FINDINGS OF FACT AND CONCLUSIONS OF LAW
SAMUEL P. KING, District Judge.
Under 42 U.S.C. § 404(a) and (b),
the Secretary of the Social Security Administration (hereinafter the “Administration”) may effect or waive recoupment of overpayments made to social security recipients. The Administration has promulgated procedures and regulations governing recoupment and waiver in its Claims Manual § 5503
and in the
Code of Federal Regulations, 20 C.F.R. § 404.901 et seq. (1973).
The Plaintiffs in this class action claim that these procedures and regulations deny them due process of law under the Fifth Amendment because their benefits are reduced or suspended without adequate notice of the reasons for the recoupment, without adequate notice of their right to reconsideration, waiver, or partial adjustment,
and without a hearing prior to the recoupment. Defendants contest the Plaintiffs’ constitutional and jurisdictional claims.
Facts:
This court has divided the Plaintiff class into two subclasses. Represented by Plaintiffs Silva, Ortiz, and Vaquilar, the first subclass consists of all social security old-age beneficiaries, resident in the State of Hawaii, whose exposure to recoupment is based upon their own annual earnings reports.
Represented by Plaintiffs Elliott, Gaines, and .Yamasaki, the second subclass consists of all social security old-age and disability benefit recipients, resident in the State of Hawaii, whose exposure to recoupment is based upon evidence other than annual earnings reports.
Named Plaintiffs of subclass one all received an Administration form letter indicating that based upon their annual earnings reports for the preceding year, a specified overpayment had
occurred and that their subsequent benefit payments would be reduced or totally suspended over a specified period. There was some notice of the right to reconsideration and waiver.
Plaintiffs believed themselves to be not liable for any overpayment, not at fault in causing the overpayment, and unable to repay the amount due; they personally contacted local Social Security Administration offices within thirty days of receipt of the form letter. At that time, none were advised that appropriate forms requesting waiver, reconsideration, and partial adjustment were available to' initiate administrative action, and none actually filed the requisite forms within thirty days.
Currently, the Administration has completed recoupment against two of these Plaintiffs while deferring recoupment against the other pending the disposition of this case. Plaintiffs of subclass one have done all that reasonably could be expected of them to exhaust their administrative remedies.
Named Plaintiffs of subclass two received overpayment notices more than thirty days before recoupment was to begin. The notice to Plaintiff Elliott set forth that the overpayment determination was based upon her receipt of both retirement and disability benefits when she was entitled to only disability benefits.
The notice to Plaintiff Gaines indicated that “duplicate pay
ments” over specified dates was the reason for the overpayment finding.
The notice to Plaintiff Yamasaki specified
“a
processing error” as the cause of the overpayment.
All three named Plaintiffs received some notice of the right to reconsideration and waiver.
The Plaintiffs believed themselves to be not liable for any overpayment, not at fault in causing the overpayment, and unable to repay the amount claimed; they contacted local Administration offices within thirty days after receipt of the overpayment notice. At that time, none were advised that appropriate forms requesting waiver, reconsideration, and partial adjustment were available to instigate administrative action, and none actually filed the requisite forms within thirty days.
Presently, recoupment against Elliott and Gaines has been deferred pending a final disposition of this case, while recoupment against Plaintiff Yamasaki has been completed. Plaintiffs of subclass two have done all that reasonably could be expected of them to exhaust their administrative remedies.
In summary, the Administration’s regulations and procedures, and the Plaintiffs’ histories in this case, show that recipients in both subclasses subject to recoupment receive recoupment notices which set out the basic reason for the recoupment, the possibility of reconsideration, the conditions for waiver, and the need to consult the local Administration office within thirty days if they wish to complain. For subclass one Plaintiffs (at least until January, 1975), recoupment begins immediately after the initial overpayment decision is made. For subclass two Plaintiffs, the notice is sent thirty days before actual recoupment begins. In practice, actual adjustment may, at the discretion of the Payment Center, be extended beyond 30 days when more time is needed to consider and process the matter. After the first determination is made, if reconsideration or waiver is requested, recoupment is further deferred until those issues are determined on the basis of any documentary evidence submitted. Finally, a post-recoupment hearing is possible should the claimant wish to seek additional review.
The initial overpayment and recoupment notice sent to beneficiaries does not set forth the forms needed for reconsideration and waiver, or information about how to complete them. The information and forms missing in the initial notice are not generally made available when the claimant consults his local Administration office. When reconsideration or waiver consideration is requested, the Administration’s decision is based upon a claimant’s
ex parte
presentation of documentary evidence on an issue which he may understand only nebulously. Many of these claimants are elderly and disabled people whose capacities may frustrate an effective documentary presentation of their case. No oral hearing is given prior to the beginning of recoupment, and any deferral of recoupment beyond 30 days after the date of the initial notice lies completely within the discretion of the Administration. Should a claimant convince the Administration to reverse itself
ex parte
on the overpayment issue, a reduced or suspended payment may ensue with a refund coming a month or more later.
