JAMES R. KLINDT, Magistrate Judge.
Benjamin Cordero ("Plaintiff"), the representative payee for Diana M. Cordero ("Beneficiary") and Beneficiary's minor children, T.R.C. and N.R.C. (the "minor children"), is appealing the Commissioner of the Social Security Administration's ("Administration('s)") final decision denying a request for wavier of recoupment of an overpayment of disability insurance benefits ("DIB") and assessment of the overpayment against Plaintiff and Beneficiary in the amount of $102,537.40. Beneficiary, a physician, was found to be disabled by the Administration and entitled to DIB as of February 4, 1997. Transcript of Administrative Proceedings (Doc. No. 34; "Tr." or "administrative transcript"), filed April 30, 2014, at 13, 29, 116, 276. The dependant minor children began receiving child's insurance benefits ("CIB") on Beneficiary's earnings record in August 1997. Tr. at 13, 279-80. When DIB was awarded, the Administration appointed a representative payee to handle the benefits apparently because Beneficiary's mental impairment precluded her from managing her finances. Tr. at 21, 305, 646-47. Plaintiff, Beneficiary's brother, Tr. at 647, 649, 700, has been the representative payee for Beneficiary since 2002 or 2003, Tr. at 278-80 (Administration documents showing 2002), 716 (Plaintiff testifying he became the personal representative in 2003).
In September 2006, the Administration informed Plaintiff that as of March 2003, due to Beneficiary's return to substantial work as a physician, Beneficiary was no longer eligible for DIB and that Beneficiary's children were no longer eligible for CIB. Tr. at 77-79, 80-82, 83-87. Plaintiff was further informed by the Administration that from the date of ineligibility through the stopping of payments in September 2006, Beneficiary was overpaid $68,939.40, and the minor children were overpaid $16,799.00 each, for a total of $102,537.40. Tr. at 83-87, 319-22.
On November 1, 2006, Beneficiary filed a "Request for Waiver of Overpayment Recovery or Change in Repayment Rate," in which Beneficiary requested that the Administration waive collection of the overpayment. Tr. at 100-07,
On November 7, 2006, the Administration issued a "Notice of Revised Decision" in which it was again determined that Beneficiary was not entitled to payments beginning in March 2003. Tr. at 111-13;
Beneficiary then had a "personal conference" with the Administration on January 17, 2007 regarding the waiver request. Tr. at 129. Following the personal conference, on January 23, 2007, the Administration again denied the request, Tr. at 129-33, noting that Beneficiary had returned to work and her "earnings exceed $10,000 per month," Tr. at 132.
On May 17, 2007, an Administrative Law Judge ("ALJ") convened a hearing but continued it to give Beneficiary the opportunity to attempt to find someone to represent her. Tr. at 635-37. On July 3, 2007, the ALJ again convened a hearing and granted Beneficiary's request for additional time to consult with her representative prior to proceeding. Tr. at 638-40. On September 28, 2007, the ALJ held a hearing, during which she heard testimony from Beneficiary, who was represented by counsel. Tr. at 641-74. Beneficiary agreed at the hearing that she was not disputing having received the overpayment. Tr. at 643. Rather, she confirmed that she was focusing on the waiver issue, and she also confirmed she "disagree[ed] as to [her] ability to pay it back more than the fact that [she] received the money[.]" Tr. at 643. Beneficiary's counsel represented that Beneficiary "realize[d] . . . she was overpaid" and that Beneficiary was "willing to try and repay back that overpayment." Tr. at 661-62. In fact, counsel requested that the ALJ set up a repayment plan for Beneficiary. Tr. at 662.
On January 10, 2008, the ALJ issued a decision denying Beneficiary's request for a waiver of recovery of the overpayment. Tr. at 331-34. On June 11, 2010, the Appeals Council granted Beneficiary's request for review; vacated the ALJ's decision; and remanded the matter for the ALJ to consider whether joint and several liability applied to Beneficiary and Plaintiff for the overpayment regarding the Beneficiary and/or the minor children, and to correct some clerical issues. Tr. at 304-07.
The ALJ then held another hearing on October 19, 2010, during which Beneficiary represented herself. Tr. at 675-706. During this hearing, Beneficiary challenged the way in which the overpayment was calculated, Tr. at 695, among other things. Because Plaintiff did not appear for the hearing, and because Beneficiary requested a continuance to review her file, the ALJ continued the hearing.
