Articles Posted in Public Benefits

by
This case focused on whether the Department for Children and Families (DCF) could deny an applicant temporary housing assistance under General Assistance (GA) Rule 2652.3 for having left her housing in response to a notice of termination without cause from her landlord. DCF argued that applicant Dezarae Durkee caused her own loss of housing and therefore was ineligible for assistance. The Human Services Board upheld this determination. Applicant argued that leaving in response to a notice of termination without cause does not constitute causing her own lack of housing and sought a declaration of such damages. The Vermont Supreme Court granted the declaratory judgment but concluded damages were not appropriate relief. View "In re Appeal of Dezarae Durkee" on Justia Law

by
Petitioner was admitted to a nursing home in September 2010. She was eighty-seven years old at the time, and had a diagnosis of dementia and Alzheimer's disease. Petitioner's adult daughter, who had the authority to act on petitioner's behalf by virtue of a power of attorney, submitted an application for long-term care Medicaid benefits in January 2011. The application sought coverage for petitioner, retroactive to October 1, 2010, pursuant to a Medicaid rule authorizing benefits for up to three months preceding the month of application. A benefits specialist with the Department for Children and Families testified that, in response to the application, she sent two separate verification requests to petitioner's daughter and an administrator at petitioner's nursing home. The Department received no response to these requests. Accordingly, in March 2011, the Department issued a Notice of Decision ("Notice") denying the application. No appeal of the denial was filed by petitioner or a person acting on her behalf within the ninety-day limit. Petitioner's daughter would submit a total of four applications, each with a request from the Department for additional information, and each time, no information was provided, and the applications were denied. With the assistance of her son, petitioner filed a fifth application for benefits in February 2012. This time, additional information verifying petitioner's financial eligibility was provided, and the application was approved by the Department in May 2012 with benefits retroactive to November 2011, which was three months prior to the date of the fifth and final application. Petitioner appealed that decision, seeking coverage retroactive to October 2010, which would have been three months prior to her first application from January 2011. An evidentiary hearing was held in July 2013 before a Department hearing officer. The Board adopted the hearing officer's findings and issued a decision reversing the Department's decision to limit retroactive benefits to November 2011. The Board concluded that, for reasons of equitable estoppel, petitioner could be awarded benefits retroactive to October 1, 2010 based on the date of the initial application. The Department sought review by the Secretary, who reversed the Board's decision. Because petitioner did not respond to the Department's multiple requests for verification, did not advise the Department of any valid reasons for failing to respond, and informed the Department's benefits specialist that the failure to respond was her responsibility, that she had "dropped the ball." Accordingly, the Secretary found no justification to invoke the doctrine of equitable estoppel, and reversed the Board's decision. Finding no reversible error, the Vermont Supreme Court affirmed the Secretary's reversal of the Board's ruling. View "In re Bernice Landry" on Justia Law

by
In consolidated appeals, petitioners, both recipients of home-based long-term care benefits through Vermont's Medicaid-funded Choices for Care (Choices) program, appealed decisions of the Human Services Board disallowing deductions for personal care services from their patient-share obligation under federal and state Medicaid laws. Upon review of the cases, the Supreme Court concluded that to the extent the services in question were medically necessary, expenses for those services must be deducted from petitioners’ patient-share obligation even if they are of a type generally covered by Medicaid. Furthermore, the Court rejected the State’s claim that the decision of the Department of Disabilities, Aging and Independent Living not to provide the personal care services in question under the Choices program constituted a conclusive finding that the services were not medically necessary. View "In re Brett" on Justia Law

by
Employer Maple Leaf Farm Association, Inc. appealed a decision of the Employment Security Board finding that its former employee Katherine Kelley was involuntarily terminated from her position and therefore eligible for unemployment compensation benefits. Employer operated an intensive inpatient drug and alcohol treatment program. Claimant worked for employer as a part-time treatment counselor for seven years. Due to a conflict with a supervisor, claimant resigned from her position in writing on August 29, 2013. She stated in her letter to employer that her last day would be September 19, 2013, and employer allowed her to continue working. Four days later, on September 3, employer terminated her employment and escorted her off the premises. Claimant applied for unemployment compensation. The claims adjudicator determined that she was not entitled to benefits for the first two weeks after her termination because the accrued vacation pay that employer paid her during that period was in excess of her weekly benefit amount. The claims adjudicator further determined that claimant was not entitled to benefits because she had left employment voluntarily without good cause attributable to her employer. Employer appealed the referee’s decision to the Employment Security Board, which adopted the referee’s findings and affirmed its conclusions. Finding no reversible error, the Supreme Court affirmed the Board's decision. View "Kelley v. Department of Labor" on Justia Law