Statistics provided by the Defendant
in this case indicate the following:
(a) In 1970 there were overpayments in approximately 1,250,000 cases.
(b) Of these 1,250,000 overpayments, there were requests for reconsideration in approximately 12,000 cases.
(c) Of the 12,000 reconsideration determinations with respect to overpayments, there were approximately 8,250 reversals and approximately 3,750 affirmances.
(d) Of the 3,750 reconsideration affirmances with respect to overpayments, there were requests for hearing in approximately 1,600 cases.
(e) Of the 1,600 cases that went to hearing with respect to overpayments, there were reversals in approximately 560 cases and affirmances in 1,040 cases.
Stated another way, these statistics mean:
(a) less than one per cent of the beneficiaries in overpayment status contest the matter.
(b) of those who do contest the initial overpayment determination, about sixty-nine per cent succeed in getting the Administration to reverse itself.
(c) about forty-three per cent of those whose overpayment status is affirmed upon reconsideration seek on oral (post-recoupment) hearing.
(d) of those who get an oral hearing, more than one-third succeed in getting the Administration to reverse itself.
(e) overall, of that small percentage of claimants questioning the overpayment determination, about seventy-three per cent (8,250 + 560 out of 12,000) finally succeed in obtaining relief.
It is quite clear from the above that when the claimant feels he has a strong enough case to question the Administration’s initial overpayment determination, there is a very substantial chance that the Administration will eventually reverse itself. What is saddest and perhaps most important about this fact is that many social security recipients, like the Plaintiffs here, depend upon their full monthly benefit payments for subsistence.
Erroneous recoupments often cause the aged and infirm drastic hardship.
Jurisdiction:
The Defendants have moved for dismissal for lack of subject-matter jurisdiction. Plaintiffs assert that federal jurisdiction exists under 28 U.S.C. § 1331(a) (1966), 28 U.S.C. § 1361 (Supp. I, 1972), and 5 U.S.C. § 701 et seq. (1967) (hereinafter the “A.P.A.”). While § 1361
may have been intended to increase the availability of mandamus jurisdiction beyond that under common law,
even under the traditional rules for mandamus writs, § 1361 applies to this case.
At common law, mandamus
would issue when three elements coexisted, namely, 1) a clear right in the plaintiff to the relief sought; 2) a clear duty on the part of the defendant to do the act in question;
and 3) the lack of another adequate remedy. Carter v. Seamans, 411 F.2d 767, 773 (5th Cir. 1969).
As to the third requirement, the Plaintiffs, if denied federal jurisdiction, may not have an adequate remedy elsewhere,
see
Burnett v. Tolson,
supra
note 20, 474 F.2d at 882-883. The state courts may not be able to issue the requested injunctive relief,
see
State of Alabama v. Rogers, 187 F.Supp. 848, 852 (M.D.Ala.1960) ; R. Arnold, The Power of State Courts to Enjoin Federal Officers, 73 Yale L.J. 1385 (1964), and any removal to a federal court from a state court would lie within the defendants’ sole discretion. Moreover, the first and second requirements are met when the application of a Supreme Court ruling to the instant ease clearly shows the existence of plaintiff’s constitutional right and its denial by the defendant. Mead v. Parker, 464 F.2d 1108 (9th Cir. 1972); Burnett v. Tolson,
supra
note 20; Daigle v. Warner, 348 F.Supp. 1074 (D.C.Hawaii 1972), rev’d on nonjurisdiction grounds, 490 F.2d 358 (9th Cir. 1973).
While the applicability of the relevant Supreme Court ruling should be beyond doubt in the opinion of the district court judge, it need not be so certain as to preclude a different opinion'from another court. For example, in
Daigle, supra,
the Chief Judge of this District Court under § 1361 applied Argersinger v. Hamlin, 407 U.S. 25, 92 S.Ct. 2006, 32 L.Ed.2d 530 (1972) to summary courts-martial. The Ninth Circuit later reversed, differing with the District Court’s use of
Argersinger
without attacking its assertion of § 1361. In this case, the Plaintiffs rely upon Goldberg v. Kelly, 397 U.S. 254, 90 S.Ct. 1011, 25 L.Ed.2d 287 (1970) (hereinafter
“Goldberg”)
to establish the existence of the constitutional right to adequate notice and prior hearings in Administration recoupment cases. One court has already approved § 1361 jurisdiction and the application of
Goldberg
to the termination and recoupment of medicare benefits under Administration regulations similar to those involved in this case. Martinez v. Richardson,
supra
note 9. Accordingly, the applicability of
Goldberg
to this case is sufficiently apparent to establish for § 1361 jurisdictional purposes the plaintiff’s clear right and the defendant’s clear duty.