On May 17, 2011, the ALJ issued another decision ("Decision") denying Beneficiary's request for a waiver of recovery of the overpayment and finding that Plaintiff and Beneficiary are jointly and severally liable for repayment of $102,537.40 in overpaid benefits. Tr. at 13-25. Beneficiary then requested review by the Appeals Council and submitted additional evidence in support of her request. Tr. at 596-634. On June 27, 2012, the Appeals Council denied Beneficiary's request for review, Tr. at 7-9, making the ALJ's May 17, 2011 Decision the final decision of the Commissioner.
Plaintiff initiated this action through counsel on August 24, 2012 by filing a Complaint (Doc. No. 1) seeking judicial review of the Commissioner's final decision. Specifically, the Complaint states that Plaintiff "hereby petitions the Court for review of the Order of the . . . Administration entered on June 27, 2012"; attached to the Complaint is the Appeals Council's June 27, 2012 Order denying the request for review. Through a later-filed "more definite statement,"
On May 1, 2014, the Court entered a Scheduling Order (Doc. No. 35) directing the parties to file memoranda in support of their respective positions. Plaintiff was ordered to "identify with particularity the grounds upon which the administrative decision is being challenged."
Through his memorandum, Plaintiff raises the following issues on appeal: 1) whether "the ALJ "err[ed] in finding that [] Plaintiff was not entitled to [DIB], and the dependent minor children, from the moment that [] Plaintiff returned to gainful employment on a [t]rial work period basis"; and 2) whether the ALJ "err[ed] in finding that [] Plaintiff was not entitled to or granted [e]xpedited [r]einstatement after her stopping from work due to a relapse of her qualifying medical condition[.]" Plaintiff's Brief in Support of the Petition for Review (Doc. No. 40; "Pl.'s Br."), filed September 29, 2014, at 11, 13 (emphasis omitted). On December 19, 2014, Defendant responded by asserting that the issue is "whether substantial evidence supports the [ALJ]'s Decision that [Beneficiary] and Plaintiff were not without fault in causing the overpayment of $102,537.40." Memorandum in Support of the Commissioner's Decision (Doc. No. 43; "Def.'s Mem.") at 1 (emphasis and capitalization omitted). Upon review of the parties' arguments and the administrative transcript, the undersigned finds that the Commissioner's final decision is due to be affirmed.
This Court reviews the Commissioner's final decision pursuant to 42 U.S.C. §§ 405(g) and 1383(c)(3). Although no deference is given to the ALJ's conclusions of law, findings of fact "are conclusive if . . . supported by `substantial evidence' . . . ."
Generally, the Social Security Act ("the Act") requires that when a social security beneficiary has been overpaid, the Administration must recoup the overpaid benefits. 42 U.S.C. § 404(a)(1)(A)
42 U.S.C. § 404(b);
An individual may be found not to be without fault if the overpayment "resulted from: (a) An incorrect statement made by the individual which he knew or should have known to be incorrect; or (b) Failure to furnish information which he knew or should have known to be material; or (c) With respect to the overpaid individual only, acceptance of a payment which he either knew or could have expected to know was incorrect." 20 C.F.R. § 404.507.
The phrase "defeat the purpose of title II" has been defined by the Regulations to mean "to deprive a person of income required for ordinary and necessary living expenses. This determination depends upon whether the person has an income or financial resources sufficient for more than ordinary and necessary needs, or is dependent upon all of his current benefits for such needs." 20 C.F.R. § 404.508(a);
20 C.F.R. § 404.508(a).
The Regulations further provide that recovery of an overpayment is against equity and good conscience if an individual "[c]hanged his or her position for the worse . . . or relinquished a valuable right . . . because of reliance upon a notice that a payment would be made or because of the overpayment itself[.]" 20 C.F.R. § 404.509(a)(1).
At the administrative level, a claimant bears the burden of showing he or she is eligible for a waiver of collection of overpayment.
The Administration has taken the position that in certain situations, when overpayment is made to a representative payee, both the payee and the beneficiary can be held jointly and severally liable.
The ALJ ultimately found both Plaintiff and Beneficiary not without fault, Tr. at 25; accordingly, the ALJ was not required to make any other findings before declining to waive collection of the overpayment and assess the payment jointly and severally. Plaintiff's stated issues on appeal do not challenge the ALJ's finding that Plaintiff and Beneficiary are ineligible for a waiver.
