Requesting Medicare Council Review of an Alj Dismissal for Untimely Filing

Argument preview: Justices to make up one's mind whether dismissal as untimely of Supplemental Security Income claimant'south request for review is final determination subject to judicial review

on Mar 11, 2019 at 10:30 am

After a hearing, an authoritative law estimate denied Ricky Lee Smith'southward application for supplemental security income benefits based on disability. The ALJ's decision was dated March 26, 2014, and under the bureau regulations, Smith was required to request review of the ALJ'southward conclusion past the Appeals Quango within threescore days of receiving the decision.

Smith'southward counsel alleges that he timely requested review of the ALJ's decision. The Social Security Assistants, however, has no record of receiving his appeal before September 21, 2014, when it received a fax from Smith'due south counsel request nigh the status of the entreatment. On November 6, 2015, the Appeals Council dismissed Smith's asking for review as untimely.

A Social Security Assistants regulation provides that "[t]he dismissal of a request for Appeals Council review is binding and is not subject to further review." Smith nonetheless brought arrange seeking judicial review of the Appeals Council'due south dismissal under 42 U.S.C. § 405(1000). Section 405(1000) provides in relevant part:

Any private, afterward any final decision of the Commissioner of Social Security 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 inside sixty days after the mailing to him of notice of such decision or within such further time as the Commissioner of Social Security may permit.

Consistent with the agency'southward regulation and the bulk view of the federal courts of appeals, the district court dismissed Smith's complaint on the basis that dismissal by the Appeals Council of a claimant's untimely asking for an appeal is not a "final decision" discipline to judicial review under Section 405(thou). The U.S. Court of Appeals for the sixth Circuit affirmed.

The Supreme Court granted certiorari to resolve a dissever among the excursion courts on this question. Smith contends that the Appeals Quango'due south decision is a last decision under the plain meaning of Department 405(g) because it is the final administrative ruling in the case — at that place is no further authoritative consideration of the merits. Smith argues that this reading is consistent with the Supreme Courtroom's interpretation of the term "last" under the closely related Administrative Procedure Human activity and that the lower court's distinction between dispositions based on the merits (which are appealable) and dispositions on other grounds (which are not subject to appeal) was entirely irrelevant. Smith points out that even if the pregnant of the term "terminal" were non clear, information technology should encompass the Appeals Council'southward determinations based on timeliness because the Supreme Court applies a strong presumption in favor of judicial review of administration activity.

Smith asserts that his entreatment is clearly distinguishable from Califano v. Sanders , a 1977 case in which the Supreme Courtroom held that an agency's terminal conclusion not to reopen a merits for benefits does non autumn within the definition of a final decision subject field to judicial review under Section 405(g). Quoting the U.S. Court of Appeals for the 11th Excursion's 1983 conclusion in Bloodsworth v. Heckler, Smith explains that "review and reopening play fundamentally different roles in the process of administrative decision making and accept significantly different effects upon the certitude of administrative decisions." Reopening a instance offers a claimant a "bonus opportunity" to obtain administrative reconsideration of a terminal decision. The Appeals Council's dismissal of Smith's appeal on the footing of untimeliness, in contrast, is the kickoff "concluding decision" in this case and thus Smith'southward kickoff opportunity for judicial review.

Smith contends that the bureau's regulation prohibiting judicial review of the Appeals Council'due south dismissal is not entitled to deference because it contradicts the plain statutory text that authorizes judicial review for "whatever final decision." Moreover, it would defy common sense to defer to that regulation when, as explained below, the government has disclaimed the legality of the regulation. Smith further argues that in lite of the Appeals Council'southward heavy workload, judicial review is peculiarly important to ensure that claimants are non subject to arbitrary and unjustified action.

With respect to Department 405(g)'s requirement that the final conclusion be made "after a hearing," Smith asserts that the requirement was satisfied because an ALJ conducted a hearing with respect to Smith's benefits merits. Moreover, Smith contends, even if there had not been a hearing, the hearing requirement is waivable.

Consequent with its regulation, the agency argued before the lower courts that the Appeals Council's dismissal of Smith's claim on the ground that it was not timely was not a final decision eligible for judicial review under Section 405(g). The government, withal, reconsidered its position before the Supreme Courtroom in light of Smith's petition for writ of certiorari and a contempo decision by the U.S. Courtroom of Appeals for the 7th Circuit in which it joined the 11th Circuit in holding that Section 405(g) "'allows judicial review when a claim has been presented and finally decided,' even when that last determination is … a dismissal for untimeliness." The government now takes the position that a dismissal gild is subject field to judicial review, only that the review is limited to the procedural ground on which the bureau based its dismissal.

The regime's arguments are similar, though not identical, to Smith's arguments. For example, the authorities contends that the Appeals Quango'due south dismissal of Smith'due south asking for review is a "final decision" discipline to judicial review nether Section 405(g) in both the ordinary sense of the term and under its customary usage in administrative law because the agency will take no farther action on Smith's claim for benefits. Similarly, the authorities argues that the agency'southward regulation is beyond the authority of the agency because information technology indicates that the agency will never issue a last decision on Smith'south application, which would deprive Smith of his statutory right to judicial review just considering he failed to comply with an administrative guideline.

