Elliott v. WeinbergerElliott v. Weinberger
FINDINGS OF FACT AND CONCLUSIONS OF LAW
Under
Facts:
This court has divided the Plaintiff class into two subclasses. Represented by Plaintiffs Silva, Ortiz, and Vaquilar, the first subclass consists of all social security old-age beneficiaries, resident in the State of Hawaii, whose exposure to recoupment is based upon their own annual earnings reports. 5 Represented by Plaintiffs Elliott, Gaines, and .Yamasaki, the second subclass consists of all social security old-age and disability benefit recipients, resident in the State of Hawaii, whose exposure to recoupment is based upon evidence other than annual earnings reports. 6
Named Plaintiffs of subclass one all received an Administration form letter indicating that based upon their annual earnings reports for the preceding year, a specified overpayment had *965 occurred and that their subsequent benefit payments would be reduced or totally suspended over a specified period. There was some notice of the right to reconsideration and waiver. 7 Plaintiffs believed themselves to be not liable for any overpayment, not at fault in causing the overpayment, and unable to repay the amount due; they personally contacted local Social Security Administration offices within thirty days of receipt of the form letter. At that time, none were advised that appropriate forms requesting waiver, reconsideration, and partial adjustment were available to' initiate administrative action, and none actually filed the requisite forms within thirty days. 8 Currently, the Administration has completed recoupment against two of these Plaintiffs while deferring recoupment against the other pending the disposition of this case. Plaintiffs of subclass one have done all that reasonably could be expected of them to exhaust their administrative remedies. 9
Named Plaintiffs of subclass two received overpayment notices more than thirty days before recoupment was to begin. The notice to Plaintiff Elliott set forth that the overpayment determination was based upon her receipt of both retirement and disability benefits when she was entitled to only disability benefits. 10 The notice to Plaintiff Gaines indicated that “duplicate pay *966 ments” over specified dates was the reason for the overpayment finding. 11 The notice to Plaintiff Yamasaki specified “a processing error” as the cause of the overpayment. 12 All three named Plaintiffs received some notice of the right to reconsideration and waiver. 13 The Plaintiffs believed themselves to be not liable for any overpayment, not at fault in causing the overpayment, and unable to repay the amount claimed; they contacted local Administration offices within thirty days after receipt of the overpayment notice. At that time, none were advised that appropriate forms requesting waiver, reconsideration, and partial adjustment were available to instigate administrative action, and none actually filed the requisite forms within thirty days. 14 Presently, recoupment against Elliott and Gaines has been deferred pending a final disposition of this case, while recoupment against Plaintiff Yamasaki has been completed. Plaintiffs of subclass two have done all that reasonably could be expected of them to exhaust their administrative remedies.
In summary, the Administration’s regulations and procedures, and the Plaintiffs’ histories in this case, show that recipients in both subclasses subject to recoupment receive recoupment notices which set out the basic reason for the recoupment, the possibility of reconsideration, the conditions for waiver, and the need to consult the local Administration office within thirty days if they wish to complain. For subclass one Plaintiffs (at least until January, 1975), recoupment begins immediately after the initial overpayment decision is made. For subclass two Plaintiffs, the notice is sent thirty days before actual recoupment begins. In practice, actual adjustment may, at the discretion of the Payment Center, be extended beyond 30 days when more time is needed to consider and process the matter. After the first determination is made, if reconsideration or waiver is requested, recoupment is further deferred until those issues are determined on the basis of any documentary evidence submitted. Finally, a post-recoupment hearing is possible should the claimant wish to seek additional review. 15
The initial overpayment and recoupment notice sent to beneficiaries does not set forth the forms needed for reconsideration and waiver, or information about how to complete them. The information and forms missing in the initial notice are not generally made available when the claimant consults his local Administration office. When reconsideration or waiver consideration is requested, the Administration’s decision is based upon a claimant’s ex parte presentation of documentary evidence on an issue which he may understand only nebulously. Many of these claimants are elderly and disabled people whose capacities may frustrate an effective documentary presentation of their case. No oral hearing is given prior to the beginning of recoupment, and any deferral of recoupment beyond 30 days after the date of the initial notice lies completely within the discretion of the Administration. Should a claimant convince the Administration to reverse itself ex parte on the overpayment issue, a reduced or suspended payment may ensue with a refund coming a month or more later.
