In Medicare Compendia and due process lawsuit, Bruce v. Azar (Case No. 4:18-cv-05022 HSG) filed by PWDF, motions for summary judgments (MSJ) are being briefed. Oral argument is scheduled for November 14, 2019.  This case is about Medicare not covering over $15,000 per month for a prescription drug for a life-threatening condition.  Medicare says that the patient must have another non-related disease (HIV) in order to provide coverage.  We are anticipating that this case will go through the Court of Appeals for the Ninth Circuit, since the judge threw out a due process count notwithstanding the Supreme Court states it can be adjudicated with a Medicare claim.

On September 16, 2019, the Social Security Administration’s (SSA’s) opposition to PWDF’s MSJ in the case of Lim v. Berryhill (No. 5:18-cv-07519-VKD) was filed.  PWDF’s reply to the SSA’s opposition is filed. This case is about whether our client’s onset date of disability is established before his insured status under the Social Security Act expired.  Claimants are not eligible for benefits if they cannot prove they were disabled before their insurance expires (usually about 5 years after the person stops working).  A federal magistrate judge will rule on the case without oral argument, as per Local Rule 16.5 for appealing administrative decisions.

PWDF has advised a client to file a discrimination complaint based on psychiatric disability against the SSA in their post-entitlement work incentive programs.  The complaint seeking meaningful, equal program access through reasonable accommodations, i.e., giving him “effective communication.”

PWDF submitted a comment to the SSA with recommendations regarding Docket SSA-2019-0026, “Agency Information Collection Activities: Proposed Request” on two items: #3 – SSA Travel Expense Reimbursement and #7 – SSA Request for Reconsideration. Regarding the SSA Travel Expense Reimbursement, PWDF believes the travel expense reimbursement from federal and state agencies for claimant travel incidental to medical examinations (to go to a doctor for a consultative examination or hearing) exceeding 75 miles or more should be lowered to 25 miles. The cost is too prohibitive for the average SSI and some SSDI claimants to bear. Regarding the Request for Reconsideration, it is PWDF’s opinion that the SSA’s estimate of the average time burden per response for respondents filing for reconsideration of an initial determination of either 8 minutes for SSA-561 (Modernized Claims System) or 5 minutes for I561 (Internet iAppeals) fails to take into consideration the fact that these time estimates are only for the time it takes to fill out the form; however, claimants should also get and submit updated medical records, which can take several hours and often requires multiple calls and/or emails to their medical providers, and perhaps additional forms.  PWDF considers the SSA’s estimate of 5 or 8 minutes to be misleading because it uses unrealistic factors to estimate the amount of time required.

PWDF’s next legal clinics for Social Security disability beneficiaries with post-entitlement / eligibility issues are from 10:00 a.m. to 12:00 p.m. on: