M. Camerino, by and through her representative, Brethren Village v. DHS
125 C.D. 2016
| Pa. Commw. Ct. | Sep 18, 2017Background
- Maria Camerino, a resident of Brethren Village Skilled Care Facility, applied for medical assistance in November 2014 through the facility.
- Lancaster County Assistance Office (CAO) denied the application on January 6, 2015 for missing documentation and informed Claimant she had 30 days (until February 5, 2015) to file a fair hearing appeal.
- Claimant did not timely appeal; the facility later submitted missing documents (MA51 and Options Assessment) to the Office of Aging in July 2015, which forwarded them to the CAO on September 10, 2015.
- Claimant filed an appeal to the January 6, 2015 denial on September 25, 2015 (approximately eight months late).
- An ALJ dismissed the appeal as untimely; the Bureau of Hearings and Appeals affirmed. Claimant appealed to the Commonwealth Court, arguing timeliness or, alternatively, entitlement to nunc pro tunc relief due to administrative breakdown.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Was Claimant's appeal timely? | Camerino: appeal should be timely under regulations or excused due to administrative error causing delay. | DHS: appeal was 232 days late; no evidence of administrative breakdown causing untimeliness. | Appeal untimely; dismissal affirmed. |
| Should the appeal be allowed nunc pro tunc? | Camerino: equitable relief warranted because delay resulted from administrative breakdown and she appealed promptly after learning. | DHS: no non-negligent circumstances or administrative breakdown shown; appellee prejudiced by delay. | Nunc pro tunc denied—Claimant failed to meet burden for extraordinary circumstances. |
| Did CAO’s alleged delay in acting within 30 days excuse late appeal? | Camerino: CAO failed to act within the 30-day regulatory period, affecting appeal rights. | DHS: any CAO delay (about 37 days) not shown to have prevented timely appeal. | Court found no evidence that the slight regulatory delay caused Claimant’s untimeliness. |
| Was there substantial evidence to support BHA’s findings? | Camerino: contends facts support reversal. | DHS: administrative record supports BHA/ALJ findings. | Yes; findings supported by substantial evidence and upheld. |
Key Cases Cited
- Falcon Oil Co. v. Department of Environmental Resources, 609 A.2d 876 (Pa. Cmwlth. 1992) (time to appeal is jurisdictional and cannot be extended as a matter of grace)
- Sofronski v. City of Philadelphia, 695 A.2d 921 (Pa. Cmwlth. 1997) (nunc pro tunc relief requires extraordinary circumstances such as administrative breakdown or non-negligent delay)
- Murphy v. Department of Public Welfare, 480 A.2d 382 (Pa. Cmwlth. 1984) (definition of substantial evidence)
- Criss v. Wise, 781 A.2d 1156 (Pa. 2001) (equitable nature and requirements for nunc pro tunc relief)