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

After his employment with the town was terminated, the plaintiff sought benefits under the Illinois Unemployment Insurance Act. The town opposed his claim, arguing that he was ineligible for unemployment benefits because he had constructively resigned “without good cause” by failing to obtain a commercial driver’s license within one year of starting work, a condition of his employment. The department agreed with the town. The plaintiff unsuccessfully appealed. He then sued in federal court under 42 U.S.C. 1983, claiming that he was fired in violation of his rights to due process of law and freedom of speech. The district court dismissed the claim as barred by collateral estoppel. The Seventh Circuit reversed, reasoning that the Illinois statute, 820 ILCS 405/1900(B), denies collateral estoppel effect to rulings in unemployment insurance proceedings. View "Council v. Village of Dolton" on Justia Law

Two nurses, formerly employed by Momence, alleged that, during their employment at Momence, they uncovered evidence that Momence knowingly submitted "thousands of false claims to the Medicare and Medicaid programs” in violation of the False Claims Act (FCA) and Illinois Whistleblower Reward and Protection Act. They filed a qui tam action on behalf of the government and alleged that Momence retaliated against them for reporting its fraud. A jury awarded the government more than $3 million in compensatory damages and imposed about $19 million in fines for the qui tam claims. Pursuant to the FCA, the compensatory damages were trebled to more than $9 million. The district court set aside the fines as violating the Excessive Fines Clause of the Eighth Amendment. The jury also awarded the nurses $150,000 and $262,320, respectively, on their retaliation claims. The Seventh Circuit vacated. Both claims failed as a matter of law. Rejecting claims of “worthless services” and false certification, the court stated that, at best, a reasonable jury might be able to say that some of Momence’s claims were false, but that is not enough to satisfy the burden of proof. The employment of one nurse was not terminated, the other’s employment was terminated for an unrelated matter.View "Absher v. Momence Meadows Nursing Ctr., Inc." on Justia Law

An MRI had revealed plaintiff’s herniated disc in 1998. The medical record is blank from then until 2007, when she complained to an emergency room physician that she had been suffering from lower-back pain. She mentioned the herniated disc, and was prescribed Vicodin. Almost a year later she was examined by an anesthesiologist who specializes in pain management, who prescribed Lyrica. The plaintiff subsequently sought disability benefits and testified that her pain, combined with the drowsiness induced by the pain medication, limited her daily activities to eating, caring for her dogs, taking naps, and watching television. The anesthesiologist opined that the plaintiff was “unable to work” because of “lumbar disc protrusion.” Another anesthesiologist reviewed her records, and concluded that she was able to work full time despite the diagnoses of lumber disk herniation, lumbar radiculopathy, and myofascial pain, and a Social Security field officer’s observation that “she had a hard time sitting in the chair during the interview.” He did not identify evidence supporting his conclusion. The district court affirmed the agency’s denial of benefits. The Seventh Circuit remanded, stating that the plaintiff deserves a more careful evaluation than she has received to date. The ALJ’s critical error was failure to obtain a medical report on the results of a 2010 MRI.View "Goins v. Colvin" on Justia Law

To compensate teaching hospitals for the extra financial burden of providing training, the Medicare program provides additional reimbursement for expenses beyond the immediate costs of patient care, including for “indirect medical education” (IME) costs to account for the time medical interns and residents spend in ways that enhance their ability to provide patient care but that are not connected to the treatment of any particular patient, 42 U.S.C. 1395ww(d)(5)(B)(ii). The district court held that time spent by interns and residents in research activities wholly unrelated to the diagnosis or treatment of patients could be counted as part of this indirect-education time and that Rush University Medical Center, was entitled to Medicare reimbursements for these activities between the years 1983 and 2001. The Seventh Circuit reversed and remanded, noting that the Secretary of Health and Human Services has interpreted the Medicare Act consistently since 1983 to exclude pure research activities from compensable IME costs. Congress codified this exclusion for Fiscal Years 2001 onward in the Patient Protection and Affordable Care Act of 2010, but explicitly declined to lay down a rule for the years 1983 to 2001. The Secretary has now promulgated a regulation excluding pure research from the IME cost calculation for all years since 1983. View "Rush Univ. Med. Ctr v. Sebelius" on Justia Law

Moon was a 26-year-old mother who had worked as a cashier, bank teller, and certified nursing assistant. She suffered from documented back and joint problems, mild sleep apnea, depression, and migraine headaches. Most of these problems are related to exceptional obesity: at a height of 5’5”, she weighs more than 400 pounds. In support of her application for disability benefits, Moon submitted extensive medical records. Her migraine headaches were diagnosed as early as 2005 and she saw doctors about her headaches many times. She was taking Imitrex and Motrin at the time of her May 2010 hearing. In his written decision denying benefits, the ALJ went through the standard five-step analysis and found that Moon was no longer engaged in substantial gainful activity and that her combination of impairments qualified as “severe,” but that she was still capable of doing sedentary work if she would be permitted to sit or stand at will. The ALJ relied on the opinions of two doctors who had reviewed medical records but had not examined Moon. The ALJ referred to “alleged headaches” dismissively. The Appeals Council and the district court upheld the denial. The Seventh Circuit reversed. The ALJ improperly discounted evidence of chronic migraine headaches. Because Moon is receiving disability benefits based on a later application, the only issue on remand will be whether she was disabled between August 2008 and the later date from which benefits have been paid.View "Moon v. Colvin" on Justia Law