Statistics provided by the Defendant 1 6 in this case indicate the following:
(a) In 1970 there were overpayments in approximately 1,250,000 cases.
*967 (b) Of these 1,250,000 overpayments, there were requests for reconsideration in approximately 12,000 cases.
(c) Of the 12,000 reconsideration determinations with respect to overpayments, there were approximately 8,250 reversals and approximately 3,750 affirmances.
(d) Of the 3,750 reconsideration affirmances with respect to overpayments, there were requests for hearing in approximately 1,600 cases.
(e) Of the 1,600 cases that went to hearing with respect to overpayments, there were reversals in approximately 560 cases and affirmances in 1,040 cases.
Stated another way, these statistics mean:
(a) less than one per cent of the beneficiaries in overpayment status contest the matter.
(b) of those who do contest the initial overpayment determination, about sixty-nine per cent succeed in getting the Administration to reverse itself.
(c) about forty-three per cent of those whose overpayment status is affirmed upon reconsideration seek on oral (post-recoupment) hearing.
(d) of those who get an oral hearing, more than one-third succeed in getting the Administration to reverse itself.
(e) overall, of that small percentage of claimants questioning the overpayment determination, about seventy-three per cent (8,250 + 560 out of 12,000) finally succeed in obtaining relief.
It is quite clear from the above that when the claimant feels he has a strong enough case to question the Administration’s initial overpayment determination, there is a very substantial chance that the Administration will eventually reverse itself. What is saddest and perhaps most important about this fact is that many social security recipients, like the Plaintiffs here, depend upon their full monthly benefit payments for subsistence. 17 Erroneous recoupments often cause the aged and infirm drastic hardship. 18
Jurisdiction:
The Defendants have moved for dismissal for lack of subject-matter jurisdiction. Plaintiffs assert that federal jurisdiction exists under
As to the third requirement, the Plaintiffs, if denied federal jurisdiction, may not have an adequate remedy elsewhere,
see
Burnett v. Tolson,
supra
note 20,
While the applicability of the relevant Supreme Court ruling should be beyond doubt in the opinion of the district court judge, it need not be so certain as to preclude a different opinion'from another court. For example, in
Daigle, supra,
the Chief Judge of this District Court under
*969 Due Process and Hearings Prior to Recoupment:
Goldberg
establishes the principle that when the impact of an erroneous administrative decision upon the individual is so severe as to deprive him of the means by which to live, due process requires that the individual have an opportunity to be heard and to cross-examine witnesses before any adverse decision is effected. Specifically,
Goldberg
held that a hearing had to be afforded the individual before his state welfare benefits were terminated. In reaching its decision, the
Goldberg
Court focused upon three considerations: The impact of an erroneous decision upon the individual, the government’s interest in fulfilling the purpose of welfare legislation by protecting against administrative mistakes, and the government’s interest in conserving the public fisc and minimizing administrative burdens. The
Goldberg
Court found that “termination of [welfare] aid pending resolution of a controversy over eligibility may deprive an eligible recipient of the very means by which to live while he waits,”
The application of
Goldberg
to this case is simply inescapable.
25
Since
*970
most social security recipients depend upon their full benefits for the necessities of life,
26
the adverse impact of an erroneous suspension or reduction upon them is great.
27
Starvation may be slower if benefits are reduced or suspended rather than terminated as in
Goldberg
28
but some recipients will suffer nonetheless. As the
Goldberg
Court noted, the government has an interest in welfare as a guard “against the societal malaise that may flow from a widespread sense of unjustified frustration and insecurity,”
There are other compelling reasons why the mandate of
Goldberg
must be applied to social security cases. At the heart of the right to due process lies the recognition of the need for a fair determination of issues and the hope of minimizing mistakes. In this case, the chance of administrative error is great.