by
Applicant Marilyn Clifford appealed the denial of long-term home-care benefits under the Medicaid-funded Choices for Care program, arguing that a second home on an adjacent piece of property should have been excluded from the financial-eligibility calculation. Given the language of the regulation, the legislative history that led to its promulgation, and the policy considerations attending the Medicaid program, the Supreme Court concluded that the Secretary correctly interpreted the home-exclusion rule when he reinstated the determination of the Department of Children and Families denying the benefits. Thus, the Court found no compelling indication of error in the Secretary’s determination and affirmed. View "In re Marilyn Clifford" on Justia Law

by
Medicaid recipient John Doe and the State appealed a trial court's decision allowing the State to partially recover the amount of its lien against Doe's settlement with a third party. In 1992 when Doe was nine years old, he was catastrophically injured and paralyzed in an automobile accident.  Due to Doe's injuries, his mother applied for Medicaid on his behalf in 1994.  Doe later brought suit in New York Supreme Court against the alleged third-party tortfeasors.  He also sued New York State Transit Authority (NYSTA) in the New York Court of Claims.  The State of Vermont notified Doe in January 2001 that it claimed a lien against any award, judgment, or settlement stemming from the accident.  In 2001, Doe settled the lawsuit against the third parties for $8.75 million. Doe's suit against NYSTA went to trial, and in 2004, the Court of Claims awarded Doe approximately $42 million and allocated approximately $2.9 million to Doe's past medical expenses from the date of injury to the date of trial. Between the 2001 and 2006 settlements, the State paid approximately $771,111 in medical expenses for Doe's care, in addition to the medical expenses paid up to the date of the first settlement.  The State claimed a lien on the 2006 settlement for $506,810, which was the difference between the amount the State paid for Doe's medical care under Medicaid and the State's share of litigation expenses. Doe sued the State of Vermont, seeking a declaratory judgment that he satisfied the State's lien by partial payment.  On summary judgment, the court concluded that it would not undo the 2001 settlement because it was an accord and satisfaction of all claims paid for medical expenses incurred to that point in time. The State argued on appeal to the Supreme Court that the trial court should have reduced the Court of Claims' findings of future economic damages to present value before making its lien allocation. Upon review, the Supreme Court concluded the parties' agreement resolved the issues surrounding the State's lien on Doe's first settlement, while leaving open the possibility that Doe would obtain a judgment against or settlement with the NYSTA.. On these facts, the Court agreed with the trial court that there was an accord and satisfaction, and that the State accepted $594,209.03. The case was reversed and remanded to recalculate the State's lien against $771,111 in medical expenses and reasonable attorney's fees, but affirmed in all other respects.  View "Doe v. Vermont Office of Health Access" on Justia Law

by
Claimant Katherine St. Martin appealed the Employment Security Board's determination that she voluntarily left her job without good cause, disqualifying her from receiving unemployment benefits. She argued on appeal that her decision to quit her job was with good cause because she reasonably believed she would not receive a paycheck for her work. Claimant worked for almost two years for her employer as an assistant financial supervisor, which required her to prepare payroll information weekly. At some point, her employer began to have financial difficulties, and the payroll submission day was moved back to later in the week. The president of Claimant’s employer told claimant not to submit payroll because there were inadequate funds to cover the checks. The president then attempted to borrow money to meet the payroll, which ultimately proved "fruitless." The chief of operations persuaded the president to close the business and pay the employees. Claimant submitted the payroll after being given permission to do so by the president. She then printed the checks, and distributed them to the employees. After the president told claimant that the checks would bounce due to lack of funds, Claimant quit. Upon review, the Supreme Court held that Claimant should not have been penalized for leaving her job when she was told not to expect a paycheck. The president's statement amounted to "good cause." View "St. Martin v. Dept. of Labor" on Justia Law

