Barnett v. Califano
Opinion of the Court
The Secretary of the Department of Health, Education and Welfare appeals from various orders of the United States District Court for the District of Vermont, Albert W. Coffrin, J., granting summary judgment in this class action suit brought by disability claimants under Title XVI of the Social Security Act, 42 U.S.C. §§ 1381-85.
I
Title XVI, as promulgated in 1972, was “designed to provide financial assistance to needy people who have reached age 65 or are blind or are disabled . . ..” H.R. Rep. No. 92-231, 92d Cong., 1st Sess. 25 (1971), reprinted in [1972] U.S.Code Cong. & AdmimNews, pp. 4989, 5012. The application procedure for Supplemental Security Income (SSI) benefits under Title XVI is virtually identical to that involved in obtaining the Title II benefits at issue in White v. Mathews, supra, 559 F.2d at 854-55. Thus, an SSI disability claimant must establish both his financial eligibility and his income impairing disability under the applicable federal standards. See generally 20 C.F.R. Part 416. The initial determination of disability is made by the appropriate state agency in accordance with the Secretary’s regulations.
The complaint alleged that protracted delays in obtaining hearings, such as those suffered by Barnett, violated appellees’ right to due process and also their statutory rights under the Social Security and Administrative Procedure Acts. In May 1975, Judge Coffrin held that mandamus jurisdiction existed over this, action, and in January 1976 the judge granted class certification.
At the outset, we note that appellant argues that no jurisdiction exists for this action and that the class was improperly certified. While we do not think that these arguments are frivolous, the same contentions were rejected by our recent opinion in White v. Mathews, supra, 559 F.2d at 855-56, 858. Finding no reason to reconsider those holdings here, we conclude that the district court had mandamus jurisdiction to hear this case, see 28 U.S.C. § 1361, and that it correctly certified the class of SSI disability claimants.
The litigants quite properly focus their attention on White v. Mathews, supra. We there held that administrative hearing delays similar to those challenged here
First, appellant points out that unlike Title II, Title XVI has prescribed a 90-day time limit for all non-disability determinations. See 42 U.S.C. § 1383(c)(2), quoted in note 3 supra. However, statutory designation of a time within which non-disability claims must be decided does not preclude a district court from fixing a time for the holding of disability hearings, which Congress requires to be conducted with reasonable dispatch. The enactment of section 1383(c)(2) cannot be read as a legislative abandonment of the reasonable opportunity requirement contemporaneously approved in section 1383(c)(1). Moreover, the requirement of section 1383(cX2) that non-disability cases be determined within 90 days indicates the fairness of Judge Coffrin’s less burdensome order mandating that disability cases be heard, but not decided, within 90 days.
The Secretary also claims that White is distinguishable because that case involved Title II claimants, while this one concerns Title XVI claimants. However, both programs provide benefits for the disabled — a group defined almost exactly alike by Titles II and XVI. Compare 42 U.S.C. § 423(d)(1)(A) with id. § 1382c(aX3)(A). Furthermore, as between the two groups of similarly beset beneficiaries, SSI disability claimants, who are by definition impoverished and thus less likely to have alternate sources of sustenance, see Mathews v. Eldridge, 424 U.S. 319, 340-43, 96 S.Ct. 893, 47 L.Ed.2d 18 (1976), are in greater need of prompt hearings. Cf. id. at 342-43 n. 27, 96 S.Ct. 893 (Title XVI beneficiaries, unlike their Title II counterparts, are entitled to
Appellant also argues that intervening administrative developments in Vermont particularly and in the nation generally suggest that a White -type order is improper here. However, the efforts made in Vermont parallel those in Connecticut that we found in White to be commendable but inadequate. See id. at 859. Appellant also points to the flurry of similar orders concerning hearing delays entered against the Secretary in various parts of the country. See, e. g., Caswell v. Califano, 435 F.Supp. 127 (D.Me. 1977), appeal docketed, No. 77-1514 (1st Cir. Nov. 30, 1977). Such orders, if anything, would seem to support our conclusion in White. But appellant responds that such decisions exacerbate rather than solve the hearing delay problem. Appellant’s point is that SSA has thus far been able to meet various court-imposed timetables only by shifting personnel around, that its resources are limited, and that as the number of such orders grows it “will simply be unable to comply with them. . . . ” We do not minimize the difficult situation in which SSA finds itself, and we repeat our emphasis in White that the solution for the problem may well ultimately depend upon congressional action. 559 F.2d at 861. But we are called upon to decide whether the substantial delays suffered by appellee claimants deprived them of a “reasonable . opportunity for a hearing.” For the reasons already given in White and in this opinion, we believe that appellees were so deprived.
Finally, we are cited to the Final Report Study of the Social Security Administration Hearing System (Center for Administrative Justice 1977) as representing “a major new development [since White] in the factual context of the SSA hearings problem.” But that Report does not reject “time limits as a reasonable response to the overall problem,” as appellant suggests. Indeed, the Report recognizes that claimants are likely to suffer “great damage” and “high psychic costs” from delays in the disability determination process — findings which support the decision of the district court here. See id. at 57-58. In any event, we do not view the Report as “a major new development” justifying our reversal, in effect, of White.
Ill
Finally, we focus our attention on the terms of the relief granted by Judge Coffrin.