33
In Kelly v. Wyman,
supra
note 25, the district court was impressed by the fact that post-termination hearings resulted in administrative reversals 36% of the time; in this case, reversals at the post-recoupment hearing stage occur more than one-third of the time.
34
Furthermore, the procedural safeguards which
Goldberg
found constitutionally insufficient for lack of a prior hearing were more stringent than those of the Administration.
35
It is thus not surprising that one court has approved the application of
Goldberg
to procedures similar to those here at issue.
See
Martinez v. Richardson,
supra
note 9.
But see
Mills v. Richardson,
supra
note 21,
Attempts to distinguish
Goldberg
on the ground that fact issues are not present in recoupment cases, or on the ground that the evidence involved is more reliable, are futile. Issues of fact arise in virtually all contested recoupment situations.
36
To predict when an issue of fact will not be present on a case by ease basis is impossible. Although the district court in Kelly v. Wyman,
supra
note 25,
Therefore, the court finds that the Administration’s recoupment regulations and procedures here challenged violate the Plaintiff’s right to due process of law, and orders that henceforth when requested
38
the Plaintiffs of both subclasses be given an oral hearing prior to recoupment.
39
At the hearing, the correctness of the overpayment determination and the recipient’s statutory right to waiver under
The pre-recoupment hearing need not take the form of a judicial or quasi-judicial trial, but it must allow the claimant to present his case orally, to submit evidence with witnesses or documents, and to cross-examine witnesses against him. Representation by legal counsel or other persons is neither required nor prohibited. The hearing officer should not have participated in making the determination under review; he should base his decision solely on the legal rules and evidence adduced at the hearing; he should state the reasons for his decision and the evidence relied upon.
Goldberg,
*973 Due Process and Notice:
Since a constitutional right can be waived only knowingly, the Plaintiffs must be notified of their due process right to request and receive a pre-recoupment hearing on the overpayment and waiver issues. Notice of that right must be stated plainly and obtrusively in the initial overpayment letter. Furthermore, the initial notice must describe the claimant’s right at any hearing to be represented by a lawyer or other person, present evidence, present witnesses in his behalf, cross-examine adverse witnesses, be afforded a fair and impartial hearing examiner, examine all documents prior to and during the hearing, and be given a prompt decision by the decisionmaker.
Due process also requires timely, adequate, and detailed notice of the. reasons for an initial overpayment determination.
Goldberg,
at 267,
In annual report overpayment cases involving subclass one Plaintiffs, the recipients are presumed to be familiar with their own reports and the reasons for filing them. The reverse side of the current initial notice explains basically how withheld amounts are determined, and the notice’s invitation to consult local Administration offices when questions arise is a necessary and added protection. Subclass two Plaintiffs present a more difficult notice problem. The myriad circumstances and diverse information which may underlie an overpayment determination make it impossible for this court to define what is and is not adequate notice for all subclass two cases. To indicate (as the reason for the overpayment decision) a “duplicate payment” over specified periods may be enough notice for the claimant, but a stated reason such as “processing error” may not be. 41 However, it is reasonable to assume that subclass two Plaintiffs, and subclass one Plaintiffs, who doubt the overpayment, will consult their local Administration office for clarification.
