T. MICHAEL PUTNAM, UNITED STATES MAGISTRATE JUDGE.
The plaintiff, Shaula Lanear Allen, individually and as representative payee and on behalf of J.L.,
When J.L. was an infant, a pharmacy filled a prescription for him, but labeled the prescribed medication with an incorrect dosage instruction. (Tr. at 209-10). Consequently, J.L. ingested four times the necessary dosage, suffered an injury, and required emergency medical care. (Tr. at 210). In 2000, Allen brought a lawsuit on behalf of J.L. in the Chancery Court of Lowndes County, Mississippi ("the chancery court"), and she settled his claim for $20,000 in 2002. (Tr. at 209-211) (engagement letter dated 2000). Pursuant to the court order approving the settlement, after deduction attorney's fees and costs, Allen paid $13,062.73 into "an F.D.I.C. insured account." Allen apparently opened a certificate of deposit with Cadence Bank ("the account") and deposited the settlement proceeds. (See Tr. at 78-85, 212-13).
Initially, the court order directed Allen to retain the settlement proceeds in the account "for the maintenance and education of the minor child" and prohibited Allen from withdrawing any of the proceeds
Allen petitioned the court once again to withdraw proceeds from the account in 2010. (Tr. at 282, 334, 426-27, 435). The chancery court denied her request to purchase a computer for J.L.'s educational needs. (Tr. at 282, 334, 426-27, 435). The chancery court explained to Allen's attorney that it was Allen's responsibility "to take care of [J.L.]" with her own resources, not with the settlement proceeds. (Tr. at 426-27). The court intended the funds in the account to be preserved for payment to J.L. upon his becoming an adult.
From July 2007 to September 2008, Allen was deployed to Iraq, during which time she relinquished her role as J.L.'s representative payee to her mother (J.L.'s grandmother). She was not in control of the account during that time.
Allen, on behalf of J.L., initially applied for SSI benefits on November 10, 2004. (Tr. at 126). Subsequently, on February 28, 2007, an ALJ awarded SSI benefits to J.L. (Tr. at 379). Allen served as J.L.'s representative payee, except for the period of time between July 3, 2007 and September 15, 2008, when Allen was deployed to Iraq. (Tr. at 304, 415). J.L.'s grandmother served as representative payee during the period that Allen served overseas. (Tr. at 304, 415). Once she returned from Iraq and resumed her role as representative payee, the Commissioner began a redetermination of J.L.'s eligibility for SSI benefits. (Tr. at 29). During this time, Allen first reported to the Commissioner the existence of the account. (Tr. at 34).
On December 9, 2009, the Commissioner informed Allen that J.L.'s payments would stop in January 2010. (Tr. at 40). The Commissioner determined that J.L. should have received no SSI benefits from May 1, 2009 forward because he had resources greater than $2,000 in November 2009 and because Allen's income was greater than the amount of SSI benefits available to J.L. during the period from May 2009 through October 2009 and from December 2009 forward. (Tr. at 40-41, 51-60). The Commissioner determined that J.L. received an overpayment of $5,722.81 for the period from December 2008 to December 2009. (Tr. at 61).
On February 23, 2010, the Commissioner further determined that J.L. impermissibly received SSI benefits for a greater period of time, specifically from December 2007 to December 2009. (Tr. at 71). According to the Commissioner, J.L.'s SSI benefits from December 2007 to April 2009 should have equaled $0.00 because J.L.'s resources exceeded $2,000 based on the settlement proceeds deposited into the account. (Tr. at 78-85). On April 2, 2010, the
At some point, Allen requested the Commissioner to waive the overpayment, and when the Commissioner denied the waiver request, Allen requested the Commissioner to reconsider the waiver request.
Allen twice appeared before an ALJ, once on April 25, 2011 (tr. at 327), and again on September 19, 2011 (tr. at 340). Subsequently, on October 13, 2011, the ALJ notified Allen of his unfavorable decision (tr. at 160), concluding that: (1) J.L. received an overpayment in the amount of $15,105; (2) Allen was at fault; and (3) Allen was not entitled to a waiver (tr. at 165-66). In effect, both Allen and J.L. were liable for repayment. On November 29, 2011, the Commissioner mailed Allen a new billing statement which reflected $15,105 as the total amount due. (Tr. at 290). Allen requested the Appeals Council to review the Hearing Decision on November 30, 2011, asserting that the unfavorable decision "does not agree with the CD transcript of the hearing in which the judge ruled differently." (Tr. at 167). Allen was referring to the hearing held on April 25, 2011, during which the ALJ stated on the record that the account was not a countable resource. (Tr. at 333) (stating "because it's frozen, apparently, it doesn't count as a resource.... Somebody counted it as a resource, and ... I don't really know [why] because the decree is pretty clear on that.").
