Public Benefits - Justia Case Law Summaries

US v. Gonzalez

2026-07-30T14:00:03-08:00

An individual, born in 1937, assumed the identity of his younger brother, who died in infancy, to fraudulently obtain a second Social Security number and collect retirement benefits under both his own and his brother’s identities. Over the course of nearly two decades, he received Social Security payments in both names and also procured and used U.S. passports issued under his deceased brother’s identity. His scheme unraveled after a state motor vehicle official noticed similarities between two identification cards with different names but similar photos and addresses. Subsequent investigation revealed the use of both identities for benefits and travel, as well as submission of multiple passport applications with false information. A grand jury in the United States District Court for the District of Maine indicted the defendant on six counts, including identity theft, passport fraud, Social Security fraud, and mail fraud. At trial, the defendant contested the propriety of venue in Maine for two passport fraud counts and challenged the calculation of restitution. The district court submitted the venue question to the jury, which found venue proper for both passport counts and convicted him on all charges. He was sentenced to probation and ordered to pay $175,757 in restitution. Upon appeal, the United States Court of Appeals for the First Circuit reviewed the jury’s venue determinations and the restitution order. The court held that sufficient circumstantial evidence supported venue in Maine for both the false statement in the passport application and the use of a fraudulently obtained passport, applying the appropriate legal standards for each count. The court also found no abuse of discretion in the district court’s method for calculating restitution, concluding that the government met its burden of proof regarding the loss amount. The First Circuit affirmed both the convictions and the restitution order. View "US v. Gonzalez" on Justia Law

In re Violet S.

2026-07-30T10:31:59-08:00

After her 18th birthday, a young woman with severe disabilities, requiring 24-hour care and living in a subacute facility since infancy, was placed under extended foster care as a nonminor dependent. She had no family contact and lacked the mental capacity to make independent decisions. Her county child welfare agency regularly submitted reports and transitional independent living plans, documenting her progress and confirming her continued eligibility for extended foster care. The agency recommended continued jurisdiction, especially while her application for supplemental security income was pending, and later reported plans for her care to be managed by a regional center as she approached adulthood. The Superior Court of San Bernardino County repeatedly found that she was making satisfactory progress toward her care goals and met the requirements to remain a nonminor dependent. The court ordered continued jurisdiction until, in a subsequent review, the agency recommended dismissal, citing the transition of her care to the regional center. Following a contested hearing, despite arguments from her counsel and guardian ad litem for continued court oversight, the juvenile court terminated jurisdiction. The court reasoned that ongoing jurisdiction was not in her best interest, finding no further benefit to her from county oversight given her new care arrangements. The California Court of Appeal, Fourth Appellate District, Division Two, reviewed the appeal. The court held that the juvenile court applied the wrong legal standard by terminating jurisdiction based on a subjective best interest determination instead of the statutory criteria. Under section 391, jurisdiction over a nonminor dependent may only be terminated if the nonminor does not wish to remain under jurisdiction, is not participating in a reasonable transitional plan, or cannot be located. None of these circumstances applied. The appellate court therefore reversed the termination order and directed reinstatement of jurisdiction. View "In re Violet S." on Justia Law

Ventura Cty Emp Ret Assn v. Crim J Atty Ret Assn Ventura Cty

2026-07-27T09:03:39-08:00

Several employee associations and a retired county employee challenged a resolution adopted by the Ventura County Employees’ Retirement Association (VCERA). The resolution limited the amount of cashed out leave that could be included in the calculation of “compensation earnable”—a key figure used to determine retirement benefits for so-called legacy members (employees hired before 2013) under the County Employees Retirement Law of 1937. The dispute centered on the California Public Employees’ Pension Reform Act of 2013 (PEPRA), which amended the law to exclude from pension calculations any leave cashout payments exceeding what may be “earned and payable in each 12-month period during the final average salary period,” regardless of when the payment is made. The controversy arose when a retired employee sought to have all 240 hours of his cashed out leave included in his final compensation period, even though county rules allowed only 200 hours to be cashed out per calendar year. The Santa Barbara County Superior Court granted summary adjudication in favor of VCERA, concluding that PEPRA’s section 31461(b)(2) was ambiguous but, as explained in the California Supreme Court’s earlier decision in Alameda County Deputy Sheriff’s Assn. v. Alameda County Employees’ Retirement Assn., the Legislature intended to curb “pension spiking” by imposing annual limits. The Second Appellate District, Division Six, affirmed this decision, interpreting the statute to mean that only leave cashouts within the annual limitation set by employment terms could be counted. The Supreme Court of California affirmed the Court of Appeal’s judgment. It held that section 31461(b)(2) of PEPRA excludes from pension calculations any cashed out leave that exceeds the applicable annual limit during the final compensation period, even if the period straddles two calendar years. This construction aligns with the statute’s purpose to prevent pension spiking and maintain the integrity and predictability of public pension systems. View "Ventura Cty Emp Ret Assn v. Crim J Atty Ret Assn Ventura Cty" on Justia Law

In Home Health, LLC v. Kennedy

2026-07-27T09:00:54-08:00

A hospice provider participated in the Medicare program and sought reimbursement for hospice services provided to several patients. Medicare, through its contractor, conducted a review and determined that a substantial number of the provider's claims did not meet the required coverage criteria, resulting in a demand for repayment of nearly $1 million. The contractor’s decision was partially reversed at the next level of administrative review for some claims, but a significant number were still denied. The provider pursued further administrative appeals, including a hearing before an administrative law judge (ALJ), where testimony and medical records were considered. The ALJ ultimately found that some additional claims were covered but upheld the denial of coverage for others, concluding that the provider was financially responsible for those denied claims and could not benefit from the statutory safe harbor. After the Medicare Appeals Council failed to resolve the provider’s appeal within the prescribed time, the provider sought judicial review in the United States District Court for the Northern District of Ohio. The district court affirmed the ALJ’s decision, agreeing with the denial of coverage for the disputed claims and with the determination that the provider was not entitled to the safe harbor protection. On appeal, the United States Court of Appeals for the Sixth Circuit reviewed two issues: whether substantial evidence supported the ALJ’s denial of Medicare coverage for the claims, and whether the ALJ properly applied the Medicare statute’s safe harbor provision. The appellate court held that substantial evidence did support the denial of coverage. However, it determined that the ALJ had applied the wrong legal standard to the safe harbor inquiry. The Sixth Circuit clarified that the correct standard requires assessment of whether the provider reasonably interpreted the relevant Medicare guidance as covering the disputed claims. The court vacated the district court’s judgment as to the safe harbor issue and remanded with instructions to return the case to the ALJ for application of the correct safe harbor standard to each disputed claim. View "In Home Health, LLC v. Kennedy" on Justia Law

Liapis v Bisignano

2026-07-06T12:00:46-08:00

The plaintiff, who has a history of bipolar disorder, chronic pain due to orthopedic injuries, and an ear injury, applied for disability benefits in July 2020, alleging an inability to work since December 2019. Several consultative medical examiners assessed the plaintiff’s physical and mental impairments. While most concluded that the plaintiff was capable of routine, unskilled work, one psychologist, Dr. Pushkash, found that the plaintiff’s ability to concentrate and persist on tasks was markedly impaired due to chronic pain and psychological symptoms, though his cognitive abilities were otherwise unremarkable. After his claim was denied by Wisconsin’s disability agency, both initially and on reconsideration, the plaintiff requested a hearing before an Administrative Law Judge (ALJ). The ALJ found the plaintiff was not disabled, deeming Dr. Pushkash’s opinion “generally unpersuasive” for reasons including the one-time nature of the evaluation and the psychologist’s comments on physical pain. The Appeals Council denied review, making the ALJ’s decision final. The plaintiff then sought review in the United States District Court for the Western District of Wisconsin, which affirmed the ALJ’s decision, focusing on the ALJ’s treatment of Dr. Pushkash’s opinion. On appeal, the United States Court of Appeals for the Seventh Circuit held that while the ALJ’s analysis of Dr. Pushkash’s opinion contained several legal errors—such as failing to properly address required regulatory factors and inconsistently assessing medical opinions—these errors were harmless. The court concluded that, even if Dr. Pushkash’s opinion were fully credited, the plaintiff would not meet the regulatory criteria for disability, as he did not have the requisite number of “marked” or “extreme” limitations in areas of mental functioning. Therefore, the Seventh Circuit affirmed the judgment of the district court. View "Liapis v Bisignano" on Justia Law

JACKSON v. COLLINS

2026-06-26T06:32:17-08:00

The case concerns an attorney who represented a veteran in seeking disability benefits from the Department of Veterans Affairs (VA). The veteran originally filed a claim in 2007 for a bilateral hip disability and received a rating in 2008, which was later increased. In 2018, the Board issued a final denial for a higher rating for the left hip, which was not appealed and thus became final. In 2021, after the veteran underwent left hip replacement surgery, the attorney assisted with a new claim, resulting in a significantly increased rating and an award of past-due benefits. The attorney sought fees from this award, arguing that her work fell within the statutory scheme permitting attorney’s fees for representation after notice of the agency’s initial decision. The Board of Veterans’ Appeals denied the attorney’s request for fees, reasoning that the December 2021 rating decision was the initial decision for the increased rating claim, and since the attorney had not performed compensable work after that decision, she was not entitled to fees under 38 U.S.C. § 5904(c)(1). The United States Court of Appeals for Veterans Claims affirmed, concluding that the September 2021 claim for increased compensation was a new claim, not part of the same “case” as the original 2007 claim, and thus the attorney’s work prior to the December 2021 decision was not compensable. The United States Court of Appeals for the Federal Circuit reviewed the matter de novo and affirmed the Veterans Court’s decision. The court held that, for purposes of attorney’s fees under § 5904(c)(1), a new claim for increased disability based on new evidence and circumstances is not part of the same “case” as the original claim. The attorney was not entitled to fees for work performed prior to the December 2021 rating decision. The judgment was affirmed. View "JACKSON v. COLLINS " on Justia Law

ORTIZ V. BISIGNANO

2026-06-24T08:01:26-08:00

The plaintiff, born in 1959, alleged disability beginning in 2016 due to chronic lower back and neck pain, degenerative disc disease, several mental health conditions, and a seizure disorder. His medical history included diagnoses of bipolar disorder, anxiety disorder, personality disorder, and non-epileptic seizures, all of which interfered with his ability to work and perform daily activities. He had not worked since 2010. His treating physician and two examining psychologists provided opinions that, if credited, would have required a disability finding. After an initial denial by an Administrative Law Judge (ALJ) and a remand by the Social Security Administration’s Appeals Council due to inconsistencies, the ALJ again denied benefits in 2020. The United States District Court for the Western District of Washington reversed and remanded, finding the ALJ’s rejection of the treating physician’s opinion was not supported by substantial evidence. On remand, a new ALJ issued another denial, again discounting the opinions of the treating and examining physicians and psychologists, and finding the plaintiff not disabled based mainly on nonexamining sources and selected evidence of normal functioning. The Magistrate Judge affirmed this decision, relying on the ALJ’s findings of inconsistencies and the law of the case doctrine regarding earlier credibility challenges. The United States Court of Appeals for the Ninth Circuit reviewed the case and held that the ALJ erred by not providing specific and legitimate reasons, supported by substantial evidence, for discounting the plaintiff’s treating physician’s and examining psychologists’ opinions, as well as the plaintiff’s subjective testimony regarding seizures and mental health symptoms. The court reversed the district court’s judgment and remanded with instructions to award benefits, concluding that the record was fully developed and did not leave serious doubt as to disability. View "ORTIZ V. BISIGNANO" on Justia Law

Department Of Health And Human Services v. Nrk Rx Inc.

2026-06-09T14:00:03-08:00

A state agency responsible for Medicaid administration alleged that a pharmacy and its owner, operating as a Medicaid provider, received excess Medicaid payments between 2011 and 2016 by submitting claims for more medications than records supported. After an audit, an administrative law judge upheld the agency’s determination of overpayment. The agency issued a final order demanding repayment, which survived several unsuccessful challenges by the pharmacy. In 2022, the agency, represented by the Attorney General, filed a civil action in Ingham County seeking to enforce its order and alleging common-law and statutory conversion, breach of contract, and unjust enrichment related to the overpayments. The defendants moved to change venue, arguing that the action should be heard in Wayne County, where the pharmacy owner resided and where the acts giving rise to the claims allegedly occurred, based on Michigan’s tort venue statutes. The Ingham Circuit Court transferred the case to Oakland County, identifying it as the site of the original injury. The Michigan Court of Appeals affirmed, holding that the tort venue statutes took precedence over the Attorney General venue provisions and that venue was proper in Oakland County, where the pharmacy’s registered office was located and where the funds were allegedly wrongfully withheld. The Supreme Court of Michigan reviewed the case and agreed with the Court of Appeals that the tort venue statutes, specifically MCL 600.1629 as mandated by MCL 600.1641(2), governed the venue determination because the complaint contained multiple claims, including a tort. However, the Supreme Court held that the “original injury” occurred in Ingham County, where the state agency was deprived of the funds and conducts its business. Therefore, venue was proper in Ingham County, not Oakland County. The Court affirmed in part, reversed in part, and remanded for transfer of the case to the Ingham Circuit Court. View "Department Of Health And Human Services v. Nrk Rx Inc." on Justia Law

Arcidiacono v Whitehorn

2026-06-08T12:31:36-08:00

Four individuals who were Medicaid beneficiaries in Illinois were admitted to long-term care facilities between 2018 and 2023. The facilities submitted required electronic admission packets to the Illinois Department of Healthcare and Family Services so that the cost of care could be reimbursed by Medicaid. In each case, the Department either rejected or mishandled these admission packets, resulting in the facilities not being reimbursed for all or part of the care provided. Despite regulations prohibiting providers from billing Medicaid beneficiaries for unreimbursed care, the facilities sent bills to the plaintiffs. The plaintiffs, however, did not pay these bills, nor did they suffer any loss of benefits or interruption in care. The plaintiffs filed a proposed class action in the United States District Court for the Northern District of Illinois against state officials responsible for Medicaid administration. They alleged violations of due process and the Medicaid Act, and requested only injunctive relief to require systemic changes in the admission packet review process. The defendants moved to dismiss, arguing both lack of standing and failure to state a claim. The district court found that the plaintiffs had standing because they received bills, but it dismissed the case for failure to state a claim, reasoning that the plaintiffs were not denied benefits or services and no statutory or constitutional rights were violated. On appeal, the United States Court of Appeals for the Seventh Circuit reviewed only standing. The appellate court held that the plaintiffs lacked standing for injunctive relief because they did not allege a real and immediate threat of repeated injury. The prior receipt of bills did not amount to legal harm, as the plaintiffs had no obligation to pay. The court modified the district court’s judgment to reflect a jurisdictional dismissal for lack of standing and affirmed the judgment as modified. View "Arcidiacono v Whitehorn" on Justia Law

Choi v. Tachibana Enterprises, LLC

2026-06-04T10:32:21-08:00

A part-time airport guide was terminated at the onset of the COVID-19 pandemic by her employer, a tour operations company serving Japanese-speaking tourists. The employer cited three incidents as reasons for termination: the employee’s failure to sign an acknowledgment of a revised handbook (containing an at-will employment clause), an incident involving attempted unauthorized use of a TSA priority lane at the airport, and a complaint from an airline about the employee’s conduct with staff. The employee, who was not proficient in English, did not sign the acknowledgment form due to lack of understanding and requested an explanation, as directed by the handbook. Following her termination, the employee applied for unemployment benefits. The Department of Labor and Industrial Relations’ Employment Security Appeals Referees’ Office initially granted benefits, but after a hearing (which the employee missed), an appeals officer reversed that decision, finding misconduct based on the three incidents. After a second hearing with interpretation services, the appeals officer reaffirmed the misconduct finding. The Circuit Court of the First Circuit affirmed the agency’s decision, finding no abuse of discretion or error, and adequate support in the record. The Intermediate Court of Appeals also affirmed, concluding the appeals officer did not clearly err and the employee had a fair opportunity to present her case. The Supreme Court of the State of Hawai‘i reviewed the case on certiorari. It held that none of the three incidents constituted misconduct under Hawai‘i unemployment law, which requires a wilful or wanton disregard of the employer’s interests. The Court reasoned that the failure to sign the acknowledgment did not meet this standard, especially since the employer’s own deadline was flexible and progressive discipline was not properly followed. The customer service incidents did not display the necessary degree of disregard. The Supreme Court vacated the decisions of the DLIR, circuit court, and ICA, and remanded for proceedings to determine the employee’s unemployment benefit amount. View "Choi v. Tachibana Enterprises, LLC" on Justia Law

In re Public Safety Officer Death Benefit for Groebner

2026-06-04T01:19:13-08:00

A patrol officer with the Anoka Police Department completed a 12-hour shift during which he responded to multiple calls, including emergency situations such as a domestic dispute involving a report of a child with a knife. The following day, the officer died from a vascular rupture. His widow applied for state line-of-duty death benefits, submitting medical evidence that the stressful nature of police work contributed to his fatal condition. While her application for federal death benefits was approved, the Commissioner of Public Safety denied her application for Minnesota death benefits, concluding the officer’s death did not meet the statutory criteria for being “killed in the line of duty.” After the Commissioner’s denial, the widow appealed to the Office of Administrative Hearings, where the Administrative Law Judge (ALJ) granted summary disposition in favor of the Commissioner. The ALJ found that the officer’s final shift did not involve “nonroutine stressful or strenuous physical law enforcement activity” as required by statute. The Minnesota Court of Appeals reversed, holding that there was a genuine issue of material fact regarding whether the officer engaged in such nonroutine activity during his last shift. The court also concluded that the definition of “killed in the line of duty” from prior Minnesota Supreme Court cases did not apply to deaths specifically addressed by the legislature in the statute. The Supreme Court of Minnesota reviewed the case and clarified the statutory presumption for certain heart-related deaths. The Court held that an emergency response is presumptively “nonroutine” under the statute, regardless of how frequently it occurs or how it is characterized by the agency. It also determined that the phrase “nonroutine stressful or strenuous physical” modifies all activities listed in the statute. Additionally, the Court held that if the statutory presumption does not apply or is rebutted, the officer’s estate may still prove line-of-duty death under the legal standard set forth in Kramer v. State, Peace Officers Benefit Fund, and Johnson v. City of Plainview. The decision of the Court of Appeals was affirmed in part and reversed in part. View "In re Public Safety Officer Death Benefit for Groebner" on Justia Law

Bonham v. Bisignano

2026-06-02T07:30:58-08:00

The appellant, a military veteran, developed significant neck and back issues following his service, which worsened in May 2012. Medical imaging revealed cervical spondylosis with a herniated disk, leading to spinal fusion surgery in October 2012. He continued to suffer pain and functional limitations, including weakness in his left arm, and received limited disability benefits from the Department of Veterans Affairs. In 2021, he applied for Social Security disability benefits, claiming a disability onset date in 2012 and eligibility through the end of 2016. His application was denied by an Administrative Law Judge (ALJ) after a hearing, where both the appellant and a vocational expert testified. The ALJ found that, despite severe impairments, the appellant retained the residual functional capacity to perform light work, including his past relevant work as generally performed and other jobs available in the national economy. The ALJ discounted the only medical opinion addressing his functional ability—a 2016 evaluation by a physician’s associate—because it was inconsistent with other medical records. The Social Security Appeals Council denied review. The United States District Court for the Western District of Missouri affirmed the ALJ’s decision, holding that the ALJ’s findings were supported by substantial evidence. On appeal, the United States Court of Appeals for the Eighth Circuit reviewed whether the ALJ’s decision was supported by substantial evidence and free from legal error. The court held that the ALJ properly based the residual functional capacity determination on all relevant medical evidence, not just specific functional medical opinions. The court found that the ALJ thoroughly considered the record, including conflicting medical findings, and was not required to obtain additional functional evidence. The judgment of the district court, affirming the denial of disability benefits, was affirmed. View "Bonham v. Bisignano" on Justia Law