The specific issues Plaintiff raises on appeal have to do with the ALJ's computation of the overpayment amount. Plaintiff's first stated issue is whether the ALJ erred in evaluating Beneficiary's trial return to work and the impact that the trial work period had on the calculation of the overpayment. Pl.'s Br. at 11-13. Plaintiff's second stated issue is whether the ALJ erred with respect to considering the impact that Beneficiary's alleged expedited reinstatement request had on the calculation of the overpayment.
The Regulations provide for a "trial work period," during which a claimant "may test [his or her] ability to work and still be considered disabled." 20 C.F.R. § 404.1592(a). The claimant is allowed to "perform services . . . in as many as 9 months, but these months do not have to be consecutive."
Here, the ALJ made the following findings in relation to Beneficiary's trial work period:
Tr. at 18-19 (citations omitted).
On appeal, Plaintiff argues, without
Defendant counters that the Court does not have subject-matter jurisdiction to review the amount of the overpayment because Plaintiff has not received a final decision from the Administration on that issue. Def.'s Mem. at 15-18. Alternatively, if the Court does have subject-matter jurisdiction to review the amount of the overpayment, Defendant contends the ALJ's findings regarding the overpayment — including the findings relating to the trial work period and the expedited reinstatement — are supported by substantial evidence.
As grounds for contending the Court does not have subject-matter jurisdiction to review the amount of the overpayment, Defendant points to the following: 1) Beneficiary's agreement with the ALJ during the September 28, 2007 hearing that her dispute focused on her ability to pay back the overpayment; 2) the ALJ's initial January 2008 decision that ruled solely on the waiver request; and 3) the Appeals Council's remand order that directed the ALJ to consider the matter of joint and several liability (and is silent as to the amount of the overpayment).
Notwithstanding that the ALJ made findings regarding the amount of the overpayment, Defendant contends that the ALJ's "ultimate" ruling was confined to the waiver issue. Def.'s Mem. at 18 (citing Tr. at 25). The undersigned disagrees. The ALJ stated initially in the Decision that "[t]he general issue is whether [Beneficiary] was overpaid benefits within the meaning of Section 204 of the Social Security Act and, if so, whether recovery of the overpayment may be waived." Tr. at 15. Necessary to the determination of whether a claimant was overpaid is the amount of the overpayment, if any. Although it is true that the last sentence of the ALJ's Decision focuses on waiver, both that sentence and the sentence just preceding it contain the final amount of the overpayment ($102,537.40).
Upon review of the ALJ's findings regarding the trial work period, the undersigned finds them to be supported by substantial evidence. Beneficiary was notified by the Administration in December 2001 that her trial work period had ended in December 1999. Tr. at 34, 37. Plaintiff points to no evidence in the administrative transcript that supports his contention that Beneficiary was entitled to the second trial work period. Before the ALJ, Beneficiary contended that "if she had been given an expedited reinstatement [in November 2003 following a relapse in her condition], she would have been entitled to another trial work period." Tr. at 20. The ALJ, however, found that Plaintiff and Beneficiary had failed to produce any documentation of a request for expedited reinstatement, and the Agency had no record of having received one. Tr. at 20. "[E]ven if [Beneficiary] would have filed a request for expedited reinstatement," continued the ALJ, "she would not have been entitled to a new trial work period under the expedited reinstatement provisions until the expiration of a 24-month initial reinstatement period." Tr. at 20 (citing POMS DI 13050.001 (A), available at, http://policy.ssa.gov/poms.nsf/lnx/0413050001 (last visited Mar. 25, 2015)). Because Beneficiary "returned to work as a physician after only 17 months . . . well before such a period would have expired . . ., she would not have been entitled to an additional trial work period even if she had filed for an expedited reinstatement of benefits." Tr. at 20. While Plaintiff contends Beneficiary was entitled to expedited reinstatement of benefits and concedes Beneficiary's "application is now allegedly missing from her file," he fails to address the reasons articulated by the ALJ why the request would have had no bearing on a second trial work period. Pl.'s Br. at 13-14. The ALJ's findings are supported by substantial evidence and need not be disturbed.
The ALJ's Decision is supported by substantial evidence. After due consideration, it is
1. The Clerk of Court is directed to enter judgment pursuant to sentence four of 42 U.S.C. § 405(g)
2. The Clerk is further directed to close the file.
42 U.S.C. § 404(a)(1)(A) (emphasis added).