Unlike Smith, the authorities contends that judicial review is limited to the procedural ground on which the agency based its dismissal. The government asserts that limited judicial review is consequent with Section 405(g)'s express authorisation of express judicial review "where a claim has been denied by the Commissioner … considering of failure of the claimant … to submit proof in conformity with any regulation prescribed nether [42 U.S.C. 405(a)]" equally well equally with the federal courts' approach to exhaustion in other contexts. Smith contends that the government's position conflicts with the Supreme Court's 2000 position in Sims five. Apfel. In Smith's view, the language that the government relies on supports his position, considering it shows that if Congress intends to limit judicial review to the grounds on which the decisions were resolved, it can and will typhoon the statute to do that expressly.

Because the government argues in favor of reversing and remanding the sixth Excursion'southward conclusion, the Supreme Court appointed Deepak Gupta as amicus curiae in support of the decision below. Gupta argues that Section 405(thousand) should be interpreted in the specific context in which it arose – every bit part of the Social Security Human action – rather than with reference to customary administrative practise and full general APA doctrines as Smith and the government contend. According to Gupta, Department 405(g) was enacted in conjunction with "the creation of a massive, quasi-judicial process for adjudicating millions of small social security claims, with limited restrictions on the circumstances in which judicial review must exist allowed." Section 405(1000)'due south "somewhat unusual" character arises from its role in ensuring that "federal courts are not swamped by disputes over the rules of the many-layered authoritative process governing the nation's largest social welfare plan."

Gupta asserts that the term "concluding conclusion" in Section 405(k) is susceptible to several different interpretations, and the almost compelling, "within the 'context of the statute equally a whole,'" is "the final disposition of a claim for benefits on its merits."

Relying on, amongst other authorities, Judge Henry Friendly'due south 1966 estimation of the requirement in Cappadora v. Celebrezze, and the Supreme Courtroom's opinion in Califano v. Sanders, Gupta argues that Section 405(g)'due south "later on a hearing" requirement is not satisfied in this case because the Appeals Council'due south dismissal is not a decision on which the Social Security Human activity requires a hearing. Gupta further argues that the requirement is not satisfied by the ALJ hearing on Smith'south claim for benefits because "in context," Section 405(one thousand)'s "after a hearing" requirement "plainly refers to a 'final decision' reached 'after a hearing' on that decision."

Gupta notes that the Social Security Administration's estimation of Section 405(g)'s finality requirement is not limited to Appeals Quango dismissals on untimeliness grounds. Finality issues come up upwards in a host of other procedural determinations nether Social Security. Moreover, other statutes, most notably Medicare and Medicaid, incorporate Department 405(one thousand) into their provisions for judicial review. Reversing the Social Security Assistants'southward longstanding interpretation of Section 405(g)'s certitude requirement could "create meaning floodgate concerns."

Finally, Gupta argues that, at a minimum, the Social Security Assistants'south longstanding estimation of the statute is reasonable and therefore entitled to deference.

The National Organization of Social Security Claimants' Representatives filed an amicus brief in support of Smith. The NOSSCR first describes the very lengthy and complicated four-footstep disability claims process that can be disruptive to claimants. The NOSSCR then argues that Smith satisfied the non-waivable, jurisdictional component of the exhaustion requirement when he applied for benefits in 2012, when he sought reconsideration later on the benefits were denied, and again when he participated in a hearing before an ALJ. Pointing to, amidst other things, the extraordinarily heavy workload of administrative appeals judges and the high frequency with which courts rule in claimants' favor in other types of Social Security cases, the NOSSCR asserts that precluding review of dismissals by the Appeals Council causes damage to claimants. Finally, relying on full general Social Security statistics likewise as experience in the 11th Circuit, which has long allowed judicial review of Appeals Council dismissals, the NOSSCR contends that allowing review of Appeals Council dismissals would only cause a slight increment in federal courtroom filings.

***

By cases linked to in this mail:

Bloodsworth five. Heckler, 703 F.2d 1233 (11th Cir. 1983)
Califano 5. Sanders , 430 U.Southward. 99 (1977)
Cappadora v. Celebrezze, 356 F.second 1 (2nd Cir. 1966)
Casey v. Berryhill, 853 F.3d 322 (7th Cir. 2017)
Sims v. Apfel, 530 U.S. 103 (2000)

Recommended Citation: Kathryn Moore, Statement preview: Justices to decide whether dismissal as untimely of Supplemental Security Income claimant's request for review is final decision discipline to judicial review, SCOTUSblog (Mar. eleven, 2019, ten:thirty AM), https://www.scotusblog.com/2019/03/argument-preview-justices-to-decide-whether-dismissal-equally-untimely-of-supplemental-security-income-claimants-asking-for-review-is-concluding-decision-discipline-to-judicial-review/

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Source: https://www.scotusblog.com/2019/03/argument-preview-justices-to-decide-whether-dismissal-as-untimely-of-supplemental-security-income-claimants-request-for-review-is-final-decision-subject-to-judicial-review/

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