Jim Coulston v. Kenneth S. Apfel, Commissioner of Social Security

224 F.3d 897, 2000 U.S. App. LEXIS 23580, 2000 WL 1358454
CourtCourt of Appeals for the Eighth Circuit
DecidedSeptember 21, 2000
Docket99-4183
StatusPublished
Cited by10 cases

This text of 224 F.3d 897 (Jim Coulston v. Kenneth S. Apfel, Commissioner of Social Security) is published on Counsel Stack Legal Research, covering Court of Appeals for the Eighth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Jim Coulston v. Kenneth S. Apfel, Commissioner of Social Security, 224 F.3d 897, 2000 U.S. App. LEXIS 23580, 2000 WL 1358454 (8th Cir. 2000).

Opinions

PER CURIAM.

Occasionally, the Social Security Administration (the Administration) sends a benefit check to the wrong person. When this occurs, the Administration is entitled to recover the money unless the recipient of the check was without fault and recovery would subvert the purpose of social security or be against equity and good conscience. See 42 U.S.C. § 404.

In this case, the Administration erroneously sent a $20,658 check to Jim Coulston, a man who receives benefits be[899]*899cause of an intellectual impairment. Coul-ston, who has trouble reading, thought the check was a back payment for medical expenses because he canceled his Medicare, so he cashed the check and used most of the money to pay bills and purchase Christmas presents. We must now decide whether the Administration may recoup its money. We find it may not.

Coulston returned the unspent money to the Administration, but he did not have the resources to immediately repay the money already spent. The Administration threatened to withhold any further benefit checks from Coulston until it reclaimed the remainder ($18,249) of the money. Coul-ston then sought a waiver from repayment to the Administration, asserting he was without fault and that recovery would subvert the purpose of social security or be against equity and good conscience. He received a hearing before an Administrative Law Judge (ALJ), who found Coulston undeserving of a waiver. Coulston then brought his case to federal district court, which upheld the ALJ’s determination. So, to decide this case, we must review the ALJ opinion and the record evidence.

After receiving the check, Coulston got, in the ALJ’s words, “advice from and was assisted by” his ex-wife and a friend. Basically, this assistance was in cashing and spending the check. In determining whether Coulston was without fault, the ALJ relied substantially on the role Coul-ston’s ex-wife and friend played. The ALJ noted that, while Coulston had an intellectual impairment, there was no evidence that either his ex-wife or friend suffered from a similar disability. This led the ALJ to conclude that, before cashing and spending the check, “at least one of the three individuals involved” should have made further inquiries with the Administration. The ALJ also noted that, in deciding the case, he considered that neither Coulston’s ex-wife nor friend testified at the hearing to explain why they did not question Coulston’s receipt of the check. Also important to the ALJ’s conclusion was the ability of Coulston’s ex-wife and friend to manage their own finances and dispense advice.

The thrust of much of the ALJ’s opinion is that Coulston’s ex-wife and friend knew or should have suspected what was going on. This may well be true, but it is irrelevant. The Administration’s regulations state that a claimant is at fault if he knew or should have known the overpayment was incorrect. See 20 C.F.R. § 404.507. The Administration’s regulations also state that the determination of fault is only made as to the overpaid individual or any other person from whom the Administration seeks to recover. See id. What that means in this case is that the ALJ should have considered what Coulston himself knew or should have known. Instead, the ALJ relied substantially on what Coul-ston’s ex-wife and friend should have known; and while Coulston’s ex-wife and friend very well may have known (or should have known) what was going on, it was erroneous to impute their actions and abilities to Coulston.

We also think the ALJ did not properly account for the intellectual impairments of Coulston. When determining whether an overpaid individual is without fault, the ALJ is required by statute to “specifically take into account” the individual’s mental or educational limitations. See 42 U.S.C. § 404(b). To be fair, the ALJ noted most of Coulston’s intellectual and educational limitations, including: his difficulty with reading and writing; his attendance of special education classes at school; and his eight months of training with Goodwill Industries to learn the skill of dishwashing. But, the ALJ then basically ignored how these limitations would have affected Coulston’s ability to know the check was erroneous. Instead, as related above, the ALJ relied substantially on the lack of intellectual limitations of Coulston’s “advisors” — his ex-wife and friend.

The ALJ also placed significant emphasis on the events surrounding Coulston’s [900]*900attempts to cash the check. The ALJ found Coulston was unable to cash the check at the first bank he tried — the obvious inference being that the bank refused to cash the check because of its substantial amount. This, according to the ALJ, should have been a tip-off to Coulston and to his friend that a problem existed with the check. But, the record reveals the bank refused to cash the check because of a problem with Coulston’s identification, not because of the large amount of the check. And, again, while his friend may have known the real situation, Coulston’s intellectual limitations may well have prevented him from ascertaining the real situation.

The parties in this case make much of Coulston’s supposed interaction or supposed non-interaction with the Administration in the month following his receipt of the erroneous check. After Coulston received the check, he received a notice from the Administration informing him he was entitled to the check and to a substantial increase in his monthly benefits. The Administration claims Coulston only received this notice after he became aware the check was an error. Coulston also claims he and his ex-wife made several phone calls to the Administration, and Administration employees said he was entitled to the $20,658. The Administration claims that, in every phone call, they informed Coulston he was not entitled to the money. But, the ALJ declined to credit either version of events, and so do we. The evidence on this issue is inconclusive, and, as an appellate court, we should not engage in fact-finding on this issue. See Duffie v. Deere & Co., 111 F.3d 70, 74 (8th Cir.1997) (role of appellate court is to “review, rather than to make, findings of fact”).

The Administration also calls to our attention Coulston’s “history” of overpay-ments. Apparently, in the early 1980s, Coulston was overpaid by about $4,000. But, the ALJ made no mention of this history in his opinion, and we do not put much stock in it either, as we doubt most people, even those without an intellectual impairment, would remember an overpayment incident that occurred almost fifteen years earlier.

So, after a careful review of the record, the following evidence remains: Coulston has an intellectual impairment substantial enough to entitle him to social security benefits for the last twenty-plus years; he received a check with an overpayment; he believed the overpayment was for back medical payments because he had canceled his Medicare policy; he spent much of the check to pay off bills and buy Christmas presents until informed the check was a mistake; and he then paid back the remaining money. Is this enough for Coulston to meet his burden of proving he is without fault? See Banuelos v. Apfel,

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Bluebook (online)
224 F.3d 897, 2000 U.S. App. LEXIS 23580, 2000 WL 1358454, Counsel Stack Legal Research, https://law.counselstack.com/opinion/jim-coulston-v-kenneth-s-apfel-commissioner-of-social-security-ca8-2000.