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

Keathley retired from working at strip mines. His health deteriorated. He sought Black Lung Benefits Act benefits, 30 U.S.C. 901. Keathley established eligibility under the 15 -year presumption; he had worked in mines for more than 16 years and was able to show a totally disabling impairment by medical opinion testimony and tests showing poor pulmonary function. His employer rebutted this presumption by offering testimony by Dr. Broudy, who diagnosed Keathley with “a combination of chronic obstructive asthma and pulmonary emphysema and chronic bronchitis” caused by smoking. Conceding that “coal dust may have contributed,” Broudy concluded that “it’s far more likely that the impairment was due to obstructive airways disease from cigarette smoking and some predisposition to asthma or bronchospasm.” On remand, the ALJ awarded benefits; the Benefits Review Board affirmed, rejecting Broudy’s opinion that “bronchitis associated with coal dust exposure usually ceases with cessation of exposure,” as contrary to federal regulations, which state that “pneumoconiosis” may be “latent and progressive” and arise after exposure ceases. The Sixth Circuit denied the employer’s petition for review. The employer did not challenge the evaluation of individual tests, identify any factor the ALJ overlooked, or offer any basis for distinguishing among the tests. View "Sunny Ridge Mining Co., Inc. v. Keathley" on Justia Law

The district court awarded Naegel, counsel for a prevailing social security disability benefits applicant, significantly reduced attorneys’ fees under 42 U.S.C. 406(b). He claimed that the court should have approved his request for $26,049.73, the 25-percent contingency fee accepted by his client and permitted by statute. The Commissioner of Social Security, representing the interests of the claimant whose benefits pay for the fees, opposed that sum as a “windfall” in light of counsel’s 35.5 hours of work. The district court agreed and awarded $12,780. The Sixth Circuit affirmed, noting that: “Within the 25 percent boundary,” prevailing counsel bears the burden of “show[ing] that the fee sought is reasonable for the services rendered.” View "Lasley v. Comm'r of Soc. Sec." on Justia Law

Wallace worked for FedEx for 21 years in a variety of positions. By 2007, she was a senior paralegal, but she had a variety of health problems that required her to take leave from her position. FedEx offered Wallace leave under the Family and Medical Leave Act (FMLA), and its representatives verbally asked her to complete a medical-certification form. FedEx never explained the consequences of not returning a completed form. Wallace failed to provide FedEx with medical certification, and once she was absent for two consecutive days after the form was due, FedEx terminated her employment. Wallace filed suit under the FMLA, alleging that FedEx interfered with her rights under the statute. A jury awarded damages of $173,000, which the judge reduced to $90,788. The Sixth Circuit reversed the remittitur decision and ordered the magistrate judge to enter judgment in favor of Wallace in the amount of $173,000.View "Wallace v. FedEx Corp." on Justia Law

Because of a 2007 car accident, Glenn suffers from degenerative disc disease, a closed head injury and cerebral concussion that cause dizziness and memory loss, left shoulder tendonitis, and post-traumatic headaches. She also suffers major depression, with slow thought processes, mood swings, agitation, poor concentration, anxiousness, feelings of anger and hopelessness, paranoia, auditory hallucinations, and suicidal and homicidal ideation. She has a chronic skin condition that has caused cysts around the vulva that occasionally prevent her from walking and require frequent bathroom breaks. In 2008, Glenn sought social security benefits. Following her hearing, at which Glenn appeared without counsel, the ALJ denied the application at the fifth step of the required analysis: whether, taking into account age, education, and work experience, the claimant can perform other work. The Appeals Council declined review. The district court remanded, based on five errors, but denied attorney’s fees under the Equal Access to Justice Act, finding that the government’s position on appeal was “substantially justified” because the magistrate rejected three of Glenn’s claims of error. The Sixth Circuit reversed the denial of fees. Regardless of what happens on remand, Glenn had to retain counsel to ensure that her claim would be properly adjudicated.View "Glenn v. Comm'r of Soc. Sec." on Justia Law

Sterling, a former coal miner, received a favorable decision from an administrative law judge (ALJ) declaring him eligible for benefits under the Black Lung Benefits Act, 30 U.S.C. 901. The Department of Labor’s Benefits Review Board affirmed. The Sixth Circuit denied a petition by Sterling’s employer that argued that the ALJ wrongly applied the statutory presumption of pneumoconiosis, improperly discredited certain medical opinions disputing Sterling’s pneumoconiosis diagnosis, and failed to explain his resolution of conflicting evidence about the extent of Sterling’s past cigarette smoking. View "Central OH Coal Co. v. Dir.r, Office of Workers' Comp. Programs" on Justia Law

Groves worked as a strip miner for more than 20 years and a smoker who accumulated more than 50 pack-years. His first claim for black lung benefits, in 1998, was denied. Groves filed his current application in 2006. The ALJ awarded benefits in 2009. The Benefits Review Board vacated and remanded so that the ALJ could provide more detailed explanations. On remand, the ALJ again granted benefits after a careful review of the medical opinions of several different doctors who evaluated Groves’ lung disease, Chronic Obstructive Pulmonary Disease (COPD). The Board affirmed. The Sixth Circuit remanded. While substantial evidence supported the determination that Groves’s COPD arose at least in part out of coal mining employment, the ALJ apparently did not apply the correct standard in determining that his total disability was due to pneumoconiosis.View "Arch on the Green, Inc. v. Groves" on Justia Law

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