On August 28, 2018, the Appeals Council vacated the October 13, 2011, hearing decision and remanded the case back to the ALJ "for further proceedings." (Tr. at 186, 188).
This Court's role in reviewing claims brought under the Social Security Act is a narrow one. The scope of its review is limited to determining (1) whether there is substantial evidence in the record as a whole to support the findings of the Commissioner, and (2) whether the correct legal standards were applied. See Richardson v. Perales, 402 U.S. 389, 390, 401, 91 S.Ct. 1420, 28 L.Ed.2d 842 (1971); Wilson v. Barnhart, 284 F.3d 1219, 1221 (11th Cir. 2002).
The Court approaches the factual findings of the Commissioner with deference, but applies close scrutiny to the legal conclusions. See Miles v. Chater, 84 F.3d 1397, 1400 (11th Cir. 1996). "Substantial evidence is more than a scintilla and is such relevant evidence as a reasonable person would accept as adequate to support a conclusion." Mitchell v. Commissioner, Soc. Sec. Admin., 771 F.3d 780, 782 (11th Cir. 2014). The Court may not decide facts, weigh evidence, or substitute its judgment for that of the Commissioner. Id. "The substantial evidence standard permits administrative decision makers to act with considerable latitude, and `the possibility of drawing two inconsistent conclusions from the evidence does not prevent an administrative agency's finding from being supported by substantial evidence.'" Parker v. Bowen, 793 F.2d 1177, 1181 (11th Cir. 1986) (Gibson, J., dissenting) (quoting Consolo v. Federal Mar. Comm'n, 383 U.S. 607, 620, 86 S.Ct. 1018, 16 L.Ed.2d 131 (1966)). Indeed, even if this Court finds that the evidence preponderates against the Commissioner's decision, the Court must affirm if the decision is supported by substantial evidence. Miles, 84 F.3d at 1400. "Speculation is, of course,
Allen argues that substantial evidence does not support the ALJ's determination that J.L.'s settlement-proceeds account was an available resource and, therefore, that an overpayment occurred because J.L.'s resources exceeded the $2,000 limit. The Commissioner contends that Allen failed to exhaust administrative remedies by not obtaining a final decision as to the fact and amount of the overpayment. Even if Allen exhausted her administrative remedies as to the overpayment issue, the Commissioner asserts that substantial evidence supports the ALJ's determination that an overpayment occurred due to the existence of the account. Furthermore, the Commissioner maintains that substantial evidence supports the ALJ's determination that (1) J.L. was without fault; (2) the denial of a waiver does not defeat the purposes or impede the efficient or effective administration of Title XVI of the Social Security Act; (3) the denial of a waiver for J.L. is not against equity and good conscience; and (4) Allen was with fault. The court finds that substantial evidence does not support the ALJ's determination that an overpayment occurred, and because of this fact, the court does not reach the merits of whether substantial evidence supports the ALJ's denials of a waiver for both Allen and J.L.
Despite the Commissioner's argument to the contrary, Allen has exhausted the administrative procedures related to the overpayment issue. This court may review only the final decisions of the Commissioner. See 42 U.S.C. § 405(g). To obtain a final decision, the claimant must undertake a four-step administrative review process. See 20 C.F.R. § 416.1400(a). First, the Commissioner must make an initial determination affecting the rights of the claimant. 20 C.F.R. §§ 416.1400(a)(1); 416.1402 (listing actions that are initial determinations). If the claimant is dissatisfied with the Commissioner's initial determination, the claimant may request the Commissioner to reconsider the initial determination. 20 C.F.R. §§ 416.1400(a)(2); 416.1407. If the request for reconsideration is denied and the claimant is still dissatisfied, the claimant may request a hearing before an ALJ. 20 C.F.R. §§ 416.1400(a)(3); 416.1429. If the claimant is dissatisfied with the ALJ's hearing decision, the claimant may request the Appeals Council to review the hearing decision. 20 C.F.R. §§ 416.1400(a)(4); 416.1467. At this point, the decision of the Appeals Council becomes a final decision when the Appeals Council either denies review or enters a decision. 20 C.F.R. §§ 416.1400(a)(5); 416.1481.
