Articles Posted in Public Benefits

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The Ninth Circuit reversed the district court's partial grant of summary judgment for the Department and held that the Department did not violate the dormant Commerce Clause in adopting Medi-Cal policies related to reimbursement to out-of-state hospitals. The panel held that when a state was acting as a market participant, rather than a market regulator, its decisions were exempted from the dormant Commerce Clause. In this case, the Department sets rates of reimbursement to hospitals for those who were essentially insured as beneficiaries under Medi-Cal in a manner much like that of a private insurer participating in the market. Therefore, the Department was acting as a market participant, rather than a regulator and was exempt from dormant Commerce Clause requirements. View "Asante v. California Department of Healthcare Services" on Justia Law

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The Ninth Circuit affirmed the district court's grant of summary judgment for the Department in an action brought by private ambulance companies challenging the reimbursement rate for their transportation of patients covered by Medi-Cal. The panel held that plaintiffs failed to carry their burden of producing evidence upon which a reasonable jury could return a verdict in their favor and thus the district court did not err in entering judgment in the Department's favor on the Takings Clause claim. The panel reasoned that the ambulance companies lacked a constitutionally protected property interest in a particular reimbursement rate, but the mandatory-care provision of Cal. Health & Safety Code 1317(d) implicated a constitutionally protected property right. The panel held that section 1317(d) did not effect a regulatory taking under the Penn Central test. The panel also held that the ambulance companies did not establish a due process claim regarding DHCS's failure to ensure that Medi-Cal reimbursement rates kept pace with their costs because they lacked a constitutionally protected interest in any particular reimbursement rate. View "Sierra Medical Services Alliance v. Kent" on Justia Law

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The Ninth Circuit affirmed the district court's grant of summary judgment for the Department in an action brought by private ambulance companies challenging the reimbursement rate for their transportation of patients covered by Medi-Cal. The panel held that plaintiffs failed to carry their burden of producing evidence upon which a reasonable jury could return a verdict in their favor and thus the district court did not err in entering judgment in the Department's favor on the Takings Clause claim. The panel reasoned that the ambulance companies lacked a constitutionally protected property interest in a particular reimbursement rate, but the mandatory-care provision of Cal. Health & Safety Code 1317(d) implicated a constitutionally protected property right. The panel held that section 1317(d) did not effect a regulatory taking under the Penn Central test. The panel also held that the ambulance companies did not establish a due process claim regarding DHCS's failure to ensure that Medi-Cal reimbursement rates kept pace with their costs because they lacked a constitutionally protected interest in any particular reimbursement rate. View "Sierra Medical Services Alliance v. Kent" on Justia Law

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The Ninth Circuit affirmed the denial of Social Security Disability Insurance (SSDI) benefits and the partial denial of Supplemental Security Income (SSI) benefits. The panel held that the ALJ did not err by finding plaintiff's disability onset date without calling on a medical advisor at the hearing. In this case, the record was adequate even before plaintiff saw a mental health specialist and no reasonable medical expert could have inferred that her disability began before May 2010. Therefore, Social Security Ruling 83-20 did not require the ALJ to consult a medical advisor before determining plaintiff's disability onset date. View "Wellington v. Berryhill" on Justia Law

Posted in: Public Benefits

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The "credit-as-true rule" permits, but does not require, a direct award of benefits on review but only where the ALJ has not provided sufficient reasoning for rejecting testimony and there are no outstanding issues on which further proceedings in the administrative court would be useful. The Ninth Circuit affirmed the district court's decision to remand for further administrative proceedings in a claimant's action seeking Title II disability insurance benefits. The panel clarified the district court's remand order, instructing the district court to remand to the ALJ consistent with the requirements pursuant to Treichler v. Comm'r of Soc. Sec. Admin., 775 F.3d 1090, 1101-02 (9th Cir. 2014), with an open record on the issue of claimant's fatigue related to his capacity to undertake full time employment. On remand, claimant shall be permitted to cross-examine the Commissioner's medical consultants, but only to the extent such cross-examination concerns the issue of claimant's fatigue. View "Leon v. Berryhill" on Justia Law