Due Process and Hearings Prior to Recoupment:
Goldberg
establishes the principle that when the impact of an erroneous administrative decision upon the individual is so severe as to deprive him of the means by which to live, due process requires that the individual have an opportunity to be heard and to cross-examine witnesses before any adverse decision is effected. Specifically,
Goldberg
held that a hearing had to be afforded the individual before his state welfare benefits were terminated. In reaching its decision, the
Goldberg
Court focused upon three considerations: The impact of an erroneous decision upon the individual, the government’s interest in fulfilling the purpose of welfare legislation by protecting against administrative mistakes, and the government’s interest in conserving the public fisc and minimizing administrative burdens. The
Goldberg
Court found that “termination of [welfare] aid pending resolution of a controversy over eligibility may deprive an eligible recipient of the very means by which to live while he waits,” 397 U.S. at 264, 90 S.Ct. at 1018. It also found that important governmental interests were served by ensuring that welfare was given to eligible recipients without interruption. Finally, it found that the additional burden on the government’s administration and fisc did not outweigh the first two considerations in favor of providing a prior hearing.
The application of
Goldberg
to this case is simply inescapable.
Since
most social security recipients depend upon their full benefits for the necessities of life,
the adverse impact of an erroneous suspension or reduction upon them is great.
Starvation may be slower if benefits are reduced or suspended rather than terminated as in
Goldberg
but some recipients will suffer nonetheless. As the
Goldberg
Court noted, the government has an interest in welfare as a guard “against the societal malaise that may flow from a widespread sense of unjustified frustration and insecurity,” 397 U.S. at 265, 90 S.Ct. at 1019. So is the Social Security Act “. . . designed for the protection of society, and enacted to alleviate the burdens which rest on large numbers of the population because of the insecurities of modern life, particularly those accompanying old age, unemployment, and disability, . . .” Sayers v. Gardner, 380 F.2d 940, 942 (6th Cir. 1967).
As with welfare, the same governmental interests that counsel the provision of social security benefits, counsel as well its uninterrupted provision to those eligible to receive it, and pre-recoupment hearings are indispensable to that end.
See Goldberg,
397 U.S. at 265, 92 S.Ct. 2006. Finally,
Goldberg
suggests that the government’s objection to pre-recoupment hearings on administrative and fiscal burden grounds cannot outweigh the arguments in favor of such hearings.
This seems especially true in this case: The Administration’s own statistics indicate that only a small percentage of overpayment cases will need to be contested beyond the “paper” hearing stage.
Pre-recoupment hearings
may also reduce the number of post-recoupment hearings necessary.
There are other compelling reasons why the mandate of
Goldberg
must be applied to social security cases. At the heart of the right to due process lies the recognition of the need for a fair determination of issues and the hope of minimizing mistakes. In this case, the chance of administrative error is great.
In Kelly v. Wyman,
supra
note 25, the district court was impressed by the fact that post-termination hearings resulted in administrative reversals 36% of the time; in this case, reversals at the post-recoupment hearing stage occur more than one-third of the time.
Furthermore, the procedural safeguards which
Goldberg
found constitutionally insufficient for lack of a prior hearing were more stringent than those of the Administration.
It is thus not surprising that one court has approved the application of
Goldberg
to procedures similar to those here at issue.
See
Martinez v. Richardson,
supra
note 9.
But see
Mills v. Richardson,
supra
note 21, 464 F.2d at 1001
(dicta).
Attempts to distinguish
Goldberg
on the ground that fact issues are not present in recoupment cases, or on the ground that the evidence involved is more reliable, are futile. Issues of fact arise in virtually all contested recoupment situations.
To predict when an issue of fact will not be present on a case by ease basis is impossible. Although the district court in Kelly v. Wyman,
supra
note 25, 294 F.Supp. at 905, may have been influenced in its decision by the fact that welfare terminations sometimes were based upon rumors or “tips”, the
Goldberg
Court did not base its decision on the possibility that flimsy
evidence might underlie a termination decision. However reliable the evidence may be, when the adverse administrative determination depends upon the resolution of factual issues and the application of legal rules to the facts found, that is enough to invoke due process hearing requirements.
Therefore, the court finds that the Administration’s recoupment regulations and procedures here challenged violate the Plaintiff’s right to due process of law, and orders that henceforth when requested
the Plaintiffs of both subclasses be given an oral hearing prior to recoupment.
At the hearing, the correctness of the overpayment determination and the recipient’s statutory right to waiver under 42 U.S.C. § 404(b) (1969) must be examined. However, since under 20 C.F.R. § 404.-502(c) (1973), partial adjustment is not a mandate, but lies within the unfettered discretion of the Administration even when the requisite conditions are met, a hearing need not be given on the partial adjustment issue.