Boley sought Social Security disability benefits. The agency denied her request initially and on reconsideration. A person dissatisfied with such a decision has 60 days to request a hearing. Boley took about nine months because SSA had notified Boley but not her lawyer (as required by 20 C.F.R.404.1715(a)). Boley was ill at the time, preparing for a double mastectomy, and did not know, until it was too late, that her lawyer was unaware of the decision. An ALJ dismissed an untimely hearing request, finding that Boley lacked “good cause” because she had received notice and could have filed a request herself. A district judge dismissed her petition for judicial review, based on 42 U.S.C. 05(g), which authorizes review of the agency’s final decisions made “after a hearing.” The Seventh Circuit vacated and remanded, with instructions to decide whether substantial evidence, and appropriate procedures, underlie the decision that Boley lacks “good cause” for her delay in seeking intra-agency review. In doing so, the court overruled its own precedent and noted a divide among the circuits. View "Boley v. Colvin" on Justia Law

Plaintiff, a former laborer, applied for social security disability benefits, claiming he was unable to work a full 40-hour week because of acute lower back pain that radiates into his right leg. He has had various treatments and takes several medications such as oxycodone and percocet. His application was denied; the Appeals Council and district court affirmed. The Seventh Circuit reversed and remanded, reasoning that the administrative law judge was likely mistaken in believing that one physician’s report refuted the findings of the other physician. What was relevant was not the cause of the pain and numbness but the severity of these symptoms and whether they disabled plaintiff from working full time. Both physicians diagnosed radiculopathy. If the administrative law judge remains skeptical of the claim, he can order a further examination of the plaintiff by a qualified physician instructed to offer a medical opinion (if possible) on the plaintiff’s physical ability to engage in full-time work. The court stated references to the credibility of the applicant are “a recurrent feature of the government’s defense of denials of social security disability benefits” that constitutes “professional misconduct and if it continues we’ll have to impose sanctions.” View "Hanson v. Colvin" on Justia Law

Murphy had a stroke in April 2007. Before leaving the hospital, Murphy was examined by Dr. Mayer, who noted a past history of headaches and diminished fluency in speech. Murphy started seeing a physical therapist but did not complete the program. A year later, Dr. Mayer noted that Murphy still had difficulty speaking and “some significant loss of sensation.” In September 2008, Murphy applied for social security disability benefits. Her application was denied. At a hearing, a vocational expert testified that there were no sedentary jobs in the regional economy for a person who could neither work with the general public nor use her hands more than occasionally for fine manipulation, but that there were a significant number of jobs for a person who had the capacity to do light, unskilled work, but who could only occasionally perform fine hand manipulation. The ALJ ruled that Murphy was not disabled. The Appeals Council adopted that decision. The district court affirmed. The Seventh Circuit reversed and remanded, finding that the ALJ erroneously excluded information about Murphy’s potential inability to perform light work and by not questioning Murphy further about her failure to comply with her home exercise program and the activities she participated in while on vacation. View "Murphy v. Colvin" on Justia Law

Yurt suffers from a psychotic disorder which causes him to experience auditory hallucinations and bouts of uncontrollable rage. He also has obsessive compulsive disorder, moderately severe chronic obstructive pulmonary disease (COPD), and chronic bifrontal tension headaches. He has worked as a cook and a janitor, last working in May 2010, when he suffered a mental break and was terminated for threatening a coworker with a knife. He applied for Disability Insurance Benefits from the Social Security Administration, but an ALJ denied his application. The Appeals Council declined review. The district court affirmed. The Seventh Circuit reversed and remanded, agreeing that the ALJ erred by failing to include many of his medical limitations in the hypothetical that she posed to the vocational expert. View "Yurt v. Colvin" on Justia Law

Beardsley was 49 years old when she fell and injured her knee. She had worked as a machine operator, assembler, inspector, and cashier. After the injury, she applied for disability insurance benefits and supplemental security income. Her doctors determined that she had meniscal tears and a ruptured ligament, compounded by obesity and worsening osteoarthritis. She declined surgery but received injections for the arthritis. Dr. Banyash examined her on behalf of the Social Security Administration and opined that pain and weakness restricted her ability to walk, stand, climb stairs, crouch, and kneel, but she was capable of sedentary work. Given Beardsley’s age and skills, a finding that she was capable of only sedentary work would have qualified her as disabled at the time under the grid SSA uses for making that determination. Another agency physician subsequently judged her able to stand or walk for about six hours of an eight-hour workday. The ALJ denied benefits, finding that she could still perform a range of light work. Beardsley argued that the ALJ gave too little weight to the opinion of the examining doctor and too much weight to an erroneous view of her daily activities, particularly care she provided for her elderly mother and that the ALJ improperly held against her the decision not to seek surgery. The district court affirmed the denial of benefits. The Seventh Circuit reversed and remanded, finding that errors undermined the “logical bridge” between evidence and conclusion. View "Beardsley v. Colvin" on Justia Law