Justia U.S. 7th Circuit Court of Appeals Opinion Summaries

Articles Posted in Public Benefits
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Under the Medicaid program, 42 U.S.C. 1396, states must ensure that certain medical assistance is available to all eligible beneficiaries. Illinois administers its Medicaid program through HFS. For managed care programs, HFS contracts with Medicaid managed care organizations (MCOs), which a flat monthly fee per patient. The MCOs pay providers for services rendered to Medicaid beneficiaries. Plaintiffs, consultants who offer business services to Illinois nursing homes and supportive living facilities, sued on behalf of a class of nursing home residents entitled to Medicaid benefits, alleging violations of Title XIX of the Social Security Act, the Americans with Disabilities Act, the Rehabilitation Act, and the Due Process and Equal Protection Clauses. They alleged that the MCOs failed to process timely payments for claims submitted by nursing homes—the plaintiff‐consultants’ clients—to the MCOs, putting the resident‐beneficiaries at risk of being discharged from the facilities. The Seventh Circuit affirmed the dismissal of the case for lack of subject matter jurisdiction. The regulation cited by plaintiffs does not permit authorized representatives to bring civil lawsuits on behalf of Medicaid beneficiaries so the plaintiffs lacked standing. The residents would be unlikely to benefit if the plaintiffs won; they apparently filed suit in an effort to push the state to pay outstanding bills owed to the consultants’ clients. View "Bria Health Services, LLC v. Eagleson" on Justia Law

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Martin, a 67-year-old woman, sought Social Security Disability benefits. Her persistent back pain stems from two car accidents; she also suffers from depression, anxiety, bipolar disorder, panic disorder, and PTSD. These conditions caused Martin to stop working in 2009. Before then she had worked as a home health aide, data entry clerk, and administrative assistant. An ALJ determined that Martin’s severe impairments left her capable of performing only a limited range of sedentary jobs. The district court remanded for a more thorough consideration of Martin’s mental health problems. A new ALJ then found that Martin had no physical limitations whatsoever and declined to award benefits. The Seventh Circuit reversed, finding the second ALJ’s decision not supported by substantial evidence, and took “the rare step of ordering the award of benefits.” The court rejected Martin’s argument that the ALJ’s residual functional capacity determination failed to translate her mental health symptoms into limitations related to concentration, persistence, and pace but the record is clear that Martin’s physical limitations leave her unable to perform any work above the light level. Given her restricted range of motion and symptoms of pain, light exertion would likely be a challenge for Martin because it requires “a good deal of walking or standing.” View "Martin v. Saul" on Justia Law

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Prater was denied Social Security Disability Insurance benefits when she was 47-years-old and weighed about 400 pounds at 64 inches tall. X-rays showed mild-to-moderate degenerative joint disease in her feet and knees and degenerative disc disease in her spine. She was diabetic and had a history of gout. Prater stated that at her last job she experienced pain and fatigue “all the time.” None of her treating physicians indicated that she must alternate between sitting and standing. A vocational expert testified that a hypothetical individual with Prater's vocational background, education, and age, limited to sedentary work with restrictions on lifting, carrying, climbing, driving, and more, who could stand and walk no more than two hours of an eight-hour day and would need to change positions during the day but could remain in place for at least 30 minutes, whether sitting or standing, could not do any of Prater’s past jobs but could perform other jobs available in the national economy. The ALJ concluded that Prater was not disabled, finding that she had the residual functional capacity (RFC) to perform sedentary work with numerous restrictions; that her statements about the intensity, persistence, and limiting effects of her symptoms were “not entirely consistent” with the evidence; and that, although Prater was morbidly obese, “her physical examination was otherwise unremarkable.” The Appeals Council, the district court, and the Seventh Circuit upheld the decision. The sit/stand limitation in the RFC assessment is not too vague. The ALJ’s finding that she could sit and stand for 30 minutes at a time does not lack medical support; the ALJ did not improperly discredit her testimony that she could remain in position for only 20 minutes. View "Prater v. Saul" on Justia Law