The pre-recoupment hearing need not take the form of a judicial or quasi-judicial trial, but it must allow the claimant to present his case orally, to submit evidence with witnesses or documents, and to cross-examine witnesses against him. Representation by legal counsel or other persons is neither required nor prohibited. The hearing officer should not have participated in making the determination under review; he should base his decision solely on the legal rules and evidence adduced at the hearing; he should state the reasons for his decision and the evidence relied upon.
Goldberg,
397 U.S. at 266-271, 90 S.Ct. 1011, 25 L.Ed.2d 287.
Due Process and Notice:
Since a constitutional right can be waived only knowingly, the Plaintiffs must be notified of their due process right to request and receive a pre-recoupment hearing on the overpayment and waiver issues. Notice of that right must be stated plainly and obtrusively in the initial overpayment letter. Furthermore, the initial notice must describe the claimant’s right at any hearing to be represented by a lawyer or other person, present evidence, present witnesses in his behalf, cross-examine adverse witnesses, be afforded a fair and impartial hearing examiner, examine all documents prior to and during the hearing, and be given a prompt decision by the decisionmaker.
Due process also requires timely, adequate, and detailed notice of the. reasons for an initial overpayment determination.
Goldberg,
at 267, 90 S.Ct. 1011. In
Goldberg,
the Court found, “New York employs both a letter and a personal conference with a caseworker to inform a recipient of the precise questions raised about his continued eligibility. Evidently the recipient is told the legal and factual bases for the Department’s doubts. This combination is probably the most effective method of communicating with recipients,” at 268, 90 S.Ct. at 1020. Since the Administration’s current procedures do not include a caseworker interview, the social security recipient may not be as fully apprised of the legal and factual bases for the overpayment finding as the welfare recipient was in
Goldberg.
In annual report overpayment cases involving subclass one Plaintiffs, the recipients are presumed to be familiar with their own reports and the reasons for filing them. The reverse side of the current initial notice explains basically how withheld amounts are determined, and the notice’s invitation to consult local Administration offices when questions arise is a necessary and added protection. Subclass two Plaintiffs present a more difficult notice problem. The myriad circumstances and diverse information which may underlie an overpayment determination make it impossible for this court to define what is and is not adequate notice for all subclass two cases. To indicate (as the reason for the overpayment decision) a “duplicate payment” over specified periods may be enough notice for the claimant, but a stated reason such as “processing error” may not be.
However, it is reasonable to assume that subclass two Plaintiffs, and subclass one Plaintiffs, who doubt the overpayment, will consult their local Administration office for clarification.
However, in light of the foregoing, the Administration’s initial notice does not complete its duty to inform the subclass one and two Plaintiffs about the reasons for an overpayment determination. Those Plaintiffs who consult their local Administration office to contest or inquire about the alleged overpayment must receive any additional information which the Administration has
The Administration must inform the Plaintiffs requesting a hearing about all the pertinent details, laws, and regulations supporting the Administration’s case far enough in advance to afford the claimant sufficient time to prepare for the hearing.
Finally, while the Administration’s current notice adequately informs
the recipient of the possibility of reconsideration and waiver, it does not indicate what requisite forms must be completed. The record indicates that even those recipients seeking aid at a local office are not provided with information about or copies of the reconsideration and waiver forms. These deficiencies must be remedied. Claimants failing to file the required forms may lose their case for failure to comply with administrative procedures. Therefore, the initial overpayment notice should specify the reconsideration and waiver forms which must be requested from the local office. The local office also has the duty to inform inquiring claimants about the requisite forms, to provide them with those forms if requested, and to assist in their completion. Accordingly :
Judgement may be entered providing that Defendant Weinberger, his successor, his agents and employees at the Social Security Administration’s Payment Centers, and all persons in active concert or participation with them shall be restrained and enjoined from reducing, terminating, or suspending social security old age and disability benefits accruing to Plaintiffs and their class without affording them an opportunity for a hearing before any reduction, termination, or suspension is effectuated;
That Defendant Weinberger, his successor, his agents and employees at the Social Security Administration’s Payment Centers, and all persons in active concert or participation with them shall restore any and all money withheld since June 22, 1972, without a prior hearing, from Plaintiffs Nancy Yamasaki, Isabelle Ortiz, John V. Vaquilar, Raymond Gaines, and Jordan A. Silva pending the holding of a preadjustment hearing in each of their individual cases;
That the Defendants shall submit to this court, for its approval, a copy of the proposed notice to be given to the members of the class informing them of the judgement herein, and a copy of the revised rules, regulations, and procedures which they will adopt to conform with the dictates of the judgement herein; and
That this court will retain jurisdiction over this case to order any further action it may deem appropriate and just in light of the decision herein.
The foregoing constitutes the Findings of Fact and Conclusions of Law required by Rule 52(a) of the Federal Rules of Civil Procedure.