Hoffman v. Bowen, 86 C 7901.
| Decision Date | 13 August 1987 |
| Docket Number | No. 86 C 7901.,86 C 7901. |
| Parties | Irving HOFFMAN, XXX-XX-XXXX, Plaintiff, v. Otis R. BOWEN, M.D., Secretary of Health and Human Services, Defendant. |
| Court | U.S. District Court — Northern District of Illinois |
David R. Bryant, Chicago, Ill., for plaintiff.
Margaret C. Gordon, Asst. U.S. Atty., Chicago, Ill., for defendant.
The plaintiff in this action, Irving Hoffman, seeks judicial review of a final decision of the Secretary of Health and Human Services denying his application for a period of disability and disability benefits. The parties have filed cross-motions for summary judgment. For the following reasons, the plaintiff's motion is denied, the defendant's motion is granted, and the Secretary's decision is affirmed.
Hoffman applied for a period of disability and disability benefits under the Social Security Act, 42 U.S.C. §§ 416(i), 423(d), on November 21, 1980, alleging that he became disabled on April 15, 1980, due to a total hip replacement and cancer. The Social Security Administration ("SSA") granted the claim on December 26, 1980, finding the plaintiff disabled as of August 15, 1980. On January 24, 1981, the plaintiff was notified that he would become entitled to disability insurance benefits "if and when his disabling impairment has continued for at least five consecutive months and all other requirements are met." The notice continued:
On November 2, 1984, the SSA notified the plaintiff that it was aware that he received earnings for work performed subsequent to August 15, 1980. On April 15, 1985, the SSA informed Hoffman that based on his own reports of work activity and his employer's reports of monthly earnings, he had demonstrated an ability to engage in substantial gainful activity in October 1981. After a review of additional evidence obtained from plaintiff's employer, the SSA determined that since the plaintiff had returned to work during the five-month waiting period, he was not disabled for a sufficient period of time to qualify for cash benefits.
The plaintiff sought review of this determination before an administrative law judge (ALJ). After a hearing, the ALJ found that the SSA initially found the claimant disabled as of August 15, 1980, that the waiting period before Hoffman could receive cash benefits ran from September 1980 through January 1981 and that, therefore, a trial work period could not begin before February 1981. He further found that Hoffman returned to substantial gainful activity in December 1980 and continued to perform such activity throughout 1981 and 1982, with the exception of one four-month period in 1981. He found that Hoffman's failure to report his work activity, information which he knew or should have known was essential to a correct determination on the issue of disability, warranted reopening of the initial determination. Accordingly, the ALJ reopened the initial determination and found the claimant not disabled because he had engaged in substantial gainful activity. The ALJ's decision became the final decision of the Secretary when the Appeals Council denied the plaintiff's request for review on October 9, 1986. This determination is now subject to judicial review under section 205(g) of the Social Security Act, 42 U.S.C. § 405(g). The issues presented for review are whether substantial evidence supports the Secretary's decision that the plaintiff is not disabled because he engaged in substantial work activity and whether the Secretary properly reopened the initial determination of disabledness dated December 26, 1980.
A claimant's eligibility for benefits under the Social Security Act depends on whether he is disabled. To be found disabled, a claimant must be unable to perform any substantial gainful activity because of a medically determinable physical or mental impairment which will be fatal or will last for twelve continuous months. 42 U.S.C. § 423(d)(1)(A). The claimant will be found disabled only if his physical and mental impairments are so severe that he is not only precluded from doing his previous work, but also cannot perform any other substantial gainful employment existing in the national economy, considering his age, education, and work experience. Id. § 423(d)(2)(A). These impairments must be demonstrated by medically acceptable clinical and laboratory diagnostic techniques. Id. § 423(d)(3). Once the claimant shows an inability to perform past work, the burden shifts to the Secretary to demonstrate an ability to engage in some other type of substantial gainful employment. Bauzo v. Bowen, 803 F.2d 917, 923 (7th Cir.1986).
The Secretary has established a five-step regulatory scheme for determining whether an individual is disabled under the Act. 20 C.F.R. § 404.1520. The first step provides that an individual will be deemed not disabled, regardless of medical findings, if he is working and the work constitutes substantial gainful activity. Id. § 404.1520(b).
Substantial gainful activity is defined as follows:
20 C.F.R. § 404.1572. The regulations further provide that a claimant earning an average of $300.00 per month in years after 1979 will ordinarily be found to have engaged in substantial gainful activity, while one earning less than $190.00 per month is presumed not able to do such work. Id. §§ 404.1574(b)(2); 416.974(b)(2). If wages alone do not decisively indicate whether the claimant engaged in substantial gainful activity, the Secretary considers other factors, such as whether the work performed is comparable to that of unimpaired people in the community performing the same or similar jobs, taking into account the time, energy, skill and responsibilities required. Id. §§ 404.1574(b)(6), 416.974(b)(6).
The regulations also provide for a "trial work period" during which an individual can test his or her ability to return to work. Id. § 1592(a). Any services rendered during a trial work period are "deemed not to have been rendered by such individual in determining whether his disability has ceased in a month during such period." 42 U.S.C. § 422(c)(2). In other words, a period of trial work enables an applicant to return to the work environment without jeopardizing his entitlement to disability...
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...because the claimant's alleged fraud was failing to inform authorities of an error in her birth certificate. In Hoffman v. Bowen, 668 F.Supp. 1146, 1149 (N.D.Ill.1987), the court focused upon the time of the benefits application because the claimant's alleged fraud was failing to notify aut......