Adams v. Califano

• Decision Date: 17 August 1979
• Docket Number: Civ. A. No. N-78-1802.
• Citation: 474 F. Supp. 974
• Parties: Letcher ADAMS, and Claude Alston, Individually and on behalf of all others similarly situated v. Joseph A. CALIFANO, Jr., Secretary, Department of Health, Education and Welfare, and David W. Hornbeck, Superintendent of Schools, Maryland Department of Education, Individually and in their official capacities.
• Court: U.S. District Court — District of Maryland

474 F. Supp. 974

Letcher ADAMS, and Claude Alston, Individually and on behalf of all others similarly situated v. Joseph A. CALIFANO, Jr., Secretary, Department of Health, Education and Welfare, and David W. Hornbeck, Superintendent of Schools, Maryland Department of Education, Individually and in their official capacities.

Civ. A. No. N-78-1802.

United States District Court, D. Maryland.

August 17, 1979.

Dennis M. Sweeney, Dennis M. Carroll, Peter M. D. Martin and Eileen Franch of Legal Aid Bureau, Inc., Baltimore, Md., for plaintiffs.

Natalie R. Dethloff, Social Security Division of HEW, and Lawrence J. Jensen and Jonathan Ginsburg, U. S. Dept. of Justice, Washington, D. C., for defendant Joseph A. Califano, Jr., Secretary, Dept. of Health, Ed. and Welfare.

Stephen H. Sachs, Atty. Gen. of Maryland, and Thomas E. Plank, Asst. Atty. Gen., Baltimore, Md., for defendant David W. Hornbeck, Superintendent of Schools, Maryland Dept. of Ed.

NORTHROP, Chief Judge.

Plaintiffs bring this action to challenge certain actions of the Secretary of Health, Education, and Welfare (the Secretary) and the Maryland State Superintendent of Schools (the State Defendant) in their administration of the federal Social Security and Supplemental Security Income programs. Through a complex statutory and regulatory scheme, the federal government, with the assistance and cooperation of the states, provides assistance to disabled persons. This assistance is provided under Title II of the Social Security Act, 42 U.S.C. §§ 423 et seq. and Title XVI of that Act, 42 U.S.C. §§ 1381 et seq.

In order to determine whether a person qualifies as "disabled" under the Act, the Secretary has established a process under which a person can apply for disability benefits and appeal unfavorable decisions. Plaintiffs in this action challenge the sufficiency of a notice that is sent to a claimant when he or she is found ineligible for benefits at one stage of the process. Plaintiffs seek to certify this case as a class action in order to represent all Maryland claimants who are similarly situated. Presently before the Court are cross motions for summary judgment and alternative motions to dismiss by both defendants.

THE CLAIMS PROCESS

Under the Secretary's regulations, a claim for disability payments is initiated by filing an application with the appropriate office of the Social Security Administration (SSA). 20 C.F.R. §§ 404.601-.619, 416.300-.345 (1978).¹ The local office of the SSA then collects information from the applicant. Under a scheme organized pursuant to 42 U.S.C. § 421 and § 1383b(a), the Secretary can contract with a state agency to handle initial adjudications of disability. In Maryland, the Secretary has entered into an agreement with the Division of Vocational Rehabilitation of the Maryland Department of Education. See Md.Educ.Code Ann. § 21-302. The State Defendant, David W. Hornbeck, is the head of that agency. The SSA continues to be responsible for ascertaining whether the claimant is properly insured under Title II or is income-qualified under Title XVI.

The State agency, in accordance with federal guidelines, evaluates the medical aspects of claims for disability payments and makes an initial decision. This decision is usually based solely on documentary evidence gathered by the SSA, but the disability examiner can contact the claimant to get more information or order the claimant to be examined by a state-paid physician. See 20 C.F.R. §§ 404.1527, 416.927. Notice of the initial decision is sent to the claimant or his appropriate representative. If the initial decision denies a claim in whole or in part, the notice must state the basis for the determination and inform the claimant of the right to reconsideration or other appellate review. 20 C.F.R. §§ 404.907, 416.1404.

A disability claimant who is dissatisfied with the initial decision may request reconsideration. 20 C.F.R. §§ 404.909-.913, 416.1408-.1413. The reconsideration is made by another examiner at the State agency. The reconsidering examiner reviews the initial determination and can consider any new evidence. 20 C.F.R. §§ 404.914, 416.1415. After the reconsideration decision has been made, a "Notice of reconsidered determination" must be sent to the claimant. In the words of 20 C.F.R. § 416.1422:

Notice of reconsidered determination.

Written notice of the reconsidered determination shall be mailed to the parties at their last known addresses. The reconsidered determination shall state the specific reasons therefor and inform the parties of their right to a hearing, or, if appropriate, inform the parties of the requirements for use of the expedited appeals process (see § 416.1424).²

It is this notice which is the crux of this case.

Following an unfavorable reconsideration, a claimant can, within 60 days, request a hearing before an Administrative Law Judge (ALJ). 20 C.F.R. §§ 404.918, 416.1426. If no request for a hearing is made, the reconsideration determination becomes final. If the ALJ rules against the claimant, the claimant can appeal further through the Appeals Council of the SSA's Bureau of Hearings and Appeals and ultimately to the federal courts.