The Commissioner concedes that Allen has obtained a final decision as to the waiver issue, but the Commissioner asserts that Allen has not obtained a final decision as to the fact and amount of alleged overpayment.
Admittedly at this point, tracking the overpayment issue becomes difficult because of the subsequent administrative proceedings, but the Court believes that Allen did not fail to exhaust the overpayment issue. The ALJ made an unfavorable decision on October 13, 2011, finding an overpayment in the amount of $15,105. (Tr. at 165). Allen requested the Appeals Council to review the ALJ's decision, arguing that decision did "not agree with the CD transcript of the hearing in which the judge ruled differently." (Tr. at 167). During a previous hearing, the ALJ stated that the account should not have counted as a resource. (Tr. at 333). The Appeals Council reviewed the ALJ's decision and vacated the decision in its entirety. (Tr. at 186). On remand, a new ALJ issued a hearing decision on February 26, 2015, finding that the account was a countable resource and that an overpayment occurred. (Tr. at 21-23). Then the ALJ determined that Allen and J.L. were not entitled to waivers of the overpayment. (Tr. at 23-26). Allen requested review of February 26, 2015, hearing decision, and the Appeals Council denied review on March 17, 2017, resulting in a final decision. (Tr. at 5).
The Commissioner makes much of the ALJ's framing of the issue on remand. However, it seems clear that when the Appeals Council vacated the earlier ALJ's decision, the entire matter, not just the waiver, was put before the second ALJ. On remand, the ALJ discussed extensively whether the account counted as a resource. The Court finds that the ALJ made a finding as to the fact and amount of overpayment in response to Allen's original request for reconsideration. Furthermore, even though the Appeals Council's instructions to the ALJ on remand were limited to the waiver issue, Allen adequately raised the overpayment issue when she requested the Appeals Council to review the October 13, 2011, hearing decision. Therefore, Allen received a final decision either when the Appeals Council failed to additionally instruct the ALJ to consider the overpayment issue on remand (indicating that the Appeals Council denied review of the overpayment issue) or when the Appeals Council denied review of the February 26, 2015, hearing decision which extensively discussed the existence of the account. In either circumstance, Allen obtained a final decision as to the overpayment issue.
The Commissioner and the ALJ determined that J.L.'s bank account was a resource. An individual may not receive SSI benefits if the individual's resources exceed $2,000. 42 U.S.C. § 1382(a)(3)(B). Resources include "cash or other liquid assets or any real or personal property that individual (or spouse, if any) owns and could convert to cash to be used for his or her support and maintenance." 20 C.F.R. § 416.1201(a); see also § 416.1208(a). As defined by regulation, "[l]iquid resources are cash or other property which can be converted to cash within 20 days ... [such as] stocks, bonds, mutual fund shares, promissory notes, mortgages, life insurance policies, [and] financial institution accounts (including savings, checking, and
Under the Social Security Administration's Program Operations Manual System ("POMS"), a conservatorship account may count as a resource in determining eligibility for SSI benefits. A "`conservatorship account' refers to a financial account in which a person or institution has been appointed by a court to manage and preserve the assets of an individual which are held in the account." POMS SI 01140.215(A)(1).
POMS SI 01140.215(B)(1) (italics added for emphasis). "Evidence to the contrary" includes, but is not limited to: "restrictive language in the court order that established the account or in a subsequent court order; state or local procedural rules for the withdrawal of funds from the account; and local court practices regarding withdrawal of funds." POMS SI 01140.215(B)(2). However, "the fact that an individual or his or her agent must petition the court for withdrawal of funds does
Admittedly, there is no binding authority and "a dearth of [persuasive] case law" to help determine when funds in a conservatorship account should be counted as a resource. See White ex rel. Smith v. Apfel, 167 F.3d 369, 374 (7th Cir. 1999). In White, a Missouri minor qualified for SSI benefits in 1990 based on injuries sustained in a car accident. The minor's mother brought a personal injury lawsuit on his behalf and secured a settlement in December 1991. The settlement proceeds were "placed in a restricted trust pursuant to a court order." White, 167 F.3d at 370. The probate court "stressed to [the mother] that she remained primarily responsible for [the minor's] needs, ... that the trust was to remain untouched until [the minor] reached the age of eighteen[, and] ... that court approval was required before she did anything with money...." Id. Subsequently, in 1995, the mother and minor moved to Illinois. After the mother completed the
The Seventh Circuit Court of Appeals reversed, holding that the mother presented sufficient evidence "contradicting the presumption [under Missouri law] that the funds in the conservatorship account [were] available for [the minor's] care." Id. at 375. "Once [the mother] rebutted the presumption ... the onus was on the SSA to show that she still had access to the funds." Id. at 376. The Commissioner "failed to adequately counter" the mother's rebuttal of the presumption. Id. The court reasoned that the Commissioner's argument rested on speculation: "the probate court might have ruled differently had [the mother] informed the court of the termination of SSI benefits." Id. at 375. The probate court's decision to deny the request was within in its sound discretion, and a reviewing court "would have been obliged to affirm." Id. After the probate court denied her request, she "no longer had the right, power or authority to liquidate the funds for [the minor's] care and maintenance." Id.
