174 Conn. App. 385
Conn. App. Ct.2017Background
- Plaintiff Raymond Godaire (pro se, age 82) received Husky C Medicaid and had dental work begun during an eligibility period that the department later disputed.
- Department sent notice discontinuing benefits (Jan 28, 2015) for failure to complete review; plaintiff requested an administrative hearing and later a redetermination occurred (Feb 2, 2015) showing a spenddown for March–August 2015.
- At the April 1, 2015 administrative hearing, department staff read a hearing summary indicating coverage through March–August 2015; plaintiff testified he relied on department representations that February 2015 was covered so his dental work could be completed.
- At the end of the hearing the department submitted a “corrected” eligibility screen changing the redetermination period to Feb–July 2015 (thereby excluding the contested February work), and the hearing officer adopted that correction and denied plaintiff’s appeal.
- Plaintiff appealed to Superior Court in New London; the court transferred the matter to New Britain (plaintiff could appear by closed-circuit TV). The trial court affirmed the agency decision; plaintiff appealed to the Appellate Court.
- Appellate Court reversed, holding the agency decision was made upon unlawful procedure because the department retroactively changed the eligibility period and the plaintiff had no meaningful opportunity to respond, so equitable tolling/equitable estoppel applied and plaintiff’s appeal must be sustained.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether transfer of the appeal from New London to New Britain denied plaintiff access to courts | Transfer deprived him of reasonable access and prejudiced him | Transfer authorized by statute and plaintiff could appear by closed-circuit TV | Transfer lawful; no denial of access or prejudice |
| Whether agency decision was based on "unlawful procedure" because records were changed after hearing | Department retroactively corrected eligibility period after hearing, depriving him of chance to present dental bill; decision thus made upon unlawful procedure | Correction was a clerical fix; record was held open and plaintiff had opportunity; no substantive prejudice | Decision made upon unlawful procedure: reversal required; plaintiff prejudiced by retroactive correction |
| Whether equitable tolling/estoppel should apply to excuse plaintiff’s failure to present the dental bill by the original deadline | He reasonably relied on department’s extension through February and was excused from timely submission | Plaintiff did not present evidence of the specific dental bills at the hearing; correction was noticed | Equitable tolling/estoppel applies; plaintiff should not be penalized for relying on department representations |
| Remedy on remand | N/A (plaintiff requests sustaining appeal) | N/A | Judgment reversed; trial court directed to render judgment sustaining plaintiff’s appeal and order department to proceed consistent with opinion |
Key Cases Cited
- Henderson v. Dept. of Motor Vehicles, 202 Conn. 453, 521 A.2d 1040 (1987) (ex parte communications or adjudicator involvement can render an agency decision "made upon unlawful procedure")
- Williams v. Commission on Human Rights & Opportunities, 67 Conn.App. 316, 786 A.2d 1283 (2001) (equitable tolling includes waiver, consent, or estoppel to excuse untimeliness)
- Dickman v. Office of State Ethics, Citizen's Ethics Advisory Board, 140 Conn.App. 754, 60 A.3d 297 (2013) (standard of judicial review under UAPA)
- Bridgeport Dental, LLC v. Commissioner of Social Services, 165 Conn.App. 642, 140 A.3d 263 (2016) (leniency afforded to pro se litigants)