VETERANS LEGAL ADVOCACY GROUP v. COLLINS

2026-06-01T05:01:22-08:00

A legal advocacy organization petitioned for a writ of mandamus to compel the Department of Veterans Affairs (VA) to update its mailing addresses, alleging that the VA continued to send correspondence to incorrect addresses despite repeated notifications of changes. The petitioner requested court intervention to ensure the VA updated its address records, ceased sending correspondence to wrong addresses, and imposed financial penalties for future errors. The United States Court of Appeals for Veterans Claims dismissed the petition as moot after the VA voluntarily corrected the addresses and created a policy to guide attorneys on updating their addresses. The VA also provided affidavits and a fact sheet to confirm these corrections. The petitioner subsequently sought attorney fees under the Equal Access to Justice Act (EAJA), asserting that the Veterans Court’s order requiring affidavits constituted the necessary “judicial imprimatur” for prevailing-party status. The Veterans Court denied the application, relying on Cavaciuti v. McDonough, and found there was no court-mandated decision on the merits and no material alteration to the parties’ legal relationship. On appeal, the United States Court of Appeals for the Federal Circuit reviewed whether the Veterans Court erred in denying attorney fees under EAJA. The Federal Circuit held that a court order requiring a party only to confirm voluntary corrective actions for the purpose of assessing mootness does not constitute sufficient judicial imprimatur to confer prevailing-party status under EAJA. The court found that the Veterans Court’s order did not address the merits of the petition or alter the legal relationship between the parties. The Federal Circuit therefore affirmed the Veterans Court’s denial of the EAJA application. View "VETERANS LEGAL ADVOCACY GROUP v. COLLINS " on Justia Law

CHAFIN v. OPM

2026-05-27T05:34:35-08:00

The petitioner began working as an Operational Support Technician with the Federal Bureau of Investigation in Miramar, Florida, in 1987. Her duties required her physical presence at the office, and she commuted daily from her home. In December 2016, she was found to have engaged in workplace misconduct—specifically, being under the influence while on duty—and was removed from her position in July 2018. In April 2019, she applied for Federal Employees’ Retirement System (FERS) disability retirement benefits, claiming that recurring seizures prevented her from commuting to work and performing the essential duties of her position. The Office of Personnel Management denied her application and subsequent request for reconsideration, determining that she had not established that her medical condition rendered her unable to provide “useful and efficient service” in her position. The petitioner appealed to the Merit Systems Protection Board. An administrative judge affirmed OPM’s determination, finding insufficient evidence that she was unable to perform the essential functions of her job. The judge also rejected her argument that her inability to commute, due to seizures and lack of transportation options, should be considered in assessing her disability status. The full Board adopted the administrative judge’s findings. The United States Court of Appeals for the Federal Circuit reviewed the Board’s final decision. The court held that, under 5 U.S.C. § 8451(a)(1)(B), the statutory definition of disability for FERS benefits does not include an employee’s ability to commute; only the refusal of reassignment to a position within the commuting area is governed by such considerations under § 8451(a)(2)(A). The court also ruled that it is statutorily barred from reviewing factual determinations underlying OPM’s disability findings. Accordingly, the Federal Circuit affirmed the Board’s decision. View "CHAFIN v. OPM " on Justia Law

Andersen v Hein

2026-05-26T07:08:43-08:00

Several individuals applied for federal Supplemental Security Income (SSI) but experienced delays in receiving a determination of eligibility. While they waited, New York State provided them with interim public assistance through the Safety Net Assistance (SNA) program, which required participation in work experience programs (WEPs). The value of the assistance was tied to the minimum wage for the hours worked. Once petitioners were deemed eligible for SSI, the Social Security Administration issued retroactive SSI payments covering the period of delay, and New York was reimbursed from these payments for the interim assistance it had provided. Petitioners received the remainder of the retroactive SSI after reimbursement. Following an unsuccessful administrative challenge, petitioners commenced a combined CPLR article 78 proceeding and putative class action, contending that New York’s practice of recouping the full value of SNA from their retroactive SSI awards violated the Fair Labor Standards Act (FLSA) by effectively creating an unlawful “kick-back” of minimum wage earned through WEP participation. Supreme Court ruled in petitioners’ favor, holding that the reimbursement process was subject to the FLSA and must reflect the value of WEP labor. The Appellate Division, Third Department, unanimously reversed, determining that petitioners were not deprived of minimum wage compensation because they had already received the value of their work in interim assistance and that reimbursement merely prevented duplicate payments for the same period. The New York Court of Appeals affirmed the Appellate Division’s order. It held that reimbursement to New York from petitioners’ retroactive SSI awards for interim assistance, conditioned on WEP participation, does not violate the FLSA. The Court concluded that petitioners received all compensation to which they were entitled under federal law, including the minimum wage, and that federal law expressly authorizes such reimbursement to prevent windfalls. The holding applies regardless of whether interim assistance is conditioned on work activities. View "Andersen v Hein" on Justia Law

Bellin v. McDonald

2026-05-21T06:01:25-08:00

A Medicaid recipient in her late 80s, suffering from serious health conditions, applied in 2019 for 24-hour at-home personal care services through New York’s Medicaid program. The state, which provides varying levels of in-home care to eligible Medicaid recipients, partners with private managed long-term care plans (MLTCPs) to assess needs and offer care plans. The plaintiff was initially offered only eight hours of daily care by all MLTCPs she applied to, though she believed she required around-the-clock assistance. Under New York’s regulations, individuals cannot immediately appeal the initial level of care offered; they must first enroll in the plan, request an increase, and only appeal if that request is denied. The plaintiff followed this process and ultimately received 24-hour care after subsequent assessments, but with a delay and a gap in retroactive reimbursement for services. The United States District Court for the Southern District of New York granted summary judgment to the defendants—the State's Health Commissioner and the MLTCP—holding that the plaintiff did not have a cognizable property interest in a particular level of care, and therefore no due process rights were implicated. The court also denied class certification. The plaintiff appealed these decisions. The United States Court of Appeals for the Second Circuit reviewed the case de novo. The Second Circuit disagreed with the District Court’s conclusion regarding the existence of a property interest. It held that New York’s laws, regulations, and practices substantially restrict discretion in determining eligibility for 24-hour personal care services, thereby creating a property interest for qualifying Medicaid recipients and triggering due process protections. However, the court determined that New York’s current appeals procedures, though delayed, are constitutionally adequate because the delay is modest, expedited procedures exist for urgent cases, and the overall private interests at stake are sufficiently protected. On this alternative ground, the Second Circuit affirmed the District Court’s grant of summary judgment to the defendants. View "Bellin v. McDonald" on Justia Law

Gibbs v. County of Humboldt

2026-05-13T09:02:12-08:00

A former court reporter who worked for nearly four decades for a California county discovered, as she approached retirement, that the county had failed to enroll her in the state retirement system (CalPERS) for several years early in her employment. Upon learning this, she attempted to secure a complete employment record from the county, which CalPERS required to adjust her retirement benefits. The county failed to provide complete records, reportedly due to records being lost or destroyed, and provided only incomplete information to CalPERS. This left her unable to purchase prior service credit or receive full retirement benefits, causing her financial harm and forcing her to delay retirement. After filing a claim with the county and receiving no response, the plaintiff brought multiple causes of action in the Humboldt County Superior Court, including alleged violations of statutory duties and negligence against the county and individual employees. The trial court sustained the defendants’ demurrers, dismissing all statutory claims without leave to amend and granting leave to amend only the negligence claim. When the plaintiff submitted an amended complaint limited to negligence, the trial court again sustained the demurrer without leave to amend, finding no statutory duty supported the claim. The California Court of Appeal, First Appellate District, Division One, reviewed the case. It held that the plaintiff had stated valid causes of action against the county for violation of mandatory statutory duties to maintain personnel records and to enroll eligible employees in CalPERS under Government Code section 815.6. The court also held, in an unpublished portion, that the plaintiff stated a viable negligence claim against the individual defendants, with the county potentially vicariously liable. The appellate court reversed the trial court’s dismissal of these claims and remanded for further proceedings. View "Gibbs v. County of Humboldt" on Justia Law

Martel v. Employee Retirement System

2026-05-04T13:02:15-08:00

A per diem judge had been credited with retirement service by the Employee Retirement System (ERS) for years under a 1990 memorandum that set eligibility criteria. In 2017, the ERS discovered that the Judiciary had not updated personnel forms as the memorandum appeared to require. Without notice or a hearing, ERS issued a new memorandum rescinding the 1990 policy and retroactively stripped the judge’s retirement credits for service after October 1, 2017. The ERS did not follow rulemaking procedures required by Hawaii’s Administrative Procedure Act. The judge administratively challenged the ERS decision. A hearing officer partially sided with her, but the Board of Trustees of the ERS overruled that recommendation and dismissed all claims. The judge appealed to the Circuit Court of the First Circuit, which reversed the ERS Board, finding that both the 1990 and 2017 memoranda were rules under HRS § 91-1 and invalid because they had not been properly promulgated. On appeal, the Intermediate Court of Appeals (ICA) reversed, agreeing that the memoranda were improperly issued but holding that the circuit court’s reasoning did not support the relief granted. The Supreme Court of the State of Hawai‘i reviewed the case. It held that both the 1990 and 2017 memoranda were rules affecting private rights, not mere internal management or intra-agency communications, and thus subject to statutory rulemaking procedures. The 2017 memorandum and its implementing letter were void as to the judge because they were not lawfully adopted and she had timely challenged them. However, because no timely challenge was made to the 1990 memorandum, it remained valid and controlled her eligibility. The Supreme Court vacated the ICA’s decision, reinstated the circuit court’s judgment, and ordered the ERS to credit the judge for eligible service. View "Martel v. Employee Retirement System" on Justia Law

Precht v. UCBR

2026-04-30T06:11:17-08:00

After separating from his employment with Walman Optical, the claimant created an optical consultation business. He designed a website, spent nearly $3,000 on advertising, and reported a net loss on his tax filings, but had not performed any services for clients or received earnings from the business. Shortly after these activities, he applied for unemployment compensation benefits. The Altoona UC Service Center determined that the claimant was ineligible for benefits, reasoning that his creation of a new business rendered him self-employed. Following a hearing, a referee affirmed this denial, and the Unemployment Compensation Board of Review adopted the referee’s findings and upheld the decision. Both the referee and the Board relied on the “positive steps” test, concluding that the claimant’s actions toward establishing a business meant he was customarily engaged in self-employment, even though he had not performed any services or received any wages. The claimant appealed to the Commonwealth Court of Pennsylvania, arguing that the “positive steps” test conflicted with the statutory requirements for self-employment. The Commonwealth Court, in a divided en banc opinion, affirmed the denial of benefits, holding that the positive steps test remained applicable in the context of a stand-alone business enterprise and that actual remuneration or performance of services was not necessary for a finding of self-employment. The Supreme Court of Pennsylvania reviewed the case and reversed the Commonwealth Court’s order. The Court held that Section 4(l)(2)(B) of the Unemployment Compensation Law sets forth the test for determining self-employment and that the positive steps test is contrary to the statute’s plain language. The Court concluded that self-employment requires the actual performance of services for wages and that merely taking steps to establish a business, without performing such services, does not disqualify a claimant from receiving benefits. View "Precht v. UCBR" on Justia Law

Miles v. Bowers

2026-04-27T21:00:03-08:00

Arthur Miles was sentenced to a total of 300 months’ imprisonment following two separate federal convictions. After his first sentencing in October 2022, Miles was housed at the Marion County Jail in Indiana for fifteen months—some of this time was before and some after his second federal sentencing. During his time at the county jail, Miles worked as an orderly. He later argued that under the First Step Act of 2018 (“FSA”), he was entitled to earn time credits for this work, which could reduce his sentence, because his federal sentence had commenced and the work was equivalent to an evidence-based recidivism reduction (“EBRR”) program. The United States District Court for the District of Massachusetts reviewed Miles’s habeas petition after a magistrate judge recommended denying the Bureau of Prisons’ (BOP) motion to dismiss. The magistrate judge found that BOP regulations preventing prisoners from earning FSA credits until they arrived at a federal facility conflicted with the FSA’s language. The district court, however, rejected this recommendation and dismissed Miles’s petition, holding that the BOP’s rules did not violate the FSA. The United States Court of Appeals for the First Circuit held that the BOP’s regulation, which delayed the accrual of FSA time credits until a prisoner’s arrival at a federal facility, was invalid because it conflicted with the statutory definition of when a sentence commences. The court further held that a risk and needs assessment is not a prerequisite for earning FSA credits, and that prisoners may earn credits for qualifying programming—such as work as an orderly—performed after sentencing even while housed in non-federal facilities. The court vacated the dismissal of Miles’s habeas petition and remanded for further proceedings to determine his entitlement to credits for his time at the county jail. View "Miles v. Bowers" on Justia Law

Garland v. Office of Personnel Management

2026-04-23T21:06:38-08:00

The petitioner, a former Legal Administrative Specialist at the Office of Personnel Management (OPM), was diagnosed with major depressive disorder, generalized anxiety disorder, and insomnia. Her treating psychiatrist determined she was unable to work, and OPM subsequently removed her from federal service, citing her medical inability to perform essential job functions. The removal decision relied on medical documentation from her psychiatrist, which described her symptoms and limitations. Following her removal, the petitioner applied for disability retirement benefits through OPM, submitting the same medical documentation. OPM denied the disability retirement application, stating that while it acknowledged her diagnoses and symptoms, there was insufficient “objective” medical evidence to demonstrate the degree of her impairment and her inability to work. On reconsideration, OPM repeated that the documentation lacked details such as test results, psychotherapy notes, and treatment records. The petitioner appealed to the Merit Systems Protection Board (the Board), where OPM maintained its position that her evidence was inadequate. The Board’s administrative judge found that OPM had rebutted the presumption of disability—established when an employee is removed for medical inability—by asserting a lack of objective medical evidence. The Board weighed the evidence and affirmed OPM’s denial, making this its final decision. On review, the United States Court of Appeals for the Federal Circuit addressed whether OPM and the Board could overcome the presumption of disability (as set out in Bruner v. Office of Personnel Management) simply by asserting the absence of objective medical evidence. The court held that such an assertion alone is insufficient to rebut the presumption of disability. Because the Board relied solely on this rationale, the court concluded the presumption was not rebutted, reversed the Board’s final order, and found the petitioner entitled to disability retirement benefits. View "Garland v. Office of Personnel Management" on Justia Law

Rhino Energy, LLC v. DOWCP

2026-04-23T10:30:26-08:00

A miner who worked in West Virginia coal mines for nearly four decades applied for benefits under the Black Lung Benefits Act after retiring in 2015. From mid-2012 through December 2014, he worked for Rhino Energy, LLC as a subcontractor in mines owned by Wildcat Energy, LLC. When Rhino’s subcontract ended, he joined Wildcat’s payroll and continued working at Wildcat until his retirement in October 2015. The dispute centers on which employer—Rhino or Wildcat—should be responsible for paying his black lung benefits. After the miner filed his claim, the district director of the Office of Workers’ Compensation Programs designated Rhino as the responsible operator, finding that Wildcat had not employed the miner for the full year required by regulations and thus was not a potentially liable operator. The district director did not address Wildcat’s financial capacity, nor did he issue a Coverage Statement regarding Wildcat’s insurance status. Rhino contested its designation, arguing Wildcat should be responsible, including as a successor operator, but the district director and subsequently the Administrative Law Judge (ALJ) reaffirmed Rhino’s liability, focusing on the duration of Wildcat’s employment. The Benefits Review Board upheld the ALJ’s decision, agreeing that Wildcat had not employed the miner for a year and noting Rhino had not demonstrated Wildcat’s financial capability. The United States Court of Appeals for the Fourth Circuit reviewed the Board’s order. It held that under the correct interpretation of the regulations, Wildcat had employed the miner for the requisite year based on working days, and because the district director did not issue a Coverage Statement, Wildcat was presumed financially capable of paying benefits. The court determined Wildcat should have been designated as the responsible operator, but because regulations prohibit imposing liability on another operator at this stage, it vacated the Board’s order and remanded with instructions for the Black Lung Disability Trust Fund to pay the miner’s benefits. View "Rhino Energy, LLC v. DOWCP" on Justia Law

Lincoln v. Bisignano

2026-04-23T06:31:15-08:00

Michael Lincoln applied for disability insurance benefits and supplemental security income, alleging that his ability to work was limited due to conditions including prostate cancer, for which he received treatment beginning in late 2019. His treatment concluded in mid-2020, and his cancer entered remission. Lincoln continued to experience symptoms such as fatigue and reported using a cane at times, but also engaged in various daily activities. He claimed an inability to work beginning in October 2019. An administrative law judge (ALJ) held a hearing in May 2022 and, in August 2022, concluded that Lincoln was not disabled. The ALJ determined that Lincoln had the residual functional capacity to perform “light work” with certain postural limitations, and specifically found that Lincoln could perform his past work as a school bus driver. In reaching this conclusion, the ALJ found that Lincoln’s subjective complaints regarding fatigue and cane use were not entirely consistent with the medical evidence and daily activities. The ALJ also found the opinions of state agency medical consultants more persuasive than that of Lincoln’s treating nurse practitioner. The Appeals Council denied further review, making the ALJ’s decision final. The United States District Court for the Central District of Illinois affirmed the ALJ’s decision. On appeal, the United States Court of Appeals for the Seventh Circuit reviewed the ALJ’s findings, applying a deferential “substantial evidence” standard. The court held that substantial evidence supported the ALJ’s determination regarding Lincoln’s residual functional capacity, including the findings related to Lincoln’s fatigue, cane use, and the persuasiveness of medical opinions. Accordingly, the court affirmed the judgment of the district court, upholding the denial of benefits. View "Lincoln v. Bisignano" on Justia Law

Benson v. Warden FCI Edgefield

2026-04-22T10:30:26-08:00

A federal prisoner was sentenced in December 2020 and, due to pending charges in another jurisdiction, was held at a detention center in Rhode Island rather than being promptly transferred to his designated Bureau of Prisons (BOP) facility in South Carolina. During this period of post-sentencing detention, the prisoner claims to have participated in programs under the First Step Act (FSA), thereby accruing approximately 150 days of time credits, which could reduce his time in custody. However, the BOP did not recognize these credits because he had not undergone a formal risk and needs assessment—the BOP’s prerequisite for awarding such credits—until his eventual arrival at the designated facility in March 2022. After exhausting administrative remedies, the prisoner filed a pro se habeas petition in the United States District Court for the District of South Carolina, seeking recognition of his alleged FSA credits. The magistrate judge, without briefing or discovery, recommended dismissal. The district court adopted this recommendation, concluding that the BOP’s regulation reasonably required an initial assessment before credits could be earned, and applied Chevron deference to uphold the agency's interpretation. The district court also found no evidence the prisoner had “successfully participated” in qualifying programs before arrival at the BOP facility and dismissed the petition without prejudice, refusing to require a government response. On appeal, the United States Court of Appeals for the Fourth Circuit vacated the district court’s judgment and remanded. The Fourth Circuit held that the case was not moot, as the prisoner could still benefit from the FSA credits if his risk status changed or a warden approved his release. The court further held that, in light of the Supreme Court’s decision in Loper Bright Enterprises v. Raimondo, which overturned Chevron deference, the district court must independently determine whether the BOP’s interpretation of “successful participation” aligns with the best reading of the statute. View "Benson v. Warden FCI Edgefield" on Justia Law

Ferderer v. NDDHHS

2026-04-22T06:08:42-08:00

A parent applied to a state-run program providing compensation for family members who give extraordinary care to individuals with significant medical needs. The applicant’s young child required extensive daily assistance due to chronic health issues. The Department of Health and Human Services denied the application, explaining that the child’s score on a standardized assessment, created internally by the Department, did not meet the minimum threshold to qualify for the program. The assessment assigned points based on responses to a set of questions about the child’s needs, and only those scoring at least fifty percent of possible points for their age group were deemed eligible. After the application was denied, the parent pursued an administrative appeal. The administrative law judge upheld the denial, finding that, under the Department’s rules, only the assessment score determined eligibility for “extraordinary care,” and other medical details were not considered. The Department adopted this finding in a final order and denied a rehearing. The parent then appealed to the District Court of Burleigh County, which affirmed the Department’s decision. On further appeal, the Supreme Court of North Dakota reviewed whether the Department could use the assessment and its scoring rubric to determine eligibility, even though these criteria had not been formally promulgated as administrative rules. The Court held that because these tools operated as binding eligibility requirements of general applicability, they were rules under North Dakota’s Administrative Agencies Practice Act and should have been formally adopted through the rulemaking process. The Court reversed the district court’s order and remanded the case with instructions for further proceedings consistent with its opinion. View "Ferderer v. NDDHHS" on Justia Law

