Justia U.S. 11th Circuit Court of Appeals Opinion Summaries

Articles Posted in Public Benefits
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The Eleventh Circuit reversed and remanded the denial of social security disability benefits to plaintiff, who stated that he was no longer able to work due to various psychiatric conditions, which included chronic depression, anxiety, and bipolar disorder. The court held that the SSA's denial of plaintiff's application for disability benefits was not supported by substantial evidence where the ALJ did not articulate adequate reasons for discounting evidence of plaintiff's mental illness, which provided support for a finding of disability. In this case, the ALJ gave little or no weight to three pieces of evidence in the record indicating that plaintiff's mental illness prevents him from maintaining a job: (1) the opinions of plaintiff's treating psychiatrist, (2) the opinions of a consulting psychologist who examined plaintiff at the request of the SSA, and (3) plaintiff's own testimony as to the severity of his symptoms. View "Simon v. Commissioner, Social Security Administration" on Justia Law

Posted in: Public Benefits
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The Eleventh Circuit affirmed the Commissioner's denial of plaintiff's application for disability insurance benefits pursuant to 42 U.S.C. 405(g). The court held that there is no apparent conflict between one's limitation to following simple instructions and positions that require the ability to follow "detailed but uninvolved" instructions. The court concluded that the decision to deny benefits is otherwise supported by substantial evidence. View "Buckwalter v. Acting Commissioner of Social Security" on Justia Law

Posted in: Public Benefits
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The Eleventh Circuit affirmed the district court's decision affirming the ALJ's denial of social security disability benefits, holding that substantial evidence supports the ALJ's decision that plaintiff is not disabled. In this case, the ALJ assigned little weight to the opinions of a physician and a vocational rehabilitation specialist where the ALJ correctly understood that their statements were not dispositive. Furthermore, a vocational rehabilitation specialist is not a treating physician, and thus his opinion is not entitled to substantial or considerable weight, and the physician's opinion that plaintiff would be "permanently and totally disabled" conflicted with his own examinations of plaintiff, which showed no significant abnormalities. Finally, the court rejected plaintiff's argument under Bjornson v. Astrue, 671 F.3d 640, 647–48 (7th Cir. 2012). View "Walker v. Social Security Administration" on Justia Law

Posted in: Public Benefits
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The Eleventh Circuit vacated the district court's order affirming the denial of plaintiff's application for benefits under the Social Security Act. The court agreed with plaintiff that substantial evidence does not support the ALJ's finding that plaintiff could perform a job that exists in significant numbers in the national economy. The court held that the vocational expert's testimony as to available jobs, on which the ALJ relied, was significantly and admittedly flawed.In this case, the vocational expert used the wrong Standard Occupational Classification (SOC) group code to determine whether there are a significant number of jobs in the national economy that plaintiff could perform. Furthermore, even if the court overlooked this foundational problem, the numbers that the vocational expert cited from the wrong SOC group code substantially overstated the number of available bakery worker jobs that plaintiff could perform. Accordingly, the court remanded for further proceedings. View "Goode v. Commissioner of Social Security" on Justia Law

Posted in: Public Benefits
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The Eleventh Circuit affirmed the denial of social security disability benefits to plaintiff. The court rejected plaintiff's claim that the ALJ erred in finding that plaintiff was not disabled because the ALJ failed to appropriately consider the VA's determination that plaintiff was unable to work due to a disability and thus entitled to veterans' benefits. Rather, the court held that the ALJ's decisions demonstrates that he considered the VA's determination. The court also held that substantial evidence, including recent medical records that postdate the VA's decision, supported the ALJ's rejection of the VA's disability decision as determinative of whether plaintiff was disabled for Social Security purposes. View "Noble v. Commissioner of Social Security" on Justia Law

Posted in: Public Benefits
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The Eleventh Circuit vacated the district court's order affirming the Commissioner's denial of plaintiff's application for disability insurance benefits. The court held that the ALJ did not have the benefit of the court's decision in Schink v. Comm'r of Soc. Sec., 935 F.3d 1245 (11th Cir. 2019) (per curiam), which may alter the fourth step of the ALJ's disability analysis. Furthermore, the court agreed with plaintiff that the ALJ's hypothetical to the vocational expert did not sufficiently communicate plaintiff's limitations from bipolar disorder. View "Samuels v. Acting Commissioner of Social Security" on Justia Law

