Searching over 5,500,000 cases.


searching
Buy This Entire Record For $7.95

Download the entire decision to receive the complete text, official citation,
docket number, dissents and concurrences, and footnotes for this case.

Learn more about what you receive with purchase of this case.

Day v. Schweiker

decided: June 28, 1982.

LEON S. DAY, ET AL., PLAINTIFF-APPELLEE,
v.
RICHARD S. SCHWEIKER, SECRETARY OF HEALTH AND HUMAN SERVICES, DEFENDANT-APPELLANT



Appeal from orders of the United States District Court for the District of Vermont, James S. Holden, Ch. J., granting summary judgment in favor of a class of Vermont claimants seeking disability payments under Title II of the Social Security Act, 42 U.S.C. § 401 et seq., and ordering interim payments if Secretary fails to process claims within time limits set by the court. Judgment affirmed. Appeal from orders of the United States District Court for the District of Vermont, James S. Holden, Ch. J., granting summary judgment in favor of a class of Vermont claimants seeking disability payments under Title III of the Social Security Act, 42 U.S.C. § 401 et seq., and ordering interim payments if Secretary fails to process claims within time limits set by the court. Judgement affirmed.

Feinberg, Chief Judge, Cardamone, Circuit Judge and Sand, District Judge.*fn*

Author: Per Curiam

The Secretary of Health and Human Services appeals from various orders of the United States District Court for the District of Vermont, James S. Holden, Ch. J., granting summary judgment in favor of a class of claimants*fn1 seeking disability benefits under Title II of the Social Security Act (the Act), 42 U.S.C. § 401 et seq. We find that most of the arguments raised in this appeal are almost indistinguishable from those decided by us in earlier cases, see Sharpe v. Harris, 621 F.2d 530 (2d Cir. 1980); Barnett v. Califano, 580 F.2d 28 (2d Cir. 1978); White v. Mathews, 559 F.2d 852 (2d Cir. 1977), cert. denied, 435 U.S. 908, 98 S. Ct. 1458, 55 L. Ed. 2d 500 (1978), and that, in any event, our prior decisions are controlling. Accordingly, we affirm the judgment of the district court.

I.

The procedure for challenging an initial determination that a Vermont claimant is ineligible for Title II disability benefits is set out in the Act and regulations adopted thereunder, and is explained in greater detail in the district court's opinions dated December 28, 1979 and August 19, 1981. The claimant's first step is to request reconsideration of his claim at the District Office (DO) of the Social Security Administration (SSA). That office locates the claimant's folder (which, the district court found, is not always easy) and forwards it to the appropriate Disability Determination Agency (DDA). The claim is then subjected to de novo review, which often entails updating the file with new evidence gathered at the claimant's initiative or pursuant to a request of the DDA. When the DDA completes its reconsideration, the claim follows one of several routes. A case involving a "new" claimant (one who had not been previously receiving benefits) is rerouted to the DO and a reconsideration notice is sent to the claimant by the DDA either by computer or manually. The DDA may, however, delay sending notice while it undertakes a "quality assurance review" of its own, or sends the case to the Office of Disability Operations (ODO) in Baltimore, Maryland for a quality control review. A case involving cessation of payments to an "old" claimant (one who was previously receiving benefits) is always sent to ODO for a final review before notice of denial is sent to the claimant. In either case, once a claimant receives notice of an adverse determination on reconsideration, he is entitled to a fair hearing before an administrative law judge. The claimant is not, however, entitled to resort to federal court to reverse a denial of benefits until he has run the full gauntlet of administrative review.

In the district court, appellees claimed that two kinds of delay violated their constitutional rights under the due process clause of the fifth amendment and their statutory rights under the Administrative Procedure Act, 5 U.S.C. § 555(b)*fn2 and the Social Security Act, 42 U.S.C. § 405(b).*fn3 First, they maintained that SSA took an unreasonable amount of time to dispose of a claim once a claimant had made a request for reconsideration.*fn4 Second, they claimed that the time between a request for a hearing and the date of hearing was unreasonably lengthy.*fn5 In his December 1979 opinion, Chief Judge Holden granted summary judgment in favor of appellees on the latter issue, finding that the unreasonable delay in scheduling hearings contravened the Social Security Act. In his August 1981 opinion, after considerable additional briefing, the judge came to the same conclusion on the reconsideration issue. He evaluated the delay there by the same standard used on the hearing issue because he reasoned that since "the time necessary to complete a reconsideration is included in the time that the claimant must wait before he is afforded a hearing . . . unreasonable delays in the reconsideration procedures trench on the statutory duty to provide a hearing within a reasonable time."