BROTHERS MARKET LLC NO. 2 V. USA

2026-04-08T08:32:20-08:00

A small convenience store in downtown Los Angeles, owned by an individual, participated in the Supplemental Nutrition Assistance Program (SNAP) and served many customers who used electronic benefit transfer (EBT) cards. In early 2022, the Food and Nutrition Service of the United States Department of Agriculture detected suspicious patterns in the store’s SNAP transactions. Over six months, the store processed hundreds of unusually large transactions, nearly 200 transactions that depleted a household’s monthly benefits in one day, numerous rapid consecutive transactions by the same household, and many transactions for the same dollar amount. Following a physical inspection and review of these patterns, the Agency charged the store with trafficking in SNAP benefits, meaning exchanging benefits for cash or non-eligible goods. After receiving a charge letter and providing a response that generally denied wrongdoing and offered explanations for customer behavior, the store was permanently disqualified from SNAP by the Agency. The owner and the store sought administrative review and submitted additional documents, including affidavits and receipts, but the Agency upheld its decision. The plaintiffs then filed for judicial review in the United States District Court for the Central District of California. The government moved for summary judgment, and the plaintiffs relied on much of the same evidence previously submitted. The district court granted summary judgment for the government, finding that the plaintiffs failed to raise a genuine dispute of material fact as to whether trafficking had occurred. On appeal, the United States Court of Appeals for the Ninth Circuit reviewed the district court’s grant of summary judgment de novo. The court held that the government’s evidence established suspicious transaction patterns supporting an inference of SNAP trafficking and that the plaintiffs failed to provide sufficient evidence to create a genuine dispute as to the legitimacy of the flagged transactions. The Ninth Circuit affirmed the district court’s grant of summary judgment in favor of the government. View "BROTHERS MARKET LLC NO. 2 V. USA" on Justia Law

Hayes v. Director, OWCP

2026-04-07T10:32:53-08:00

An employee worked for Cowin & Company for nearly three decades, performing construction in coal mines and regularly being exposed to coal dust. Years after his employment ended, he filed a claim for benefits under the Black Lung Benefits Act, alleging total disability due to pneumoconiosis (“black lung disease”) caused by his coal mine work. The claimant relied on a regulatory presumption that applies to miners who have a disabling breathing impairment and at least fifteen years of qualifying coal mine employment. A key dispute in the case involved how to calculate a “year” of coal mine employment under Department of Labor regulations. An administrative law judge initially granted benefits, finding the claimant had at least fifteen years of qualifying employment, thus triggering the presumption. Cowin & Company appealed to the Benefits Review Board, which vacated the benefits award in part and instructed the judge to recalculate the length of coal mine employment, questioning the method used to credit years of employment. On remand, the judge again found more than fifteen years, but the Board disagreed with the method, holding that a claimant must prove both a 365/366-day period of employment and at least 125 working days during that period. Ultimately, after further proceedings, the administrative law judge found only 13.76 years of qualifying employment, and the Board affirmed the denial of benefits. The United States Court of Appeals for the Eleventh Circuit reviewed the Board’s decision. The court held that, under the plain text of the relevant regulation, a claimant establishes a “year” of coal mine employment by showing at least 125 working days in or around coal mines during a calendar year or partial periods totaling one year. The court granted the petition for review, vacated the Board’s decision, and remanded for further proceedings. View "Hayes v. Director, OWCP" on Justia Law

Wolf Run Mining Company v. DOWCP

2026-04-07T10:30:32-08:00

A miner filed a claim for benefits under the Black Lung Benefits Act, asserting total disability due to lung disease following over two decades of coal mine employment. The miner had a significant history of cigarette smoking, but no evidence of clinical pneumoconiosis was present. The dispute centered on whether his disabling pulmonary impairment—despite his smoking history—was legally attributable to his coal mine dust exposure. An Administrative Law Judge (ALJ) first reviewed the claim and found that the miner had worked in coal mines for 27 years and suffered from a totally disabling pulmonary impairment. These facts entitled the miner to a statutory presumption that his disability was caused by pneumoconiosis. The ALJ determined that the mining company, as the responsible employer, failed to rebut this presumption. The ALJ discredited the employer’s medical experts, who attributed the impairment solely to smoking, because their opinions did not properly consider the additive effects of smoking and coal dust, as recognized by the Department of Labor’s Preamble to its Black Lung regulations. The Benefits Review Board affirmed the ALJ’s decision. The United States Court of Appeals for the Fourth Circuit reviewed the case. The court held that the ALJ correctly applied the law by requiring the employer to rebut the presumption, and properly evaluated the medical evidence in light of the regulatory guidance. The court found that the ALJ’s decision was supported by substantial evidence and that there was no legal error in the treatment of expert opinions or the regulatory preamble. The Fourth Circuit denied the mining company’s petition for review, leaving the award of benefits to the miner in place. View "Wolf Run Mining Company v. DOWCP" on Justia Law

Walls v Posey

2026-04-06T12:30:43-08:00

William Walls was found by an Illinois state court to be a sexually violent person in 2015, leading to his civil commitment under Illinois law. The commitment was based, in part, on statements he made or that were made by his treatment providers while he was incarcerated for a prior sexual assault conviction. Walls has argued that these statements were obtained in violation of his constitutional rights. After his commitment, his case involved extensive delays, including a twelve-year period before the initial commitment decision and seven years before the state appellate court resolved the appeal filed by his counsel. After the 2015 commitment order, Walls—sometimes proceeding pro se despite being represented—filed a series of appeals and petitions. The Illinois Appellate Court eventually affirmed both the 2015 and a subsequent 2018 recommitment decision in a consolidated opinion. Walls’s first federal habeas petition under 28 U.S.C. §2254 was dismissed by the United States District Court for the Central District of Illinois on procedural default grounds. He did not appeal that dismissal. After the 2018 recommitment proceeding, Walls filed a second federal habeas petition, which was dismissed as an unauthorized successive petition under 28 U.S.C. §2244(b) because it challenged the same 2015 order or did not raise new claims as required. The United States Court of Appeals for the Seventh Circuit reviewed Walls’s appeal of the district court’s dismissal. The court held that, to the extent Walls was once again contesting the 2015 commitment order, his petition was barred as a successive habeas application. Alternatively, if he was challenging later decisions, he had failed to raise or exhaust federal claims relating to those decisions. The Seventh Circuit affirmed the district court’s dismissal of Walls’s petition. View "Walls v Posey" on Justia Law

National Alliance to End Homelessness v. Department of Housing and Urban Development

2026-04-01T09:30:05-08:00

The case concerns significant changes made by the U.S. Department of Housing and Urban Development (HUD) to the Continuum of Care (CoC) program, which provides federal funding for homeless assistance projects. In November 2025, HUD issued a new Notice of Funding Opportunity (NOFO) that rescinded a previously issued two-year NOFO and introduced new requirements, including a drastic reduction in renewal funding for core permanent housing projects and new eligibility conditions. These changes threatened to eliminate funding for many projects, risking increased homelessness in the affected communities. Two groups of plaintiffs, including states, cities, and advocacy organizations, challenged HUD’s actions, alleging violations of the Administrative Procedure Act (APA) and constitutional provisions. The United States District Court for the District of Rhode Island issued preliminary injunctions prohibiting HUD from rescinding the prior NOFO and from implementing the challenged conditions in the new NOFOs. The court found that HUD’s actions likely violated the APA, were arbitrary and capricious, and would cause irreparable harm by creating funding gaps and service disruptions for vulnerable populations. After Congress passed new appropriations legislation in early 2026—setting a structure for grant renewals to avoid funding gaps—HUD moved to dissolve the injunctions, arguing that the legislative changes eliminated any ongoing harm and affected the merits of the legal claims. The district court denied the motion, concluding that the risk of harm persisted and that the plaintiffs remained likely to succeed on their claims. On appeal, the United States Court of Appeals for the First Circuit reviewed only the district court’s denial of HUD’s motion to dissolve the preliminary injunctions. The court held that HUD failed to make a strong showing that the intervening appropriations law eliminated the plaintiffs’ risk of harm or undermined the basis for the injunctions. The First Circuit therefore denied HUD’s request for a stay pending appeal. View "National Alliance to End Homelessness v. Department of Housing and Urban Development" on Justia Law

United States v. Florida

2026-03-31T12:31:50-08:00

The United States brought a lawsuit against Florida alleging that the state was discriminating against children with medically complex conditions by failing to provide care in the most integrated setting as required under Title II of the Americans with Disabilities Act (ADA). The federal government claimed that Florida’s inadequate provision of at-home and group-home care forced some children into institutionalization and placed others at serious risk of institutionalization. Additionally, it argued that once children were institutionalized, Florida’s poor care coordination and deficient transition planning made it difficult for families to bring their children home. This litigation proceeded over many years, culminating in a bench trial in the United States District Court for the Southern District of Florida. Previously, the United States Court of Appeals for the Eleventh Circuit had determined that the United States had statutory authority to sue Florida under the ADA. After trial, the district court found that Florida’s Medicaid program failed to provide adequate private duty nursing (PDN) services and effective care coordination, resulting in unnecessary institutionalization of children or placing them at risk. The district court concluded that these failures constituted violations of the ADA as interpreted by Olmstead v. L.C. ex rel Zimring, and issued a permanent injunction requiring Florida to improve its services, with specific mandates regarding PDN, care coordination, transition planning, data collection, and appointment of a monitor. On appeal to the United States Court of Appeals for the Eleventh Circuit, Florida challenged the findings and scope of the injunction. The Eleventh Circuit held that the United States may seek injunctive relief for systemic ADA violations affecting a group of children, not just those who individually filed complaints. The court affirmed the district court’s findings that the United States established the elements required under Olmstead, that the violations were widespread, and that system-wide injunctive relief was warranted. The Eleventh Circuit affirmed the district court’s liability determinations and most provisions of the injunction, but vacated or modified some portions as overbroad. View "United States v. Florida" on Justia Law

Kelly v. Kobach

2026-03-27T06:36:12-08:00

Two high-ranking Kansas executive officials became embroiled in disputes stemming from federal government actions related to the Supplemental Nutrition Assistance Program (SNAP) and federal grant funding for state agencies. The federal government requested sensitive data from state SNAP programs and threatened to withhold funding if states did not comply. The Kansas Governor viewed these demands as unlawful and opposed compliance, while the Kansas Attorney General disagreed with the Governor’s legal position and asserted that only his office could represent Kansas in related legal challenges. This led to friction over which state official had authority to control litigation involving the state’s interests. The Governor filed a quo warranto petition directly in the Kansas Supreme Court, seeking a declaration that she had constitutional authority to litigate on behalf of the state or, alternatively, on behalf of her office and its agencies. The Attorney General took the position that only he could represent the state as a whole, but conceded there was no objection to the Governor representing her office or executive agencies when they, not the state as a whole, were the real party in interest. The dispute in the lower courts did not involve any jury findings, and the Kansas Supreme Court had original jurisdiction to consider the petition. The Supreme Court of the State of Kansas concluded that, as the case developed, the parties narrowed their disagreement. Both agreed that the Attorney General speaks for the state when the state is the real party in interest, and the Governor speaks for her office or agencies when they are the real party in interest. Because the parties’ positions converged and the remaining dispute was not of significant public importance or suitable for resolution through quo warranto, the Kansas Supreme Court declined to exercise discretionary jurisdiction and dismissed the Governor’s petition. View "Kelly v. Kobach " on Justia Law

Yokosh v Bisignano

2026-03-19T11:30:43-08:00

The plaintiff, a woman in her early sixties, stopped working in August 2015 due to chronic back pain related to degenerative spinal and hip conditions. She had a history of mental health issues, including previous disability benefits for bipolar disorder, but her primary complaint at the time was physical pain. After her pain worsened, she sought both physical and psychological treatment. Her treatment included various forms of physical therapy and pain management, as well as psychotherapy with a clinical psychologist specializing in pain management. This psychologist, after several months, opined that the plaintiff had significant mental limitations affecting her ability to perform complex work tasks. However, other medical experts who evaluated her found only mild mental limitations. The plaintiff applied for Social Security disability benefits in September 2015, alleging disability from August 2015. Her application was denied, after which the United States District Court for the Eastern District of Wisconsin remanded the case for further proceedings. Following a second remand from the Social Security Appeals Council, an Administrative Law Judge (ALJ) found that the plaintiff was disabled beginning in September 2017, but not before that date. The ALJ determined that her mental impairments prior to September 2017 were non-severe, giving little weight to her treating psychologist’s opinion. On appeal, the United States Court of Appeals for the Seventh Circuit reviewed whether the ALJ erred in discounting the treating psychologist’s opinion and in finding the plaintiff’s mental limitations non-severe. The Seventh Circuit held that the ALJ appropriately considered the relevant regulatory factors, offered adequate reasons supported by the record for discounting the opinion, and that substantial evidence supported the ALJ’s findings. The Seventh Circuit therefore affirmed the judgment of the district court, upholding the denial of benefits for the period before September 1, 2017. View "Yokosh v Bisignano" on Justia Law

Baldwin v. DOWCP

2026-03-19T10:30:31-08:00

A coal miner worked for more than fifteen years for a mining company in Virginia, performing various tasks that exposed him to coal dust. After his health deteriorated, he filed for benefits under the Black Lung Benefits Act (BLBA), which provides compensation to miners disabled by pneumoconiosis caused by coal mine employment. Following his death, his wife continued the benefits claim. The miner’s work history included several periods of layoff, resulting in years of both continuous and partial employment. The District Director initially awarded benefits, finding that the miner’s employment exceeded fifteen years based on Social Security records. However, the employer contested the award, and the claim was referred to an Administrative Law Judge (ALJ). The ALJ credited the miner with only 14.14 years of coal mine employment, using a calculation method that required a 365-day employment relationship for each credited year, and therefore denied the statutory presumption of total disability due to pneumoconiosis. On appeal, the Benefits Review Board affirmed the ALJ’s decision, holding that both a 365-day employment relationship and 125 working days were required for each year of credit. The United States Court of Appeals for the Fourth Circuit reviewed the case. The court held that, under the applicable Department of Labor regulation, a miner establishes a year of employment for BLBA purposes by demonstrating at least 125 working days in or around a coal mine within a calendar year or partial periods totaling one year, regardless of a continuous 365-day employment relationship. The court found the regulation unambiguous and rejected the contrary interpretation of the lower tribunals. The Fourth Circuit granted the petition for review, vacated the Board’s order, and remanded for further proceedings consistent with its opinion. View "Baldwin v. DOWCP" on Justia Law

In Re Estate Of Sizick

2026-03-19T05:00:04-08:00

An elderly man, Jerome, experienced significant health decline and was moved into a nursing home, prompting his wife, Janet, to petition the Saginaw Probate Court for a protective order under Michigan law. She requested the transfer of all of Jerome’s assets and most of his income to her, citing her increased financial needs and Jerome’s inability to manage his affairs due to physical and mental health issues. Janet’s petition was filed before Jerome’s application for Medicaid was resolved, and the probate court granted the transfer and set a monthly support payment for Janet. The Department of Health and Human Services (DHHS) appealed. The Michigan Court of Appeals affirmed in part but vacated the probate court’s order, relying on its earlier precedent in In re Estate of Schroeder, which prohibited consideration of Medicaid eligibility before a formal determination. The case was remanded for a new assessment of need and current valuation of assets. On remand, the probate court again ordered the transfer and support, applied retroactively, but the Court of Appeals vacated this order as well, citing reliance on outdated asset information and the same legal standard regarding Medicaid eligibility. The Michigan Supreme Court reviewed the case after Jerome’s death, holding that the appeal was not moot because Medicaid benefits can be awarded retroactively, even to a deceased individual’s estate. The Supreme Court ruled that probate courts may consider the likely availability of Medicaid benefits before a final eligibility determination when assessing the needs of an individual and their dependents under MCL 700.5401(3)(b). The Court expressly overruled the contrary rule announced in In re Estate of Schroeder, reinstated the probate court’s 2022 protective order, and remanded the case for further proceedings. View "In Re Estate Of Sizick" on Justia Law

POWLEY V. BISIGNANO

2026-03-18T08:31:49-08:00

A claimant applied for disability insurance benefits and supplemental security income, alleging a range of physical and mental health impairments. After an initial denial and an earlier remand from the district court, the claimant appeared before a new administrative law judge (ALJ). At the hearing, a vocational expert (VE) testified about the number of jobs in the national economy that someone with the claimant’s limitations could perform. The VE identified three specific jobs and provided job-number estimates, relying on sources such as SkillTRAN and manufacturer databases. The claimant then submitted post-hearing objections and contrary job-number evidence, using similar data sources, including SkillTRAN and the U.S. Census Bureau, to show far fewer available jobs or, in some cases, none at all. The ALJ briefly acknowledged the claimant’s contrary evidence but found it unpersuasive, stating that the VE’s testimony was more reliable due to his professional experience. The Appeals Council denied review, and the claimant then challenged the decision in the United States District Court for the District of Oregon. The district court affirmed, reasoning that the claimant’s alternative job numbers lacked probative value because the evidence did not sufficiently explain the methodology or expertise involved in generating those numbers. On appeal, the United States Court of Appeals for the Ninth Circuit found that the claimant’s counter evidence was both significant and probative, as it was generated using data sources and methods frequently relied upon by the Social Security Administration and showed large discrepancies with the VE’s estimates. The Ninth Circuit held that the ALJ erred by failing to adequately address and resolve the inconsistencies between the competing job-number evidence. The court reversed the district court’s decision and remanded the matter to the agency for further proceedings to resolve these discrepancies. View "POWLEY V. BISIGNANO" on Justia Law

O'Connell v. Employees' Retirement System of Rhode Island

2026-03-16T08:19:29-08:00

A deputy sheriff employed by the Rhode Island Department of Public Safety applied for both ordinary and accidental disability retirement pensions, claiming a back injury sustained in 2011 caused him to stop working in 2020. The Employees’ Retirement System of Rhode Island’s Disability Committee recommended approval of only the ordinary disability pension, finding the accidental disability claim untimely under the statutory filing limits, and noting no evidence of an intervening injury or aggravation. The state retirement board adopted this recommendation and denied the accidental disability pension. Despite submitting additional evidence and requesting rehearing and further medical evaluation, the deputy sheriff’s application continued to be denied by the board, which advised that any appeal could be made in the Superior Court or the Workers’ Compensation Court, if applicable. Following these denials, the deputy sheriff filed appeals in both the Superior Court and the Workers’ Compensation Court. The Employees’ Retirement System moved to dismiss the Workers’ Compensation Court matter, arguing that the court lacked jurisdiction over a state employee’s appeal. The trial judge of the Workers’ Compensation Court denied the motion, concluding that jurisdiction existed based on multiple statutes, including those relating to injured-on-duty payments and the right to appeal denials of accidental disability pensions. The Supreme Court of Rhode Island reviewed the case on certiorari and held that the Workers’ Compensation Court did not have subject matter jurisdiction to hear the deputy sheriff’s appeal. The Court reasoned that the statutory scheme provides for Workers’ Compensation Court jurisdiction only for municipal employees covered under the Optional Retirement Plan, not for state employees like the petitioner, who are covered by the state retirement system. The Supreme Court therefore quashed the trial judge’s order and remanded the case for dismissal due to lack of jurisdiction. View "O'Connell v. Employees' Retirement System of Rhode Island" on Justia Law