Posted in: Public Benefits
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Of two people injured in a car wreck in April 2012, one was a Medicare beneficiary who received her benefits from an MAO-Florida Healthcare Plus, which later assigned its claims to appellant MSPA Claims 1, LLC. The other party involved in the accident was insured by appellee Kingsway Amigo Insurance. The Medicare beneficiary obtained medical treatment for her accident-related injuries between April 29, 2012 and July 26, 2012, and Florida Healthcare made $21,965 in payments on her behalf. On March 28, 2013, the beneficiary settled a personal-injury claim with Kingsway and received a $6,667 settlement payment. The issue this case presented for the Eleventh Circuit’s review centered on the timeliness requirement with which the government had to comply as a prerequisite to filing suit to seek reimbursements that it made on behalf of the Medicare beneficiary, and whether filing suit beyond a statutory three-year period beginning on the date on which medical services were rendered was fatal to the government’s claim. The district court held that MSPA’s claim was stale because it didn’t comply with what the court (somewhat confusingly) called “the three-year limitation requirement.” The Eleventh Circuit disagreed and reversed. “The Medicare Secondary Payer Act’s private cause of action, and our cases interpreting it lead us to conclude that the Act’s claims-filing provision, doesn’t erect a separate bar that private plaintiffs must overcome in order to sue. A closer look at the claims-filing provision’s text and the Act’s structure confirms that conclusion. Accordingly, the district court erred in granting Kingsway’s motion for judgment on the pleadings.” View "MSPA Claims 1, LLC v. Kingsway Amigo Insurance Company" on Justia Law

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Plaintiff appealed the denial of his application for Social Security disability benefits, claiming that he had various physical impairments and that he suffered from bipolar disorder. The Eleventh Circuit held that, although plaintiff's claim of bias was forfeited, the ALJ's conclusion contained errors that must be addressed. In this case, the ALJ failed to articulate good cause for discounting two treating physicians' opinions; substantial evidence does not support the finding that plaintiff's bipolar disorder was non-severe; and the ALJ failed to consider plaintiff's mental impairments when assessing his residual functional capacity. Accordingly, the court affirmed in part, reversed in part, and remanded with instructions. View "Schink v. Commissioner of Social Security" on Justia Law

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The materiality standard—asking whether a school has failed to implement substantial or significant provisions of the child's individualized education plan (IEP)—is the appropriate test in a failure-to-implement case. L.J. and his mother filed suit under the Individuals with Disabilities Education Act (IDEA), challenging the implementation of his IEP.The Eleventh Circuit held that the content outlined in a properly designed IEP is a proxy for the IDEA's educational guarantee, and thus a material deviation from that plan violates the statute. In this case, the court held that there was no material deviation from L.J.'s IEP and affirmed the district court's judgment in favor of the school. View "L.J. v. School Board of Broward County" on Justia Law

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MSPA, a firm that obtains Medicare Secondary Payer Act (MSP Act) claims and brings them on behalf of Medicare Advantage Organizations (MAOs), filed suit against Tenet over a delayed reimbursement of $286. The Eleventh Circuit affirmed the district court's grant of Tenet's motion to dismiss. The court held that MSPA had standing to invoke a federal court's jurisdiction because it suffered an injury in fact when it had to wait seven months for appropriate reimbursement and it validly assigned the right to vindicate that injury to La Ley Recovery Systems, who in turn validly assigned it to MSPA.On the merits, the court held that the MSP Act's private cause of action was only available in the case of a primary plan which fails to provide for primary payment (or appropriate reimbursement). In this case, MSPA did not sue a primary plan, but instead, it sued two medical services providers. Because private MSP Act plaintiffs could only sue primary plans, and MSPA had not done so, its claim was not plausible on its face. Therefore, the district court correctly dismissed MSPA's complaint for failure to state a claim. View "MSPA Claims 1, LLC v. Tenet Florida, Inc." on Justia Law