Lois JEFFERSON, Plaintiff-Appellant, v. Otis R. BOWEN, Secretary of Health and Human Services, Defendant-Appellee

794 F.2d 631, 1986 U.S. App. LEXIS 27477, 14 Soc. Serv. Rev. 129
CourtCourt of Appeals for the Eleventh Circuit
DecidedJuly 23, 1986
Docket85-8927
StatusPublished
Cited by14 cases

This text of 794 F.2d 631 (Lois JEFFERSON, Plaintiff-Appellant, v. Otis R. BOWEN, Secretary of Health and Human Services, Defendant-Appellee) is published on Counsel Stack Legal Research, covering Court of Appeals for the Eleventh Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Lois JEFFERSON, Plaintiff-Appellant, v. Otis R. BOWEN, Secretary of Health and Human Services, Defendant-Appellee, 794 F.2d 631, 1986 U.S. App. LEXIS 27477, 14 Soc. Serv. Rev. 129 (11th Cir. 1986).

Opinion

*632 Amended Opinion

KRAVITCH, Circuit Judge:

The Social Security Administration (SSA) overpaid benefits to Lois Jefferson from 1978 through 1982. Jefferson concedes that the SSA overpaid her, but requests that it waive repayment, pursuant to 42 U.S.C. § 404(b) 1 because she was not at fault. The district court adopted a magistrate’s recommendation affirming the SSA decision not to waive repayment. We reverse and remand with instructions to enter judgment for Mrs. Jefferson.

I. BACKGROUND

In 1972, Jefferson’s husband applied for retirement and disability benefits and she signed an application form that entitled her to $12.60 per month for wife’s insurance benefits. Mrs. Jefferson testified that her husband brought the form home from the Social Security office and told her that the SSA requested that she sign it. She testified that she neither read nor filled out the application because she thought it concerned her husband. Her application form indicated that she was earning about $3,400 per year and her award certificate, which was issued shortly thereafter, stated she would receive a monthly benefit of $12.60 even though her taxable earnings “would ordinarily require that no benefits be paid.” The award certificate also directed Jefferson to notify the SSA if her earnings became “substantially more or less than [she] expected.” In her application, Jefferson agreed to report her annual income; the award certificate, however, did not indicate that she was required to report her income annually. She received wife’s insurance benefits from 1972 through 1978.

At a Social Security hearing, an Administrative Law Judge (ALJ) found Mrs. Jefferson’s testimony both credible and truthful. Her testimony established the following. On January 11, 1978, Mrs. Jefferson’s husband died. Shortly thereafter she telephoned the SSA to report her husband’s death and to inquire about her continued eligibility for benefits. Although she informed the SSA that she was still employed, an SSA official assured her that she would continue to receive benefits because she had a dependent child in her care. She was not advised that she was required to report her income and did not receive a form on which to report her income until 1982. The ALJ also determined that Jefferson’s income did not affect her entitlement to a benefit award until after her husband’s death.

In 1982, the SSA wrote to Jefferson informing her that, in light of her earnings, she had been overpaid benefits after 1978, but that she would continue to receive some benefits in her name for the use of her minor child. The SSA subsequently notified her that she had been overpaid a total of $5,851.80 for the years 1978-1982. Jefferson does not contest this amount. Instead she argued unsuccessfully before the ALJ and in the district court that overpayment should be waived because she was not at fault.

II. ANALYSIS

The SSA may waive the repayment of funds it has incorrectly paid out if (a) the recipient was without fault and (b) repayment would either defeat the purpose of the Social Security Act or offend equity and good conscience. 42 U.S.C. § 404(b); 20 C.F.R. § 404.506.

*633 The determination of when a recipient is without fault is based on subjective criteria including the recipient’s age, intelligence, education, and physical and mental condition. 20 C.F.R. § 404.507. “[T]he decision which must be reached in a fault determination is highly subjective, highly dependent on the interaction between the intentions and state of mind of the claimant and the peculiar circumstances of his situation.” Harrison v. Heckler, 746 F.2d 480, 482 (9th Cir.1984); see Rini v. Harris, 615 F.2d 625, 627 (5th Cir.1980) (claimant’s health, status as high school dropout and his reliance on SSA officials were circumstances that showed claimant was without fault). 2

The ALJ held that Jefferson “failed to exercise the high standard of care required of benefit recipients in reporting pertinent information, and that she should have known that the level of her earnings was material to the amount of benefits she was receiving.” 3 It thus appears that the ALJ erroneously held Jefferson to an objective standard rather than considering the subjective reasonableness of her actions. Reviewing Jefferson’s actions in light of the subjective standard mandated by 20 C.F.R. § 404.507, we conclude that Jefferson was without fault. As in Rini, Jefferson had a limited education. The Rini plaintiff was a high school dropout, whereas Jefferson completed only the fourth grade and possessed minimal literacy. Mrs. Jefferson’s testimony indicated that while she could read birthday and Christmas cards, she would have difficulty reading Social Security forms. Moreover, as in Rini, Jefferson relied in good faith on the SSA’s expertise. See Rini, 615 F.2d at 627 (claimant who assumed, perhaps erroneously, that SSA “must know what they are doing” was without fault).

Jefferson’s case is also similar to Viehman v. Schweiker, 679 F.2d 223 (11th Cir.1982). There, this court concluded that a claimant’s oral notification of a change of status coupled with SSA assurances that no further notification was necessary can establish that the claimant was without fault. Jefferson’s case is more compelling than Viehman. Unlike Viehman, which was remanded to determine the claimant’s credibility regarding his conversations with the SSA, the ALJ in the present case explicitly determined that Jefferson’s testimony was credible and truthful and that she had not knowingly withheld information.

The government attempts to distinguish Viehman by noting that, according to Jefferson, the SSA never told her she did not have to file an annual income report. The magistrate’s recommended decision followed this reasoning and found that Jefferson did not testify that the SSA told her she was “relieved of her responsibility to report annual income.” The government’s reading of Viehman would suggest that a recipient must show that he was affirmatively misled by the SSA in order to meet the “without fault” standard. We conclude that the government’s gloss is an overly narrow view of Viehman. Viehman

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794 F.2d 631, 1986 U.S. App. LEXIS 27477, 14 Soc. Serv. Rev. 129, Counsel Stack Legal Research, https://law.counselstack.com/opinion/lois-jefferson-plaintiff-appellant-v-otis-r-bowen-secretary-of-health-ca11-1986.