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For four years, nurse practitioner Jordan treated Clanton’s severe hypertension. Jordan, an employee of the U.S. Public Health Service, failed to properly educate Clanton about his disease or to monitor its advancement. Clanton’s hypertension developed into Stage V kidney disease requiring dialysis and a transplant. Clanton successfully sued the government under the Federal Tort Claims Act. The court determined that Clanton had not contributed at all to his own injuries, noting that Clanton did not understand why it was important to take his medication and to attend appointments. The court awarded $30 million in damages. The Seventh Circuit vacated, finding that the court erred in its analysis of comparative negligence. Clanton’s subjective understanding does not end the inquiry. Illinois law requires the court to take the additional step of comparing Clanton’s understanding of his condition to that of a reasonable person in his situation. Clanton was in the position of a person whose caregiver failed to provide information about the severity of his condition but he had external clues that he was seriously unwell: two employment-related physicals showed that he had dangerously high blood pressure. The court upheld the court’s method of calculating damages and agreed that Clanton’s Medicare benefits are collateral to his damages award under Illinois law, so the government is not entitled to a partial offset. View "Clanton v. United States" on Justia Law

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Crump applied for social security disability benefits based on her long history of numerous mental health impairments, including bipolar disorder and polysubstance abuse disorder. An administrative law judge denied benefits, finding that Crump, despite her severe impairments, could perform work limited to simple and repetitive tasks. The district court affirmed. The Seventh Circuit vacated. The ALJ did not adequately account for Crump’s difficulties with concentration, persistence, or pace in the workplace. An ALJ generally may not rely merely on catch-all terms like “’simple, repetitive tasks’” because there is no basis to conclude that they account for problems of concentration, persistence or pace. In addition, observing that a person can perform simple and repetitive tasks says nothing about whether the individual can do so on a sustained basis. Beyond disregarding the Vocational Expert’s opinion in response to a second hypothetical, the ALJ gave short shrift to the medical opinions of Crump’s treating psychiatrist. View "Crump v. Saul" on Justia Law

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Krell, a former ironworker, applied for Social Security disability benefits. Krell was notified that a vocational expert would testify at his hearing and that Krell had the right to request a subpoena for documents or testimony “that you reasonably need to present your case.” Krell’s counsel requested a subpoena to require the vocational expert to produce documents upon which the expert may rely in forming opinions, including statistics, reports, surveys, summaries, work product, and a description of the methodologies used by publishers or compilers of the statistics. The ALJ did not respond. At the hearing, the ALJ denied the request, reasoning that it had not specified what the documents would show and why these facts could not be shown without a subpoena and that counsel could challenge the testimony post‐hearing. During cross‐examination, the vocational expert stated that to determine available job numbers, he relied on Wisconsin occupational projections produced by the Department of Workforce Development. Krell made no post‐hearing challenge. The ALJ found that Krell was disabled and entitled to benefits, but only as of 2014, rather than 2011. Based on the expert’s testimony, the ALJ concluded that up to 2014, Krell was able to perform work existing in significant numbers in the economy. The Social Security Appeals Council denied review. The district court concluded that the ALJ had erred in denying Krell’s subpoena request. The Seventh Circuit reversed. While Krell’s case was pending, the Supreme Court held (Biestek) that a vocational expert is not categorically required to produce his supporting data. Krell advanced no reason why it was necessary for the expert to produce his underlying sources. View "Krell v. Saul" on Justia Law

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Jozefyk applied for Disability Insurance Benefits and Supplemental Security Income, claiming disability based on several conditions, including degenerative changes in his cervical spine, lumbar strain, obesity, affective disorder, and anxiety disorder. An ALJ denied benefits. The district court and Seventh Circuit affirmed, rejecting Jozefyk’s arguments that the ALJ did not establish a valid waiver of attorney representation before allowing Jozefyk to proceed pro se and that the residual functional capacity finding did not account for Jozefyk’s moderate limitations in concentration, persistence, or pace. Jozefyk was sent several Social Security Administration communications, including a publication entitled “Your Right to Representation,” explaining his right to an attorney, organizations that could help him find an attorney, the fee structure, and the benefits of representation. In his request for a hearing, Jozefyk certified: “I do not have a representative. I understand that I have a right to be represented and that if I need representation, the Social Security office or hearing office can give me a list of legal referral and service organizations to assist me in locating a representative.” The ALJ offered to continue the hearing to give Jozefyk more time to find an attorney, but Jozefyk again stated that he wanted to proceed. Jozefyk cited self-reported symptoms that doctors, including his own treating physician, could not confirm. View "Jozefyk v. Berryhill" on Justia Law

