of the BLBA conditioned her eligibility for benefits on proof that pneumoconiosis either caused or hastened her husband’s death. Her 2003 claim was denied. The Benefits Review Board and Sixth Circuit affirmed. In 2010, Congress passed the Affordable Care Act, which amended the law so that survivors are automatically entitled to benefits if the miner received BLBA benefits during his lifetime. Congress specified that the changes would apply to claims filed after January 2005, but did not address whether persons whose claims had been denied under the previous eligibility framework, could receive benefits by filing a subsequent claim. The issue was answered in the affirmative by the Benefits Review Board and affirmed by the Third and Fourth Circuits. Although the Department of Labor, an administrative law judge, and the Benefits Review Board agreed Maynes was entitled to benefits, they disagreed about the appropriate commencement date for benefits. The Sixth Circuit rejected Consolidated’s appeal, upholding the 2009 commencement date. View "Consolidation Coal Co. v. Maynes" on Justia Law

Ogle, born in 1954, worked in underground coal mines for 21 years, most recently in 1996 in Kentucky. Ogle smoked since age 12. He sought black lung benefits in 2007. After the record closed but before the ALJ issued a decision, Congress revived a rebuttable statutory presumption that a coal miner who worked in an underground mine for at least 15 years and suffers from a total respiratory or pulmonary disability is presumed to be totally disabled due to pneumoconiosis, 30 U.S.C. 921(c)(4). The ALJ awarded benefits, finding that Ogle suffered from totally disabling respiratory impairment, a conclusion with which all medical opinions agreed. The ALJ stated that the presumption shifts the burden to demonstrate by a preponderance of the evidence that either the miner’s disability does not, or did not, arise out of coal mine employment or the miner did not, suffer from pneumoconiosis. The Fund demonstrated that Ogle did not suffer from clinical pneumoconiosis, but failed to rebut the presumption that Ogle suffers from legal pneumoconiosis. The Board affirmed. The Sixth Circuit denied a petition for review, finding no evidence that the ALJ improperly restricted the Fund’s ability to rebut the 15-year presumption or that the ALJ applied the wrong standard. View "Big Branch Res., Inc. v. Ogle" on Justia Law