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

In 2000, while working as a welder, Cole (then in his 20s) broke his left arm and wrist, requiring insertion of a metal plate and screws in his arm. He experienced pain that has still not gone away. In 2008, employed as a factory foreman, he fell off a 10‐foot ladder, landing on his right elbow. He received physical and occupational therapy, but the pain has persisted. An orthopedic surgeon diagnosed cubital tunnel syndrome and performed an anterior ulnar nerve transposition. Cole’s pain increased. Another orthopedic surgeon diagnosed posterolateral rotatory instability and replaced the ligament in Cole’s elbow with a graft from Cole’s arm. Cole’s pain became constant. Another orthopedic surgeon noted his “chronic pain” but said that Cole could return to work “without restrictions.” Cole settled his worker’s compensation claim and obtained unemployment benefits. When they ran out, Cole unsuccessfully applied for social security disability benefits. The Seventh Circuit reversed, stating that the ALJ “appears to have thought Cole a malingerer,” and “cherry-picked” the medical record. View "Cole v. Colvin" on Justia Law

Taylor has an IQ of 70-75. In her twenties, living with her mother, and never having worked, Taylor needs help to get dressed, wash her hair, and take her medications. She can do simple household chores, very slowly and only if reminded, sometimes repeatedly. She cannot drive and cries when she feels overwhelmed. She has poor depth perception and is clumsy. She has seizures and debilitating headaches that require her to sleep during the day. She has a history of kidney problems. A social security field officer interviewed her regarding her application for Supplemental Security Income benefits and reported that her “capability [of working] is questionable.” A psychologist found her verbal comprehension to be particularly low and deemed her “incapable of managing her funds independently.” Taylor had volunteered an hour a week at the public library folding brochures, cutting slips and notices, and affixing labels. The librarian reported that Taylor “completes her tasks well” but “has problems following procedures unless she has a list to follow, which her mother created.” The librarian said she “would hesitate in giving [Taylor] any more responsibilities” The Seventh Circuit reversed the denial of benefits, stating “there is no evidence to support the administrative law judge’s conjecture” that Taylor could work full-time. View "Taylor v. Colvin" on Justia Law

Baptist began working at Ford’s assembly plant, operating a forklift. Less than three months later, Baptist inadvertently hit a pillar, injuring his left wrist. He visited Ford’s medical department and submitted an injury report. An investigator and Ford’s physician doubted Baptist’s account of his injury; Baptist did not report the incident properly and refused to release medical records from a prior workers’ compensation case against another employer involving an injury to his other wrist. Ford paid for Baptist’s initial visit to an orthopedic surgeon, Dr. Heller. The parties are litigating Baptist’s workers’ compensation claim. After working two months, Baptist again sought medical attention. Dr. Heller diagnosed him with a complete ligament tear, recommended surgery, indicated that Baptist was not able to perform the essential function of his job, and cleared him to return to work if he did not lift or grip over five pounds with his left hand. Disagreeing with Ford's doctor, Baptist believed that this prevented him from operating the forklift and asked for another position. He did not work for several days. Ford suspended him for one month. When Baptist returned, he was told that the only available work was as a forklift driver. Baptist later testified that he was told that he would be fired unless he agreed to state that his injury did not happen at work. The company denied this assertion. Baptist was discharged for having three consecutive absences without justification. In a suit alleging retaliation for exercising his workers’ compensation rights, the court granted Ford summary judgment. The Seventh Circuit vacated. A triable issue exists regarding whether Baptist was put to the impracticable choice between keeping his job or giving up a key argument for workers’ compensation. View "James Baptist v. Ford Motor Company" on Justia Law

Thomas applied for Supplemental Security Income in 2010 when she was 55 years old. An administrative law judge identified her medically determinable impairments as degenerative changes in her back and left shoulder, Graves’ disease, and dysthymic disorder (a form of chronic depression), but concluded that the impairments did not impose more than minimal limitations on Thomas’s ability to work and denied her application. The Seventh Circuit reversed and remanded. The ALJ’s omission of fibromyalgia from Thomas’s medically determinable impairments and his conclusion that she has no severe impairments were not supported by substantial evidence. Thomas’s doctors’ lack of specialization in rheumatology was not an acceptable basis for discounting their assessments. View "Thomas v. Colvin" on Justia Law

In 2005, D.U., then three years old, was severely injured in a car accident. She qualified for Wisconsin Medicaid services on financial grounds and was provided extensive medical care until August 2013. After a change in family circumstances, D.U. no longer qualified on financial grounds. Wisconsin continued to provide the same services under its “Katie Beckett Program,” which funds Medicaid benefits for children who are otherwise ineligible because of the assets or income of their parents, 42 U.S.C. 1396a(e)(3). The state noted that D.U., whose condition had substantially improved over the years, was “borderline” for meeting the criteria to qualify for private duty nursing care and later informed D.U. and her father that D.U. no longer qualified for those services. D.U.filed a new request for 70 hours per week of private duty nursing and submitted additional information, but the request was denied. D.U. did not appeal the denial, but sought a preliminary injunction. The district court concluded that the evidence that D.U. submitted in support of her request for injunctive relief failed to demonstrate a likelihood of success on the merits. The Seventh Circuit affirmed, holding that D.U. failed to demonstrate that she will suffer irreparable harm if the injunction is denied. View "D. U. v. Rhoades" on Justia Law