Posted in: Public Benefits

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The Ninth Circuit affirmed in part and reversed in part the district court's order affirming the Commissioner's denial of plaintiff's application for social security disability insurance (SSDI) benefits. The panel held that the ALJ erred in its assessment by not calling a medical advisor at the hearing; by giving too little weight to the observations of plaintiff's fiancé; and by finding that plaintiff was only partially credible. The panel reversed on these grounds and remanded. In a separately filed memorandum disposition, the panel rejected plaintiff's other challenges and affirmed that portion of the ALJ's decision. View "Diedrich v. Berryhill" on Justia Law

Posted in: Public Benefits

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The Ninth Circuit reversed the district court's order affirming the denial of supplemental security income and disability insurance benefits. Plaintiff suffers from fibromyalgia. In July 2012, the SSA issued Social Security Ruling (SSR) 12-2P, a ruling that establishes that fibromyalgia may be a severe medical impairment for purposes of determining disability, and provided guidelines for the proper evaluation of the disease. The panel held that the ALJ, SSA Appeals Council, and the district court failed to heed the instructions of those rulings, and instead analyzed plaintiff's symptoms and rejected her claim without considering the unique characteristics of fibromyalgia, the principal source of her disability. The panel remanded with instructions for the district court to remand the case to the agency for the calculation and award of benefits. View "Revels v. Berryhill" on Justia Law

Posted in: Public Benefits

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The Ninth Circuit reversed the denial of Disability Insurance Benefits and Supplemental Security Income, holding that plaintiff's contention that the ALJ made two errors at step two of its analysis of disability claims had no merit; all impairments were taken into account both times; any alleged error was harmless and could not be the basis for remand; using the shorthand "personality disorder" did not indicate any error in the ALJ's determination of plaintiff's residual functioning capacity (RFC); Dr. Kenderdine's partial reliance on plaintiff's self-reported symptoms was not a reason to reject his opinion; conflict in the record corroborated the rejection of Dr. Toews' testimony as a basis for rejecting Dr. Kenderdine's opinion; the ALJ did not err in rejecting Dr. Schechter's opinion; plaintiff's complaint that the ALJ only considered Dr. Fisher's opinion in the third section of a submitted form and ignored the first section lacked merit; any error in excluding three jobs identified by the vocational expert (VE) was harmless; but, the vast discrepancy between the VE's job numbers and those tendered by plaintiff, presumably from the same source, was simply too striking to be ignored. Therefore, this inconsistency in the record must be addressed by the ALJ on remand. View "Buck v. Berryhill" on Justia Law

Posted in: Public Benefits

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An educational agency does not commit a per se violation of the Individuals with Disabilities Education Act (IDEA), 20 U.S.C. 1414, by not specifying the anticipated school where special education services will be delivered within a child's individualized education program. The Ninth Circuit affirmed the district court's grant of summary judgment for the Department in an action brought on behalf of a student under the IDEA. The panel held that the IDEA did not require identification of the anticipated school where special education services would be delivered in light of the student's planned move to a new school district. Therefore, the student was not denied a free appropriate public education because of a purported procedural error. View "Rachel H. v. Department of Education, State of Hawaii" on Justia Law

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A claimant must, at a minimum, raise the issue of the accuracy of the vocational expert's estimates at some point during administrative proceedings to preserve the challenge on appeal in federal district court. The Ninth Circuit affirmed the denial of plaintiff's application for disability insurance benefits. In this case, the ALJ's residual functional capacity determination was supported by substantial evidence and there was no inconsistency between the opinions of two physicians regarding his capability for interaction with colleagues. Furthermore, plaintiff waived his challenge to the vocational expert's job numbers where he did not suggest that the vocational expert's job estimates might be unreliable at any point during administrative proceedings. View "Shaibi v. Berryhill" on Justia Law

Posted in: Public Benefits