Guadamuz v. Heckler

662 F. Supp. 1060, 1986 U.S. Dist. LEXIS 18606
CourtDistrict Court, N.D. California
DecidedOctober 23, 1986
DocketC-84-6396 MHP
StatusPublished
Cited by4 cases

This text of 662 F. Supp. 1060 (Guadamuz v. Heckler) is published on Counsel Stack Legal Research, covering District Court, N.D. California primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Guadamuz v. Heckler, 662 F. Supp. 1060, 1986 U.S. Dist. LEXIS 18606 (N.D. Cal. 1986).

Opinion

OPINION

PATEL, District Judge.

Plaintiffs originally brought this class action challenging the Secretary of Health and Human Services (“Secretary”) policy of delaying the payment of retroactive benefits under Title II of the Social Security Act, 42 U.S.C. §§ 401-433 (1983) (“Title II”) until after retroactive benefits under Title XVI of the Social Security Act, 42 U.S.C. §§ 1381-1383 (1982) (“Title XVI”) were calculated and paid in “concurrent claims cases” — cases in which the claimant applies for both types of benefits at roughly the same time and the Secretary ultimately awards both types of benefits retroactively. Plaintiffs alleged that the Secretary’s policy artificially reduced the amount of past-due Title II disability benefits from which attorneys’ fees could be withheld, providing a disincentive for attorneys to represent claimants in Social Security cases, and resulting in an underpayment of Title XVI Supplemental Security Income (“SSI”) benefits to claimants represented by attorneys.

After plaintiffs moved for class certification and a preliminary injunction, but before the court ruled on the motions, the parties entered into a stipulated order under which the Secretary was to submit to the court a set of instructions and procedures to remedy the problems identified by plaintiffs. The Secretary filed her new procedures with the court on July 10, 1985, in the form of an amendment to the Program Operation Manual System (“POMS”).

Plaintiffs now move for partial summary judgment and an injunction. Plaintiffs contend that although the new procedures alleviate some of the problems originally complained of, a number of problems remain. For the reasons discussed below, plaintiffs’ motion for partial summary judgment and an injunction is granted in part and denied in part.

STATUTORY BACKGROUND

There are two types of federal benefits available to disabled individuals: disability benefits under Title II and SSI benefits under Title XVI. Eligibility for Title II benefits is based on a claimant’s insured status and is independent of financial need. Eligibility for Title XVI benefits, on the other hand, is wholly dependent upon financial need; the more “chargeable” income and resources an individual has, the less Title XVI benefits, if any, she will receive. Title II benefits, though not themselves based on need, are considered “chargeable” income for purposes of determining Title XVI eligibility. 42 U.S.C. § 1382a(a)(2)(B). Thus, an award of Title II benefits will generally have the effect of reducing a claimant’s Title XVI eligibility, although the reduction will not necessarily be dollar-for-dollar. The amount of Title II benefits a claimant is entitled to is not affected by an award under Title XVI, however.

The problem arises when a claimant has already been receiving Title XVI benefits and then later receives a retroactive award of Title II benefits for the same period. Had the Title II benefits been paid when due, they would have reduced the amount of Title XVI benefits the claimant would *1062 have received. However, where the Title II benefits are paid retroactively, the Title XVI benefits which have already been paid out were never reduced by the amount of Title II benefits. As a result the claimant receives a windfall.

In order to remedy this problem Congress enacted a “windfall offset” provision in 1980. 42 U.S.C. § 1320a-6. Under § 1320a-6, when a claimant is awarded retroactive Title II benefits for a period in which she has already received Title XVI benefits, the Title II benefits are reduced by the amount of Title XVI benefits which the claimant would not have received had the Title II benefits been awarded when due rather than retroactively. The original version of § 1320a-6 did not provide for a similar offset in those cases in which Title II benefits were paid first. Therefore, in order to ensure that the windfall offset would be applied in all concurrent claims cases, the Secretary developed a policy of delaying Title II benefits until after Title XVI benefits had been calculated and paid. This policy, originally termed “Title XVI offset,” was effective in all claims adjudicated after June 30, 1981. POMS GN 02610.005 et seq.

In 1984, Congress amended § 1320a-6 to allow for offset regardless of which class of benefits was paid first. 1 This amendment became effective on February 1, 1985 and removed the need to calculate and pay Title XVI benefits first in all cases. Following the amendment of § 1320a-6, the Secretary developed a new set of instructions and procedures for handling concurrent claims cases. When Title II benefits are paid first the Secretary applies the “Title XVI offset” procedures; when Title XVI benefits are paid first the “Title II offset” procedures are applied. The order in which the benefits are paid is determined by which current monthly benefit check is processed and ready for mailing first.

DISCUSSION

1. Attorneys’ Fees Under § J/.06

Attorneys’ fees can be recovered for services performed in connection with Title II claims. 42 U.S.C. § 406. Section 406(a) deals with fees awarded at the administrative level. Under § 406(a), “[wjhenever the Secretary, in any claim before him for benefits under [Title II], makes a determination favorable to the claimant, he shall [fix] ... a reasonable fee to compensate such attorney for the services performed by him in connection with such claim.” 42 U.S.C. § 406(a). In addition to providing for the authorization of attorneys’ fees, § 406(a) requires the Secretary to withold up to 25% “of the total amount of past-due [Title II] benefits” and to pay the withheld amount directly to the attorney. However, § 406(a) does not limit the amount of fee which the Secretary may authorize. See 20 C.F.R. § 404.1725(b) (1986). However, direct payment is made from past-due benefits of the smallest of 25% of the total past-due benefits, the amount set by the Secretary or the amount agreed upon between the attorney and the claimant. See 20 C.F.R. § 404.1730(b) (1986).

Section 406(b) deals with attorneys’ fees awarded by a court and provides that, where a court renders a judgment favorable to a claimant who was represented by an attorney, the court may authorize a reasonable fee not to exceed 25% “of the total of the past-due benefits to which the claimant is entitled by reason of such judg *1063 ment.” 42 U.S.C. § 406(b)(1).

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Related

Pappas v. Bowen
863 F.2d 227 (Second Circuit, 1988)
Guadamuz v. Bowen
859 F.2d 762 (Ninth Circuit, 1988)

Cite This Page — Counsel Stack

Bluebook (online)
662 F. Supp. 1060, 1986 U.S. Dist. LEXIS 18606, Counsel Stack Legal Research, https://law.counselstack.com/opinion/guadamuz-v-heckler-cand-1986.