Rankin v. Heckler
| Decision Date | 25 February 1985 |
| Docket Number | No. 84-3496,84-3496 |
| Citation | 761 F.2d 936 |
| Parties | , Unempl.Ins.Rep. CCH 16,067 Lou J. RANKIN, Appellant, v. Margaret M. HECKLER, Secretary of Health and Human Services. . Submitted Under Third Circuit Rule 12(6) |
| Court | U.S. Court of Appeals — Third Circuit |
Robert N. Peirce, Jr., Pittsburgh, Pa., for appellant.
J. Alan Johnson, U.S. Atty., Anthony M. Mariani, Asst. U.S. Atty., W.D. Pa., Pittsburgh, Pa., Beverly Dennis, III, Regional Atty., John E. Newton, Jr., Asst. Regional Atty., Dept. of Health & Human Services, Philadelphia, Pa., for appellee.
Before ADAMS, WEIS and WISDOM, * Circuit Judges.
The Social Security Disability Benefits Reform Act of 1984, Pub.L. No. 98-460, Sec. 2(d)(2)(C), 1984 U.S.Code Cong. & Ad.News (98 Stat.) 1794, 1797 (Reform Act) provides that cases involving determinations of medical improvement with respect to which a request for judicial review was pending on September 19, 1984, and which involve an individual litigant, shall be remanded to the Secretary of Health and Human Services for review in accordance with the provisions of the Social Security Act as amended by the Reform Act. Because this appeal was pending in this Court on September 19, 1984, we must decide whether the plaintiff's challenge to the Secretary's determination that, because of medical improvement, the plaintiff's entitlement to benefits ended in 1977 is properly before us. We hold that it is, and accordingly we remand the case to the Secretary under Sec. 2(d) of the Reform Act.
The plaintiff, Lou Rankin, sustained a comminuted fracture of the left tibia in 1976. He applied for Social Security disability benefits and, on January 27, 1977, was awarded benefits as of the date of the injury, April 26, 1976. On January 25, 1980, the plaintiff returned to work and so notified the Social Security Administration soon thereafter. In March 1980 he completed a work activity report and in May 1980 advised the Administration that he felt he was able to return to work. The Administration requested that Dr. Robert Botkin, a physician who treated the plaintiff's fracture and last saw him in September 1977, complete a Physical Capacities Evaluation report. Based on the report and Dr. Botkin's clinical notes from 1977, the Administration determined that the plaintiff's disability ended in September 1977 and that his eligibility for benefits therefore ceased in November 1977. The Administration notified the plaintiff of its determination by letter dated July 11, 1980, which was mailed on September 28, 1980.
On October 21, 1980, the plaintiff timely requested reconsideration of the determination. The Administration affirmed its original decision and notified the plaintiff of this fact in a letter dated April 16, 1981. The letter also informed the plaintiff that he could request a hearing before an administrative law judge (ALJ) not later than 60 days after the date of receipt of the letter. The plaintiff did not request a hearing before an ALJ within the 60-day period.
The Administration determined that the plaintiff had received overpayment of benefits in the amount of $15,285.40. On December 21, 1981, the plaintiff was notified by letter that he did not qualify for a waiver of the overpayment because his medical records demonstrated that he was released to return to work in September 1977, but he did not report that fact to the Administration. The plaintiff then retained a lawyer, who challenged both the determination of disability cessation after 1977 and the refusal to waive refund of the overpayment. The plaintiff's lawyer requested a conference.
On April 15, 1982, the Administration notified the plaintiff's lawyer that the disability cessation determination was no longer in issue because the plaintiff failed to appeal from the determination upon reconsideration of April 16, 1981. The Administration scheduled a conference for May 20, 1982, limited to the issue whether the overpayment was to be waived. The plaintiff filed a statement with the Administration at the conference in support of his claim for waiver. By letter dated September 30, 1982 the plaintiff was advised that the decision denying his waiver request was affirmed and that he could request review of that decision by an ALJ within 60 days of receipt of the notice. The plaintiff timely requested a hearing before an ALJ.