In Shields v. Comm'r of Soc. Sec., No. 2:14-cv-226, 2015 WL 9238990 (W.D. Mich. Dec. 17, 2015), a minor sustained injuries during a car accident in 1998, resulting in her disability. As the result of a lawsuit, the minor received a settlement in 2000, with the proceeds deposited into a conservatorship account that could not be accessed by the minor without court approval until she turned eighteen. The minor began receiving SSI benefits approximately 1.5 years after the settlement was approved. However, in 2012, the Commissioner terminated the minor's SSI benefits because of the account and determined that an overpayment of $17,858.96 occurred.
Over the course of several years, the minor's conservator received court-approved access to the account on multiple occasions to purchase items for the minor. When the minor's home burned in 2003, the minor's conservator petitioned the court for access to the account to purchase the minor new clothes, which the court granted. In 2005, the court likewise granted the conservator's petition to buy the minor additional new clothes after she outgrew the previous clothes. Subsequently, the court approved access for the conservator to purchase the minor a computer and a replacement computer. Finally, the court granted access to the conservator to pay for the minor's driver's education class.
The United States District Court for the Western District of Michigan reversed the decision and remanded the case for further proceedings. Shields, 2015 WL 9238990, at *4. The plaintiff argued that, because "the funds in her conservatorship account were not used for her support and maintenance,... the account was an excludable resource." Id. at *2. The court held that the "question of whether the conservatorship account could be (or was) used for [the
Conversely, in Frerks by Frerks v. Shalala, 848 F.Supp. 340 (E.D.N.Y. 1994), the minor began receiving SSI benefits in June 1988 because of his mental handicap. Furthermore, his parents, serving as his guardians, could not "dispose of their son's property `without' further order' of the Surrogate's Court." Frerks, 848 F.Supp. at 345. Subsequently, the minor received a settlement in September 1988. His parents deposited the settlement proceeds into four accounts, and the Surrogate's Court explained to Secretary of Health and Human Services ("HHS Secretary") that
Frerks, 848 F.Supp. at 345. The parents began to withdraw $700 per month from the settlement proceeds with court approval in July 1990. The HHS Secretary terminated the minor's SSI benefits in March 1990 "because of excess resources[,]" with the termination retroactive to September 1988. Id. The ALJ found that the settlement proceeds were available as a resource, but did not order repayment of the overpayment.
The United States District Court for the Eastern District of New York affirmed, holding that substantial evidence supported the ALJ's decision because "the Surrogate has allowed disbursements of $700 per month ... to be applied towards Frerks' support and education." Frerks, 848 F.Supp. at 349. The court reasoned that, "when determining an individual's SSI eligibility, any assets and other funds readily available to that person for support and maintenance should be applied towards those purposes before the state must intervene to provide minimal financial support to that person." Id. The court also found that the HHS Secretary and the ALJ applied the correct legal standards. Finally, the court distinguished Navarro by Navarro v. Sullivan, 751 F.Supp. 349 (E.D.N.Y. 1990). According to the court in Frerks, the court in Navarro found that the settlement proceeds deposited into an account did not count as a resource "because the specific language of the settlement order precluded the availability of the funds for the plaintiff's support and maintenance." Frerks, 848 F.Supp. at 351. The language of the order before the court in Frerks allowed the parents to use the funds for the minor's support and maintenance. Id. Consequently, the minor appealed. The Second Circuit Court of Appeals affirmed, holding that substantial evidence supported the "ALJ's determination that [the minor] had resources in excess of the statutory limits." Frerks v. Shalala, 52 F.3d 412, 414 (2d Cir. 1995).
