Justia U.S. 2nd Circuit Court of Appeals Opinion Summaries

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

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Plaintiff filed for Social Security benefits, but her application was denied by the Social Security Commissioner. The Appeals Council denied review, which made the Commissioner’s decision final. Plaintiff appealed that decision to the district court, which denied her motion and granted the Commissioner’s motion for judgment on the pleadings. Plaintiff appealed that judgment.   The Second Circuit affirmed in part and remanded in part. The court held the district court failed to properly assess Plaintiff’s Residual Functional Capacity (RFC) with regard to her ability to work consistently as well as her limitations regarding social interactions, and that substantial evidence accordingly does not support the determination that Plaintiff’s psychological impairments do not render her disabled. By contrast, the court held that substantial evidence does support the determination that Plaintiff’s physical impairments do not render her disabled. View "Rucker v. Kijakazi" on Justia Law

Posted in: Public Benefits
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Plaintiff filed a claim for Social Security benefits. In support of her disability claims, she presented the opinions of two of her treating physicians. After a hearing, an ALJ assigned partial weight to the treating physicians’ opinions, ultimately concluding that the plaintiff was not disabled. Congress has authorized federal courts to engage in a limited review of final SSA disability benefit decisions.Plaintiff argued that the ALF’s residual functional capacity (“RFC”) finding was not supported by substantial evidence. The court reasoned that in this instance, the ALJ had complete records such as medical opinions, treatment notes, and relevant test results. The court found that the plaintiff failed to identify any missing medical records, and therefore the ALJ did not err in failing to supplement the administrative record. Similarly, the ALJ found notable inconsistencies between the plaintiff's treating doctors' conclusions and the longitudinal records of the plaintiff’s physical health.Thus, the court concluded that substantial evidence supports the ALJ’s ultimate RFC determination. Finally, although the ALJ committed procedural error by failing to explicitly apply each of the factors listed in 20 C.F.R. Sec. 404.1527(c), the error was harmless because substantial evidence supported the ALJ's determinations. View "Schillo v. Saul" on Justia Law

Posted in: Public Benefits
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The Second Circuit reversed the district court's denial in part of the law firm's motion for attorney's fees in a Social Security disability case. The court held that for a court to find an attorney's agreed-upon contingency fee unreasonable under 42 U.S.C. 406(b) on the sole ground that it constitutes a windfall, it must be truly clear that the high fee represents a sum unearned by counsel. In this case, the requested fee was not such a windfall and there is no other reason to think that the fee requested is unreasonable. Therefore, the court remanded with instructions to order the Social Security Administration to release the requested fee to the law firm. View "Fields v. Kijakazi" on Justia Law

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Colgan, a teacher at a special education high school, attempted to break up a fight between students but either fell or was pushed into a wall, leading to serious injuries. Colgan’s injuries and symptoms persisted despite treatment from several medical sources. Her treating physician, Dr. Ward, a concussion specialist, found that Colgan satisfied the medical criteria for mild traumatic brain injury and post-concussion syndrome with persistent cognitive defects and fatigue, chronic post-traumatic headaches, sleep disturbance, and dizziness; Colgan's debilitating headaches severely hampered her ability to carry out activities of daily living and basic job-related functions.Colgan successfully applied for workers’ compensation benefits. In 2016, Colgan sought social security disability insurance benefits. An ALJ denied Colgan’s claim, concluding that she had the residual functional capacity (RFC) to perform sedentary work, subject to physical and cognitive limitations (42 U.S.C. 423(d)(1)(A)). The district court affirmed. The Second Circuit vacated. The ALJ’s factual determination with respect to Colgan’s RFC was not supported by substantial evidence. The ALJ misapplied the treating physician rule to Dr. Ward’s “check-box” medical opinion, which was supported by voluminous treatment notes gathered over almost three years of clinical treatment View "Colgan v. Kijakazi" on Justia Law

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The Second Circuit affirmed the district court's judgment, which (A) declared the Board to be in violation of the Individuals with Disabilities Education Act (IDEA) for denying a free appropriate public education (FAPE) to disabled students between the ages of 21 and 22 while providing a free public education to nondisabled students in the same age range, and (B) permanently enjoined the Board and its successors, employees, and agents, etc., from terminating, on the basis of age, FAPEs for plaintiff class members who have not received a regular high school diploma before they reach the age of 22.The court concluded that the original plaintiff, D.J., had standing to bring the action where D.J. received ten months less of special education than he would have if not for the Board's enforcement of the challenged state regulation, thereby demonstrating injury for purposes of Article III standing. Furthermore, D.J.'s standing was entirely traceable to the Board's enforcement of the regulations at issue and the injury could be redressed by judicial action. On the merits, the court concluded that the district court did not abuse its discretion in interpreting the IDEA term "public education" to encompass free adult education programs offered by the State of Connecticut. The court considered all of the Board's arguments on appeal and found them to be without merit. View "A.R. v. Connecticut State Board of Education" on Justia Law

