Articles Posted in Public Benefits

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Charles Wimberly filed an application for disability retirement benefits with the Kentucky Retirement Systems (KERS). A hearing officer recommended that Wimberly's application be denied and, before KERS could render a final decision, Wimberly filed a second application pursuant to Kentucky Revised Statute (KRS) 61.600(2). Following the recommendation of another hearing officer, KERS denied that application. Wimberly sought judicial review; the circuit court reversed KERS. KERS appealed to the Court of Appeals, which affirmed the circuit court. The Supreme Court granted discretionary review to address the parties' arguments regarding the application of the doctrine of res judicata and to determine whether the consumption of alcohol was or could be a pre-existing condition. Having reviewed the record and the arguments of the parties, the Supreme Court affirmed. View "Kentucky Retirement Systems v. Wimberly" on Justia Law

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Dianne Carson first filed an application for retirement disability benefits in November 2007. Based on the recommendation of a hearing officer, the Kentucky Retirement Systems (KERS) denied Carson's claim. Carson did not seek judicial review of KERS's order, choosing instead to file a second application in October 2009. Based on a recommendation of a different hearing officer, KERS again denied Carson's claim. Carson sought judicial review and the circuit reversed and remanded with instructions for KERS to consider all of the medical evidence Carson submitted. The Court of Appeals affirmed. KERS argued that Carson's second application should have been dismissed under the doctrine of res judicata. "If res judicata applied to this action, Carson would have been barred from filing a second application that was based on the same claim as her first application. However, KRS 61.600(2) requires KERS to accept an employee's timely filed "reapplication based on the same claim of incapacity" and to reconsider the claim 'for disability if accompanied by new objective medical evidence.'" This case was remanded for KERS to undertake the correct review of the evidence. The Supreme Court affirmed the Court of Appeals. View "Kentycky Retirement Systems v. Carson" on Justia Law

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Kentucky Spirit Health Care Plan, Inc. brought a declaratory judgment action seeking a ruling that it had a right to terminate its Medicaid managed care contract with the Finance and Administration Cabinet prior to the expiration of the contract without penalty. The trial court entered partial summary judgment in favor of the Cabinet. Both parties appealed. While the appeals were pending, the circuit court stayed Kentucky Spirit’s pre-trial discovery efforts relating to its rights under the Medicaid contract until resolution of the partial summary judgment appeals. The Court of Appeals granted Kentucky Spirit’s petition for a writ of prohibition against the circuit court judge prohibiting the judge from enforcing the order imposing the stay of discovery. The Supreme Court vacated the writ and remanded for entry of an order denying Kentucky Spirit’s petition for a writ of prohibition, holding that the circuit court did not abuse its discretion by temporarily staying discovery, as a stay of discovery was appropriate pending resolution of the threshold issues currently on appeal. View "Commonwealth v. Hon. Wingate" on Justia Law

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Mary Bell was a disabled person who drew Social Security Insurance benefits and participated in a federally-funded, community-based program operated by the Cabinet for Health and Family Services. When Thomas Bell, Mary’s father, retired and began to draw his Social Security benefits, Mary became eligible for Old Age, Survivor and Disability Insurance. Consequently, Mary was charged $60 per month for her continued program participation. Thomas filed an administrative appeal on Mary’s behalf. The matter ultimately reached the circuit court, which held that Mary could not be charged to participate in the program. Thereafter, the circuit court (1) awarded attorney’s fees against the Cabinet due to the Cabinet’s “egregious government behavior,” and (2) ordered the Cabinet to disclose the personal information of all other participants in the program. The court of appeals reversed. The Supreme Court affirmed, holding that the trial court erred by (1) ordering the payment of attorney’s fees solely for egregious conduct without statutory authorization or a contract providing for such fees; and (2) ordering the disclosure of records of all persons participating in the program without the other persons having filed claims and no class action being certified. View "Bell v. Commonwealth" on Justia Law

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Appellants, PremierTox, Inc. and PremierTox 2.0 (collectively, PremierTox) filed an action against Kentucky Spirit Health Plan, Inc. and others (collectively, Appellees), alleging that it was owed $1.8 million by Kentucky Spirit for services it had provided to Medicaid patients and for which Kentucky Spirit had allegedly been paid by the Commonwealth. The circuit court ordered Appellees to deposit $1.8 million into an escrow account controlled by the circuit court pending adjudication of the claim. The court of appeals issued a writ to prohibit enforcement of the circuit court's order, concluding that the circuit court lacked the authority to require Appellees to pay the demanded judgment into court in advance of an adjudication that Appellees owed the money. The Supreme Court affirmed the decision of the court of appeals to issue the writ of prohibition, holding (1) the circuit court acted erroneously in ordering Appellees to escrow the disputed funds under Ky. R. Civ. P. 67.02; (2) the circuit court's order was essentially a pre-judgment attachment for which Appellees lacked an adequate remedy on appeal or otherwise; and (3) Appellees satisfied the "irreparable injury" prong of the proper writ analysis. View "PremierTox 2.0 v. Circuit Court" on Justia Law

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The Cabinet for Health and Family Services filed a motion to hold Renee Ivy in contempt after Ivy fell behind in her child support payments. At the hearing on the motion, Ivy presented evidence that her sole source of income was a federal benefit under the Supplemental Security Income program (SSI). The trial court reduced Ivy's support obligation and held her in contempt for having failed to pay the past due amount. The court of appeals reversed, holding that the contempt finding and the order to pay even reduced child support could not stand because evidence showed Ivy did not have the ability to pay. The Supreme Court (1) reversed the court of appeals' decision to the extent that it suggested that a SSI recipient-parent's present inability to pay precludes even the assessment of child support; (2) vacated the existing order and remanded for the family court to determine if the guidelines-based amount would be unjust or inappropriate pursuant to Ky. Rev. Stat. 403.211(2); and (3) affirmed the holding that a contempt finding was inappropriate here where there was essentially uncontroverted evidence that Ivy's failure to provide child support stemmed only from her inability to do so. View "Cabinet for Health & Family Servs. v. Ivy" on Justia Law