United States District Court, S.D. New York
YOLANDA N. TEJADA, Plaintiff,
CAROLYN W. COLVIN, Acting Commissioner of Social Security, Defendant.
JAMES L. COTT, Magistrate Judge.
Pro se plaintiff Yolanda Tejada seeks judicial review of a final decision by the Commissioner of Social Security ("Commissioner") denying her application for a waiver of overpayment of Supplemental Security Income ("SSI") benefits. The Commissioner has moved for judgment on the pleadings pursuant to Federal Rule of Civil Procedure 12(c). For the reasons set forth below, the motion is granted.
Tejada was found eligible for SSI benefits under Title XVI of the Social Security Act ("Act"), 42 U.S.C. § 1381 et seq., and received SSI payments until May 1, 2011. Administrative Record ("R.") (Dkt. No. 19), at 16, 47. On August 2, 2011, the Social Security Administration ("SSA") issued a notice informing Tejada that she had been overpaid SSI benefits in the amount of $6, 970.00 between August 1, 2010 and May 1, 2011. Id. at 16, 47, 106. The stated reason for the overpayment was that, in June 2010, Tejada's husband moved back into her household and he had been receiving monthly income of $952.00 in Social Security disability benefits and $1, 138.00 in long-term disability benefits. Id. at 16, 25, 48. Based on these circumstances, the SSA found that Tejada had excess household income, rendering her ineligible for SSI benefits. Id. at 16, 44.
On November 4, 2011, Tejada requested a waiver of the overpayment, claiming that she was not at fault in causing the overpayment because she "was under the impression [her] husband Francisco Tejada Rivas reported to SSA he was living at [her] household. He reported a change of address on 06/2010." Id. at 21-22, 47. Tejada also listed and provided supporting documentation for her monthly household expenses, which included: $577 for rent; $800 for food; $347.52 for utilities (electric, telephone, and cable television); and $80 for laundry detergent. Id. at 26-35.
On November 21, 2011, the SSA denied Tejada's waiver request on the grounds that she was able to repay the overpayment and was at fault for not self-reporting her husband's addition to her household. Id. at 16, 47-50. Tejada filed a request for reconsideration on December 22, 2011, stating that she was "not aware that [she] needed to report when [her] husband returned to the house." Id. at 16, 51-53. Her reconsideration request was denied on the same date. Id. at 54-56. Tejada requested a hearing on January 19, 2012, stating that she was "not able to pay [her] overpayment because [her] husband's income is not sufficient to pay all [their] household expenses and his medical expenses." Id. at 57. On April 10, 2012, Tejada appeared without counsel before Administrative Law Judge ("AU") Patrick Kilgannon and testified with the assistance of a Spanish interpreter. Id. at 120-32. Tejada testified that her current monthly expenses included: $602 for rent; approximately $300 for electricity and cable television; and $900 to $1, 000 for food and laundry detergent. Id. at 131. She further testified that her 25-year-old son resides with her and receives approximately $500 per month in Social Security benefits (on account of his schizophrenia and bipolar diagnoses), $200 of which her husband typically retained toward household expenses. Id. at 126, 131. Tejada explained that her husband has cancer but provided no documentation of his or any other household member's medical expenses. Id. at 130. Tejada stated that as a result of her husband's reinstatement to her household, she had lost all of her benefits, including Medicaid. Id. at 131.
In a decision issued on April 20, 2012, the AU found that Tejada was overpaid $6, 970 in SSI benefits during the period August 1, 2010 to February 1, 2011. Id. at 18. The AU further found that Tejada was not at fault in causing the overpayment but denied waiver of recovery on the grounds that recovery of the overpayment would not defeat the purpose of Title XVI, would not be against equity and good conscience, nor would it impede efficient or effective administration of Title XVI. Id. at 18-19. Based on Tejada's current financial circumstances, the AU recommended that she repay $100 each month to satisfy the debt. Id. at 20.
Tejada then sought review of the ALJ's decision by the SSA Appeals Council on May 17, 2012, id. at 7, which was denied on December 20, 2013, making the ALJ's decision the final determination of the Commissioner, id. at 2.
On February 6, 2014, Tejada, again proceeding pro se, commenced this action by timely filing a form complaint seeking judicial review of the ALJ's decision pursuant to 42 U.S.C. §§ 405(g) and/or 1383(b)(1)(B). (Dkt. No. 2). Tejada submitted additional evidence with her complaint, including a January 14, 2014 SSA billing statement for the $6, 970 outstanding balance (Dkt. No. 2 at 17-24), and an outpatient department ("OPD") "Management Care Plan, " listing tests performed and medications prescribed to her by Dr. Maria T. Espejo in 2013 (id. at 25). Tejada was granted in forma pauperis status on February 27, 2014. (Dkt. No. 3). On June 10, 2014, the Commissioner filed her answer (Dkt. No. 13), and moved for judgment on the pleadings pursuant to Rule 12(c), see Motion for Judgment on the Pleadings (Dkt. No. 14); Memorandum of Law in Support of Judgment on the Pleadings (Dkt. No. 15).
On June 9, 2014, Tejada submitted an application for the appointment of pro bono counsel. (Dkt. No. 12). While not formally granting the motion, the Court sought counsel for Tejada, but was unsuccessful in securing representation for her. (Dkt. No. 17). The Court gave Tejada additional time to submit a cross-motion, but advised her that if the Court remained unable to appoint pro bono counsel for her, she must nonetheless submit her response to the Commissioner's motion. ( Id. ) Despite this warning, Tejada has not filed any papers in opposition to the motion.
A. Legal Standards
1. Statutory and Regulatory Scheme for Overpayment of SSI Benefits
If an individual receiving SSI benefits is incorrectly paid more than the amount to which she is entitled, the Commissioner is authorized to seek a refund of the excess amount of benefits. 42 U.S.C. § 1383(b)(1); 20 C.F.R. § 416.537. When an individual seeks a waiver of the repayment, the analysis proceeds under a two-step inquiry. The requirement to repay can be waived only if: (1) the recipient was without fault; and (2) recovery of the overpayment would either: (a) defeat the purpose of Title XVI; (b) be against equity and good conscience; or (c) impede efficient or effective administration of Title XVI due to the small amount involved. 42 U.S.C. § 1383(b)(1)(B); 20 C.F.R. § 416.550; see also Mesias v. Doe, No. 11-CV-2373 (RRM), 2012 WL 3704824, at *3 (E.D.N.Y. Aug. 24, 2012). The burden is on the plaintiff to satisfy both prongs of the test. See, e.g., Valente v. Sec'y of Health & Human Svcs., 733 F.2d 1037, 1042 (2d Cir. 1984); Posnack v. Sec'y of Health & Human Svcs., 631 F.Supp. 1012, 1015 (E.D.N.Y. 1986). Here, the ALJ ...