Articles Posted in Public Benefits

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New York's intestacy law, as it existed in 2013 at the time of the agency's final determination, did not permit children conceived posthumously to inherit via intestacy. In this case, plaintiff had conceived twins via in vitro fertilization eleven years after her husband, the donor spouse, died. Plaintiff filed applications for child's survivors' benefits, based on her husband's earnings history, with the Social Security Administration. The Second Circuit held that, under the applicable provisions of New York's Estates, Powers and Trusts Law (EPTL) in effect at and prior to the time of the agency's final decision, the twins were not entitled to inherit from the decedent in intestacy. Accordingly, the court affirmed the district court's denial of benefits. View "MacNeil v. Berryhill" on Justia Law

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Plaintiffs Chorches and Fabula filed a qui taim suit under the False Claims Act (FCA), 31 U.S.C. 3729 et seq., against AMR, alleging that AMR made false statements and submitted false Medicare and Medicaid claims. Plaintiff Fabula also alleged a retaliation claim. The Second Circuit vacated the district court's dismissal of the claims and held that Chorches has pled the submission of false claims with sufficient particularity under Fed. R. Civ. P. 9(b), as applied in the qui tam context, and that Fabula's refusal to falsify a patient report, under the circumstances of this case, qualified as protected activity. Accordingly, the court remanded for further proceedings. View "Fabula v. American Medical Response, Inc." on Justia Law

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Plaintiff, on behalf of herself and her son, K.T., filed suit under the Individuals with Disabilities Education Act (IDEA), 20 U.S.C. 1400 et seq., against the DOE. At issue is the adequacy of three individualized education programs (IEP), which were characterized by a pattern of procedural violations of the IDEA committed by the DOE, and whether these errors deprived K.T. of a free appropriate public education (FAPE) for a period of three consecutive years. The court concluded that the procedural violations in formulating each IEP, when taken together, deprived K.T. of a FAPE for each school year. The DOE displayed a pattern of indifference to the procedural requirements of the IDEA and carelessness in formulating K.T.’s IEPs over the period of many years, repeatedly violating its obligations under the statute, which consequently resulted in the deprivation of important educational benefits to which K.T. was entitled by law. Accordingly, the court reversed the judgment of the district court and remanded for further proceedings. On remand, the district court is directed to consider, in the first instance, what, if any, relief plaintiff is entitled to as an award for K.T.'s FAPE deprivations. View "L.O. ex rel. K.T. v. N.Y.C. Dep’t of Educ." on Justia Law

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Plaintiff filed a class action against the Commissioner, challenging New York’s coverage restrictions on certain medical services provided under its Medicaid plan. Plaintiffs argued that New York’s 2011 plan amendments, which restrict coverage of orthopedic footwear and compression stockings to patients with certain enumerated medical conditions, violate the Medicaid Act’s, 42 U.S.C. 1396 et seq., reasonable standards, home health services, due process, and comparability provisions, as well as the anti‐discrimination provision and integration mandate of Title II of the Americans with Disabilities Act (ADA), 42 U.S.C. 12131 et seq., and section 504 of the Rehabilitation Act, 29 U.S.C. 794. Because neither the Medicaid Act nor the Supremacy Clause confers a private cause of action to enforce the reasonable standards provision, the court vacated the district court’s grant of summary judgment to plaintiffs on that claim; the court declined to reach plaintiffs’ unequal treatment claim under the ADA and Rehabilitation Act as largely duplicative of their integration mandate claim; and the court affirmed the summary judgment rulings with respect to the remaining claims. Defendant is entitled to summary judgment on plaintiffs' home health services plan because orthopedic footwear and compression stockings constitute optional “prosthetics” rather than mandatory “home health services” under the Medicaid Act; defendant is entitled to summary judgment on the hearing element and plaintiffs are entitled to summary judgment on the notice element of plaintiffs’ due process claim, because the due process provision required New York to provide plaintiffs with written notice – though not evidentiary hearings – prior to terminating their benefits; plaintiffs are entitled to summary judgment on their comparability provision claim because New York’s coverage restrictions deny some categorically needy individuals access to the same scope of medically necessary services made available to others; and plaintiffs are entitled to summary judgment on their anti‐discrimination claims because New York’s restrictions violate the integration mandate of the ADA and Rehabilitation Act. Finally, the court vacated the injunction and remanded for further consideration on the appropriate relief because the injunction is broader than is warranted by the court's liability conclusions. View "Davis v. Shah" on Justia Law