by
Respondent Alan Cote appealed a family court's garnishment order that directed the Social Security Administration to withhold his Social Security benefits to offset alimony arrearages. On appeal, Respondent contended that the garnishment order violated a provision of the Federal Consumer Credit Protection Act which imposes a cap on the percentage of aggregate disposable earnings that any court, state or federal, may garnish. While the trial court garnished only Respondent's Social Security disability benefits and not his veterans' disability benefits, the court did include the latter in its calculation of aggregate disposable earnings.  This broad calculation of disposable earning increased the percentage of Respondent's Social Security payments subject to garnishment.  Respondent contended that as defined and excluded from such a calculation by federal law, his particular veterans' disability benefits were not to be counted as earnings because they were not paid for a service related disability and are not received in lieu of retirement payments to which he would otherwise be entitled as earnings.  Upon review of the lower court's record and calculations, the Supreme Court agreed, reversed the lower court's order and remanded the case for recalculation of the garnishment. View "Cote v. Cote" on Justia Law

by
Claimant Katrina Blue appealed an Employment Security Board decision that denied her claim for unemployment compensation benefits.  Claimant contended the Board erred in: (1) finding that she was disqualified from receiving benefits because she left her employment voluntarily; and (2) assigning her the burden of proof.  Claimant worked for about four years for Hickok & Boardman Realty.  In the early summer of 2010, claimant left her employment to participate in a three-month cross-country bicycle ride for multiple sclerosis. Claimant acknowledged that she did not submit a written request for leave, as required in the company's personnel policy, which stated that employees who apply for unpaid personal leave, "must apply in writing" and that, "reinstatement is not guaranteed" but rather, "at the Company's sole discretion."  While conceding that her leave arrangement "was not typical," Claimant maintained that her supervisor had agreed, "that an exception would be made in this instance." In its ruling, the ALJ's findings indicated that Claimant "requested a three-month leave of absence" but do not state whether the request was granted or, if so, on what terms.   Its key conclusion, however, was that, "[w]hile the claimant maintain[ed] that she was fired when the employer would not allow her to come back from a personal leave of absence, it was the claimant who initiated the separation from employment by requesting the leave of absence . . . thus making this a voluntary separation from employment."  Since there was no claim that the separation was for "good cause attributable" to the employer, the ALJ concluded that claimant was disqualified from receiving benefits. In a divided ruling, the Employment Security Board adopted the ALJ's findings and conclusions and sustained its decision.  The dissenting member of the Board would have found that claimant's "departure for her cross-country ride was . . . not a voluntary abandonment of her employment, but a temporary unpaid leave of absence," that claimant was let go upon her return in late August, and therefore that she was entitled to unemployment compensation benefits from that time forward.  This appeal followed. Upon review of the record, the Supreme Court reversed and remanded the case to the Department of Labor's ALJ: "[m]indful that our unemployment compensation scheme must be broadly construed so that no claimant is "excluded unless the law clearly intends" it … we direct the ALJ on remand to enter additional findings and conclusions on the material issues presented, and to award unemployment compensation benefits to claimant in the event it is determined that she  did not leave her employment voluntarily." View "Blue v. Dept. of Labor" on Justia Law

by
Employer Ethan Allen, Inc. appealed the Commissioner of the Department of Labor's decision that Claimant Robin Houle's right shoulder condition was compensable under the Workers' Compensation Act.  Claimant experienced pain and weakness in her left shoulder and arm, and her job duties as a furniture refinisher were modified to account for her medical restrictions.  Claimant was assigned to an inventory control/stockroom clerk position where she engaged in a variety of duties.  Interspersed among these duties, claimant also wrapped finished shelves to prepare them for shipping. Claimant was initially treated for the increased symptoms in her shoulder and neck by her primary care provider.  The primary care provider referred her to an orthopedist for further evaluation.  The orthopedist suspected that her left shoulder complaints were most likely due to her repetitive work for Ethan Allen.  He attributed claimant's right shoulder pain to normal wear and tear to be expected of someone claimant's age.  Claimant was dissatisfied with this evaluation and was then referred to an orthopedic surgeon for further evaluation and treatment. In view of the competing expert medical opinions, the Commission relied on a traditional five-part test to evaluate their persuasiveness. Ethan Allen raised numerous arguments on appeal to the Supreme Court. Principal among them, Ethan Allen challenged the Commissioner's use of the five-part test to evaluate competing medical opinions, both as applied in this case and in general.  According to the Employer, the use of this test improperly shifts the burden of proof from claimant to employer, unfairly places employers at a disadvantage, and erroneously employs a "winner take all" approach to evaluating a claimant's expert testimony. Upon review, the Supreme Court concluded that Ethan Allen failed to show that the Commissioner's findings were clearly erroneous or that her conclusions were unsupported by the findings. The Court affirmed the Commissioner's decision in this case. View "Houle v. Ethan Allen, Inc." on Justia Law