The ALJ concluded that the settlement proceeds deposited into the account were
When the ALJ applied the POMS presumption of availability of the account as a countable resource to terminate J.L.'s SSI benefits,
Before applying the presumption of availability, the ALJ should have referred to state law. The relevant POMS specifically directs the Commissioner to consider local law when assessing the availability funds in such an account. Social Security adjudicators must take into account that "State statutes or case law may specifically prohibit the use of funds held in the conservatorship account for general support of the individual in certain circumstances." POMS SI 01140.215(B)(1). Under longstanding Mississippi law, access to funds set aside for a minor are severely restricted by the court practice and by statute. A court may appoint a guardian for a minor and that "guardian is the legally recognized custodian of the person [and] property of [the minor] with prescribed fiduciary duties and responsibilities under court authority and direction." Harvey v. Meador, 459 So.2d 288, 291 (Miss. 1984). The Mississippi Supreme Court succinctly described the fiduciary relationship between a guardian and her ward:
Welch v. Childers, 195 Miss. 415, 15 So.2d 690, 691 (1943). A guardian has a duty "to improve the estate committed to his charge, and to apply so much of the income, profit or body thereof as may be necessary for the comfortable maintenance and support of the ward ... after obtaining an order of the court fixing the amount." Miss. Code Ann. § 93-13-38; see
Because Mississippi statutes and case law do not affirmatively mandate "that funds in a conservatorship account be made available for the care and maintenance of an individual," see Miss. Code. Ann. §§ 93-13-35 and -38,
Nothing in the record demonstrates that the ALJ consulted Mississippi law to determine whether a conservatorship account can be presumed available as a resource. Therefore, the ALJ applied the presumption of availability in contravention of the POMS. Application of the presumption here allowed the ALJ to shift the burden of proof to Allen, and the ALJ's determination that the account was a resource is based Allen's purported failure to rebut the presumption. The ALJ did not adequately determine the availability of the account as a resource because he impermissibly applied the presumption and did not undertake his own required factual analysis regarding the resource's availability
Additionally, the ALJ failed to follow POMS SI 01140.215(C)(1)-(4), which failure constitutes a legal error requiring reversal. After recognizing that the chancery court denied Allen's request to purchase J.L. a computer with funds from the account, the ALJ failed to cite evidence from the chancery court explaining its reasons for doing so. The ALJ needed to know whether the chancery court denied the request because Allen sought access to the account in order to purchase a non-essential item, or because the purpose of the account was to preserve the funds until J.L. obtained adulthood. Without that evidence, the ALJ could only make the unwarranted assumption that the request was for a non-essential.
On remand, the ALJ must determine whether the account was a resource and whether Allen requested to purchase a non-essential item (namely, the computer). The ALJ cannot rely on the presumption of availability contained in the POMS or assume that Allen requested to purchase a non-essential item.
Assuming arguendo that, correctly, the ALJ did not apply the presumption that the funds in the account were available for J.L's maintenance and support, but actually determined that the account was a resource that could be used for J.L.'s support and maintenance, substantial evidence does not support that determination. As discussed previously, in the absence of a regional instruction, the ALJ should have collected evidence as necessary to make a "determination as to whether the funds in the [conservatorship] account are a resource for SSI purposes." POMS SI 01140.215(C)(1)-(4); see also 20 C.F.R. § 416.1208. A reasonable person could not accept the 2002 court order relied upon by the ALJ as "adequate to support" the ALJ's determination that the account was an available resource when analyzed in light of Allen's allegations and the other evidence in the record. In other words, based on the 2002 court order, the ALJ assumed that the account could be used for J.L.'s maintenance and support; that assumption is not supported by the substantial evidence in the record. The ALJ based his decision on two faulty assumptions: (1) that the account was an available resource and (2) that the proceeds in the account were used for J.L's support and maintenance. As discussed previously, assumptions and speculation do not establish substantial evidence. See White, 167 F.3d at 375-76; Shields, 2015 WL 9238990, *3-4.
First, the ALJ made the faulty assumption that the settlement proceeds in the account "were available for his [support] and maintenance" based on the 2002 Decree Authorizing Settlement of Minor's Claim ("2002 decree"). (Tr. at 23). The ALJ asserted that "[t]he fact that the court had to be petitioned before funds could be withdrawn or that some requests for funds were denied does not mean that the funds were unavailable for [J.L.'s] support and maintenance." (Tr. at 22-23).