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Binder, a law firm representing claimants before the SSA, appealed from summary judgment in two related cases where Binder seeks past attorney's fees. When Binder sought to hold the SSA liable for the fees, the district courts granted summary judgment to the SSA on the basis of sovereign immunity. The court affirmed the judgments and held that, regardless of the SSA’s statutory duties to withhold attorney’s fees from payments to successful claimants, there is no waiver of sovereign immunity in 42 U.S.C. 406(a) that would permit Binder’s lawsuits for money damages. View "Binder & Binder v. Colvin" on Justia Law

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The Department appealed a judgment awarding plaintiffs reimbursement under the Individuals with Disabilities Education Act (IDEA), 20 U.S.C. 1400 et seq., for one year of private school education for their daughter, L.K. The court concluded that the Department’s refusal to discuss the bullying of L.K. with her parents during the process of developing L.K.’s individualized education program (IEP), violated the IDEA. The court also concluded that plaintiffs have met their burden to show that their choice of a private placement for L.K. was appropriate and that the equities favored reimbursing them. Accordingly, the court affirmed the judgment. View "T.K. v. N.Y.C. Dept. of Educ." on Justia Law

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Plaintiff appealed the denial of social security disability benefits, alleging that the Appeals Council erred by failing to provide an explanation for why it disregarded the treating physician’s opinion and that the ALJ’s decision is not supported by substantial evidence in light of a treating physician’s opinion. The court agreed and held that, based on the record, including the physician's opinion, the ALJ's determination is not supported by substantial evidence in the record. Accordingly, the court vacated the judgment and remanded for further proceedings. View "Lesterhuis v. Colvin" on Justia Law

Posted in: Public Benefits

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Plaintiff appealed the denial of his application for Social Security disability benefits (SSI). The district court granted defendant's motion for judgment on the pleadings. The court concluded, however, that the ALJ erred by failing to provide “good reasons” for giving little weight to the treating physician's opinion, and that this error was not harmless. Accordingly, the court vacated the district court's judgment and remanded for further proceedings. View "Greek v. Colvin" on Justia Law

Posted in: Public Benefits

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Plaintiffs filed suit under 42 U.S.C. 1983 against DSS to enforce the Food Stamp Act's, 7 U.S.C. 2020(e)(3) and (9), time limits for awarding food stamp benefits. The district court certified a class consisting of all past, current, and future Connecticut food stamp applicants whose applications are not processed in a timely manner and the district court issued a preliminary injunction requiring DSS to process food stamp applications within the statutory deadlines. The court concluded that plaintiff can maintain a private lawsuit under 42 U.S.C. 1983 to enforce the statutory time limits in section 2020(e)(3) and (9). The court also concluded that federal regulations do not excuse DSS from processing food stamp applications within the statutory time limits. Accordingly, the court affirmed the judgment. View "Briggs v. Bremby" on Justia Law

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Robinson worked for Concentra as a medical assistant from 2003 until she was terminated in 2010. Robinson applied for Social Security disability benefits four days after being terminated, claiming that she had multiple sclerosis that rendered her unable to work. The initial application was denied. An ALJ reversed, summarizing Robinson’s statements that: she must use a cane to walk because of leg numbness; she has poor vision; her hands frequently cramp and she has difficulty holding objects; and she needs help with all household chores. Robinson then filed suit against Concentra under Title VII, 42 U.S.C. 1981, and the Family and Medical Leave Act, claiming that she had been terminated on the basis of her race and color and in retaliation for filing a complaint with the EEOC and taking FMLA leave and that Concentra had interfered with her ability to take FMLA leave. The court entered summary judgment, finding that Robinson was estopped from showing that she was qualified for her position when she was terminated in September 2010, because she received disability benefits based on her statement that she was fully disabled as of June 2010. The Second Circuit affirmed, noting that Robinson failed to “proffer a sufficient explanation” for the contradictory statements. View "Robinson v. Concentra Health Servs.,Inc." on Justia Law