In 2009 Crespo applied for Supplemental Security Income benefits for his mother, representing that she lived with him in Illinois and that he took care of her. He served as her representative payee. By signing the form, Crespo acknowledged that he could be held liable for any improper overpayments he caused. Crespo’s mother was not entitled to those benefits because she lived in Puerto Rico (20 C.F.R. 416.215), which Crespo hid from the Social Security Administration by falsely representing, in three subsequent reports as representative payee, that she lived with him. Airline records established that she resided in Puerto Rico; his mother was serving as representative payee for her own mother’s retirement benefits, declaring herself a resident of Puerto Rico. An ALJ imposed a $114,956 civil penalty on Crespo for misrepresentation. The Departmental Appeals Board of the Department of Health and Human Services dismissed his appeal as untimely. The Seventh Circuit affirmed. The Board did not abuse its discretion in rejecting Crespo’s untimely appeal and finding good cause lacking. Appeals are due 30 days after the ALJ’s initial decision is deemed served. A copy of the regulation is included when the decision is delivered. Crespo offered no reason why he did not request an extension. View "Crespo v. Colvin" on Justia Law

Garbe, an experienced pharmacist, began working at Kmart pharmacy in Ohio in 2007. When Garbe picked up a personal prescription at a competitor pharmacy, he discovered the competitor pharmacy had charged his Medicare Part D insurer far less than Kmart ordinarily charged it for the same prescription. He inspected Kmart’s pharmacy reimbursement claims and discovered that Kmart routinely charged customers with insurance—whether public or private—higher prices than customers who paid out of pocket, even ignoring “discount programs sales. Garbe shared his discovery with the government and filed a qui tam suit in 2008. The government has not intervened. Garbe asserts that Kmart’s “usual and customary” prices should be based on the prices Kmart charged the majority of its cash customers. The district court granted Garbe partial summary judgment. On interlocutory appeal, the Seventh Circuit, reversed in part, holding that Medicare Part D Pharmacy Benefit Managers and Plan Sponsors are not “officers or employees of the United States” for purposes of the False Claims Act, 31 U.S.C. 3729(a). The court agreed that Garbe has satisfied the materiality requirement under the Act for his Medicare Part D claims; and that Kmart’s “discount” prices were offered to the “general public.” View "Garbe v. Kmart Corp." on Justia Law

The Home and Community‐Based Care Waiver Program allowed states to diverge from the traditional Medicaid structure by providing community‐based services to people who would, under the traditional structure, require institutionalization, 42 U.S.C. 1396n. The Indiana Family and Social Services Administration operates the Aged and Disabled Medicaid Waiver Program (A&D waiver), the Community Integration and Habilitation Medicaid Waiver Program (CIH waiver), and the Family Supports Medicaid Waiver Program (FS waiver). Because Indiana has closed most of its institutional facilities, these waiver programs serve the vast majority of its people with disabilities. Until 2011, the Administration placed many people with developmental disabilities on the A&D waiver, which has no cap on services. The Administration then changed its policies, rendering many developmentally disabled persons ineligible for the A&D waiver. These people were moved to the FS waiver, under which they may receive services capped at $16,545 annually. The CIH waiver is uncapped, but not everyone qualifies for the CIH waiver. Plaintiffs argue that their new assignments violated the integration mandate of the Americans with Disabilities Act, 42 U.S.C. 12101 because it deprives them of community interaction and puts them at risk of institutionalization. The court granted defendants summary judgment on the integration‐mandate claims and denied class certification. The Seventh Circuit reversed, finding that there is a genuine dispute of material fact with respect to the individual claims based on the integration mandate. The court agreed that the proposed class is too vague. View "Steimel v. Wernert" on Justia Law

In 2012, Illinois enacted legislation requiring prior approval for reimbursement for more than four prescriptions for one Medicaid patient within a 30‐day period. 305 ILCS 5/5‐5.12(j). Ciarpaglini is an Illinois Medicaid recipient and suffers from chronic conditions, including bipolar disorder, attention deficit hyperactivity disorder, panic disorder, and generalized anxiety disorder. Doctors have prescribed at least seven medications to manage these conditions. Ciarpaglini alleges that after the prior‐approval requirement took effect, he could not, at least at times, obtain medications he needed and that he has contemplated committing suicide, committing petty crimes so that he would be jailed, or checking himself into hospitals just to get medications. He challenged the requirement under federal Medicaid law, the Americans with Disabilities Act, the Rehabilitation Act, and the Constitution. Illinois subsequently moved Ciarpaglini from the general fee‐for‐service Medicaid program to a new managed care program, under which the requirement does not apply. The district court dismissed the matter as moot. The Seventh Circuit remanded, finding insufficient evidence to determine whether the claims were moot, given Ciarpaglini’s stated desire to move to another county and the lack of information about whether the change in his program was individual or part of a change in policy. View "Ciarpaglini v. Norwood" on Justia Law

Plaintiffs, including many with disabilities, had cases pending in state courts and were represented by an attorney who uses a wheelchair. They claimed that the St. Joseph County Courthouse and the Mishawaka County Services Building did not comply with the Americans with Disabilities Act and the Rehabilitation Act, particularly with respect to restrooms, elevators, witness stands, jury boxes, jury deliberation rooms, attorney podiums, spectator seating, entrance ramps, clerk counters, services for the blind, water fountains, and parking. While the case was pending, defendants remodeled the courthouse restrooms, which are now accessible. Defendants presented evidence that their facilities complied with the statutes. Plaintiffs offered little evidence in rebuttal. The district court granted defendants summary judgment. The court dismissed the claims of non-disabled plaintiffs represented by a disabled lawyer and claims relating to jury facilities, saying that the ADA did not provide for “associational” standing. The court found no evidence that other plaintiffs had suffered past injuries that would support standing for damages, and that the prospect of future injury was too speculative to support an injunction. Some plaintiffs had died; some were no longer in litigation. The Seventh Circuit affirmed, without finding the facilities compliant and without expressing an opinion on possible future claims. View "Hummel v. St. Joseph Cnty. Bd. of Comm'rs" on Justia Law