The hearing was held on January 27, 1982, and on March 9, 1983, the ALJ issued a decision. The ALJ noted that the plaintiff did not timely appeal the determination that his disability ceased in 1977, but found that the disability cessation determination was nonetheless correct. The ALJ also ruled that waiver of the overpayment could not be made because the plaintiff was "at fault" for not reporting information that he should have known would be needed to determine if he was under a continuing disability. On July 25, 1983, the Appeals Council denied the plaintiff's request for review, and on November 22, 1983, it extended the time to file a civil action in district court under 42 U.S.C. Sec. 405(g) to 60 days from the date of receipt of the November 22, 1983 letter. The plaintiff timely filed a complaint in district court on December 14, 1983.
In its opinion and order of May 10, 1984, the district court stated that the issues before it were whether the plaintiff's disability ceased in 1977, whether the plaintiff was at fault in receiving overpayment of disability benefits, and whether an exception to the Secretary's policy not to terminate disability benefits before a notice letter is sent to the recipient (in this case in 1981) was applicable to the plaintiff's case. 1 The district court granted summary judgment in favor of the defendant on all issues. The plaintiff filed a motion for relief from judgment under Fed.R.Civ.Pro. 60(b), insisting that the court made an error of fact in finding that one of Dr. Botkin's clinical reports contained a statement by Dr. Botkin that the plaintiff was told he had regained the capacity to work. The district court denied the motion, 2 and the plaintiff appealed.
The Reform Act requires us to remand to the Secretary "actions relating to medical improvement" that were pending on September 19, 1984. 3 We must therefore decide whether the cessation of disability issue was properly before the district court, and, in turn, properly before us. 4
The plaintiff filed this action in district court under 42 U.S.C. Sec. 405(f) (1982), which provides that an individual, "after any final decision of the Secretary made after a hearing to which he was a party, irrespective of the amount in controversy, may obtain a review of such decision by a civil action commenced [in district court] within sixty days after the mailing to him of notice of such decision" (emphasis added). We must decide whether the requirement of a final decision is satisfied here with respect to the disability cessation issue, in light of the fact that the plaintiff failed to appeal that determination within 60 days of the letter of April 16, 1981, affirming the determination that disability ceased in 1977.
In order for a district court properly to entertain an action under Sec. 405(g), two conditions must be satisfied. First, a claim for benefits must have been presented to the Secretary. Second, there must have been a final decision after a hearing. The Supreme Court has held, however, that only the first condition is a mandatory requirement. The second--the requirement that the claimant exhaust his administrative remedies--can be waived either by the Secretary, Mathews v. Diaz, 426 U.S. 67, 76, 96 S.Ct. 1883, 1889, 48 L.Ed.2d 478 (1976), or, under certain circumstances, by the court on its own determination, Mathews v. Elridge, 424 U.S. 319, 328, 96 S.Ct. 893, 899, 47 L.Ed.2d 18 (1976).
Liberty Alliance of the Blind v. Califano, 568 F.2d 333, 344 (3d Cir.1977). The first, non-waivable, condition is clearly satisfied here because the defendant was in fact paid the claim for benefits.
With respect to the second condition, we have found a waiver of the exhaustion of administrative remedies requirement where the claimant raises constitutional issues 5 or where the claimant raises statutory issues upon which the Secretary has taken a final position. 6 In those cases the requirement of exhaustion does not serve any underlying policy, because in the former case the federal court is more qualified to address constitutional questions than the agency 7 and in the latter case further appeals are futile in the light of the final position already taken. 8 "When, however, the claim involves an individual disability determination, the policies of exhaustion counsel full compliance with the Sec. 405(g) requirements." Tustin v. Heckler, 749 F.2d 1055, 1063 n. 13 (3d Cir.1984).
Although the plaintiff failed to appeal from the cessation determination of April 16, 1981, we find that later events in this case establish the equivalence of full compliance with the Sec. 405(g) requirement. The ALJ in his decision of March 9, 1983, noted that the plaintiff did not timely appeal the determination of April 16, 1981, but nevertheless found, after a review of the record, that the disability cessation determination was correct. The Appeals Council denied the plaintiff's request for review. Thus, the plaintiff obtained the equivalent amount of review of the cessation determination that he would have had if he had timely appealed the decision of April 16, 1981. "Exhaustion of administrative remedies ensures that the Secretary has a chance to develop fully her position in a case before she must defend that position in the courts, and that the judiciary has access to a detailed administrative record that will facilitate meaningful judicial review." Tustin, 749 F.2d at 1062. Because both of...
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