However, in light of the foregoing, the Administration’s initial notice does not complete its duty to inform the subclass one and two Plaintiffs about the reasons for an overpayment determination. Those Plaintiffs who consult their local Administration office to contest or inquire about the alleged overpayment must receive any additional information which the Administration has 42 The Administration must inform the Plaintiffs requesting a hearing about all the pertinent details, laws, and regulations supporting the Administration’s case far enough in advance to afford the claimant sufficient time to prepare for the hearing. 43
Finally, while the Administration’s current notice adequately informs *974 the recipient of the possibility of reconsideration and waiver, it does not indicate what requisite forms must be completed. The record indicates that even those recipients seeking aid at a local office are not provided with information about or copies of the reconsideration and waiver forms. These deficiencies must be remedied. Claimants failing to file the required forms may lose their case for failure to comply with administrative procedures. Therefore, the initial overpayment notice should specify the reconsideration and waiver forms which must be requested from the local office. The local office also has the duty to inform inquiring claimants about the requisite forms, to provide them with those forms if requested, and to assist in their completion. Accordingly :
Judgement may be entered providing that Defendant Weinberger, his successor, his agents and employees at the Social Security Administration’s Payment Centers, and all persons in active concert or participation with them shall be restrained and enjoined from reducing, terminating, or suspending social security old age and disability benefits accruing to Plaintiffs and their class without affording them an opportunity for a hearing before any reduction, termination, or suspension is effectuated;
That Defendant Weinberger, his successor, his agents and employees at the Social Security Administration’s Payment Centers, and all persons in active concert or participation with them shall restore any and all money withheld since June 22, 1972, without a prior hearing, from Plaintiffs Nancy Yamasaki, Isabelle Ortiz, John V. Vaquilar, Raymond Gaines, and Jordan A. Silva pending the holding of a preadjustment hearing in each of their individual cases;
That the Defendants shall submit to this court, for its approval, a copy of the proposed notice to be given to the members of the class informing them of the judgement herein, and a copy of the revised rules, regulations, and procedures which they will adopt to conform with the dictates of the judgement herein; and
That this court will retain jurisdiction over this case to order any further action it may deem appropriate and just in light of the decision herein.
The foregoing constitutes the Findings of Fact and Conclusions of Law required by
. Affidavit of Bernard Popick, Director of the Bureau of Disability Insurance of the *967 Social Security Administration, Department of Health, Education, and Welfare, para. 36.
Notes
.
(a) Whenever the Secretary finds that more or less than the correct amount of payment has been made to any person under this subchapter, proper adjustment or recovery shall be made, under regulations prescribed by the Secretary, as follows :
(1) With respect to payment to a person of more than the correct amount, the Secretary shall decrease any payment under this subchapter to which such overpaid person is entitled, or shall require such overpaid person or his estate to refund the amount in excess of the correct amount, or shall decrease any payment under this subchapter payable to his estate or to any other person on the basis of the wages and self-employment income which were the basis of the payments to such overpaid person, or shall apply any combination of the foregoing. A payment made under this subchapter on the basis of an erroneous report of death by the Department of Defense of an individual in the line of duty while he is a member of the uniformed services (as defined in section 410 (m) of this title) on active duty (as defined in section 410(1) of this title) shall not be considered an incorrect payment for any month prior to the month such Department notifies the Secretary that such individual is alive.
(2) With respect to payment to a person of less than the correct amount, the Secretary shall make payment of the balance of the amount due such underpaid person, or, if such person dies before payments are completed or before negotiating one or more checks representing correct payments, disposition of the amount due shall be made in accordance with subsection (d) of this section.
(b) In any case in which more than the correct amount of payment has been made, there shall be no adjustment of payments to, or recovery by the United States from, any person who is without fault if such adjustment or recovery would defeat the purpose of this subchapter or would be against equity and good conscience.
. The Claims Manual § 5503(a) provides that standard form letters sent to recipients subject to recoupment contain:
(1) The incorrect payment made and how and when it occurred.
(2) The right to request reconsideration of the overpayment determination.
(3) The required recovery.
(4) The proposed adjustment or the demand for repayment where adjustment is not possible.
(5) The waiver provisions of the law (Social Security Act, secs. 204(b) or 1370(c)).
(6) The availability of partial adjustment or partial refund.
(7) The need to notify the DO [Department Office] promptly if the person feels that the circumstances in the case would justify reconsideration, waiver, partial adjustment, or partial refund.
§ 5503(b) provides:
Delay in Withholding Benefits to Recover Overpayments.
Before we start to adjust the overpayment against the benefits due a beneficiary, he or his payee will normally be given reasonable opportunity to contest the correctness of the determination or to establish that a basis exists for waiver or partial adjustment. The notice to the beneficiary will advise him that adjustment will be deferred for a longer period when the facts in a given case, including but not limited to time case is being worked, cutoff dates, mailing time, etc., indicate that a 30-day period would be inad *964 equate for consideration of the matter and reply by the beneficiary and reviewing office processing time.
