Legal Case: The Appellant V. Case

Appeals of MOL Inspector’s orders (an applicant must have first contacted the MOL to receive the Inspector’s order or decision)

The district court granted the defendant’s motion for summary judgment on the plaintiff’s Americans with Disability Act claim. The plaintiff’s is not estopped by her SSDI and long term disability claims.The court foreclosed to grant the plaintiff new trial. The appellate court the district court’s ruling.

The Court ruled in favor of the appellant, and the decision is described as follows:

"Cornell Law says that if you have a late filling of an appeal note, then that note will be disregarded along with the appeal request. If you get the court to grant you more time, than that is acceptable, but other wise the request will be dismissed. ("HAMER v. NEIGHBORHOOD HOUSING SERVS. OF CHICAGO").

Code §150.2. as of February 1, 2017. Moreover, the Regulations are explicit that “the emergency medical services required to treat an emergency medical condition are only funded by MA until the medical condition is no longer an emergency. MA funded medical services are not available for treatment received after the emergency ends.” 55 Pa. Code § 150.11(emphasis added). In this case, the Appellant’s emergency medical condition ended (February 1, 2017) and she is seeking continuous MA funding for ongoing treatment after that emergency, which is prohibited by the Regulations. Accordingly, the ALJ finds the Department was correct to discontinue the Appellant’s MA benefits because she is a noncitizen who is not in immediate need of emergency medical services and has not provided evidence that a new emergency medical condition

Regulations found at 55 Pa. Code § 275.5 stated that the issue “is not whether the CAO or administering agency acted properly based upon the information then available, but whether the appellant was eligible for the period of time at issue based upon evidence of eligibility the client is able to provide at or before the hearing”. The Department’s Representative’s testimony was that the new determination based on the new information was still pending with another Department worker and that the issue of the appeal was related to category MG-91, specifically. The ALJ finds that prior to the administrative hearing the Department was in receipt of information that could have altered the Appellant’s eligibility for MA. Prior to the administrative hearing, the Appellant should have been reviewed for eligibility under the MAWD program as requested on her appeal and issued a new eligibility determination, but the Department failed to do

Summary: Guinn’s stated that trial court abused the discretion in objecting Dotson’s second amended complaint and rule on the motion to filing a certificate of merit late.

ON APPEAL AS OF RIGHT FROM THE U.S. DISTRICT COURT OF THE DISTRICT OF COLUMBIA

Our constituent, Timothy Rouse, recently contacted our office regarding his SSDI appeal. Mr. Rouse recently lost his home and is facing a financial hardship. In a letter to Mr. Rouse from SSA in November of 2014, Mr. Rouse was instructed to provide more evidence for his appeal. Mr. Rouse is unaware of what further evidence he should provide? Could you please look into Mr. Rouse’s case, provide status, a list of what further materials are needed, and if possible provide critical status due to Mr. Rouse’s financial hardship? I have attached Mr. Rouse’s privacy release. Please let me know if there is anything more I can do to help Mr. Rouse.

This appeal arises out of an order of the Circuit Court for Anne Arundel County affirming the decision of the Board of Appeals (“Board”) of the Department of Labor, Licensing and Regulation (“DLLR”) to deny appellant’s, Gallen Floyd’s (“Floyd’s”), application for unemployment insurance benefits. Floyd contends that the Board found he was terminated due to gross misconduct in want of substantial evidence to support its conclusion. Additionally, Floyd avers the Board erroneously considered hearsay evidence in violation of procedural due process.

This letter is in response to your first level Administrative Appeal filed with Horizon Behavioral Health on November 3, 2016. In this appeal, you requested reconsideration of the payment in the amount of $3632.16 on the claim for dates of service October 1, 2016 through October 4, 2016. You stated that the member was involuntarily admitted through the Emergency Department, therefore the claim should be covered at the full charge of $9137.40.

This case was the last appealed case of the series and therefore, no other actions followed. This is because the judge affirmed the case as “an order sustaining demurrer without leave to amend”. This statement means that the plaintiff cannot amend the complaint.

I would like it if the Appeals Council review the judge’s decision for my daughter Nora Deloris Harris (759-05-7543) because my child has education limitations due to her ADHD, Read Disorder, and Asthma. Yes, these conditions are under medical management, but I do not want my daughter to be on medicine for the rest of her life. The medicine gets expensive as well as traveling to her doctor’s appointment, especially the appointments in Jackson, MS.

The situation surrounding the problem within the Office of Appeals is adapting from seeing things as they are to seeing things as they could be. The Agency must take final administrative action on a hearing within 90 days of the date of the initial request. Although, the 90 day time frame allowed pursuant to regulations, the Agency makes every effort to conduct hearings promptly, and if possible, render decisions in a shorter time frame. Therefore, the new tracking system will have a tremendous impact on conducting the hearing within the allotted time.

On the issue of timeliness, the PA IEB Representative RH testified that the Appellant was issued a notice on July 20, 2017, again on August 16, 2017 based on the Appellant’s request, and then again on September 13, 2017, based upon the Appellant’s request. The PA IEB’s position is that the appeal is untimely filed as the notice was issued three times before receiving the appeal on September 25, 2017.