Anderson v. Crouch

2026-03-10T11:00:33-08:00

Several individuals who participate in West Virginia’s Medicaid program and have been diagnosed with gender dysphoria sought surgical treatments that are excluded from coverage under West Virginia’s Medicaid plan. The state plan expressly excludes coverage for “sex change” or “transsexual” surgeries, though it covers these procedures for other medical indications, such as cancer or congenital abnormalities. The plaintiffs, representing a class of similarly situated individuals, alleged that this exclusion discriminates against them in violation of the Equal Protection Clause, Section 1557 of the Affordable Care Act, and certain provisions of the Medicaid Act. In proceedings before the United States District Court for the Southern District of West Virginia, the court granted summary judgment to the plaintiffs on all claims. The court found that the exclusion was unlawful under the Equal Protection Clause, the Affordable Care Act’s anti-discrimination provision, and the Medicaid Act’s comparability and availability requirements. The district court issued a declaratory judgment and enjoined enforcement of the exclusion. On appeal, the United States Court of Appeals for the Fourth Circuit sitting en banc affirmed the district court’s judgment. The state defendants then sought review by the Supreme Court, which granted certiorari, vacated the Fourth Circuit’s en banc decision, and remanded for reconsideration in light of two recent Supreme Court cases: United States v. Skrmetti and Medina v. Planned Parenthood South Atlantic. Upon reconsideration, the United States Court of Appeals for the Fourth Circuit reversed the district court. The court held that, under Skrmetti, West Virginia’s exclusion does not violate the Equal Protection Clause or the Affordable Care Act, because the exclusion is based on medical diagnosis rather than sex or transgender status and is supported by rational, non-discriminatory reasons. Applying Medina, the court further held that the Medicaid Act’s comparability and availability requirements do not provide a private right of action, and thus plaintiffs could not sue under those provisions. The Fourth Circuit reversed and remanded the case with instructions to enter summary judgment for the defendants. View "Anderson v. Crouch" on Justia Law

Cedar Coal Company v. DOWCP

2026-03-06T11:30:24-08:00

Roger Mullins, a coal miner, filed a claim for Black Lung benefits in 2012, asserting he was totally disabled due to pulmonary disease caused by coal dust exposure. His initial claim was denied. In 2019, Mullins sought modification of the denial, alleging a mistake of fact and a change in conditions. During the modification proceedings, Mullins submitted new evidence, including medical reports, pulmonary function tests, and treatment records. His medical experts attributed his total disability to legal pneumoconiosis, a chronic pulmonary condition substantially aggravated by coal dust exposure. Cedar Coal Company, his last coal mine employer, contested this, arguing that his impairment was due to other causes such as asthma, obesity, and coronary bypass surgery. An Administrative Law Judge (ALJ) heard the case and determined that Mullins was totally disabled due to legal pneumoconiosis, awarding Black Lung benefits. The ALJ gave greater weight to the medical opinion of Dr. Go, Mullins’ expert, over those of the employer’s experts, finding Dr. Go’s interpretation of the evidence more persuasive and his experience more relevant. Cedar Coal Company appealed this decision to the Benefits Review Board, which affirmed the ALJ’s award of benefits. The United States Court of Appeals for the Fourth Circuit reviewed the case. Cedar Coal Company argued that Mullins exceeded the regulatory limitations on affirmative medical evidence and that the ALJ’s finding of legal pneumoconiosis was not supported by substantial evidence. The Fourth Circuit rejected both arguments. It held that the ALJ properly considered all admissible evidence, including treatment records and expert analysis, without violating evidentiary limits. The court found the ALJ’s factual determinations were supported by substantial evidence and adequately explained. The petition for review was denied, and the award of benefits was affirmed. View "Cedar Coal Company v. DOWCP" on Justia Law

Harrington v. Housing Authority of Riverside County

2026-03-04T16:02:01-08:00

A participant in the federal Section 8 housing assistance program received notice from the local housing authority that her benefits would be terminated based on several alleged violations, including a recent eviction for serious lease violations, untimely submission of eligibility documentation, failure to allow an inspection, and failure to maintain her unit. The participant contested the termination, explaining that her appeal of the eviction was still pending and that she ultimately complied with inspection and paperwork requirements. At the administrative hearing, the hearing officer concluded that because a court-ordered eviction had occurred and, according to the officer, had been upheld on appeal, termination of assistance was mandatory under federal regulations. The participant then petitioned the Superior Court of Riverside County for a writ of administrative mandamus, arguing that the finding regarding her eviction was factually incorrect, as the appeal was still pending. Soon after, the appellate division of the Riverside County Superior Court reversed the eviction judgment for insufficient evidence. The trial court acknowledged that the hearing officer’s findings regarding the eviction were not supported by the record. However, it proceeded to independently review the evidence and found other violations of program obligations, upholding the housing authority’s discretionary decision to terminate benefits. The California Court of Appeal, Fourth Appellate District, Division Two, found that the trial court misunderstood the scope of judicial review under Code of Civil Procedure section 1094.5. The appellate court held that the trial court was required to review whether the administrative agency’s factual findings—not any alternative grounds—were supported by the record. Since the hearing officer’s findings were unsupported and the court could not uphold termination based on new grounds not adjudicated at the administrative hearing, the judgment was reversed with instructions to grant the petition and vacate the termination of assistance. View "Harrington v. Housing Authority of Riverside County" on Justia Law

Howard v. D.C. Department of Employment Services

2026-02-26T07:07:51-08:00

Caroline McCall was employed for over twenty years as a Clinical Systems Coordinator at a hospital, where her responsibilities evolved to include inventory management, IT systems, and various administrative tasks. Over time, her duties increased and she began to suffer from bilateral carpal tunnel syndrome, which medical professionals attributed to her intense hand activity at work. Despite undergoing two surgeries and being prescribed specific workplace accommodations, her employer failed to provide some of these adjustments. After her pain worsened and her responsibilities continued to grow, McCall resigned in December 2020, citing physical and mental exhaustion due to her condition. Following her resignation, McCall applied for temporary total disability benefits under the D.C. Workers’ Compensation Act. An Administrative Law Judge (ALJ) found her testimony and the medical evidence credible, determining that her carpal tunnel syndrome was work-related and that she was unable to perform her job due to insufficient accommodations. The ALJ awarded her temporary total disability benefits. The Compensation Review Board (CRB) affirmed the ALJ’s order, agreeing that the correct legal standard was applied and that substantial evidence supported the findings. The employer challenged the CRB’s decision, arguing that the wrong time frame was used to assess her ability to perform her “usual job,” that the findings were not supported by substantial evidence, and that the ALJ failed to address whether McCall voluntarily retired for reasons unrelated to her disability. The District of Columbia Court of Appeals reviewed the case and affirmed the CRB’s decision. The court held that the CRB applied the correct legal standard by considering McCall’s job duties at the time of her resignation, that substantial evidence supported the finding of temporary total disability, and that McCall’s resignation was causally related to her work injury rather than being a voluntary limitation of income for unrelated reasons. View "Howard v. D.C. Department of Employment Services" on Justia Law

Bishop v. San Diego County Employees Retirement Assn.

2026-02-18T11:01:58-08:00

A former employee of the County of San Diego pleaded guilty to a felony charge for violating a state conflict-of-interest law, which prohibits public employees from having a financial interest in contracts made in their official capacity. After the guilty plea, but before sentencing, the San Diego County Employees Retirement Association (SDCERA) notified him that a portion of his accrued pension benefits would be forfeited under Government Code section 7522.74, as he had been “convicted” of a job-related felony. At sentencing, the criminal court reduced the offense to a misdemeanor under Penal Code section 17, subdivision (b)(3). The employee then requested reinstatement of his pension benefits, which SDCERA denied. The employee challenged SDCERA’s denial through administrative appeals, including to its chief executive officer and Board of Retirement, but both appeals were denied. He subsequently petitioned the Superior Court of San Diego County for a writ of administrative mandate to set aside SDCERA’s decision. The court denied the petition, finding that section 7522.74 precluded reinstatement of the forfeited pension benefits. The employee timely appealed the judgment. The California Court of Appeal, Fourth Appellate District, Division One, reviewed the case. The court held that a public employee is “convicted” for purposes of Government Code section 7522.74 upon an adjudication of guilt—whether by plea or jury verdict—and not only upon entry of judgment. The reduction of the felony to a misdemeanor at sentencing under Penal Code section 17, subdivision (b)(3), did not retroactively affect the forfeiture. The court affirmed the judgment, concluding that the employee’s pension benefits remained forfeited, and SDCERA properly denied reinstatement. View "Bishop v. San Diego County Employees Retirement Assn." on Justia Law

United States v. Green

2026-02-13T11:31:22-08:00

During a contentious divorce and custody dispute, Amanda Hovanec, who had returned to Ohio from South Africa with her children, conspired with Anthony Theodorou, her romantic partner, to kill her husband, T.H. After failed attempts to hire hitmen in South Africa, Theodorou, at Hovanec’s direction, obtained and shipped etorphine, a dangerous animal tranquilizer, to the United States. Hovanec ultimately used the drug to fatally inject T.H. at her mother Anita Green’s home. Green assisted after the murder by helping to select a burial site, driving the others to dig a grave, and later transporting them and the body for burial. The group also undertook efforts to conceal the crime, including disposing of T.H.’s belongings and misleading authorities. All three were arrested after an investigation revealed dashcam footage of the crime. In the United States District Court for the Northern District of Ohio, Hovanec pleaded guilty to multiple controlled-substance offenses resulting in death, and Green pleaded guilty to being an accessory after the fact. Hovanec received a 480-month sentence; Green received 121 months and was ordered to pay restitution for psychological care for T.H.’s and Hovanec’s children. Both defendants appealed their sentences and, in Green’s case, the restitution order. The United States Court of Appeals for the Sixth Circuit affirmed the sentences for both Hovanec and Green. The appellate court upheld the denial of a sentencing reduction for Green based on her lack of candor regarding knowledge of the murder plan. The court also affirmed the sentencing enhancements for Hovanec’s leadership role and obstruction of justice. However, the court reversed the restitution order against Green, holding that under federal law, restitution for psychological care requires evidence of bodily injury, defined as physical harm or physical manifestations of psychological harm, and remanded for further factual findings on this issue. View "United States v. Green" on Justia Law

Spann v. National Conference of Bar Examiners

2026-02-12T09:33:18-08:00

The plaintiff, who has a disability, took the New Mexico bar exam in February 2020 and was approved for testing accommodations. She alleged that these accommodations were not properly provided during the exam. Subsequently, she initiated legal action, amending her complaint multiple times before any defendant appeared. The third amended complaint asserted claims under Titles II and III of the Americans with Disabilities Act (ADA), § 504 of the Rehabilitation Act, and other federal and state laws. The United States District Court for the District of New Mexico dismissed all claims. Specifically, it dismissed claims against the National Conference of Bar Examiners (the National Conference) for lack of personal jurisdiction, and permitted amendment of the complaint only to allow a Title III ADA claim against the New Mexico Board of Bar Examiners (the State Board). The district court later dismissed the Title III claim against the State Board on Eleventh Amendment sovereign immunity grounds. It also granted summary judgment to the State Board on the Rehabilitation Act claim, finding the Board did not receive federal funds, and denied the plaintiff’s requests for additional discovery as insufficient under Rule 56(d). On appeal, the United States Court of Appeals for the Tenth Circuit affirmed the district court’s judgment. The court held that the plaintiff had not properly preserved her entitlement to jurisdictional discovery regarding the National Conference, nor did she adequately request or specify discovery that could alter the personal jurisdiction determination. The court also found no abuse of discretion in denying additional discovery on the Rehabilitation Act claim, as the plaintiff failed to meet procedural requirements. Finally, the Tenth Circuit concluded that the State Board was protected by Eleventh Amendment immunity from Title III ADA claims and that the plaintiff failed to show any waiver or valid abrogation of immunity. The judgment below was affirmed. View "Spann v. National Conference of Bar Examiners" on Justia Law

Follen v. Commissioner of Social Security

2026-02-11T14:30:37-08:00

The plaintiff applied for disability benefits from the Social Security Administration (SSA) but was denied at the agency level. She then sought judicial review in the United States District Court for the Northern District of Ohio. After the Commissioner of Social Security reviewed the case further, the Commissioner moved to remand the matter to the Administrative Law Judge (ALJ) for additional proceedings, specifically for further articulation regarding the persuasiveness of the evidence and further consideration of medical opinions. The Commissioner did not argue that the ALJ committed reversible error. The plaintiff agreed to a remand but requested that the court issue instructions to award her benefits outright. The district court granted the Commissioner’s motion for remand, reasoning that factual disputes remained and that it was not prepared to award benefits. The court remanded the case to the SSA for further consideration without affirming, modifying, or reversing the ALJ’s decision, and without expressly finding reversible error or making the specific predicate findings required for a remand under Sentence Six of 42 U.S.C. § 405(g). The plaintiff appealed the district court’s order. The United States Court of Appeals for the Sixth Circuit reviewed the case. The court held that a district court may not remand a Social Security case under Sentence Four of 42 U.S.C. § 405(g) without explicitly affirming, modifying, or reversing the decision of the ALJ. The appellate court found that the district court’s order failed to comply with the requirements of either Sentence Four or Sentence Six and that district courts do not have inherent authority to issue other types of remand orders in Social Security cases. The Sixth Circuit therefore vacated the district court’s order and remanded the matter for further proceedings consistent with the opinion. View "Follen v. Commissioner of Social Security" on Justia Law

Hebert v. Donahue

2026-02-06T09:00:04-08:00

A dispute arose regarding the proceeds of a federal life insurance policy held by a United States Postal Service employee, who was insured under the Federal Employees’ Group Life Insurance Act (FEGLIA). Shortly before his death from cancer, he executed a beneficiary designation form naming his ex-wife and their two sons as beneficiaries. However, he failed to fully complete a section of the form, omitting certain requested information. After his death, the form was processed but ultimately rejected by the employer’s HR office because it was incomplete and received after the employee’s death. Under FEGLIA, absent a valid designation, the benefits would have gone to his widow, who passed away during the litigation, leaving her daughter as the estate’s representative. The plaintiffs (ex-wife and sons) sued in the United States District Court for the District of Massachusetts, seeking a declaration that the January 2017 designation form was valid. The District Court converted the case to an interpleader proceeding. After an evidentiary hearing and additional discovery, the court found that the form met all statutory requirements for a valid designation under FEGLIA, was signed and witnessed, and that there was no evidence the decedent lacked mental capacity when signing. The court denied the defendant’s motions for additional discovery and summary judgment, and granted summary judgment for the plaintiffs. On appeal, the United States Court of Appeals for the First Circuit reviewed the District Court’s rulings for abuse of discretion and de novo as appropriate. The First Circuit held that the designation form was valid under federal law, as it was signed and witnessed, and that omitted information did not affect statutory requirements. The court also held that the appellant failed to present medical evidence of incapacity, so the challenge to mental competency failed. The judgment for the plaintiffs was affirmed. View "Hebert v. Donahue" on Justia Law

Essintial Enterprise Solutions LLC v. SBA

2026-02-03T11:48:51-08:00

Essintial Enterprise Solutions, LLC, a staffing and services company, received a $7 million Paycheck Protection Program (PPP) loan during the COVID-19 pandemic. The company calculated its loan amount based on its reported payroll costs, which included payments made to both employees and independent contractors. After the loan was issued and the company applied for forgiveness, its bank approved forgiveness of the full amount. However, the Small Business Administration (SBA) reviewed the forgiveness request and determined that payments made to independent contractors were not eligible as “payroll costs” under the CARES Act, resulting in only partial forgiveness. The SBA forgave approximately $3.7 million and denied forgiveness for the remainder that was based on contractor payments. Essintial challenged the SBA’s decision by filing suit in the United States District Court for the Middle District of Pennsylvania. The company argued that the SBA’s interpretation of “payroll costs” was erroneous and violated the Administrative Procedure Act (APA). The District Court agreed with Essintial, granting summary judgment in its favor. It held that the SBA’s exclusion of independent contractor payments from payroll costs was arbitrary and capricious, and ordered full loan forgiveness for Essintial. On appeal, the United States Court of Appeals for the Third Circuit reviewed the statutory definition of “payroll costs” in the CARES Act de novo. The Third Circuit held that the SBA’s interpretation was correct: payments to independent contractors by a business are not included as “payroll costs” for PPP loan forgiveness purposes. The court concluded that the CARES Act provides two separate definitions of “payroll costs” depending on the borrower’s type, and Essintial’s payments to independent contractors did not qualify. The Third Circuit reversed the District Court’s judgment and remanded for further proceedings. View "Essintial Enterprise Solutions LLC v. SBA" on Justia Law

Clinchfield Coal Company v. DOWCP

2026-01-15T10:30:21-08:00

Vernon Vanderpool worked underground for over twenty years in coal mines, primarily as a roof bolter and section foreman. After retiring due to a back injury, he developed progressively worsening respiratory symptoms and was eventually diagnosed with pneumoconiosis, commonly known as black lung disease. In 2014, Vanderpool filed a claim for benefits under the Black Lung Benefits Act, asserting that his respiratory ailments rendered him totally disabled. Following his claim, the District Director of the U.S. Department of Labor’s Office of Workers’ Compensation Programs issued a decision awarding benefits. Clinchfield Coal Company, Vanderpool’s former employer, contested this decision. An Administrative Law Judge (ALJ) held a hearing and upheld the award, finding total disability based on pulmonary function tests and medical opinion evidence. Clinchfield then appealed to the Benefits Review Board, arguing that the ALJ erred in crediting certain pulmonary function tests and in weighing medical opinions. The Board rejected these arguments and affirmed the ALJ’s decision. The United States Court of Appeals for the Fourth Circuit reviewed Clinchfield’s petition, applying a highly deferential standard to the ALJ’s findings. The court held that the ALJ properly applied regulatory standards regarding pulmonary function tests, treating deviations from quality standards as affecting the weight rather than admissibility of the evidence. The ALJ’s assessment of medical opinions, including his rationale for crediting one expert over others, was sufficiently explained and satisfied the requirements of the Administrative Procedure Act. Substantial evidence supported the finding of total disability, permitting invocation of the statutory presumption of disability under the Act. As a result, the Fourth Circuit affirmed the Board’s decision and denied Clinchfield’s petition for review. View "Clinchfield Coal Company v. DOWCP" on Justia Law

Dominion Coal Corporation v. DOWCP

2026-01-15T10:30:21-08:00

Darrell Meade worked as a coal miner for 37 years and applied for benefits under the Black Lung Benefits Act, which provides compensation to miners totally disabled by pneumoconiosis. A Labor Department claims examiner initially found that Meade qualified for benefits and that Dominion Coal Corporation was responsible for payment. However, the administrative law judge reviewing the case denied the claim, concluding that Meade’s medical evidence—including x-rays, biopsies, and CT scans—did not establish the irrebuttable presumption of complicated pneumoconiosis required for benefits. Meade appealed to the Benefits Review Board. The Board agreed with the judge’s findings regarding the x-ray and biopsy evidence but determined that the judge had not sufficiently evaluated or explained his analysis of the conflicting expert opinions on the CT scans. The Board vacated the denial in part and remanded the case, instructing the judge to address the competing expert rationales and to provide a clear explanation for his findings. On remand, the judge found Dr. DePonte’s interpretation of the scans more persuasive than Dr. Adcock’s and concluded that the evidence supported a diagnosis of complicated pneumoconiosis, awarding benefits to Meade. Dominion Coal Corporation appealed, challenging both the Board’s standard of review and the judge’s authority based on alleged unconstitutional removal protections. The United States Court of Appeals for the Fourth Circuit reviewed the Board’s interlocutory and final orders. The court held that it had jurisdiction to review interlocutory Board orders after a final order was issued. It found that the Board properly remanded the case when the administrative law judge failed to adequately explain his reasoning and that substantial evidence supported the final award of benefits. The court also rejected Dominion’s constitutional challenge, holding that Dominion had not shown harm from the removal protections. The Fourth Circuit denied Dominion’s petition for review. View "Dominion Coal Corporation v. DOWCP" on Justia Law

MCKINNEY v. SECRETARY OF VETERANS AFFAIRS

2026-01-14T08:03:01-08:00

A veteran who suffered a traumatic brain injury from an improvised explosive device while deployed sought financial assistance under the Traumatic Servicemembers’ Group Life Insurance (TSGLI) program after experiencing a stroke within two years of the injury. The Army denied his claim, determining the stroke was a physical illness or disease, not a qualifying traumatic injury as defined by the relevant statute and regulations. The veteran then petitioned the Department of Veterans Affairs (VA) to amend its rules to include coverage for illnesses or diseases caused by explosive ordnance, arguing these conditions are analogous to those already covered under existing exceptions for injuries resulting from chemical, biological, or radiological weapons. The VA initially denied the rulemaking petition but agreed to further review as part of a program-wide assessment. After several years, extensive consultation with medical experts, and consideration of the petition and supporting materials, the VA issued a final denial. It concluded that expanding coverage to delayed illnesses or diseases linked to explosive ordnance would be inconsistent with TSGLI’s purpose, which focuses on immediate injuries, would deviate from the insurance model underlying the program, and could threaten its financial stability. The VA also found insufficient evidence of a direct causal relationship between explosive ordnance, traumatic brain injury, and downstream illnesses like stroke. The United States Court of Appeals for the Federal Circuit reviewed the VA’s denial under the highly deferential “arbitrary and capricious” standard of the Administrative Procedure Act. The court held that the VA provided a reasoned explanation addressing the petitioner’s arguments and the record, and did not act arbitrarily or capriciously. The petition for review was therefore denied. View "MCKINNEY v. SECRETARY OF VETERANS AFFAIRS " on Justia Law

