Pasquale v. Cohen

296 F. Supp. 1088, 1969 U.S. Dist. LEXIS 10482
CourtDistrict Court, D. Rhode Island
DecidedMarch 5, 1969
DocketCiv. A. No. 3934
StatusPublished
Cited by7 cases

This text of 296 F. Supp. 1088 (Pasquale v. Cohen) is published on Counsel Stack Legal Research, covering District Court, D. Rhode Island primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Pasquale v. Cohen, 296 F. Supp. 1088, 1969 U.S. Dist. LEXIS 10482 (D.R.I. 1969).

Opinion

OPINION

PETTINE, District Judge.

This is an action under section 205(g) of the Social Security Act, as amended, [1090]*109042 U.S.C. § 405(g), to review a decision of the Secretary of Health, Education and Welfare so far as that decision refused to reopen a previous final decision of the Administration on a prior application for disability benefits filed by the plaintiff on August 29, 1961.1

The defendant has filed a motion for summary judgment pursuant to Rule 56 Fed.R.Civ.P. contending there is no genuine issue as to any material fact and that he is entitled to judgment as a matter of law. The Government also seeks dismissal under 12(b) Fed.R.Civ.P. on the ground the plaintiff has failed to state a claim upon which relief can be granted. In so far as the record, including the transcript from the Social Security Administration, is complete, I will treat this case as one submitted to the court for summary judgment by both parties.

The court’s jurisdiction is founded in the Act which provides, inter alia, that “the court shall have power to enter, upon the pleadings and transcript of the record, a judgment affirming, modifying or reversing the decision of the Secretary, with or without remanding the cause for a hearing” and “the findings of the Secretary as to any fact, if supported by substantial evidence, shall be conclusive.” Section 205(h) of the Act (42 U.S.C.A. § 405(h)) expressly restricts the judicial remedy to the aforesaid manner of judicial review and contains a prohibition against an action under the general jurisdiction of the Federal District Courts for a money judgment.

Statement of Facts

On August 29, 1961, the plaintiff applied for the establishment of a period of disability and the payment of disability insurance benefits alleging that he had become disabled on October 20, 1959. On January 10, 1962, this application was initially denied. Thereafter the plaintiff further pursued his administrative remedies and on January 10, 1963 obtained a decision from a hearing examiner that he had failed to establish his entitlement to either a period of disability or to the [1091]*1091payment of disability insurance benefits. On July 5, 1963, the Appeals Council denied the plaintiff’s request for review and at that time he was notified that if he desired a judicial review of that decision, he would have to commence an action in the United States District Court within 60 days from the date of the notice of denial. No further action was taken by the plaintiff on this application.

On February 10, 1966, the plaintiff again applied for a period of disability and for the payment of disability insurance benefits. Following a series of progressive administrative appeals, a hearing examiner, on May 3, 1967 held that the plaintiff was entitled to a period of disability commencing on November SO, 1961 but to disability insurance benefits only on the basis of his application of February 10, 1966. The hearing examiner further held that the decision on the plaintiff’s application of August 29, 1961 could not be reopened. On July 25, 1967, a request for review of this finding was denied by the Appeals. Council.

From the express provisions of the Social Security Act, the plaintiff cannot be entitled, on the basis of his February 10, 1966 application, to the payment of disability benefits for any month prior to February 1965; any such entitlement must be on the basis of the August 29, 1961 application.

The Government’s position is that the final decision on the 1961 application was rendered on July 5, 1963 and since the plaintiff did not commence an action for its judicial review within the 60-day period provided by Section 205 of the Act, it is not reviewable by this court. It argues that the only way for the plaintiff to be entitled to benefits on the basis of the August 29, 1961 application is for that application to have been able to be reopened by the Administration. However, this cannot be done because the initial determination was made January 10, 1962 and the plaintiff did not reapply for benefits until February 10, 1966 which is a full month more than four years after the date of the initial determination.2

The defendant points out that the regulation at 20 C.F.R. 404.957 specifically limits the time in which a decision on an application may be reopened for good cause to four years after the date of the notice of the initial determination. Hence, even if there was “good cause” for the reopening of the final decision, the time limit for doing so had expired.

Conclusions of Law

Certain limiting features of the Social Security Act must be noted:

a) The right to judicial review is limited to final decisions, and

b) must be commenced within sixty days after the mailing of notice of the final decision of the Secretary or within such further time as the Secretary may allow. The Act does not afford any right of judicial review or administrative reopening to an individual who has failed to exhaust his administrative remedies or has failed to commence an action for judicial review within the time limitation set forth in section 205(g) of the Act.

c) The Secretary, who is empowered to make rules and regulations (42 U.S.C.A. § 405(a)), promulgated 20 C.F.R. 404.957 which provides that a decision which is otherwise final may be reopened within four years after the date of the [1092]*1092notice of the “initial determination” upon a finding of “good cause.”

In other words, finality of decision through lapse of time is no bar to a reopening of the same if done within four years of “initial determination” upon showing of good cause.

The Government argues that there are four categories of determinations and decisions under the Act. These are (1) “initial determination”; (2) “reconsidered determination”; (3) decision of a hearing examiner; and (4) decision of the Appeals Council. Each constitutes a definite administrative step in the progression towards a final decision; that when the regulation refers to “initial determination” it does not mean any of the others. It must be given its normal meaning of the “first determination” in a series of determinations; and that in this instance the “first determination” on the plaintiff’s application of August 29, 1961 was made on January 10, 1962.

“Initial Determination”

The interpretation of this specific provision must be found in a reading of the Act and regulations as a whole. Congress intended a sensible non-technical approach in order to afford equitable treatment to those seeking coverage.

“The Social Security Act should be liberally construed in favor of those seeking its benefits. (Citations omitted) The legislation had its origin in the observed frequency of the tragic sequence of old age, disability, loss of earning power, destitution and dependency on public or private charity, but coverage has not been limited to cases actually presenting all these features in full scope.

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Cite This Page — Counsel Stack

Bluebook (online)
296 F. Supp. 1088, 1969 U.S. Dist. LEXIS 10482, Counsel Stack Legal Research, https://law.counselstack.com/opinion/pasquale-v-cohen-rid-1969.