The plaintiffs in this action are disability claimants under Title II and/or Title XVI of the Act. Their claims were denied, in whole or in part, through the reconsideration stage of the claim process. They allege that the reconsideration notices they received were legally insufficient, and that by sending out insufficient notices the defendants are violating the Constitution, the Social Security Act, and the Secretary's own regulations.

THE NOTICES

The facts concerning the reconsideration notices are not in dispute. When the State agency's examiners make a decision at either the initial or reconsideration stage, they "create" the notice to the claimant by selecting "stock paragraphs" from a list provided by SSA. In some cases, the notices are typed out from these stock paragraphs. In other cases, the paragraphs are stored in a computer at an SSA regional office. The paragraphs are each identified by a code number. Under the computer system, the state agency examiner tells the SSA computer which paragraphs to include in the notice and the computer generates the notice. For example, if the examiner specifies paragraphs MU50, MU80, MU70, and MU81, the computer will generate the following notice, which was actually received by plaintiff Letcher Adams:

UPON RECEIPT OF YOUR REQUEST FOR RECONSIDERATION WE HAD YOUR CLAIM FOR DISABILITY INSURANCE BENEFITS INDEPENDENTLY REVIEWED BY A PHYSICIAN AND DISABILITY EXAMINER IN THE STATE AGENCY WHICH WORKS WITH US IN MAKING DISABILITY DETERMINATIONS. THE EVIDENCE IN YOUR CASE HAS BEEN THOROUGHLY EVALUATED; THIS INCLUDES THE MEDICAL EVIDENCE AND THE ADDITIONAL INFORMATION RECEIVED SINCE THE ORIGINAL DECISION. WE FIND THAT THE PREVIOUS DETERMINATION DENYING YOUR CLAIM WAS PROPER UNDER THE LAW.

TO BE CONSIDERED DISABLED, A PERSON MUST BE UNABLE TO PERFORM ANY SUBSTANTIAL GAINFUL WORK DUE TO A MEDICAL CONDITION WHICH HAS LASTED OR CAN BE EXPECTED TO LAST FOR A CONTINUOUS PERIOD OF AT LEAST 12 MONTHS. THE IMPAIRMENT MUST BE SO SEVERE AS TO PREVENT THE PERSON FROM WORKING NOT ONLY IN THE PERSON'S USUAL OCCUPATION BUT IN ANY OTHER SUBSTANTIAL GAINFUL WORK CONSIDERING AGE, EDUCATION, TRAINING, AND WORK EXPERIENCE. THIS CONDITION MUST BE DISABLING AT A TIME WHEN THE PERSON MEETS THE EARNINGS REQUIREMENT OF THE LAW.

THIS NOTICE CONCERNS ONLY YOUR SOCIAL SECURITY DISABILITY APPLICATION. IT IS NOT A DECISION AS TO WHETHER RETIREMENT, SURVIVORS, HOSPITAL AND MEDICAL INSURANCE, OR SUPPLEMENTAL SECURITY INCOME BENEFITS ARE PAYABLE.

IF YOU BELIEVE THAT THE RECONSIDERATION DETERMINATION IS NOT CORRECT, YOU MAY REQUEST A HEARING BEFORE AN ADMINISTRATIVE LAW JUDGE OF THE BUREAU OF HEARINGS AND APPEALS. IF YOU WANT A HEARING, YOU MUST REQUEST IT NOT LATER THAN 60 DAYS FROM THE DATE YOU RECEIVE THIS NOTICE. READ THE ENCLOSED LEAFLET BHA-1 FOR A FULL EXPLANATION OF YOUR RIGHT TO APPEAL.

IF YOU DO NOT REQUEST A HEARING OF YOUR CASE WITHIN THE PRESCRIBED TIME PERIOD, YOU STILL HAVE THE RIGHT TO FILE ANOTHER APPLICATION AT ANY TIME.

IF YOU HAVE QUESTIONS ABOUT YOUR CLAIM, YOU SHOULD GET IN TOUCH WITH ANY SOCIAL SECURITY OFFICE. MOST QUESTIONS CAN BE HANDLED BY TELEPHONE OR MAIL. IF YOU VISIT AN OFFICE, HOWEVER, PLEASE TAKE THIS LETTER WITH YOU.

Exhibit D to plaintiff's Complaint, filed September 22, 1978.

The stock paragraphs do not refer to the specific medical or vocational reasons for denying the disability claim. They generally set out only the statutory or regulatory standards that were applied and tell the claimant that he does not qualify. The medical or vocational reasons are prepared at both the initial and reconsideration stages and are set out by the examiner on Form SSA-831. This form is not sent to the claimant at any stage of the proceedings, but may be available to the claimant or an appropriate representative for inspection prior to the ALJ hearing. The plaintiffs contend that the reconsideration notices, like the one above, are insufficient because they tell the claimant nothing about the individual medical or vocational reasons for the decision in his or her case. They claim that, at the very least, the information on Form SSA-831 should be sent to each claimant who is denied benefits.

The plaintiffs initially filed a motion for a preliminary injunction. Subsequently, however, the parties agreed to a plan whereby the Court would hear and decide cross motions for summary judgment and the plaintiffs' motion for class certification. The motion for a preliminary injunction was then withdrawn. Oral argument was held and the Court, by this opinion, renders its decision on all pending issues.

The Secretary and the State Defendant each assert different reasons for dismissing this case or for granting summary judgment in their favor. Since the liability of the State Defendant on...