Posted in: Public Benefits
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Since his March 2008, birth, L.D.R. has consistently received medical care in the fields of pediatrics, otolaryngology, pulmonology, psychology, and speech pathology. His mother first sought social security benefits on his behalf when he was one year old. L.D.R.’s health, development, and behavioral issues deteriorated and improved at various times. A child is disabled under social security income rules if the child has a “medically determinable physical or mental impairment, which results in marked and severe functional limitations” that “has lasted or can be expected to last for a continuous period of not less than 12 months,” 42 U.S.C. 1382c(a)(3)(C)(i). The Social Security Administration determined that L.D.R. was disabled as of August 2015, just before he enrolled in second grade. The Seventh Circuit rejected a request for retroactive payments and a challenge to the constitutionality of the law prohibiting an award of benefits for a period before the application for benefits. The AuSgust 2015 disability date was well supported in the ALJ’s decision, which considered in particular detail L.D.R.’s various conditions, their history, the treatments he received, and L.D.R.’s reactions to these treatments. The prohibition on pre-application benefits satisfies rational basis scrutiny. View "L.D.R. v. Berryhill" on Justia Law

Posted in: Public Benefits
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In 2010, Burmester applied for disability benefits alleging a 2008 onset of her disability. She described degenerative disc disease, pseudo-gout in her left knee, osteoarthritis in both knees and left thumb, a heart condition, and depression. Burmester’s education included one year of technical college; she worked as a hand-packager for many years. The application was denied. At a hearing, Burmester testified that her husband helped her out of bed, did the cooking, cleaning, and went grocery shopping and a friend helped with cleaning. Burmester was able to go to church; out to dinner once a month; use the computer to check her email and social media; and let her dog out. Following a remand, the ALJ again found that Burmester had the residual function capacity to perform light work, and was mentally limited to simple, routine, repetitive tasks requiring only simple work-related decisions and no more than occasional interaction with supervisors, coworkers, and the general public. Based on the testimony of a vocational expert, the ALJ found that Burmester could not continue her past relevant work but that a significant number of jobs existed in the national economy that Burmester could perform—such as router, price marker, or routing clerk. The district court and Seventh Circuit upheld the ALJ’s decision. The ALJ did not improperly evaluate Burmester’s credibility, nor erroneously reject the opinions of medical experts. The ALJ’s opinion that Burmester was not disabled was supported by substantial evidence. View "Burmester v. Berryhill" on Justia Law

Posted in: Public Benefits
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Hernandez filed a voluntary Chapter 7 bankruptcy petition in December 2016, reporting one sizable asset: a pending workers’ compensation claim valued at $31,000. To place that claim beyond the reach of creditors, she listed it as exempt under section 21 of the Illinois Workers’ Compensation Act, 820 ILCS 305/21, applicable via 11 U.S.C. 522(b). Two days after filing for bankruptcy, Hernandez settled the claim. Hernandez owed significant sums to three healthcare providers who treated her work-related injuries. The providers objected to her claimed exemption, arguing that 2005 amendments to the Illinois Act enable unpaid healthcare providers to reach workers’ compensation awards and settlements. The bankruptcy court denied the exemption and the district judge affirmed. The Seventh Circuit certified to the Illinois Supreme Court the question: Whether the Illinois Workers’ Compensation Act, as amended, allows care-provider creditors to reach the proceeds of workers’ compensation claims. The court noted that Section 21 has been interpreted by bankruptcy courts to create an exemption for these assets; 2005 amendments imposed a new fee schedule and billing procedure for care providers seeking remuneration. The Illinois Supreme Court has not addressed the interplay between these competing components of state workers’ compensation law. View "Hernandez v. Marque Medicos Fullerton, LLC" on Justia Law