López-Dávila v. Acting Commissioner of Social Security

39 F. Supp. 3d 184, 2014 WL 3546852
CourtDistrict Court, D. Puerto Rico
DecidedJuly 16, 2014
DocketCivil No. 13-1836 (BJM)
StatusPublished

This text of 39 F. Supp. 3d 184 (López-Dávila v. Acting Commissioner of Social Security) is published on Counsel Stack Legal Research, covering District Court, D. Puerto Rico primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
López-Dávila v. Acting Commissioner of Social Security, 39 F. Supp. 3d 184, 2014 WL 3546852 (prd 2014).

Opinion

OPINION AND ORDER

BRUCE J. McGIVERIN, United States Magistrate Judge.

Plaintiff José R. López-Dávila filed a complaint against the Acting Commissioner of Social Security (“Commissioner”), alleging that the Commissioner’s disability decision was not supported by substantial evidence. Docket No. 2 (“Compl.”). Plaintiff demanded judicial review of the decision so that disability insurance benefits may be allowed and paid, or in the alternative that the court remand the case for a hearing. Id. at 2. The parties have consented to proceed before a magistrate judge. Docket No. 9. The Commissioner filed a motion to dismiss for lack of subject matter jurisdiction (Docket No. 11), a memorandum in support of the motion to dismiss (Docket No. 12) (“Mot.”), and a declaration from Paul Halse, Acting Chief of Court Case Preparation and Review Branch 2 of the Office of Disability Adjudication and Review (Docket No. 15) (“Deck”). Plaintiff responded in opposition. Docket No. 13 (“Opp’n”).

For the reasons set forth below, the motion to dismiss is GRANTED.

STANDARD OF REVIEW

Federal Rule of Civil Procedure 12(b)(1) is a “large umbrella, overspreading a variety of different types of challenges to subject-matter jurisdiction,” Valentin v. Hosp. Bella Vista, 254 F.3d 358, 362-63 (1st Cir.2001), including the availability of federal judicial review of agency action. See Califano v. Sanders, 430 U.S. 99, 107, 97 S.Ct. 980, 51 L.Ed.2d 192 (1977). When deciding a motion to dismiss under Rule 12(b)(1), a court must accept as true all well-pleaded factual claims, and indulge all reasonable inferences in the non-movant’s favor. McCloskey v. Mueller, 446 F.3d 262, 266 (1st Cir.2006). The court may also “consider whatever evidence has been submitted,” including exhibits, without converting the Rule 12(b)(1) motion into a motion for summary judgment. See Aversa v. United States, 99 F.3d 1200, 1210 (1st Cir.1996). Once contested, the burden ultimately is on the plaintiff to prove the existence of subject matter jurisdiction. See Murphy v. United States, 45 F.3d 520, 522 (1st Cir.1995). Under Rule 12(b)(1), “dismissal would be proper if the facts alleged reveal a jurisdic[186]*186tional defect not otherwise remediable.” Dennehy v. Frambes, 385 F.Supp.2d 121, 123 (D.P.R.2005).

FACTUAL AND PROCEDURAL BACKGROUND

On November 8, 2006, plaintiff filed a claim for disability insurance benefits (Decl. at 11), which was denied both initially and upon reconsideration. Decl. at 3, 11. An administrative hearing was held, after which it was decided, on May 15, 2009, that plaintiff was not disabled through December 31, 2005, when his insurance status expired. Id. at 3, 11-18. On June 17, 2011, the Appeals Council denied plaintiffs request for review, rendering the May 15, 2009 decision the final decision of the Commissioner. Id. at 3, 19. Plaintiff did not appeal the ALJ’s decision to the district court. Id. at 3.