In making this assumption, the ALJ wrongly concluded that the 2002 decree was the only operative decree to determine whether the account was a resource, failing to consider the effect of the 2010 Amended Decree Authorizing Settlement of Minor's Claim ("2010 decree"). Although the 2002 decree asserted that the "remaining proceeds ... be retained by [Allen] for the maintenance and education of [J.L.]" (tr. at 210A), the 2010 decree omitted this statement (tr. at 324), and instead declared that the proceeds "are to remain until further order of the Court [or,] once the ward arrives at the age of twenty-one (21) years[,] ... the Court grants a discharge of the guardianship." (Tr. at 324). Even
At this point, the court finds it helpful to distinguish Frerks on the facts. Although the court order in Frerks is very similar to the 2002 decree here, the court in Frerks permitted the minor's parents to withdraw regularly $700 per month from the "accounts to pay for the support and education of" the minor. Frerks, 848 F.Supp. at 345. Unlike the facts in the instant case, the court in Frerks did not intend to restrict access to the minor's account for purposes of support and maintenance. Here, by contract, the chancery court granted Allen's one-time request to withdraw $2,000 to pay emergency medical expenses, but denied a subsequent request to purchase a computer. The access to the accounts and the use of the funds in Frerks was materially different from the potential access to the account and the use of the funds here. In Frerks, the language of the order creating the accounts and the language of the order granting the parents the authority to withdraw $700 per month establish that the accounts were intended by the court to be available as a resource for the minor's support and maintenance. While the 2002 decree contained similar language to the order in Frerks, the chancery court's actual supervision of the account and its subsequent amendment of the 2002 decree to establish explicitly the account's restrictions are powerful and substantial evidence of the original understanding of the restricted nature of the funds at the time of the creation of the account in 2002.
Furthermore, Mississippi statutory and case law strongly indicate that the proceeds were not available for J.L.'s support and maintenance. As previously discussed, under Mississippi law, the chancery court has complete discretion to deny a very reasonable request for access to the settlement proceeds. See Welch, 195 Miss. 415, 15 So.2d at 691. The ALJ could easily have consulted Mississippi law to discover that access to the account was severely restricted. Importantly, Allen's Mississippi attorney submitted a letter to the SSA in 2010, which indicated that
(Tr. at 283). This letter corroborates the perception of Mississippi law as it relates to a court's restrictive control of an account maintained by a guardian on behalf of a minor, and it supports the conclusion that the 2010 decree applied retroactively as a clarification of the actual restrictions on J.L's account. Therefore, this letter undercuts the ALJ's speculation that the chancery court would have granted Allen's reasonable request; in fact, this letter indicates the opposite result would have occurred.
To find the account available as a resource required the ALJ to speculate as to whether the chancery court would have granted an additional reasonable request. See White, 167 F.3d at 375-76. For the same reasons the court in White did not speculate as to the probate court's possible alternative actions, this court cannot speculate as to whether the chancery court would have granted Allen's reasonable request to access the proceeds for J.L.'s support and maintenance. In White, the probate court admonished that the parent "remained primarily responsible for [the minor's] needs, [and] ... that the trust was to remain untouched until [the minor] reached the age of eighteen...." White, 167 F.3d at 370. Here, the chancery court similarly admonished Allen and amended the decree to prohibit access to the account until J.L. reaches the age of twentyone. While the ALJ may have believed that the chancery court would have granted Allen's reasonable requests for support money, the ALJ could only have speculated about the chancery court's actions based on the language of the 2002 decree and the previous grant of limited access in 2006. As announced in White, speculation does not equal substantial evidence. See White, 167 F.3d at 375-76. The ALJ should not have speculated in this manner given Mississippi law as it relates to guardian access to a minor's funds and the entry of the 2010 decree.
Even with these restrictions in place by the chancery court, the ALJ wrongly assumed that the account was available based on the chancery court's previous order granting Allen access to the account for emergency medical treatment for J.L. In 2006, the chancery court granted Allen access to the settlement proceeds to help pay for relocation expenses and J.L.'s emergency medical expenses. This grant is the only time that the chancery court permitted Allen to access the account. In fact, the chancery court subsequently denied Allen's request to purchase a computer for J.L.'s education and subsequently amended the original settlement decree in 2010 in response to make plain what it had intended all along — that the funds were to be preserved for J.L. until his adulthood. In conjunction, these two facts indicate that Allen did not have access to the settlement proceeds for J.L.'s support and maintenance.