E.N. v. Kehoe

2026-01-13T13:30:05-08:00

The Missouri General Assembly enacted two statutes effective August 28, 2023: the SAFE Act, which generally prohibits health care providers from performing gender transition surgeries or prescribing cross-sex hormones and puberty-blocking drugs for minors, and the Medicaid ban, which precludes MO HealthNet payments for such treatments when used for gender transition. The statutes include specific exemptions, such as for treatment of certain medical conditions and for minors already receiving such care prior to enactment. E.N., on behalf of her minor child and joined by medical professionals and organizations, challenged both laws, alleging violations of equal protection, due process, and the gains of industry clause under the Missouri Constitution. The Circuit Court of Cole County conducted a two-week bench trial and entered judgment in favor of the State, upholding the constitutionality of both statutes. The court found the challengers had raised only facial challenges and determined that neither statute violated the constitutional provisions cited. The challengers appealed, raising multiple points of error regarding the constitutional analysis and factual findings at trial. The Supreme Court of Missouri reviewed the circuit court’s determination de novo, applying a presumption of constitutionality. Relying on recent decisions from the United States Supreme Court and the United States Court of Appeals for the Eighth Circuit, the court held that both statutes classify based only on age and medical use, not on sex or transgender status. Thus, rational-basis review applied. The court found that the statutes are rationally related to legitimate state interests, such as safeguarding minors and managing public resources, and do not infringe fundamental rights. The court affirmed the circuit court’s judgment, concluding that the challengers failed to demonstrate any constitutional violation. View "E.N. v. Kehoe" on Justia Law

YOUNG v. COLLINS

2026-01-13T06:31:34-08:00

James Young, a veteran who served in the military during the mid-1980s, initially filed a claim for service-connected disability benefits in 1988, alleging head injuries from an in-service car accident. The Department of Veterans Affairs (VA) regional office denied his claim in 1991, and after several years of proceedings, the Board of Veterans’ Appeals denied the claim in 1999, citing Young’s failure to appear for scheduled medical examinations. Young did not appeal the Board’s 1999 denial. Years later, in 2017, following a new claim and medical examinations, the VA granted service connection for his head injuries effective August 17, 2012. Seeking an earlier effective date linked to his original 1988 claim, Young filed a motion in 2022 with the Board to vacate its 1999 denial, alleging due process violations because the Board had failed to ensure the regional office complied with orders to search for certain records. The Board denied the motion, characterizing the alleged error as a “duty to assist error” rather than a due process error. Young appealed this denial to the United States Court of Appeals for Veterans Claims, which dismissed the appeal. The Veterans Court found that while the appeal was timely regarding the denial of the motion to vacate, such a denial was not an appealable decision under its jurisdictional statute. Upon review, the United States Court of Appeals for the Federal Circuit affirmed the Veterans Court’s dismissal. The Federal Circuit held that the Board’s denial of a motion to vacate under 38 C.F.R. § 20.1000(a), when based solely on alleged material error known at the time of the original decision, does not constitute an appealable “decision” under 38 U.S.C. § 7252. The court determined that allowing appeals from such procedural denials would undermine the statutory time bar and permit indefinite judicial review of Board decisions. View "YOUNG v. COLLINS " on Justia Law

Mendoza v. Bd. of Retirement of the Ventura County

2025-12-29T11:00:57-08:00

The appellant, a Ventura County Deputy Sheriff, suffered two work-related back injuries in 2014 and 2015. Medical evaluations revealed degenerative disc disease and herniation at the L5-S1 level. Multiple physicians recommended surgical intervention, and the County authorized surgery to address his condition. However, the appellant declined the recommended procedures, citing concerns about surgical outcomes and referencing anecdotal experiences of colleagues. Later, his condition progressed, and more extensive surgery was suggested, but authorization for additional procedures was denied due to insufficient evidence. Despite ongoing pain, the appellant also declined to participate in a recommended home exercise program and a work hardening regimen. After the appellant applied for service-connected disability retirement, his application was challenged by the County and assigned to VCERA’s hearing officer for review. During the administrative hearing, the appellant testified about his refusal of surgery and physical therapy, while medical experts presented conflicting views on his prognosis and ability to return to work. The hearing officer found that the appellant had unreasonably refused recommended medical treatments with a high probability of success, and that his refusal likely worsened his condition, making him ineligible for service-connected disability retirement benefits. The Board adopted these findings and denied his application. The Superior Court of Ventura County denied the appellant’s petition for a writ of administrative mandate, concluding that his unreasonable refusal of authorized surgery and other treatments constituted valid grounds to deny benefits under the doctrine of avoidable consequences/mitigation of damages. The California Court of Appeal, Second Appellate District, Division Six, affirmed this decision. The court held that a disability retirement application may be denied if the disability is caused, continued, or aggravated by an unreasonable refusal to undergo medical treatment, even if the refused treatment is no longer effective due to the passage of time. View "Mendoza v. Bd. of Retirement of the Ventura County" on Justia Law

Myres v. Bd. of Admin. for CalPERS

2025-12-26T12:30:51-08:00

A longtime deputy sheriff was convicted by a federal jury of mail and wire fraud after she submitted an insurance claim for items stolen during a burglary at her home, some of which she falsely claimed as her own but actually belonged to her employer, the sheriff’s office. She also used her employer’s fax machine and cover sheet in communicating with the insurance company and misrepresented her supervisor’s identity. The criminal conduct arose after a romantic relationship with a former inmate ended badly, leading to the burglary, but the fraud conviction was based on her false insurance claim, not on the relationship or the burglary itself. Following her conviction, the California Public Employees’ Retirement System (CalPERS) determined that her crimes constituted conduct “arising out of or in the performance of her official duties” under Government Code section 7522.72, part of the Public Employees Pension Reform Act, and partially forfeited her pension. The administrative law judge and the San Francisco Superior Court both upheld CalPERS’s decision, reasoning that her actions were sufficiently connected to her employment, particularly in her misuse of employer property and resources and in the context of her relationship with the former inmate. The Court of Appeal of the State of California, First Appellate District, Division One, reversed the trial court’s judgment. The appellate court held that the statute requires a specific causal nexus between the criminal conduct and the employee’s official duties, not merely any job-related connection. The court found that the deputy’s fraudulent insurance claim, although it referenced employer property and resources, did not arise out of or in the performance of her official duties as required by the statute. Accordingly, the pension forfeiture determination was set aside. View "Myres v. Bd. of Admin. for CalPERS" on Justia Law

Thigpen vs. Best Home Care LLC

2025-12-25T02:18:23-08:00

Christopher Thigpen applied for and received unemployment benefits from the Minnesota Department of Employment and Economic Development (DEED) for 104 weeks spanning March 2020 to March 2022. During this period, Thigpen was employed as a personal care assistant, earning weekly wages, but reported to DEED each week that he had not worked or received other income. This misrepresentation led to Thigpen receiving overpayments totaling $39,605 in standard and pandemic unemployment benefits. In April 2022, DEED reviewed his account, confirmed his employment during the relevant period, and determined that he had obtained the overpayments due to misrepresentation. As a result, DEED assessed a penalty of 40 percent of the overpaid amount, imposed 1 percent monthly interest, and barred Thigpen from receiving any future unemployment benefits until repayment, subject to a statutory ten-year cancellation period. Thigpen appealed the determination before an unemployment law judge, arguing that he did not intend to defraud DEED and misunderstood the forms. After multiple evidentiary hearings, the unemployment law judge found Thigpen’s explanations not credible, upheld the finding of misrepresentation, and applied the statutory penalty, interest, and benefit ineligibility. Thigpen requested certiorari review from the Minnesota Court of Appeals, challenging the sufficiency of evidence, burden of proof, denial of due process, and constitutionality of the penalties under the Excessive Fines Clauses of the U.S. and Minnesota Constitutions. The Court of Appeals rejected all arguments, specifically finding the penalties proportionate and comparable to those for similar offenses in Minnesota and other states. On further appeal, the Minnesota Supreme Court affirmed the Court of Appeals, holding that the penalty, interest, and benefit ineligibility for unemployment benefit misrepresentation do not violate the Excessive Fines Clauses, as they are not grossly disproportionate to the gravity of the offense and are consistent with penalties in Minnesota and other jurisdictions. View "Thigpen vs. Best Home Care LLC" on Justia Law

Klosterman v. Department of Corrections and Community Supervision

2025-12-16T08:30:10-08:00

During the COVID-19 pandemic, full-time civil service employees working as instructors and teachers at facilities operated by the New York State Department of Corrections and Community Supervision sought unemployment benefits when their optional summer work was suspended in 2020. These employees, paid an annual salary under a collective bargaining agreement, applied for regular state unemployment benefits as well as federal pandemic-related benefits authorized by the CARES Act. Initially, their applications for benefits were granted. However, the New York State Department of Labor subsequently determined that, because the employees continued to receive their annual salary and did not meet the statutory requirements for "total unemployment" under state law, they were ineligible for both state and federal benefits, and were charged with overpayments. After hearings, Administrative Law Judges upheld the Department of Labor’s revised determinations, concluding that the claimants were not entitled to benefits due to failure to meet the "total unemployment" requirement. The Unemployment Insurance Appeal Board affirmed these decisions. On further appeal, the Appellate Division also affirmed, finding that substantial evidence supported the Board’s determination that the claimants were not "totally unemployed" during the summer in question. The court reasoned that the annual salary compensated the claimants for the entire year, including the summer, making them ineligible for unemployment benefits under state law and, consequently, ineligible for federal pandemic benefits. The New York Court of Appeals reviewed the case and held that the Department of Labor properly applied New York’s "total unemployment" requirement when evaluating eligibility for both CARES Act and related federal benefits. The court concluded that this requirement does not conflict with the CARES Act, which does not define "unemployed" or "partially unemployed" and incorporates state law for determining benefit eligibility. The court affirmed the orders of the Appellate Division. View "Klosterman v. Department of Corrections and Community Supervision" on Justia Law

Hultz v. Bisignano

2025-12-15T11:00:16-08:00

Crystal Hultz, a woman born in 1987, stopped working full-time in December 2013 due to multiple health conditions, including lupus, fibromyalgia, spinal disorders, and depression. Although some of her conditions improved with treatment and surgery, she continued to experience severe, persistent symptoms of fibromyalgia, leading to fatigue and periods of being bedridden. Her daily functioning depended heavily on support from her family. Based on these ongoing symptoms, Hultz applied for Social Security disability benefits, asserting that her fibromyalgia and related health problems rendered her unable to work. Her claims for benefits were initially denied by the Social Security Administration (SSA) and again after reconsideration. Following a hearing, an Administrative Law Judge (ALJ) denied her applications, a decision upheld by the SSA's Appeals Council. Hultz sought review in the United States District Court for the District of Maryland, which remanded the case to the ALJ for further consideration of certain impairments. On remand, another ALJ again denied benefits, finding that Hultz's subjective reports of her symptoms were not fully supported by objective medical evidence. The District Court affirmed this denial. The United States Court of Appeals for the Fourth Circuit reviewed the case and found that the ALJ erred by discounting Hultz’s subjective testimony about her fibromyalgia symptoms based on a lack of objective medical evidence. The Fourth Circuit emphasized its precedent that, for conditions like fibromyalgia—which cannot be measured by objective tests—ALJs may not use the absence of such evidence to discredit claimants’ subjective accounts. The court also held that the ALJ improperly gave little weight to the opinion of Hultz’s treating physician. The Fourth Circuit reversed the denial of benefits and remanded the case for a calculation of benefits. View "Hultz v. Bisignano" on Justia Law

In re Appeal of H.D.

2025-12-12T08:15:56-08:00

This case involves the eligibility of H.D. for Vermont’s General Assistance Emergency Housing Program as of July 1, 2025. The Department for Children and Families (DCF) determined that H.D. had exceeded the program’s eighty-day housing limit by counting days she received before the start of fiscal year 2026 (FY26). H.D. contended that only the days received during FY26 should count toward the limit, based on the language of the Fiscal Year 2026 Appropriations Act. At the time of the appeal, H.D. had exhausted her eighty days under the Board’s interpretation, no longer lived in emergency housing, and was ineligible for further benefits under the statute. The Human Services Board reviewed DCF’s determination and ruled in H.D.’s favor. The Board interpreted the statute to mean that only days received during FY26 should be counted, making H.D. eligible for emergency housing at the time of her application. DCF then appealed this decision to the Vermont Supreme Court. The Vermont Supreme Court determined that the case was moot. It found that, because H.D. had already exhausted her eighty-day benefit and was no longer eligible for emergency housing under the statute, there was no longer an actual controversy between the parties. The Court also rejected DCF’s argument that the case was “capable of repetition but evading review,” concluding that DCF failed to show a reasonable expectation that H.D. would be subject to the same action again. The Court emphasized that its jurisdiction is limited to live controversies and that it cannot issue an advisory opinion on the statutory interpretation for future cases. As a result, the appeal was dismissed as moot. View "In re Appeal of H.D." on Justia Law

Florida Agency for Health Care Administration v. Administrator for the Centers for Medicare & Medicaid Services

2025-12-05T14:02:13-08:00

Florida challenged a federal agency document known as the “Informational Bulletin” that interpreted Medicaid’s hold-harmless rule and threatened to claw back billions in Medicaid funds if certain state practices continued. Florida’s Medicaid funding system relies on a Directed Payment Program, under which local governments assess special fees on private hospitals, pool these fees, and transfer the funds to the state agency, which then uses them to secure additional federal matching funds. The state feared the new federal interpretation could jeopardize its program and moved to preliminarily enjoin the Bulletin’s implementation. The United States District Court for the Southern District of Florida, following a magistrate judge’s recommendation, denied Florida’s motion for a preliminary injunction and dismissed the case for lack of subject matter jurisdiction. The district court held that the Bulletin was not a “final agency action” under the Administrative Procedure Act (APA), and therefore not subject to judicial review. The United States Court of Appeals for the Eleventh Circuit reviewed the case and found that, contrary to the district court’s conclusion, the Bulletin was indeed a final agency action subject to judicial review under the APA. However, the Eleventh Circuit held that Florida was unlikely to succeed on the merits of its challenge, concluding that the Bulletin’s interpretation of the Medicaid hold-harmless rule was consistent with the statutory text, was not arbitrary or capricious, and did not require notice-and-comment rulemaking. The court thus reversed the dismissal of the complaint, affirmed the denial of the preliminary injunction, and remanded the case for further proceedings. View "Florida Agency for Health Care Administration v. Administrator for the Centers for Medicare & Medicaid Services" on Justia Law

COLAGE v. COLLINS

2025-12-03T06:30:49-08:00

The claimant served in the U.S. Navy and, upon his voluntary separation in 1992, received a lump sum Special Separation Benefit (SSB) under 10 U.S.C. § 1174a. Many years later, in 2017, he was awarded VA disability compensation with entitlement to a total disability rating, effective from late 2016. The Department of Veterans Affairs (VA) notified him that it would withhold a portion of his monthly disability benefits to recoup the SSB payment, which the claimant contested, arguing that SSB payments are not subject to recoupment and that the relevant statutory authority did not apply to his situation. The Board of Veterans’ Appeals found that the VA acted properly in withholding his disability compensation to recoup the SSB payment. The claimant then appealed to the United States Court of Appeals for Veterans Claims, which affirmed the Board’s decision. He sought reconsideration, asserting that the court had relied upon the wrong statutory provision. The Veterans Court granted reconsideration, but in its new decision, it again held that the relevant statute required recoupment of his SSB payment from his VA disability compensation, and affirmed the Board’s decision. The United States Court of Appeals for the Federal Circuit reviewed the statutory interpretation de novo. The court held that 10 U.S.C. § 1174(h)(2) applies to SSB payments received under 10 U.S.C. § 1174a, requiring such payments to be deducted from VA disability compensation. The court rejected the claimant’s alternative statutory interpretation, finding it inconsistent with the statutory text and structure. The court also dismissed for lack of jurisdiction arguments that were not addressed by the Veterans Court. The judgment was affirmed in part and dismissed in part. View "COLAGE v. COLLINS " on Justia Law

Department of Public Health and Human Services v. Johnson

2025-12-02T15:05:47-08:00

The case concerns the Montana Department of Public Health and Human Services’ attempt to recover $5,360.89 in Medicaid benefits paid on behalf of a deceased recipient, Florence Pound. The sole heir, Minta Johnson, inherited Pound’s home, the primary estate asset valued at approximately $200,000. After Pound’s death, Johnson, as personal representative, published notice to creditors as required by Montana law. The Department submitted its claim one day after the four-month statutory deadline for creditor claims had expired, and the Probate Court denied the claim as untimely. The estate was then distributed entirely to Johnson. Following the denial of its claim in the Eleventh Judicial District Court (Probate Court), the Department filed a new action in the Fourth Judicial District Court, seeking recovery from Johnson personally under a separate statute, § 53-6-167(2), MCA, which allows the Department to seek reimbursement from anyone who received property from the estate. The District Court granted summary judgment to Johnson, reasoning that the Department’s untimely creditor’s claim barred further action and that issue preclusion applied because the same underlying issue had already been decided in probate. The Supreme Court of the State of Montana reviewed the matter de novo. It held that the Department’s statutory right under § 53-6-167(2), MCA, to recover Medicaid benefits from an heir is independent of the probate creditor claim process, and that a missed probate deadline does not bar a subsequent action against an heir. The Court further found that issue preclusion did not apply because the probate court lacked jurisdiction to consider the Department’s statutory claim against the heir, and the issues in the two proceedings were not identical. The Supreme Court reversed the District Court’s dismissal and remanded for judgment in favor of the Department. View "Department of Public Health and Human Services v. Johnson" on Justia Law

Clinchfield Coal Company v. Mullins

2025-12-02T11:31:31-08:00

After the death of her husband, who had worked in coal mining for nearly 28 years, a widow applied for survivor benefits under the Black Lung Benefits Act (BLBA). Her husband died in 2014 following a hospitalization, and she filed her claim shortly thereafter. The BLBA provides survivor benefits to eligible dependents if a miner’s death is due to pneumoconiosis (“black lung disease”) arising from coal mine employment. A key question in this case was whether the miner’s terminal arterial blood gas (ABG) studies, taken during his last hospitalization, could be used to establish that he was totally disabled due to a chronic respiratory or pulmonary condition at the time of his death. Initially, the District Director awarded benefits and identified the employer as the responsible operator. The employer requested a hearing before the Office of Administrative Law Judges. The first Administrative Law Judge (ALJ) denied benefits, finding that although the miner worked long enough to invoke a presumption that his death was due to pneumoconiosis, the ABG tests lacked an adequate physician’s report linking the results to a chronic condition, as required by regulation. The widow sought modification, arguing that a mistake of fact had been made. A second ALJ granted modification and awarded benefits, relying on a comprehensive report from one of the physicians that sufficiently connected the ABG results to the miner’s chronic lung disease. The Benefits Review Board (BRB) affirmed, holding that the widow established her entitlement to benefits and that the employer failed to rebut the statutory presumption. The United States Court of Appeals for the Fourth Circuit reviewed the case and denied the employer’s petition. The court held that substantial evidence supported the BRB’s decision affirming the award of benefits. Specifically, the court found the physician’s report was sufficient to link the terminal ABG results to a chronic respiratory condition, thus satisfying regulatory requirements and entitling the widow to the statutory presumption. The court also concluded that the ALJ properly granted modification based on a mistake of fact. View "Clinchfield Coal Company v. Mullins" on Justia Law

Shapiro v. U.S. Soc. Sec. Admin.