The Secretary also argues that the exceptions and allowances to the time schedules are materially less generous than those approved in White. Specifically, the Secretary points to the absence of a provision waiving the 90-day rule when additional evidence is sought. See White, supra, 559 F.2d at 860. However, as indicated above, we interpret the 90-day requirement to mean that a hearing will be scheduled and initially completed during the 90-day period. If, after holding this hearing, the administrative law judge determines in good faith that further medical consultation or evidence is needed in order to accurately make a determination of disability, such consultation or request for evidence may be diligently pursued beyond the 90-day limit without running afoul of the district court order and without requiring the payment of interim benefits. This interpretation is apparently conceded by appellees,
We agree with the Secretary, however, that the district court abused its discretion in ordering that all SSI payments made to claimants whose hearings have not been held within the designated time periods be non-refundable even if the claimant is ultimately found to be ineligible.
We have considered all of appellant’s arguments and except as noted immediately above, find them to be without merit. The judgment of the district court is affirmed as modified.
. Title XVI of the Social Security Act provides Supplemental Security Income for the financially destitute aged, blind, and disabled. See 42 U.S.C. § 1381a.
. If a state chooses not to enter into an agreement with the SSA concerning SSI benefits, the SSA itself makes the initial determination. See 20 C.F.R. § 416.920(b). Apparently, Vermont does provide a disability determination service.
. 42 U.S.C. § 1383(c) provides as follows:
(c)(1) The Secretary is directed to make findings of fact, and decisions as to the rights of any individual applying for payment under this subchapter. The Secretary shall provide reasonable notice and opportunity for a hearing to any individual who is or claims to be an eligible individual or eligible spouse and is in disagreement with any determination under this subchapter with respect to eligibility of such individual for benefits, or the amount of such individual’s benefits, if such individual requests a hearing on the matter in disa*30 greement within sixty days after notice of such determination is received, and, if a hearing is held, shall, on the basis of evidence adduced at the hearing affirm, modify, or reverse his findings of fact and such decision. The Secretary is further authorized, on his own motion, to hold such hearings and to conduct such investigations and other proceedings as he may deem necessary or proper for the administration of this subchapter. In the course of any hearing, investigation, or other proceeding, he may administer oaths and affirmations, examine witnesses, and receive evidence. Evidence may be received at any hearing before the Secretary even though inadmissible under the rules of evidence applicable to court procedure.
(2) Determination on the basis of such hearing, except to the extent that the matter in disagreement involves a disability (within the meaning of section 1382c(a)(3) of this title), shall be made within ninety days after the individual requests the hearing as provided in paragraph (1).
(3) The final determination of the Secretary after a hearing under paragraph (1) shall be subject to judicial review as provided in section 405(g) of this title to the same extent as the Secretary’s final determinations under section 405 of this title.
. In his memorandum opinion, the judge defined the class as “all present and future [Vermont] applicants for SSI disability benefits whose initial claims are denied on a finding that no disability exists and who subsequently request a reconsideration hearing.” Such a definition properly included claimants for SSI benefits only and those who had claims for both SSI and Title II benefits, so-called concurrent claimants.
. This finding, which was based on stipulated facts, is not challenged on appeal. A substantial proportion of the delay is attributable to hearing requests by concurrent claimants, see note 4 supra.
. The district court did not reach appellees’ constitutional claims. In view of our disposition of this case, we do not decide whether these substantial delays violated either the due process clause or the Administrative Procedure Act.
. The district judge’s order dated April 12, 1977, contained the following four exceptions to the designated time periods:
(a) the claimant or his representative causes a delay by his failure to provide information essential for adjudication;
(b) the claimant or his representative requests] a delay;
(c) the claimant or his representative fails to appear for a scheduled hearing;
(d) other action or omission directly attributable to the claimant or his representative.
. The district judge in White found the delays to average 211.8 days, see 559 F.2d at 855, which is substantially equivalent to the delays involved in this appeal.
. See Pub.L. No. 94-202, 89 Stat. 1135 (1976).
. In 1975, the reversal rate of unfavorable determinations against SSI disability claimants was 45.7% nationwide and 35.9% for Region I, which includes Vermont.
. We thus find unpersuasive appellant’s argument that the existence of pretermination hearings under Title XVI but not under Title II made the order proper in White but improper here. The Supreme Court’s decision in Mathews v. Eldridge, supra, indicates that Title II claimants are arguably less in need of prompt administrative action. Moreover, the existence of pretermination hearings is of little solace to those, like appellees, who have been initially denied SSI benefits.
. As in White, the Secretary argues that payment of interim benefits to claimants who are not accorded a timely hearing violates the Social Security Act. We adhere to our ruling there that the district court has power to grant such equitable relief. See 559 F.2d at 860-61.
. See Brief for Appellees at 20.
. This portion of the order has been stayed pending appeal.
. Appellees state that they “would not argue too strongly against deleting the provision that the benefits be non-refundable, and leaving the order as in White, with the SSA entitled to seek recoupment for any interim amounts paid.” See Brief for Appellees at 25.
Reference
- Full Case Name
- Carroll BARNETT and Harold McBrine, on behalf of themselves and all others similarly situated v. Joseph A. CALIFANO, Jr., Secretary of Health, Education, and Welfare
- Cited By
- 37 cases
- Status
- Published