Like the probate court's denial in White, the chancery court here denied Allen's last request for access to the account. Because Allen has requested authority to access the account only twice, the court's denial of her second request is significant. In White, the probate court's denial stripped the plaintiff of "the right, power or authority to liquidate the funds for [her son's] care and maintenance." White, 167 F.3d at 376. Similarly, Allen did not have a right to liquidate the account for J.L.'s support and maintenance without the court's prior approval. Even though the court previously
Second, the ALJ based his decision on the faulty assumption that the proceeds withdrawn from the account in 2006 were used for J.L.'s "support and care." (Tr. at 22). Specifically, the court granted Allen access to the account in 2006 so that she could pay for J.L.'s emergency medical expenses.
Here, the same concern as in Shields rings true. The ALJ has impermissibly assumed that the funds were used for J.L.'s support and maintenance. In fact, while the ALJ recognized that the chancery court granted access to the account in 2006 because of J.L's relocation and emergency medical expenses, the ALJ unfairly focused on the relocation aspect to determine that the proceeds were used for J.L.'s "support and care." (See tr. at 22). Because of the relocation, Allen did not have insurance in place to cover the costs of the medications and counseling that J.L. needed. The funds were not used for ordinary relocation expenses, but for medical expenses caused by the relocation. It is unlikely and speculative that Allen will move again and be in the same situation. So the use of the funds to pay for J.L.'s emergency medical expenses do not indicate that the funds were available for J.L.'s ordinary support and maintenance; the funds were used to pay for his emergency medical expenses, not for food, clothing, or shelter. See POMS SI 01140.215(D)(2).
Upon review of the administrative record, and considering all of Allen's arguments, the court finds that the Commissioner's decision is not supported by substantial evidence and, therefore, is due to be remanded for further proceedings not inconsistent with this opinion to determine (1) whether an overpayment occurred and (2) if an overpayment did occur, the amount of the overpayment.
DONE this 10
Furthermore, the issue of income was not determined by the ALJ in his October 13, 2011, hearing decision. (Tr. at 163-166). While the ALJ found that Allen failed to accurately report her income, the ALJ held that the overpayment totaled $15,105 (tr. at 163-66), matching the amount of the purported overpayment due to the existence of the account as a resource for the period of December 2007 through December 2009, not because of Allen's alleged income for the period of December 2008 through October 2009 and December 2009. (See Tr. at 21-22 for further explanation of the "confusion"). Accordingly, because the ALJ neither explained Allen's purportedly inaccurate income reporting nor established an accurate overpayment total based on her purportedly inaccurate income reporting, the ALJ's finding is not based on substantial evidence and is not entitled to any deference. More fundamentally, the ALJ's hearing decision is not entitled to any weight because it was vacated by the Appeals Council.
On remand, the ALJ acknowledged the initial income determination by the Commissioner in his February 26, 2015, hearing decision, but the ALJ did not make any factual findings about the accuracy of Allen's reported income and whether the reported income resulted in an overpayment. (Tr. at 19-26). The ALJ focused exclusively on whether the account counted a resource and whether Allen and J.L. were entitled to a waiver. Therefore, there has not been a final decision as to whether Allen inaccurately reported her income for the period of December 2008 through October 2009 and December 2009 that resulted in an overpayment of $5,722.81. The statement made by the Appeals Council in its decision (tr. at 189) is not supported by substantial evidence.
Although recently enacted in September 2017, POMS SI ATL01140.215 embodies the state of Mississippi guardianship law as it has existed for many decades.
The Commissioner argues that, despite a court's denial to access the funds, an account may still be considered a resource if the court denied a request for a "non-essential" item. (See doc. 15, pp. 16-17; POMS SI 01140.215(B)(3)). The Commissioner appears to assume that the chancery court denied Allen's request for access to the settlement proceeds because a computer is a non-essential item. However, the record does not indicate why the chancery court denied Allen's request. Even in 2009 or 2010, when the denial occurred, it is difficult for the court to conclude that a computer is a non-essential item for a child's education. In any event, the court gives little weight to this argument. It is equally likely that the court denied the request because the funds were not intended for even essential support, but were to be preserved until J.L. reached adulthood. The crucial point is that the ALJ had no substantial evidence on which to reach the conclusion he did.