2025-11-26T07:30:11-08:00

A neurologist submitted a Freedom of Information Act (FOIA) request to the United States Social Security Administration (SSA) seeking documents about how the SSA evaluates disability claims for migraines and other headache disorders. The SSA determined that this request was not directly related to the administration of any of its benefit programs. Relying on a provision in the Social Security Act (42 U.S.C. § 1306(c)), the SSA required the requester to pay the full cost of processing the request, which totaled $2,908. The requester paid the fee but later objected because the SSA did not respond within the statutory deadline set by FOIA. The United States District Court for the District of Vermont found in favor of the requester. The district court concluded that FOIA’s provision prohibiting fees when the agency fails to respond on time superseded the Social Security Act’s cost-reimbursement clause. As a result, the court ordered the SSA to refund the fee and awarded the requester attorneys’ fees and costs. The court reasoned that allowing the SSA to charge fees despite late responses would undermine the FOIA amendments designed to ensure agency timeliness. On appeal, the United States Court of Appeals for the Second Circuit considered whether the Social Security Act’s cost-reimbursement provision or FOIA’s fee-preclusion provision controlled. The Second Circuit held that the plain language of § 1306(c), which begins with a “notwithstanding” clause, explicitly exempts the SSA from FOIA’s fee rules for requests not directly related to program administration. The court agreed with the SSA’s determination that the request was not program-related and found the statute unambiguous. Therefore, the court reversed the district court’s judgment and vacated the award of attorneys’ fees and costs. View "Shapiro v. U.S. Soc. Sec. Admin." on Justia Law

Nunez v. Commissioner of Social Security

2025-11-25T07:30:07-08:00

The plaintiff, a former security guard, began experiencing panic attacks and anxiety, particularly when using public transportation, which ultimately led to the loss of his job. He was treated with medication, but continued to suffer from symptoms that interfered with his ability to work consistently. He applied for Supplemental Security Income and Social Security Disability Insurance, claiming disability from the time he was terminated due to his condition. The record included testimony from the plaintiff, a vocational expert, and five medical professionals, all of whom opined that he had at least moderate limitations in maintaining concentration, staying on task, and regular work attendance. After an initial denial by the Social Security Administration, the plaintiff requested a hearing before an Administrative Law Judge (ALJ). The ALJ found that the plaintiff had severe impairments but did not meet the criteria for a listed disability. Relying on some aspects of one consultative psychiatrist's opinion, and discounting others, the ALJ concluded that the plaintiff retained the residual functional capacity (RFC) to perform unskilled work in a goal-oriented setting, without finding any specific limitations on his ability to stay on task or maintain regular attendance. The vocational expert testified that an individual who was off task more than 10% of the workday or absent more than one day per month would be unable to maintain employment. The ALJ nonetheless found the plaintiff not disabled. The Appeals Council denied review, making the ALJ's decision final. The United States District Court for the Southern District of New York affirmed the denial. The United States Court of Appeals for the Second Circuit reviewed the administrative record de novo and concluded that the ALJ’s RFC finding was not supported by substantial evidence, particularly given the unanimous medical opinions regarding the plaintiff's limitations and the vocational expert’s testimony. The Second Circuit vacated the district court’s judgment and remanded the case to the Commissioner for further development of the record and reconsideration of the plaintiff’s application. View "Nunez v. Commissioner of Social Security" on Justia Law

Camacho v. Northern Mariana Islands Settlement Fund

2025-11-20T11:01:33-08:00

Rosa A. Camacho, a retired Class II member of the Northern Mariana Islands Retirement Fund, claimed that she was entitled to cost-of-living allowances (COLAs) as part of her retirement benefits. When Camacho entered the Retirement Fund in 1980, COLAs were not part of the retirement package. In 1989, the Commonwealth legislature amended the Retirement Fund Act to provide a two percent COLA. Over the years, this provision was repeatedly modified, suspended, and ultimately repealed in 2011. The Commonwealth’s financial difficulties led to a class action and a subsequent settlement agreement in 2013, which entitled participants to 75% of their “Full Benefits,” as defined by statute or guaranteed by the Commonwealth Constitution. The United States District Court for the Northern Mariana Islands held that Camacho was not entitled to COLAs under the settlement agreement, reasoning that COLAs were not constitutionally protected benefits at the time she joined the Retirement Fund and were discretionary by statute as of 2013. Camacho appealed, arguing that the statutory introduction of COLAs during her membership created a protected right under Article III, section 20(a) of the Commonwealth Constitution. The United States Court of Appeals for the Ninth Circuit certified to the Supreme Court of the Commonwealth of the Northern Mariana Islands the question of whether section 8334(e) of the Retirement Fund Act conferred a constitutionally protected accrued benefit in the form of COLAs for Class II members employed when the Act took effect. The Commonwealth Supreme Court answered in the negative, finding that COLAs were legislative policy adjustments and not protected contractual benefits. In accordance with this interpretation, the Ninth Circuit held that Camacho did not acquire a constitutionally protected right to COLAs under section 8334(e). The district court’s decision was affirmed. View "Camacho v. Northern Mariana Islands Settlement Fund" on Justia Law

Moreland v. Retirement Board of the Policemen Y Annuity and Benefit Fund of the City of Chicago

2025-11-20T07:33:34-08:00

A Chicago police officer was injured in a traffic accident while responding to a call in 2017, resulting in ongoing back and hip problems. Despite returning to unrestricted duty for a period, his condition worsened, leading to medical leave and various treatments, including surgery for a hip injury and ongoing care for back pain. Multiple physicians were involved in his care. His treating orthopedic specialist eventually deemed him permanently disabled from police work, while a Board-appointed independent medical examiner found him capable of full, unrestricted police duty. The officer sought reinstatement with the police department but was not cleared due to medical opinions regarding his disability. He applied to the Retirement Board for duty disability benefits. The Retirement Board of the Policemen’s Annuity and Benefit Fund of the City of Chicago held a hearing and ultimately denied his application for both duty and ordinary disability benefits, finding the Board-appointed physician’s opinion more credible. The Circuit Court of Cook County affirmed the Board’s decision, holding it was not against the manifest weight of the evidence. The officer appealed, and the Appellate Court, First District, reversed and remanded. The appellate court relied on the Illinois Supreme Court’s holding in Kouzoukas v. Retirement Board of the Policemen’s Annuity & Benefit Fund of Chicago, reasoning that the officer was caught in a “catch-22” because he was not offered a suitable position by the police department and therefore should be considered disabled under the statute. The Supreme Court of Illinois reviewed the Retirement Board’s decision, holding that section 5-156 of the Illinois Pension Code does not require proof of disability from a Board-appointed doctor as a prerequisite to granting benefits; the Board remains the ultimate arbiter of disability. The Court found that the Board’s denial of benefits was not against the manifest weight of the evidence, distinguishing the facts from Kouzoukas. The Supreme Court reversed the appellate court’s judgment and affirmed the circuit court and the Board’s denial of benefits. View "Moreland v. Retirement Board of the Policemen Y Annuity and Benefit Fund of the City of Chicago" on Justia Law

Rainey v. Retirement Board of the Policemen & Annuity and Benefit Fund of the City of Chicago

2025-11-20T07:33:33-08:00

Tamica Rainey, a Chicago police officer, was injured in duty-related car accidents in 2013 and 2015. She was awarded duty disability benefits in 2017 based on injuries to her neck and shoulder. As required by statute, Rainey’s disability status was periodically reviewed, and in 2022, after multiple hearings and submissions of medical records, the Retirement Board of the Policemen’s Annuity and Benefit Fund of the City of Chicago discontinued her duty disability benefits, concluding she was no longer disabled from her duty-related injuries. However, when Rainey attempted to return to work, the police department determined she could not perform her duties. Rainey sought administrative review in the Circuit Court of Cook County, which reversed the Board’s decision, relying on precedent that an officer remains disabled if the department cannot provide a position with needed accommodations. The circuit court also awarded Rainey attorney fees and costs under section 5-228(b) of the Illinois Pension Code. The Board appealed, and the Appellate Court of Illinois, First District, affirmed both the restoration of Rainey’s benefits and the award of attorney fees and costs. The Supreme Court of Illinois reviewed the Board’s challenge to the attorney fees and costs award. The court held that section 5-228(b) of the Illinois Pension Code authorizes an award of attorney fees and costs not only to police officers who successfully challenge the initial denial of duty or occupational disease disability benefits, but also to those who successfully challenge the discontinuation of such benefits. The court rejected the Board’s argument that statutory attorney fee awards are limited to initial applications, finding the statute’s plain language and legislative intent favor such awards for both denial and discontinuation challenges. The Supreme Court affirmed the judgments of the appellate and circuit courts and reversed the Board’s decision. View "Rainey v. Retirement Board of the Policemen & Annuity and Benefit Fund of the City of Chicago" on Justia Law

Carroll v. City & County of S.F.

2025-11-12T10:31:41-08:00

Several employees of the City and County of San Francisco who joined the city’s retirement system at age 40 or older and later retired due to disability challenged the method used to calculate their disability retirement benefits. The city’s retirement system uses two formulas: Formula 1, which provides a higher benefit if certain thresholds are met, and Formula 2, which imputes service years until age 60 but caps the benefit at a percentage of final compensation. Plaintiffs argued that Formula 2 discriminates against employees who enter the system at age 40 or above, in violation of the California Fair Employment and Housing Act (FEHA). Initially, the San Francisco City and County Superior Court sustained the city’s demurrer, finding the plaintiffs had not timely filed an administrative charge. The California Court of Appeal reversed that decision, allowing the case to proceed. After class certification and cross-motions for summary judgment, the trial court found triable issues and held a bench trial. At trial, plaintiffs presented expert testimony based on hypothetical calculations, while the city’s expert criticized the lack of actual data analysis and highlighted factors such as breaks in service and purchased credits. The California Court of Appeal, First Appellate District, Division Four, reviewed the trial court’s post-trial decision. The appellate court affirmed the trial court’s judgment, holding that the plaintiffs failed to prove intentional age discrimination or disparate impact under FEHA. The court found substantial evidence that Formula 2 was motivated by pension status and credited years of service, not age. The plaintiffs’ evidence was insufficient because it relied on hypotheticals rather than actual data showing a disproportionate adverse effect on the protected group. The appellate court also affirmed the denial of leave to amend the complaint, finding no reversible error. The judgment in favor of the city was affirmed. View "Carroll v. City & County of S.F." on Justia Law

Rhode Island State Council of Churches v. Rollins

2025-11-10T05:00:03-08:00

During a government shutdown that began on October 1, 2025, the United States Department of Agriculture (USDA) announced it would not provide November Supplemental Nutrition Assistance Program (SNAP) benefits, affecting millions of Americans who rely on these funds for food. Despite having approximately $6 billion in contingency funds appropriated by Congress for emergencies, USDA stated it would not use these funds, arguing they were unavailable once regular appropriations lapsed. Plaintiffs, including nonprofits, local governments, a union, and a food retailer, filed suit, alleging that USDA’s suspension of benefits was arbitrary, capricious, and contrary to law under the Administrative Procedure Act (APA). The United States District Court for the District of Rhode Island granted a temporary restraining order (TRO) requiring USDA to provide either full or partial November SNAP payments by specified dates. The government chose to provide partial payments but failed to do so in a timely manner, as many recipients would not receive benefits by the court’s deadline. The district court found the government had not complied with its order, both by failing to resolve administrative burdens and by not ensuring timely disbursement. As a result, the court ordered USDA to make full November SNAP payments, including by using funds from the Section 32 fund in combination with contingency funds. The government appealed and sought a stay of the district court’s order. The United States Court of Appeals for the First Circuit reviewed the government’s request for a stay pending appeal. The court held that the government had not met its burden to justify a stay, finding it had failed to show a likelihood of success on the merits or that irreparable harm would result from compliance. The court emphasized the immediate and substantial harm to SNAP recipients if benefits were withheld and denied the government’s motion for a stay. View "Rhode Island State Council of Churches v. Rollins" on Justia Law

Craig v. Bisignano

2025-11-04T16:30:23-08:00

Ramona Craig applied for Social Security disability benefits and, after her application was denied, she filed suit challenging that denial. The key issue in her case was whether she had properly exhausted her administrative remedies before seeking judicial review. The magistrate judge specifically warned Craig that she needed to present sufficient evidence of exhaustion prior to proceeding with her lawsuit. Despite these warnings, Craig did not provide the necessary evidence before the district court entered final judgment. The United States District Court for the Western District of Texas reviewed Craig’s case and dismissed it without prejudice, finding that she had failed to demonstrate exhaustion of administrative remedies. After the district court entered its final judgment, Craig submitted an additional document intended to establish exhaustion, but this filing occurred after the judgment was entered. On appeal, the United States Court of Appeals for the Fifth Circuit considered whether it could review Craig’s post-judgment filing. The Fifth Circuit held that, under Rule 10(a) of the Federal Rules of Appellate Procedure, the record on appeal does not include documents filed in the district court after the entry of final judgment. The court further declined to exercise its discretion to take judicial notice of the post-judgment filing. The Fifth Circuit affirmed the district court’s dismissal without prejudice, holding that the district court lacked subject matter jurisdiction because Craig failed to establish exhaustion of administrative remedies based on the filings made before final judgment. The court clarified that Craig may file a new case or seek to reopen the existing case if she wishes to pursue her claims. View "Craig v. Bisignano" on Justia Law

Patel v. USA

2025-10-17T09:00:11-08:00

Nita and Kirtish Patel operated two companies that provided mobile diagnostic medical services. To obtain Medicare reimbursement for neurological testing, they falsely represented that a licensed neurologist would supervise the tests. In reality, Kirtish, who lacked a medical license, wrote the reports, and Nita forged a physician’s signature. Their fraudulent scheme generated over $4 million, including substantial Medicare payments. In 2014, a former employee filed a sealed qui tam action in the United States District Court for the District of New Jersey, alleging healthcare fraud and asserting claims under the False Claims Act. The Patels were subsequently arrested and each pleaded guilty to one count of healthcare fraud. Their plea agreements did not address or preclude future civil or administrative actions. After their guilty pleas, the Government intervened in the qui tam action and obtained summary judgment against the Patels, relying on collateral estoppel from their criminal admissions. The District Court trebled the Medicare loss and imposed civil penalties, resulting in a judgment exceeding $7 million. Nita appealed, and the United States Court of Appeals for the Third Circuit affirmed her liability under the False Claims Act. Both Patels later moved to vacate their criminal sentences under 28 U.S.C. § 2255, arguing ineffective assistance of counsel because their attorneys did not advise them that their guilty pleas could have collateral estoppel effects in the civil qui tam action. The District Court denied their motions, finding that counsel’s performance was not objectively unreasonable and that the Patels were aware their plea agreements did not preclude civil actions. On appeal, the United States Court of Appeals for the Third Circuit held that the Sixth Amendment does not require criminal defense counsel to advise clients of collateral consequences such as civil liability under the False Claims Act. The court affirmed the District Court’s judgment, concluding that Padilla v. Kentucky’s holding is limited to deportation consequences and does not extend to civil liability. View "Patel v. USA" on Justia Law

In the Matter of the SIRS Appeal by Best Care, LLC

2025-10-16T01:20:28-08:00

A personal care assistance provider agency in Minnesota was audited by the Department of Human Services (DHS) for recordkeeping deficiencies related to its provision of services under the state’s Medicaid program. The agency, which served both traditional and PCA Choice recipients, was found to have various documentation errors, including missing or incomplete care plans and timesheets, as well as timesheets lacking required elements. DHS did not allege fraud or that services were not provided, but sought to recover over $420,000 in payments, arguing that these deficiencies constituted “abuse” under state law and justified monetary recovery. After an evidentiary hearing, an administrative law judge (ALJ) recommended limited recovery for some missing documentation but rejected most of DHS’s claims, finding that DHS had not shown the deficiencies resulted in improper payments. The DHS Commissioner disagreed, ordering full repayment. The Minnesota Court of Appeals reversed the Commissioner’s decision, holding that DHS must prove not only that the provider engaged in “abuse” but also that the abuse resulted in the provider being paid more than it was entitled to receive. The court also determined that provider agencies must maintain care plans for both traditional and PCA Choice recipients in their files. The Minnesota Supreme Court affirmed in part, reversed in part, and remanded. It held that, to obtain monetary recovery under Minn. Stat. § 256B.064, subd. 1c(a), DHS must prove either: (1) the provider engaged in conduct described in subdivision 1a and, had DHS known of the conduct before payment, it would have been legally prohibited from paying under a statute or regulation independent of subdivision 1a; or (2) the payment resulted from an error such that the provider received more than authorized by law. The Court also held that provider agencies must keep care plans for all PCA services, including PCA Choice, in their files. View "In the Matter of the SIRS Appeal by Best Care, LLC" on Justia Law

Long v. Chattanooga Fire and Police Pension Fund

2025-10-13T11:50:06-08:00

A firefighter with fifteen years of service applied for disability pension benefits from a municipal pension fund, claiming he was permanently disabled due to post-traumatic stress disorder (PTSD) resulting from several traumatic events encountered during his career. The pension fund’s Board of Trustees denied his application after a hearing, finding he did not meet the policy’s requirements for a mental health disability benefit, specifically the requirement that the traumatic events causing the disability be “unexpected” within the context of his regular duties. The applicant sought judicial review in the Chancery Court for Hamilton County, which reviewed the Board’s decision under Tennessee’s Uniform Administrative Procedures Act (UAPA). The trial court found the Board’s interpretation of the policy arbitrary and capricious, holding that the events were unexpected to the applicant and that the policy should be construed in favor of the employee. The trial court reversed the Board’s denial and awarded benefits. The Tennessee Court of Appeals affirmed, finding the policy ambiguous and applying a liberal construction doctrine to interpret the policy in favor of the applicant. On further appeal, the Supreme Court of Tennessee held that the term “unexpected” in the policy was not ambiguous and should be given its plain meaning. The Court concluded that the Board’s decision was supported by substantial and material evidence and was not arbitrary or capricious. The Court also held that the liberal construction doctrine did not apply because the policy was unambiguous. Accordingly, the Supreme Court of Tennessee reversed the judgments of the Court of Appeals and the trial court, reinstating the Board’s denial of disability benefits, and remanded the case for further proceedings consistent with its opinion. View "Long v. Chattanooga Fire and Police Pension Fund" on Justia Law

Hoffman v. City of Birmingham Retirement and Relief System

2025-10-10T05:30:08-08:00

A firefighter employed by the City of Birmingham developed hypertension during his employment and applied to the City of Birmingham Retirement and Relief System for both extraordinary and ordinary disability benefits, arguing that his condition and the medications required to control it prevented him from safely performing his job. He detailed unsuccessful attempts to manage his hypertension with various medications and provided medical opinions supporting his claim that only beta-blockers, which are not recommended for firefighters, could control his blood pressure. The Board, after considering the opinion of its medical expert, denied both applications, concluding that he had not exhausted all other antihypertensive regimens. The firefighter sought review of the Board’s decisions by filing a petition for a writ of mandamus in the Jefferson Circuit Court, as permitted by statute. Initially, the circuit court dismissed the action for lack of service, but the Supreme Court of Alabama reversed that dismissal and remanded the case. After service was obtained, the respondents argued that the claim for extraordinary disability benefits failed as a matter of law because the hypertension was not caused by a specific workplace accident, and that the Board’s denial of ordinary disability benefits was not manifestly wrong. The circuit court denied the mandamus petition without a hearing or consideration of evidence beyond the pleadings. The Supreme Court of Alabama affirmed the circuit court’s denial of extraordinary disability benefits, holding that the statutory requirements were not met because the disability did not result from an accident at a definite time and place. However, the Supreme Court reversed the denial of ordinary disability benefits, finding that the circuit court erred by not allowing the petitioner to present evidence or reviewing the evidence considered by the Board. The case was remanded for further proceedings on the ordinary disability claim. View "Hoffman v. City of Birmingham Retirement and Relief System" on Justia Law