On July 13, 2011, plaintiff again applied for disability benefits, and the claim was denied both initially and upon reconsideration. Id. at 3-4, 29. Plaintiff requested an administrative hearing (Decl. at 4), which was reportedly held on January 10, 2013, and where plaintiff and a vocational expert testified about plaintiffs impairments.1 Opp’n at 3'. The ALJ then issued an order on January 15, 2013, dismissing the hearing request on res judicata grounds.2 Id. at 4, 23-32. The ALJ concluded that the 2011 claim was an “implied request for reopening and revision of the first application dated November 8, 2006,” and said he could not reopen the final determination on the 2006 application. Id. at 29-30. The ALJ found no new and material evidence that warranted reopening the prior claim. Id. at 31 (citing 20 C.F.R. §§ 404.988). On October 9, 2013, the Appeals Council denied plaintiffs request for review of the ALJ’s dismissal. Id. at 4, 33.

DISCUSSION

• The Commissioner seeks to dismiss the instant case for lack of subject matter jurisdiction, arguing that the ALJ’s refusal to reopen plaintiffs prior claim was not a “final decision” subject to judicial review. Plaintiff claims that the court does have subject matter jurisdiction over the case pursuant to 42 U.S.C. § 405(g). Plaintiffs main argument is that estoppel should apply, barring the ALJ from rejecting the second claim after holding a hearing on it. Opp’n at 1-4. He claims this hearing gave the impression that he would receive a “hearing decision.” Id. at 3.

I. Subject Matter Jurisdiction over Agency Action

Judicial review of social security disability decisions by the Commissioner is governed by § 405(g). The section provides that “[a]ny individual, after any final decision of the Commissioner of Social Security made after a hearing to which he was a party ... may obtain a review of such [187]*187decision by a civil action commenced within sixty days after the mailing to him of notice of such decision or within such further time as the Commissioner of Social Security may allow.” § 405(g). A “final decision” generally refers to the initial substantive decision on the disability benefits claim. See Doe v. Sec. of Health & Human Servs., 744 F.2d 3, 4 (1st Cir.1984).

Decisions not to reopen earlier determinations are not considered “final” under § 405(g). See Matos v. Sec. of Health, Ed. & Welfare, 581 F.2d 282, 285 (1st Cir.1978) (citing Califano, 430 U.S. at 107-08, 97 S.Ct. 980). A decision rejecting a request to reopen an earlier claim, while noting that additional evidence did not change the original decision, is therefore not subject to judicial review. Id. Courts do not have jurisdiction to examine a claim that was denied due to res judicata. Id. at 286. Allowing judicial review simply by filing and being denied a petition to reopen a claim would frustrate the congressional purpose in § 405(g) to impose a time limitation upon judicial review of the final decision in an initial claim for benefits. See Sanders, 430 U.S. at 108, 97 S.Ct. 980 (citing 20 C.F.R. § 404.951). The court also does not have jurisdiction to review whether additional medical reports are new or material, such that they could warrant reopening of a claim under 20 C.F.R. § 404.989. See Dvareckas v. Sec.

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Related

Califano v. Sanders
430 U.S. 99 (Supreme Court, 1977)
Murphy v. United States
45 F.3d 520 (First Circuit, 1995)
Aversa v. United States
99 F.3d 1200 (First Circuit, 1996)
Dantran, Inc. v. U.S. Department of Labor
171 F.3d 58 (First Circuit, 1999)
Christopher v. Stanley-Bostitch, Inc.
240 F.3d 95 (First Circuit, 2001)
Valentin-De-Jesus v. United Healthcare
254 F.3d 358 (First Circuit, 2001)
McCloskey v. Mueller
446 F.3d 262 (First Circuit, 2006)
Girard v. Chater
918 F. Supp. 42 (D. Rhode Island, 1996)
Dennehy v. Frambes
385 F. Supp. 2d 121 (D. Puerto Rico, 2005)

Cite This Page — Counsel Stack

Bluebook (online)
39 F. Supp. 3d 184, 2014 WL 3546852, Counsel Stack Legal Research, https://law.counselstack.com/opinion/lopez-davila-v-acting-commissioner-of-social-security-prd-2014.