Benson ex rel. Fabiano v. Department of Health

948 F. Supp. 213, 1996 U.S. Dist. LEXIS 20093, 1996 WL 729300
CourtDistrict Court, E.D. New York
DecidedDecember 9, 1996
DocketNo. CV-95-0982 (CPS)
StatusPublished

This text of 948 F. Supp. 213 (Benson ex rel. Fabiano v. Department of Health) is published on Counsel Stack Legal Research, covering District Court, E.D. New York primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Benson ex rel. Fabiano v. Department of Health, 948 F. Supp. 213, 1996 U.S. Dist. LEXIS 20093, 1996 WL 729300 (E.D.N.Y. 1996).

Opinion

MEMORANDUM AND ORDER

SIFTON, Chief Judge.

Plaintiff Lee Fabiano, represented by her husband William Benson, has brought this action against the Secretary of Health and Human Services (the “Secretary”). Defendant filed an answer to plaintiffs complaint and now moves for judgment on the pleadings for failure to state a claim. Thereafter, plaintiff submitted a reply with an amended complaint.

For the reasons stated below, defendant’s motion is granted and plaintiffs complaint is dismissed. Leave to file the amended complaint is denied.

BACKGROUND

The following allegations are taken from plaintiffs complaint, reply, repleading, and two amended complaints. For the purposes of this motion, they are assumed to be true.

Plaintiff Lee Fabiano was an employee of the Department of Health and Human Services Administration (“DHHS”). On November 2,1983, she was injured in an automobile accident. Since then, plaintiff has pursued various forms of relief related to the accident. Shortly after her injury, she applied for benefits under New York State’s no fault insurance system and received compensation for some expenses relating to the automobile accident. On September 12, 1988, she applied for Medicare health insurance. Due to her disability and her former employment with the federal government, plaintiff was found eligible for Medicare’s qualified government employment coverage. She has received Medicare insurance since September 1989.

On January 22, 1984, plaintiffs position at DHHS was reclassified by the Office of Personnel Management (“OPM”). On June 8, 1984, she was terminated from her position for cause. Plaintiff administratively appealed both decisions to the Merit Systems Protection Board (“MSPB”).

Plaintiff has filed four complaints in the Eastern District of New York relating to the above events. In January of 1985, plaintiff filed an action (CV 85-300) against the MSPB challenging its affirmation of her termination from DHHS. The case was administratively closed on July 28, 1986, for lack of prosecution. Plaintiffs appeal to the Second Circuit was dismissed for failure to file an appellate brief.

In October of 1994, plaintiff filed an action (CV 94-4739) against the OPM challenging its reclassification of her position. Defendant was granted summary judgment on January 19,1996. Plaintiff has appealed this order to the Second Circuit.

In May of 1996, plaintiff filed an action (CV 96-2230) against Countrywide Insurance Company. She sought to modify an adverse arbitration decision relating to her no fault insurance claims. Defendant was granted summary judgment on July 15,1996.

This case is the third of the four cases. On March 10,1995, plaintiff filed a complaint against the Secretary alleging a wide range of violations and seeking various forms of relief. On February 28, 1996, all but one cause of action alleged in the complaint was dismissed.

The remaining cause of action involves plaintiffs eligibility for Medicare and is based on the following allegations. In May 1984, plaintiffs supervisor Annette Blum ad[215]*215vised her to seek benefits under New York State’s no fault insurance system for expenses arising out of her accident. Blum did not take steps to ensure plaintiff received Medicare. Also in May 1984, DHHS Personnel Manager Robert Collins by Jerome Marullo wrote a letter to plaintiffs attorney describing plaintiffs employment status and the amount of sick leave she had been taking. As a result of the action and inaction of Blum, Collins, and Marullo, plaintiff did not apply for Medicare insurance.

In 1988, plaintiff applied for and was granted Medicare coverage to start September 1989. Because plaintiff had not applied for Medicare until September 12, 1988, the mandatory waiting period for benefits did not expire until September 1989. Plaintiff sought to have that eligibility date changed. She pursued her claim through the Social Security Administration’s (the “SSA”) appeals process and has submitted copies of the various decisions with respect to her claim.

At the administrative hearing, plaintiffs representative, William Benson, claimed that plaintiff would have applied for benefits earlier had she not been misled by her supervisors. The administrative law judge (the “ALJ”) rejected this argument and found her eligible for benefits as of September 1989, but not before. The SSA Appeals Council affirmed this decision on January 6, 1995.

DISCUSSION

Defendant’s Motion for Judgment on the Pleadings

Rule 12(c) of the Federal Rules of Civil Procedure provides for a judgment on the pleadings. A motion made pursuant to Rule 12(e) must be made after defendant’s answer has been filed and may raise a defense of failure to state a claim upon which relief can be granted. See Fed.R.Civ.P. 12(h)(2).

In- deciding such a motion, a court must accept all the facts pleaded in the complaint as true and may only dismiss if “the plaintiff can prove no set of facts in support of his claim which would entitle him to relief.” Conley v. Gibson, 355 U.S. 41, 45-46, 78 S.Ct. 99, 102, 2 L.Ed.2d 80 (1957); see also George C. Frey Ready-Mixed Concrete, Inc. v. Pine Hill Concrete Mix Corp., 554 F.2d 551, 553 (2d Cir.1977)..

Plaintiff appeals from the Secretary’s administrative decision determining the date of plaintiffs eligibility for Medicare benefits.1 She seeks to move her eligibility date from the September 1989 date determined by the Secretary to May 1984.

Defendant moves for judgment on the pleadings asserting that plaintiff fails to state a cause of action. Defendant argues that the Secretary’s eligibility date is based on a clear legal standard and that there are no applicable exceptions as a matter of law.2

Medicare is a federally funded health insurance program for the elderly and disabled. An individual can become eligible for Medicare benefits in a number of ways. The most common means is becoming entitled to Social Security monthly benefits. Once entitled to Social Security benefits, an individual is automatically entitled to Medicare upon reaching age 65. See 42 U.S.C. § 426(a); 42 C.F.R. § 406.10. However, an individual under age 65 is eligible for Medicare if that person has been “under a disability” for at least twenty-five months. See 42 U.S.C. § 426(b); 42 C.F.R. § 406.12(a). An individual is disabled within the meaning of Medi[216]*216care if that individual is “entitled or deemed entitled to Social Security disability benefits.” 42 C.F.R. 406.12(a)(1).

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Related

Conley v. Gibson
355 U.S. 41 (Supreme Court, 1957)
Haines v. Kerner
404 U.S. 519 (Supreme Court, 1972)
Schweiker v. Hansen
450 U.S. 785 (Supreme Court, 1981)
United States v. Mitchell
463 U.S. 206 (Supreme Court, 1983)
Office of Personnel Management v. Richmond
496 U.S. 414 (Supreme Court, 1990)
City of New York v. Shalala
34 F.3d 1161 (Second Circuit, 1994)

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Bluebook (online)
948 F. Supp. 213, 1996 U.S. Dist. LEXIS 20093, 1996 WL 729300, Counsel Stack Legal Research, https://law.counselstack.com/opinion/benson-ex-rel-fabiano-v-department-of-health-nyed-1996.