Black Farmers & Agriculturalists Ass'n v. Rollins

2025-10-08T10:00:20-08:00

A group of Black farmers and their association, along with several individual members, sought to file claims with the U.S. Department of Agriculture (USDA) for financial assistance under a program created by the Inflation Reduction Act of 2022. They wished to submit applications on behalf of deceased relatives who had allegedly experienced discrimination in USDA farm lending programs. The USDA, however, had a policy that excluded applications reporting only discrimination against individuals who were deceased at the time of application, making such claims ineligible for the program. The plaintiffs filed suit in the United States District Court for the Western District of Tennessee, seeking an injunction to require the USDA to accept these “legacy claims.” The district court denied their motion for a preliminary injunction and granted the government’s motion to dismiss under Rule 12(b)(6), holding that the relevant statute only authorized financial assistance to living farmers. The plaintiffs appealed this decision to the United States Court of Appeals for the Sixth Circuit and also sought an emergency injunction pending appeal, which was denied. The United States Court of Appeals for the Sixth Circuit reviewed the district court’s dismissal de novo. The appellate court held that the statutory language of § 22007(e) of the Inflation Reduction Act required the USDA to provide “assistance” to farmers who experienced discrimination, and that “assistance” was forward-looking and could not be provided to deceased individuals. The court found that the statute did not authorize compensation for past harm to deceased farmers, distinguishing “assistance” from “compensation.” The court affirmed the district court’s judgment and denied the motion for an injunction pending appeal as moot, holding that the USDA was required to reject applications filed on behalf of deceased farmers. View "Black Farmers & Agriculturalists Ass'n v. Rollins" on Justia Law

Rabdeau v. Bisignano

2025-10-06T12:00:18-08:00

Claudette Rabdeau sought disability benefits under the Social Security Act, claiming that her cervical spine disorder, severe headaches, and mental impairments rendered her unable to work since June 2014. Medical records showed that while Rabdeau experienced significant pain and frequent headaches beginning in 2014, her symptoms were generally well-managed through medication and treatments, including Botox injections, until May 2018, when her condition worsened and became disabling. Rabdeau’s initial application for benefits was denied by an Administrative Law Judge (ALJ) in 2018, who found she could still work during the relevant period. After a remand from the Social Security Administration Appeals Council for further consideration of her migraines and mental impairments, the same ALJ issued a partially favorable decision in 2019, finding Rabdeau disabled only from May 9, 2018 onward. Rabdeau appealed the unfavorable portion, and the Appeals Council remanded the case again in 2021, citing insufficient evaluation of evidence regarding her headaches prior to May 2018. On remand, a different ALJ reviewed the case and, after considering testimony from a new vocational expert, denied benefits for the period before May 2018, finding her impairments were not severe enough to be disabling. The United States District Court for the Eastern District of Wisconsin affirmed this decision. The United States Court of Appeals for the Seventh Circuit reviewed the district court’s affirmance, applying the “substantial evidence” standard. The court held that the second ALJ was not required to address the prior ALJ’s findings as long as the decision was supported by substantial evidence. The Seventh Circuit found that the medical record supported the ALJ’s conclusion and affirmed the denial of benefits for the period before May 2018. View "Rabdeau v. Bisignano" on Justia Law

Hobet Mining, Inc. v. Director, Office of Workers' Compensation Programs

2025-10-01T10:30:47-08:00

Horace Meredith worked as a coal miner for several decades, with his last employment at Hobet Mining, Inc. During Meredith’s tenure at Hobet, Arch Coal Company, Inc. was Hobet’s parent company and provided self-insurance for black lung liabilities. Years after Meredith left Hobet and after Arch had sold Hobet to Magnum Coal (which was later acquired by Patriot Coal Company), Meredith filed a claim for black lung benefits. By the time of his claim, both Patriot and Hobet were defunct, and the Department of Labor sought to hold Arch liable for Meredith’s benefits, despite Arch no longer owning or insuring Hobet. After Meredith filed his claim, the district director designated Hobet as the responsible operator and Arch as the insurance carrier. Arch and Hobet contested this designation, arguing that Arch was no longer responsible for Hobet’s liabilities and that the Black Lung Disability Trust Fund should cover the claim. The Administrative Law Judge (ALJ) found Hobet to be the responsible operator and Arch liable as its self-insurer at the time of Meredith’s last employment. The Department of Labor’s Benefits Review Board affirmed the ALJ’s decision, holding Hobet and Arch liable for the claim. The United States Court of Appeals for the Fourth Circuit reviewed the Board’s decision. The court held that neither the Black Lung Benefits Act nor its regulations imposed liability on Arch under these circumstances. Specifically, the court found that Hobet did not meet the regulatory requirements to be a financially capable responsible operator, and Arch could not be held liable as a self-insurer for claims filed long after it ceased to own or insure Hobet. The Fourth Circuit granted the petition for review, vacated the Board’s decision, and remanded for further proceedings consistent with its opinion. View "Hobet Mining, Inc. v. Director, Office of Workers' Compensation Programs" on Justia Law

United States v. Sandoval

2025-09-30T10:33:43-08:00

The defendant, who had been receiving disability insurance benefits due to a medical diagnosis, operated a jewelry business while collecting these benefits. The Social Security Administration (SSA) began investigating after suspecting that the defendant was earning income that could affect his eligibility. The SSA asked the defendant whether he had worked or received income since his diagnosis, to which he responded negatively. However, evidence showed that he had significant gross income from jewelry sales, and the SSA determined that his countable income likely exceeded regulatory caps, making him ineligible for benefits. The defendant was subsequently charged with taking government property and making false statements. The United States District Court for the District of New Mexico presided over the trial. The government presented evidence of substantial gross income and efforts by the defendant to conceal earnings. The defendant did not provide information about business expenses that could have reduced his countable income. The jury convicted him on multiple counts related to theft of government property and false statements. At sentencing, the district court calculated the loss amount, including benefits paid to the defendant’s children and payments made outside the charged period, resulting in a 15-month prison sentence. The United States Court of Appeals for the Tenth Circuit reviewed the case. The court held that the evidence was sufficient for a reasonable jury to find that the defendant’s countable income exceeded the regulatory caps, even without detailed expense information, given the high gross income and lack of contrary evidence. The court also found no reversible error in the jury instructions, as the defendant failed to timely challenge the district court’s reasoning. Regarding sentencing, the court held that it was proper to include reasonably foreseeable payments to the defendant’s children and payments outside the charged period in the loss calculation. Any error in including Medicare premiums was deemed harmless. The convictions and sentence were affirmed. View "United States v. Sandoval" on Justia Law

Hook & Ladder Apartments, L.P. v. Nalewaja

2025-09-26T06:07:05-08:00

A tenant entered into a lease for an apartment in Minneapolis that was subsidized under the Section 8 project-based voucher program, with the local public housing authority paying most or all of the rent directly to the landlord. After the tenant fell behind on utility payments, her electricity was disconnected, and she and her boyfriend broke into the building’s utility closet to restore power, inadvertently affecting other units. The landlord learned of this breach but continued to accept three months of rental payments from the public housing authority on the tenant’s behalf. Later, the landlord filed an eviction action based on the tenant’s breach of the lease. The Hennepin County District Court dismissed the tenant’s counterclaim regarding the utility shutoff and, following the Minnesota Court of Appeals’ decision in Westminster Corp. v. Anderson, held that the common law doctrine of waiver by acceptance of rent did not apply to rental payments made by a public housing agency. The district court found the tenant had materially breached the lease and did not address her retaliation defense. The Minnesota Court of Appeals affirmed the district court’s rulings on the waiver and breach issues but remanded for consideration of the retaliation defense. The Minnesota Supreme Court reviewed only the waiver issue. It overruled Westminster, holding that the common law rule—whereby a landlord who accepts rent with knowledge of a tenant’s breach waives the right to evict for that breach—applies equally to private and publicly subsidized tenancies. The court clarified that whether a landlord has accepted rent for purposes of this doctrine is a factual question, to be determined by the totality of the circumstances, including the landlord’s conduct after payment. The Supreme Court reversed the court of appeals and remanded for further proceedings. View "Hook & Ladder Apartments, L.P. v. Nalewaja" on Justia Law

State v. Post

2025-09-23T14:36:39-08:00

The defendant was cited for a third offense of driving under the influence (DUI) and for driving with a suspended license, both misdemeanors, in November 2021. He was initially convicted in Justice Court and then sought a trial de novo in the District Court. At trial, a jury found him guilty of both offenses. During sentencing, the defendant’s counsel informed the court that the defendant was on a limited income, receiving disability and social security, and requested that the court consider his financial situation when imposing fines and fees, including a request to waive the public defender fee. After the jury verdict in the Twenty-First Judicial District Court, the court sentenced the defendant to jail time, most of which was suspended, and imposed a $3,000 fine with statutory surcharges and a $250 public defender fee. The written judgment also included a $10 technology fee and $50 in prosecution costs, which were not mentioned in the oral pronouncement. The defendant appealed, arguing that the written judgment conflicted with the oral sentence and that the court failed to consider his ability to pay the fines and fees. The Supreme Court of the State of Montana reviewed the case. It held that when there is a conflict between the oral sentence and the written judgment, the oral sentence controls, and thus the $10 technology fee and $50 prosecution costs should not have been included. The court further held that the District Court erred by failing to inquire into the defendant’s ability to pay the public defender fee, the $3,000 fine, and the statutory surcharges, as required by Montana statutes. The Supreme Court reversed the sentence and remanded the case for a new sentencing hearing consistent with its opinion. View "State v. Post" on Justia Law

State v. LaForge

2025-09-16T14:07:15-08:00

The case concerns the fatal shooting of Brett Ness in Billings, Montana, following a series of drug-related disputes. Alexander Garrett LaForge III, along with several others, was involved in confrontations with Ness over an alleged shortfall in a methamphetamine transaction. After escalating tensions and threats, LaForge and a group of associates returned to Ness’s trailer, where LaForge shot Ness in the head with a .45 caliber pistol. Ness died later that day. Multiple co-defendants received plea deals in exchange for their testimony against LaForge. The Thirteenth Judicial District Court, Yellowstone County, presided over LaForge’s trial. LaForge requested a substitution of counsel shortly before trial, citing communication issues and dissatisfaction with his attorney’s preparation. The District Court conducted an inquiry and denied the request, finding no substantial breakdown in communication. During trial, LaForge also requested a cautionary jury instruction regarding the credibility of co-defendants’ testimony, which the District Court declined, instead providing standard witness credibility instructions and a specific instruction regarding one co-defendant’s accountability. The jury convicted LaForge of deliberate homicide. At sentencing, the court ordered LaForge to pay $72,000 in restitution to the victim’s mother for lost business income, based on her testimony about canceled jobs following her son’s death. The Supreme Court of the State of Montana reviewed the case. It held that the District Court did not abuse its discretion in denying LaForge’s request for substitute counsel or in its jury instructions regarding co-defendant testimony. However, the Supreme Court found that the $72,000 restitution award was not supported by sufficient evidence and that the record was unclear as to whether the victim’s mother, as a business representative, qualified as a “victim” under the restitution statutes. The Supreme Court affirmed the conviction and other aspects of the judgment, reversed the restitution award, and remanded for a new hearing to determine the proper amount and recipient of restitution. View "State v. LaForge" on Justia Law

Johnson v. Reed

2025-09-12T06:30:04-08:00

A group of plaintiffs filed suit against the Secretary of the Alabama Department of Workforce, alleging that the Department’s handling of their unemployment benefits applications during the COVID-19 pandemic was unlawful. The plaintiffs claimed that the Department’s policies and practices resulted in unreasonable delays and inadequate communication, violating both the Social Security Act and the Due Process Clause of the Fourteenth Amendment. They sought various forms of injunctive relief, including orders requiring prompt decisions on applications, timely payment of approved claims, and clearer communication with claimants. The Montgomery Circuit Court granted the Secretary’s motion to dismiss the case, without specifying the grounds for dismissal. The plaintiffs’ motion to alter or vacate the judgment was denied. On appeal, the Supreme Court of Alabama affirmed the dismissal, holding that the plaintiffs had not exhausted their administrative remedies and that the courts lacked the power to address the merits of their claims. The plaintiffs then sought review by the United States Supreme Court. The United States Supreme Court reversed the Alabama Supreme Court’s judgment, holding that the state’s administrative exhaustion requirement could not be used to bar federal due process claims under 42 U.S.C. § 1983 for alleged delays in processing unemployment benefits. On remand, the Supreme Court of Alabama considered supplemental briefing on whether the case had become moot, as the Secretary asserted that all plaintiffs had either been paid or received final denials. The plaintiffs disputed this and requested a remand for a factual determination. The Supreme Court of Alabama remanded the case to the Montgomery Circuit Court to determine whether the case is now moot, instructing the lower court to resolve the factual dispute regarding mootness. View "Johnson v. Reed" on Justia Law

GALVEZ V. BISIGNANO

2025-09-10T08:30:45-08:00

Lydia Galvez applied for Social Security disability insurance benefits, claiming disability from 2008 to 2018 due to various medical conditions. Her initial claim was denied by an Administrative Law Judge (ALJ) in 2013, who found she could perform light work. After Galvez appealed, the United States District Court for the Eastern District of Washington remanded the case in 2017 for further evaluation of her fibromyalgia diagnosis. On remand, the same ALJ, whose appointment had since been ratified, again denied benefits in 2019, incorporating parts of his earlier decision. Subsequent proceedings led to the assignment of a new ALJ, who held additional hearings, considered new evidence, and ultimately found Galvez not disabled for the period in question, though he found her disabled as of January 1, 2019 due to a new injury. After the new ALJ’s decision, Galvez again appealed to the district court, arguing that the decision was tainted by reliance on findings from the prior, improperly appointed ALJ, thus violating the Appointments Clause. The district court agreed, holding that the new ALJ’s decision was not independent because it incorporated portions of the earlier, tainted decision, and remanded the case for a new hearing before a different ALJ. The United States Court of Appeals for the Ninth Circuit reviewed the case. The court held that a new ALJ’s decision is not automatically tainted by an Appointments Clause violation simply because it incorporates or echoes portions of a prior, tainted decision. The key inquiry is whether the new ALJ provided an independent assessment. The Ninth Circuit found that the new ALJ conducted additional hearings, considered new evidence, and made independent findings, thus satisfying the requirement for a fresh, independent review. The Ninth Circuit vacated the district court’s order and remanded for consideration of the merits of Galvez’s claim. View "GALVEZ V. BISIGNANO" on Justia Law

Baker v. San Mateo County Employees Retirement Assn.

2025-09-05T13:00:57-08:00

Catherine Baker was employed by San Mateo County as a Social Worker III but went on medical leave in 2009 due to back pain. In 2015, she returned to work in a different position as a screener trainee, which involved different duties but was compensated at the same pay rate as her original position. Her last paycheck was issued in January 2016. In 2017, Baker applied for a service-connected disability retirement, and the San Mateo County Employees Retirement Association (SamCERA) determined that the effective date for her retirement benefits should be January 22, 2016, the day after her last receipt of “regular compensation.” After SamCERA’s Board approved her application and set the effective date, Baker sought administrative review, arguing that her compensation as a screener trainee did not qualify as “regular compensation” under Government Code section 31724 because she had not returned to her original job. An administrative law judge recommended denial of her request to change the effective date, and the Board adopted this recommendation. Baker then filed a petition for writ of administrative mandamus in the Superior Court of San Mateo County, which denied the petition and confirmed the January 22, 2016 effective date. On appeal, the California Court of Appeal, First Appellate District, Division One, reviewed whether “regular compensation” under section 31724 included Baker’s pay as a screener trainee. Exercising independent judgment on statutory interpretation, the court held that “regular compensation” refers to regular salary or full wages, regardless of whether the position is the employee’s original job. Because Baker’s screener trainee pay matched her original position’s rate, it qualified as “regular compensation.” The court affirmed the trial court’s judgment, upholding the effective date set by SamCERA. View "Baker v. San Mateo County Employees Retirement Assn." on Justia Law

STERLING V. FEEK

2025-09-04T08:01:08-08:00

A plaintiff who lost his job during the COVID-19 pandemic applied for and received regular unemployment benefits from the Washington State Employment Security Department (ESD). After exhausting those benefits, he applied for and received additional benefits under the federally funded Pandemic Emergency Unemployment Compensation (PEUC) program, created by the CARES Act. Following an audit, ESD redetermined his eligibility, reduced his weekly benefit, and assessed overpayments, sending him multiple, confusing notices with inconsistent information and deadlines. While the plaintiff appealed, ESD began offsetting his ongoing PEUC benefits to recover the alleged overpayments. An administrative law judge later found that ESD’s notices failed to provide adequate explanation or legal basis for the benefit reductions and overpayment assessments, and ordered ESD to issue a new redetermination. ESD reimbursed the plaintiff for the offset amounts, but its system continued to show a balance owed. The plaintiff, on behalf of himself and similarly situated individuals, filed a putative class action in the United States District Court for the Western District of Washington, alleging deprivation of property without due process under the Fourteenth Amendment and the Social Security Act. The district court held that while the plaintiff had a property interest in regular unemployment benefits, he did not have a constitutionally protected property interest in PEUC benefits, because state participation in the PEUC program was voluntary and could be terminated at any time. On interlocutory appeal, the United States Court of Appeals for the Ninth Circuit reversed the district court’s ruling. The Ninth Circuit held that the CARES Act’s PEUC program, once a state opted in, created a constitutionally protected property interest in PEUC benefits for eligible individuals. The Act’s mandatory language and objective eligibility criteria significantly constrained state discretion, giving rise to legitimate claims of entitlement. The case was remanded for further proceedings. View "STERLING V. FEEK" on Justia Law

Madkins v. Bisignano

2025-09-03T15:30:16-08:00

The plaintiff, a former machine operator with a high school education, stopped working after a workplace injury and subsequently experienced a range of medical issues, including spinal stenosis, degenerative joint disease, carpal tunnel syndrome, arthritis, depression, and anxiety. In November 2018, she applied for disability insurance benefits, claiming her disability began in March of that year. Her application was denied at multiple stages within the Social Security Administration (SSA), including after a hearing before an administrative law judge (ALJ). The SSA Appeals Council denied her request for review, prompting her to seek judicial review. The United States District Court for the Northern District of Mississippi reversed and remanded the ALJ’s decision, instructing the ALJ to specifically evaluate certain medical opinions, including that of Dr. William Booker, in accordance with relevant regulations. On remand, the ALJ held another hearing, considered extensive medical evidence and testimony, and again found that while the plaintiff had several severe impairments and could not perform her past work, she retained the residual functional capacity to perform light work with certain restrictions. The ALJ concluded that jobs existed in significant numbers in the national economy that she could perform, and thus she was not disabled. The Appeals Council adopted this as the final decision of the Commissioner. The district court, with the consent of both parties, affirmed the Commissioner’s decision, and the plaintiff appealed to the United States Court of Appeals for the Fifth Circuit. The Fifth Circuit reviewed whether the Commissioner’s decision was supported by substantial evidence and whether proper legal standards were applied. The court held that the ALJ’s decision was supported by substantial evidence and that any alleged errors did not prejudice the plaintiff’s substantial rights. The court affirmed the judgment of the district court. View "Madkins v. Bisignano" on Justia Law

Filyaw v. Corsi

2025-08-27T07:30:25-08:00

The plaintiff, a Nebraska resident, received Medicaid benefits administered by the Nebraska Department of Health and Human Services (NDHHS). In April 2024, she was sent a notice stating her Medicaid eligibility was ending due to income exceeding program standards. The notice informed her of her rights to request a conference or appeal and outlined the process for a fair hearing. She did not appeal the termination, and her coverage ended on May 1, 2024. Subsequently, she filed a federal lawsuit on behalf of herself and similarly situated individuals, alleging that the termination notices failed to meet due process requirements and seeking class certification, declaratory and injunctive relief, including reinstatement of benefits until proper notice was provided. The United States District Court for the District of Nebraska considered only her individual claims, as she did not challenge the court’s decision to exclude class claims on appeal. The district court denied her request for a temporary restraining order, finding she was unlikely to succeed because her claims sought retroactive relief barred by sovereign immunity and because the notices likely satisfied due process. The court then dismissed her complaint for lack of subject matter jurisdiction, concluding she had not alleged an ongoing violation of federal law and was not seeking prospective relief, as required to invoke the Ex parte Young exception to Eleventh Amendment immunity. The United States Court of Appeals for the Eighth Circuit reviewed the case and affirmed the district court’s dismissal. The Eighth Circuit held that the plaintiff’s alleged due process violation was a discrete past event—the issuance of the notice and termination of benefits—not an ongoing violation. The court further held that the relief sought was retrospective, not prospective, and thus barred by the Eleventh Amendment. The court concluded that the Ex parte Young exception did not apply, and affirmed the dismissal. View "Filyaw v. Corsi" on Justia Law

Johnson v. United States Congress

2025-08-19T07:01:44-08:00

An Army veteran serving a lengthy prison sentence in Florida applied for and received disability benefits for service-related post-traumatic stress disorder. Initially, the Veterans Benefits Administration approved his claim at a 70 percent rate, later increasing it to 80 percent. However, after his felony conviction and incarceration, the Administration reduced his monthly benefits to a 10 percent rate pursuant to 38 U.S.C. § 5313, which limits disability payments for veterans incarcerated for more than 60 days due to a felony. The veteran filed a pro se complaint in the United States District Court for the Middle District of Florida, naming the United States Congress as defendant. He alleged that the statute reducing his benefits violated the Bill of Attainder Clause and the Equal Protection component of the Fifth Amendment, seeking both prospective and retroactive relief. A magistrate judge recommended dismissal, assuming without deciding that the court had jurisdiction over facial constitutional challenges, but finding the claims frivolous. The district court adopted this recommendation, dismissing the complaint and declining to address the plaintiff’s general objections. On appeal, the United States Court of Appeals for the Eleventh Circuit reviewed the case. The court held that sovereign immunity barred the suit against Congress, as Congress has not waived immunity for constitutional claims arising from its enactment of legislation. The court further held that any amendment to name a different defendant would be futile because the Veterans’ Judicial Review Act provides an exclusive review scheme for challenges to veterans’ benefits decisions, channeling all such claims—including constitutional challenges—through the administrative process and ultimately to the Court of Appeals for Veterans Claims and the Federal Circuit. The Eleventh Circuit vacated the district court’s judgment and remanded with instructions to dismiss the case without prejudice for lack of jurisdiction. View "Johnson v. United States Congress" on Justia Law

In re Butterfly Kisses Child Care Center, Inc.