Relying on our decisions in Barnett and White, Judge Holden next turned to fashioning relief for appellees' class. In a judgment entered in November 1981, the district court ordered that with certain significant exceptions,*fn6 reconsideration processing must be completed within 90 days of a request for reconsideration, and that with similar exceptions,*fn7 a hearing must be scheduled within 90 days of a request for hearing. Judge Holden then went on to order that interim disability payments be made, subject to the exceptions described above and to recoupment if the claimant is later found to be ineligible for disability payments, whenever no reconsideration determination is issued within 180 days of the request for reconsideration, whenever no hearing is held within 180 days of a prior request for reconsideration that is followed by a hearing request and whenever no hearing is held within 90 days of a request for a hearing.

II

On appeal, the Secretary raises several arguments that are similar to those made in our earlier cases. First, he claims that the case is nonjusticiable because Congress has entrusted the administration of the Act to the Department of Health and Human Services. It is true that this argument, strengthened somewhat by the Seventh Circuit's reading of the decision in Vermont Yankee Nuclear Power Corp. v. Natural Resources Defense Council, Inc., 435 U.S. 519, 55 L. Ed. 2d 460, 98 S. Ct. 1197 (1978), won the day for the Secretary in Wright v. Califano, 587 F.2d 345, 352-54 & 356 (7th Cir. 1978). But see Smith v. Miller, 665 F.2d 172 (7th Cir. 1981). A similar claim also gained him a partial victory in Blankenship v. Secretary of HEW, 587 F.2d 329, 335 (6th Cir. 1978). We, however, agree with the First Circuit's view that "while . . . Congress must bear the ultimate responsibility for remedying problems in the administration of federal programs . . . cf. Vermont Yankee. . ., that does not mean that a judicial role is precluded where the statutory mandate is not being followed." Caswell v. Califano, 583 F.2d 9, 16 (1st Cir. 1978). This is particularly true when "the danger of judicial intervention is outweighed by the irreparable harm suffered by members of the plaintiff class who encounter unreasonable delays in gaining consideration of their applications." Sharpe, 621 F.2d at 531. See also White, 559 F.2d at 858-59.

Next, the Secretary argues that our previous decisions should not be followed because the increase in caseload and congressional "assumption of oversight" show that circumstances have changed significantly since the earlier cases were decided. As to the former argument, the increment in SSA's caseload is a variant of the claim made in White that the Secretary is precluded from adhering to a judicially mandated timetable by the "flood of claims," 559 F.2d at 859. As before, we sympathize with the severe problems that beset SSA, and we understand that Judge Holden's decision may have a significant impact on its operations. But the new statistics presented to us on this appeal do not persuade us to revise the position we took in White :

Although what is reasonable depends upon a variety of circumstances, [the] statutory command should not be ignored. The disability insurance program is designed to alleviate the immediate and often severe hardships that result from a wage-earner's disability. In that context, delays of the better part of a year in merely affording an evidentiary hearing detract seriously from the effectiveness of the program. Perhaps this unfortunate impact might be diminished to a tolerable level if a high percentage of claimants seeking hearings before an administrative law judge were not actually entitled to benefits. But such hearings have led to reversals in more than half the cases heard. (Citation omitted.)

559 F.2d at 858. We also share the First Circuit's concern that "if the Secretary's resources truly are inadequate to the task, the more litigious of the applicants may gain an advantage over the less assertive." Caswell, 583 F.2d at 17. But we also agree with the First Circuit's conclusion:

However, the vindication of almost every legal right has an impact on the allocation of scarce resources. And the courts, while mindful of the impact of remedies upon persons not before them, can hardly permit the legal rights of litigants to turn upon the alleged ...


Buy This Entire Record For $7.95

Download the entire decision to receive the complete text, official citation,
docket number, dissents and concurrences, and footnotes for this case.

Learn more about what you receive with purchase of this case.