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Plaintiff, an applicant for Social Security Income benefits, appeals the district court's judgment denying her motion for an extension of time to file an appeal pursuant to Federal Rule of Appellate Procedure 4(a)(5). Plaintiff contends that because of her mental impairments, she established both "good cause" and "excusable neglect" under Rule 4(a)(5) for her failure to file a timely appeal.The Second Circuit concluded that "excusable neglect," rather than "good cause," is the appropriate standard for evaluating plaintiff's claim because her failure timely to appeal was at least in part due to her own inadvertence. The court explained that, in evaluating claims of "excusable neglect" under Rule 4(a)(5), courts consider the four factors set forth by the Supreme Court in Pioneer Investment Services Company v. Brunswick Associates Limited Partnership, 507 U.S. 380 (1993): the risk of prejudice to the non-movant; the length of the movant's delay and its impact on the proceedings; the reason for the delay, including whether it was within the movant's reasonable control; and whether the movant acted in good faith.In this case, the district court did not abuse its discretion in applying these factors to plaintiff's claim and concluding that she failed to demonstrate excusable neglect. The court explained that because plaintiff's untimely appeal was caused by her failure to maintain contact with her attorney—a factor within her reasonable control—she failed to establish excusable neglect under the Pioneer test. While plaintiff attributes her delay to her mental illness, which she argues is beyond her control, the court determined that the record does not compel the conclusion that her impairments as opposed to her neglect caused her failure timely to appeal. Accordingly, the court affirmed the district court's judgment. View "Alexander v. Saul" on Justia Law

Posted in: Public Benefits
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Plaintiff, a retired "dual status technician" with the National Guard, argues that the civil service pension he received in connection with his employment as a dual status technician – a civilian position that requires concurrent National Guard membership – is not subject to reduction under the Social Security Act's Windfall Elimination Provision because the pension falls within an exception applicable to payments based wholly on work performed as a member of a uniformed service. The district court granted summary judgment to plaintiff and the Administration appealed.The Second Circuit reversed the Administration's calculation of plaintiff's Social Security retirement benefits. The court read the plain language of the statute and used traditional tools of statutory interpretation, holding that a civil service pension based on federal civilian employment as a dual status technician does not fall within the uniformed service exception. Therefore, the court remanded for further proceedings consistent with the court's opinion. View "Linza v. Saul" on Justia Law

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In March 2020, Congress created the Paycheck Protection Program (PPP), which authorized the SBA to guarantee favorable loans to certain business affected by the COVID-19 pandemic. The SBA Administrator promulgated regulations imposing several longstanding eligibility requirements on PPP loan applicants, including that no SBA guarantee would be given to businesses presenting "live performances of a prurient sexual nature." Pharaohs, a business featuring nude dancing, sought a preliminary injunction directing the SBA to give it a PPP loan guarantee.The Second Circuit affirmed the district court's denial of Pharaoh's motion, holding that the district court did not abuse its discretion in finding that Pharaohs has failed to show that it is substantially likely to succeed on its claims that (1) the SBA exceeded its statutory authority to promulgate eligibility restrictions, and (2) the exclusion of nude-dancing establishments from the Program violates the First or Fifth Amendments. The court need not address the remaining preliminary injunction factors in light of its conclusion. View "Pharaohs GC, Inc. v. United States Small Business Administration" on Justia Law

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The Individuals with Disabilities Education Act (IDEA) does not permit a school district to amend an individualized education program (IEP) unilaterally during the thirty-day resolution period. The Act envisions the resolution period as a time for mediation and agreement, not one-sided action. In this case, the first IEP that the school district prepared for the child and presented to the parents indicated erroneously that the child would be placed in a 12-student classroom, which the parents deemed insufficient. After the parents filed a due process complaint, the school district sought to cure this deficiency by unilaterally amending the original IEP to reflect that the student would be in a 15-student class. The district court found in favor of the parents and ordered the school district to reimburse the parents for the private school tuition.The Second Circuit affirmed and concluded that because the school district argues only that it provided the student with a free appropriate education (FAPE) based on her IEP as unilaterally amended during the resolution period, and does not dispute that the unamended IEP denied the student a FAPE, the school district denied the student a FAPE for her 2016-17 school year. Finally, the district court's other conclusions relevant to the reimbursement order are not challenged on appeal and therefore stand unaltered. View "Board of Education of the Yorktown Central School District v. C.S." on Justia Law