2025-08-14T08:15:45-08:00

A childcare provider operating two centers in Vermont participated in the federal Child and Adult Care Food Program (CACFP), which reimburses centers for meals provided to children if certain regulatory requirements are met. The provider had previously been cited for noncompliance in 2019, but the matter was resolved after corrective action. In 2022, the Vermont Agency of Education (AOE) again found serious deficiencies, including inadequate recordkeeping, improper meal claims, and failure to monitor facilities. The provider submitted a corrective-action plan, and AOE initially determined the deficiencies were fully and permanently corrected. However, a subsequent unannounced review in 2023 revealed recurring deficiencies, such as missing enrollment forms, incorrect eligibility determinations, and incomplete documentation. Following these findings, AOE issued a notice proposing to terminate the provider’s participation in CACFP and to disqualify the provider and two employees from future participation. The provider requested an administrative review. At the hearing, the provider acknowledged some paperwork was not in compliance but argued the errors were minor and unintentional. Due to time constraints, the hearing officer allowed both parties to submit post-hearing written arguments and documentation, to which the provider did not initially object but later challenged as a violation of due process and agency procedures. The Vermont Supreme Court reviewed the case after the hearing officer affirmed AOE’s decision to terminate and disqualify the provider. The Court held that the hearing officer applied the correct legal standard and that the record supported the findings of persistent serious deficiencies. The Court also determined that the provider had not properly preserved its objection to post-hearing submissions and, regardless, was not prejudiced by the procedure. The Court affirmed the termination and disqualification from the CACFP. View "In re Butterfly Kisses Child Care Center, Inc." on Justia Law

PROFESSIONAL HOME HEALTH CARE V. COMMONWEALTH OF KENTUCKY CABINET FOR HEALTH AND FAMILY SERVICES

2025-08-14T06:14:59-08:00

A healthcare provider participated in Kentucky’s Medicaid program, offering in-home services to recipients in rural areas under the Home and Community Based (HCB) Waiver program. The Department for Medicaid Services had, for several years, reimbursed the provider at enhanced rates for “case management” services, even though the relevant administrative regulation did not list “case management” as a reimbursable “revenue code service.” In 2016, the Department determined that these payments were made in error and sought to recoup over $1 million from the provider for services rendered between 2011 and 2013. After the Department initiated recoupment, the provider contested the action through the Cabinet’s administrative process, arguing that the omission of “case management” from the regulation was a drafting error and that the Department should be estopped from recouping the funds due to its prior representations and delay. The administrative hearing officer rejected these arguments, finding the regulation’s text unambiguous and concluding that neither equitable estoppel nor laches applied. The Secretary of the Cabinet adopted this decision. The provider then sought judicial review in the Franklin Circuit Court, which affirmed the agency’s decision. The Kentucky Court of Appeals also affirmed. The Supreme Court of Kentucky reviewed the case and affirmed the Court of Appeals. The Court held that the Department’s regulation unambiguously excluded “case management” from the list of services eligible for enhanced reimbursement, and the Department was within its authority to recoup the overpaid funds. The Court declined to read omitted language into the regulation, found no basis for equitable estoppel or laches against the Department, and rejected the provider’s arguments regarding the sufficiency of the Department’s audit. View "PROFESSIONAL HOME HEALTH CARE V. COMMONWEALTH OF KENTUCKY CABINET FOR HEALTH AND FAMILY SERVICES" on Justia Law

Indiana Protection and Advocacy Services Comm'n v Indiana Family and Social Services Administration

2025-08-11T06:30:36-08:00

Two children, E.R. and G.S., have severe, complex medical conditions that require constant, skilled care. Their mothers, who are their primary caregivers and sole financial supporters, have been trained by medical professionals to provide the necessary care at home. For years, Indiana’s Medicaid program reimbursed these mothers for providing “attendant care services” under a waiver program designed to keep individuals out of institutions. In July 2024, the Indiana Family and Social Services Administration (FSSA) implemented a policy change that would make parents ineligible to be paid providers of attendant care for their children, threatening to force E.R. and G.S. into institutional care due to the lack of available in-home nurses. The Indiana Protection and Advocacy Services Commission, along with E.R. and G.S., sued to block the policy change and require FSSA to secure in-home nursing. The United States District Court for the Southern District of Indiana initially granted a preliminary injunction requiring FSSA to take steps to obtain in-home nurses and to pay the mothers for a different, lower-paid service. After further proceedings, the court modified its order, ultimately requiring FSSA to pay the mothers for attendant care at the previous rate until in-home nursing could be secured. The United States Court of Appeals for the Seventh Circuit affirmed the district court’s October 1 injunction. The court held that the plaintiffs are likely to succeed on their claims under the Americans with Disabilities Act’s integration mandate, which requires states to provide services in the most integrated setting appropriate. The court found that prohibiting the mothers from providing paid attendant care placed the children at serious risk of institutionalization and that FSSA had not shown that allowing such care would fundamentally alter the Medicaid program or violate federal law. The case was remanded for further proceedings. View "Indiana Protection and Advocacy Services Comm'n v Indiana Family and Social Services Administration" on Justia Law

Luce v. Lexington County Health Services District, Inc.

2025-08-06T06:20:01-08:00

A certified registered nurse anesthetist, who had already retired and was receiving retirement benefits, resumed work at a medical center. He and other similarly situated salaried healthcare workers received additional pay for working undesirable shifts, such as weekends, holidays, late hours, on-call, and for hours worked beyond their scheduled shifts. This extra compensation, referred to as the "Wages in Controversy," was subject to mandatory deductions for the South Carolina Retirement System (SCRS). The plaintiff challenged these deductions, arguing that the extra pay should not be considered "earnable compensation" under the SCRS Act and thus should not be subject to retirement contributions. The United States District Court for the District of South Carolina, recognizing that the resolution of the plaintiff’s claims depended on the interpretation of state law, certified a question to the Supreme Court of South Carolina. The question was whether the Wages in Controversy constituted "earnable compensation" under South Carolina law, making them subject to mandatory employer deductions for SCRS contributions. The Supreme Court of South Carolina held that the Wages in Controversy are "earnable compensation" as defined by the SCRS Act. The court reasoned that these payments, although labeled differently by the employer, were all compensation for hours actually worked and not irregular, one-time, or bonus payments excluded by statute. The court concluded that such pay is subject to mandatory employer deductions under the relevant statutory provisions. The certified question was answered accordingly. View "Luce v. Lexington County Health Services District, Inc." on Justia Law

Smith v. Wayne County

2025-08-05T12:30:20-08:00

In 1994, Kenneth Hayes was murdered in Wayne County, Michigan. Larry Smith was convicted of first-degree murder and a firearm charge, largely based on the testimony of Edward Allen, a jailhouse informant who claimed Smith confessed to the crime. Smith’s conviction was affirmed on direct appeal, and his subsequent state and federal habeas petitions were unsuccessful. Years later, the Wayne County Prosecutor’s Conviction Integrity Unit investigated and found evidence suggesting Allen’s testimony may have been fabricated as part of a broader scheme involving police and prosecutors eliciting false testimony from informants. Smith’s conviction was vacated in 2021, and he was released from prison. After his release, Smith obtained compensation from the State of Michigan under the Wrongful Imprisonment Compensation Act (WICA), settling for $850,000 and signing a release of claims against the State. He then filed a federal lawsuit against Wayne County and prosecutor Robert Donaldson, alleging constitutional violations under 42 U.S.C. § 1983 and a Monell claim against the County for policies encouraging false testimony. The United States District Court for the Eastern District of Michigan granted summary judgment to both defendants, finding Donaldson was protected by absolute prosecutorial immunity and that Smith’s settlement under WICA released his claims against Wayne County. The United States Court of Appeals for the Sixth Circuit reviewed the case de novo. It held that Donaldson was entitled to absolute prosecutorial immunity because his conduct—preparing a witness for trial—was within the scope of his advocacy role, not investigatory. The court also held that Smith’s acceptance of the WICA settlement released all claims against Wayne County, including federal claims, as a matter of law. The Sixth Circuit affirmed the district court’s grant of summary judgment to both defendants. View "Smith v. Wayne County" on Justia Law

Cain v Bisignano

2025-08-04T07:00:18-08:00

Jonathan Cain applied for supplemental security income (SSI) due to severe impairments, including degenerative disc disease, migraine headaches, obesity, depression, and anxiety. Despite his conditions, an administrative law judge (ALJ) determined that Cain could perform certain types of work and denied his disability benefits. Cain challenged this decision in federal court. The United States District Court for the Southern District of Indiana affirmed the ALJ's decision, holding that substantial evidence supported the ALJ's conclusion. The court found that the ALJ met the minimal articulation requirements in assessing the medical evidence and did not err in relying on the vocational expert's testimony. The United States Court of Appeals for the Seventh Circuit reviewed the case. The court held that the ALJ's decision was supported by substantial evidence. The ALJ adequately evaluated the medical opinions of Cain's treating physician, Dr. Amanda Williams, and the state agency psychologists, Dr. Joelle Larsen and Dr. Ken Lovko. The ALJ also properly relied on the vocational expert, Thomas Dunleavy, who provided a reliable basis for his job number predictions. The court concluded that the ALJ did not commit legal error and affirmed the district court's judgment. View "Cain v Bisignano" on Justia Law

Fletcher Properties, Inc. vs. City of Minneapolis

2025-08-01T08:19:58-08:00

Fletcher Properties, Inc. and other appellants own multi-tenant residential properties in Minneapolis. The City of Minneapolis enacted an ordinance prohibiting property owners from refusing to rent to individuals based on requirements of public assistance programs, including Section 8 housing vouchers. Fletcher challenged the ordinance, claiming it violated the Minnesota Constitution’s Takings Clause and was preempted by the Minnesota Human Rights Act (MHRA). The district court initially ruled in favor of Fletcher, finding the ordinance violated due process and equal protection clauses. The court of appeals reversed this decision, and the Minnesota Supreme Court affirmed, remanding the case to address the remaining claims. On remand, the district court granted summary judgment for the City, rejecting Fletcher’s takings and preemption claims. The court of appeals affirmed this decision, leading to the current appeal. The Minnesota Supreme Court reviewed the case and held that the ordinance does not constitute a physical or regulatory taking under the Minnesota Constitution. The court applied the Penn Central factors, concluding that the economic impact of the ordinance, interference with investment-backed expectations, and the character of the government action did not support a finding of a regulatory taking. The court also determined that the ordinance does not effect a physical taking as landlords voluntarily rent their properties and are not compelled to continue doing so. Additionally, the court held that the ordinance is not preempted by the MHRA. The court found no conflict between the ordinance and the MHRA, as the MHRA does not grant landlords an affirmative right to reject voucher holders. The court also concluded that the MHRA does not occupy the field of housing discrimination based on public assistance, allowing for local regulation. The Minnesota Supreme Court affirmed the decision of the court of appeals, upholding the ordinance. View "Fletcher Properties, Inc. vs. City of Minneapolis" on Justia Law

Padua v. Bisignano

2025-08-01T06:30:32-08:00

Jada Padua applied for Social Security benefits, claiming disability due to fibromyalgia, chronic fatigue, depression, and anxiety. An administrative law judge (ALJ) denied her benefits, concluding that she was not disabled as defined by the Social Security Act and that jobs existed in significant numbers in the national economy that she could perform. Padua challenged the agency’s denial in federal court, but the district court upheld the ALJ's decision, finding substantial evidence to support it. Padua filed her disability benefits application in November 2010, initially claiming a disability onset date of July 2008, later amended to November 2010. After an initial denial and a remand by a magistrate judge in February 2016, the ALJ held a second hearing in August 2016. The ALJ determined that Padua was not disabled under the Social Security Act, finding that her impairments did not meet a listing for presumptive disability and that she had the residual functional capacity (RFC) to perform light work with additional limitations. The ALJ discounted Padua’s complaints of extreme pain and fatigue, noting inconsistencies with her daily activities and the overall medical record. The ALJ also gave little weight to the opinions of her treating physicians, Drs. Carpenter and Pendolino, finding them inconsistent with the evidence. The United States Court of Appeals for the Seventh Circuit reviewed the case and affirmed the district court’s decision. The court held that the ALJ’s assessment of Padua’s fibromyalgia and the opinions of Drs. Carpenter and Pendolino were supported by substantial evidence. The court found that the ALJ reasonably considered the objective medical evidence, treatment history, and daily activities in determining Padua’s RFC. The court also concluded that the ALJ provided adequate reasons for discounting the treating physicians’ opinions and that the RFC determination was supported by substantial evidence. View "Padua v. Bisignano" on Justia Law

Arnold v. Bisignano

2025-07-31T11:02:03-08:00

Christian Arnold retained Binder & Binder in April 2018 to represent him in a claim for disability benefits under the Social Security Act. After the Commissioner of Social Security denied his claim, Arnold appealed to the district court, which remanded the case to the agency. An administrative law judge later determined Arnold was entitled to $160,797.10 in past-due benefits. Binder then moved for attorneys' fees under 42 U.S.C. § 406(b), seeking twenty-five percent of the retroactive benefits, amounting to $40,199.27. The district court awarded Binder $16,920, reducing the fee based on an effective hourly rate of $600. The United States District Court for the Central District of Illinois initially awarded Binder $16,920, despite the contingency fee agreement. Binder appealed, and the United States Court of Appeals for the Seventh Circuit held that the district court abused its discretion by not anchoring its reasonableness analysis on the contingency fee agreement. The case was remanded for further proceedings. On remand, the district court again awarded $16,920, maintaining that the contingency fee should be reduced to reflect a more reasonable effective hourly rate. Binder appealed once more. The United States Court of Appeals for the Seventh Circuit reviewed the case and found that the district court abused its discretion by inadequately explaining its decision to reduce Binder’s fees. The appellate court emphasized that the district court must begin with the contingency fee agreement and consider relevant factors, such as the plaintiff’s satisfaction and the attorney’s expertise. The appellate court reversed the district court’s decision and remanded with instructions to order the Social Security Administration to remit attorneys’ fees at Binder’s requested amount of $34,199.27. View "Arnold v. Bisignano" on Justia Law

Thorpe v Bisignano

2025-07-31T09:01:56-08:00

Donald Thorpe sought disability benefits, claiming that his health issues rendered him unable to work. The Administrative Law Judge (ALJ) denied his claim, relying on the testimony of a vocational expert. Thorpe appealed to the district court, which affirmed the ALJ’s decision, stating that Thorpe forfeited any challenge to the expert testimony by failing to object timely and that the decision was supported by substantial evidence. The district court found that Thorpe did not object to the vocational expert’s testimony during the hearing or in a post-hearing brief, thus forfeiting his right to challenge it. The court also determined that the ALJ’s decision was based on substantial evidence, including the expert’s testimony, which was consistent with the Dictionary of Occupational Titles (DOT) and supported by the expert’s qualifications and experience. The United States Court of Appeals for the Seventh Circuit reviewed the case and agreed with the district court. The court held that Thorpe forfeited his ability to challenge the expert’s testimony by not objecting during the hearing. The court also found that the ALJ’s decision was supported by substantial evidence, as the expert’s testimony had sufficient indicia of reliability, including consistency with the DOT and the expert’s qualifications. The Seventh Circuit affirmed the district court’s decision, concluding that the ALJ did not err in relying on the vocational expert’s testimony to determine that Thorpe was not disabled and could find other gainful employment. View "Thorpe v Bisignano" on Justia Law

In re FT

2025-07-29T12:04:39-08:00

A skilled nursing facility accepted a new resident who was receiving Medicaid benefits. The resident's husband was designated as her authorized representative. Nearly two years later, the Department of Human Services (DHS) terminated the resident's Medicaid benefits due to excess assets. Both the resident and her husband were incapacitated, and the resident's public guardian submitted a new Medicaid application, which was denied. The nursing facility continued to care for the resident without compensation until her death. The facility later sought an administrative hearing to challenge the eligibility decision, but the request was denied because the facility was not an authorized representative and the appeal was late. The circuit court and the Intermediate Court of Appeals (ICA) affirmed the denial, holding that the nursing home lacked standing to challenge the eligibility determination under Hawai'i Revised Statutes (HRS) § 346-12, which limits appeals to the applicant or recipient. The courts concluded that the nursing home did not have a close relationship with the resident for third-party standing purposes. The Supreme Court of the State of Hawai'i reviewed the case and disagreed with the lower courts regarding standing. The court held that skilled nursing facilities have constitutionally protected property interests in compensation for medical services performed for residents based on DHS eligibility determinations. The court ruled that these facilities have due process rights under the Hawai'i Constitution, including notice and the opportunity to appeal Medicaid eligibility determinations when the beneficiary is incapacitated and no authorized representative is available or willing to appeal. The court vacated the ICA's judgment and the circuit court's order, remanding the case for a new administrative hearing on the merits of the resident's Medicaid eligibility. View "In re FT" on Justia Law

Nadon v. Bisignano

2025-07-25T08:00:43-08:00

Dionne Marie Nadon applied for disability insurance benefits and supplemental security income in April 2015 and May 2016, respectively, citing conditions such as fibromyalgia, spinal abnormalities, depression, and anxiety. The administrative law judge (ALJ) initially denied her applications in January 2017, finding she could return to her past work as a cashier/checker. On appeal, the case was remanded because the ALJ had not adequately addressed Nadon’s post-traumatic stress disorder (PTSD). On remand, the ALJ again determined that Nadon was not disabled, following the five-step sequential analysis for determining disabilities. The ALJ found that Nadon had engaged in substantial gainful activity as a personal care attendant from July 2021 through 2022 but continued the analysis due to a continuous period of at least twelve months during which Nadon did not engage in substantial gainful activity. The ALJ found that Nadon had severe impairments but did not have an impairment or combination of impairments that met or equaled the severity of a listed impairment. The ALJ determined that Nadon’s residual functional capacity allowed her to perform light work with certain limitations and found that she could perform her past relevant work as a personal care attendant and other work as a housekeeper, marker, or small products assembler. The district court affirmed the ALJ’s decision. The United States Court of Appeals for the Ninth Circuit reviewed the case de novo and affirmed the district court’s decision. The court held that the ALJ did not err by considering Nadon’s work as a personal care attendant, as an ALJ is permitted to consider any work done by a claimant when evaluating a disability claim. The court also found that the ALJ provided several reasons for discounting Nadon’s testimony and the opinions of several healthcare professionals, beyond her work as a personal care attendant. The court rejected Nadon’s argument that the ALJ erred by relying on the vocational expert’s testimony, as it relied on the rejected premise that the ALJ erred in discounting the healthcare professionals’ opinions. View "Nadon v. Bisignano" on Justia Law