Violette v. Department of Healthcare & Family Services

904 N.E.2d 1229, 388 Ill. App. 3d 1108
CourtAppellate Court of Illinois
DecidedMarch 27, 2009
Docket5-07-0595
StatusPublished
Cited by7 cases

This text of 904 N.E.2d 1229 (Violette v. Department of Healthcare & Family Services) is published on Counsel Stack Legal Research, covering Appellate Court of Illinois primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Violette v. Department of Healthcare & Family Services, 904 N.E.2d 1229, 388 Ill. App. 3d 1108 (Ill. Ct. App. 2009).

Opinion

JUSTICE WELCH

delivered the opinion of the court:

Dwight Violette (the appellant) brought an action in the circuit court of Williamson County pursuant to the Administrative Review Law (735 ILCS 5/3 — 101 et seq. (West 2006)), to obtain the review of a decision of the Department of Healthcare and Family Services (the Department), which had denied him benefits under the Health Benefits for Workers with Disabilities program. The circuit court affirmed the decision of the Department in an order entered September 28, 2007, and the appellant brings this appeal. For reasons that follow, we reverse the order of the circuit court, vacate the decision of the Department, and remand this cause to that agency for further proceedings.

The Health Benefits for Workers with Disabilities program (the Program) was implemented by the Department in January 2002 to help persons with disabilities who wish to go to work, or to increase their earnings, to do so without fear of losing their medical assistance benefits. The Department administers the Program pursuant to article V of the Illinois Public Aid Code (305 ILCS 5/5 — 1 et seq. (West 2006)), and the Program was established in section 120.510 of Title 89 of the Illinois Administrative Code (89 Ill. Adm. Code §120.510, added at 25 Ill. Reg. 16098, eff. December 1, 2001). In order to be eligible for benefits under the Program, a person must meet the definition of “disabled” used by the Social Security Administration under the Social Security Supplemental Security Income program. 305 ILCS 5/6— 11(c)(2)(A) (West 2006); 89 Ill. Adm. Code §120.314, amended at 22 Ill. Reg. 19875, eff. October 30, 1998. Under the Social Security Supplemental Security Income program, “disability” is defined as follows:

“(a) The law defines [‘]disability[’] as the inability to do any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months. To meet this definition, you must have a severe impairment(s) that makes you unable to do your past relevant work (see §416.960(b)) or any other substantial gainful work that exists in the national economy. *** If we find that you cannot do your past relevant work, we will use [your] residual functional capacity assessment and your vocational factors of age, education, and work experience to determine if you can do other work.” 20 C.F.R. §416.905(a) (2005).

However, according to the Department’s policy memorandum, for purposes of determining eligibility for benefits under the Program, “a person’s earnings (substantial gainful activity) will not be considered in the determination of disability status.”

The initial determination regarding whether a person is disabled is made by the client assessment unit, which reviews all the medical evidence the client submits in support of his application. An applicant has the right to appeal the initial decision of the client assessment unit and submit additional medical evidence in support of his application. A new determination is then made, and if the application is again denied, the applicant is entitled to a hearing before a neutral hearing officer.

The appellant applied for benefits under the Program on February 2, 2006, but was denied as being not disabled. He appealed arid Submitted additional medical evidence but was denied again on August 28, 2006. The appellant again submitted additional medical evidence but was again denied as not meeting the definition of “disabled.” Finally, on February 2, 2007, a hearing was held on the appellant’s appeal, and the appellant testified on his own behalf. The following evidence was presented in support of his application for benefits.

The appellant was born in 1950, and at the time of his appeal he was a 57-year-old man with an eleventh-grade education and a GED. He had been incarcerated in the Illinois Department of Corrections from 1977 to 2004. He was working at least 40 hours per week installing countertops. The appellant suffers from several medical conditions. In 1988 he was first diagnosed with aortic stenosis, a heart condition. In 1998, he had a pacemaker implanted, but he continued to have medical problems with his heart over the years. He experienced light-headedness, dizziness, fatigue, shortness of breath, heart palpitations, and chest pain on exertion.

In 2003, the appellant underwent an aortic valve replacement and pleural effusion. He continued to experience difficulties related to his heart condition. In 2003, he experienced atrial flutter and underwent a pericardectomy and left thoracotomy. He takes Coumadin to prevent blood clots and must have his blood tested monthly to regulate the dosage. He continues to experience problems related to his heart condition.

The appellant also suffers from hepatitis C, a chronic, incurable condition. Although he is in need of medical treatment, including a liver biopsy, he is not able to afford the tests or treatment.

In June 2005, the appellant suffered an injury to his left leg as a result of a wall falling on him at work. The wound became infected, requiring hospitalization and a period of missed work, but it eventually healed.

At the hearing on his appeal, the appellant testified almost exclusively regarding the problems he suffers as a result of his heart condition and his hepatitis C.

On or about February 16, 2007, the Department issued its final administrative decision, which adopted the findings of fact of the hearing officer and affirmed the Department’s denial of benefits to the appellant. The hearing officer’s “findings of fact” consist exclusively of photocopies of medical evaluation decisions completed by the client assessment unit. The first decision, completed on or about March 6, 2006, indicates that the appellant’s primary diagnosis was a hematoma wound to the left leg and that his secondary diagnosis was arthritis in the knee and hepatitis. The decision briefly noted the appellant’s history of heart disease, as well as other medical history, and concluded that the appellant had not demonstrated that he had a condition that precluded his past activities and that he was therefore not disabled.

After the submission of additional medical evidence by the appellant, the client assessment unit issued a second decision, in which it found that the appellant’s primary diagnosis was an infected hematoma wound of the left leg, minimal-to-moderate osteoarthritis of the left knee, and back pain and that his secondary diagnosis was aortic valve replacement and pacemaker placement, hematoma, and hepatitis C. This determination seemed to focus on the injury to the appellant’s left leg and concluded that, although his condition had caused some restrictions in his ability to function, he had the ability to return to past relevant activities and was therefore not disabled.

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Bluebook (online)
904 N.E.2d 1229, 388 Ill. App. 3d 1108, Counsel Stack Legal Research, https://law.counselstack.com/opinion/violette-v-department-of-healthcare-family-services-illappct-2009.