The only exceptions to this rule are :
(1) the overpayment is based on an annual report by the beneficiary; or
(2) the overpayment results from the superendorsement procedures under Section 205 (n) of the Act whereby payment of a combined check is made to the survivor. ... In the above two situations immediate , adjustment action is taken.
§ 5503 (c) provides :
If the person responds raising some question about the correctness of the determination of overpayment, or raises a question about recovery, waiver or partial adjustment, the DO will obtain the necessary evidence and prepare a recommendation to the reviewing office for disposing of the case. Thus, if the person liable requests reconsideration of the substantive determination and it appears that the determination mil be affirmed, the DO will develop the possibility of waiver of adjustment or recovery of the overpayment at the same time it receives evidence to resolve the request for reconsideration. This is necessary since, if the substantive determination is affirmed the Reconsideration Determination will cover both issues (§ 8737). (Emphasis original).
When development is initiated for reconsideration of the overpayment determination, for waiver, or for partial adjustment, withholding to recoup the overpayment will be further deferred and payment will be continued until development has been completed, if the beneficiary is otherwise entitled to benefits. If development will not be completed before the expiration of the initial 30-day deferral period, the DO will . . . advise the reviewing office.
After this case was heard, the Administration reported that by January 1, 1975, over-payments based on beneficiaries’ annual reports [§ 5503(b)(1)] will not be an exception to the rule of § 5505(b).
.
The initial overpayment determination notice must state the basis of the determination and inform the recipient of his right to reconsideration (§ 404.907). The initial determination is final unless a written request for reconsideration is filed (§ 404.908). The reconsideration decision is final unless a hearing is requested in writing (§ 404.914).
. Partial adjustment is a recoupment method whereby part of monthly benefits are withheld. It is permitted (not mandated) by
. Recipients of old age retirement benefits are required to file annual earnings reports; and under
. The exposure of Plaintiffs Elliott and Gaines to recoupment is based upon the Administration’s discovery of its own alleged *965 error. Plaintiff Yamasaki’s exposure is based upon information supplied to the Administration by the insurance carrier of her unemployment compensation insurance.
. The pertinent parts of the form letter are as follows:
“If you believe that this determination is not correct, you may request that your case be reexamined. If you want the reconsideration, you must request it not later than 6 months from the date of this notice. You may make any such request through any social security office. If additional evidence is available, you should submit it with your request.
To recover the overpayment, we shall withhold your benefits beginning with the check you would normally receive in _. The next check that you will receive after the full overpayment has been withheld will be for $__It will be sent to you about__ Thereafter, your regular monthly benefits of $_ will be resumed. Under social security law, any overpayment must be withheld from benefits or paid back unless both of the following are true:
1. The overpayment wasn’t your fault in any way and you cashed the check (s) because you thought they were correct, and
2. You couldn’t meet your necessary living expenses if you had to pay back the overpayment or have it withheld from your social security benefits; or it would be unfair for some other reason.
To decide whether repayment would cause you financial hardship, we shall need a statement of your assets, and monthly income, and expenses. If you think you meet both conditions, call, write, or visit any social security office within 30 days from the receipt of this letter. Please take this letter with you if you visit the office. Unless we iiear from you within 30 days, we shall withhold benefits as indicated above.”
. One Plaintiff (Vaquilar) did immediately ask for and receive a partial adjustment of the amount to be withheld monthly. Moreover, acting on advice of counsel, he completed and filed the requisite forms requesting waiver and reconsideration more than thirty days after receipt of the overpayment notice. However, trial testimony indicates that timely completion of the forms would not have changed the Administration’s disposition of the first subclass cases.
. The general rule is that a litigant must exhaust his administrative remedies, if such remedies exist, before invoking federal jurisdiction. Myers v. Bethlehem Shipbuilding Corp.,
. Affidavit of Bernard Popick, para. 12.
. Plaintiff’s Exhibit, P-15.
. Affidavit of Nancy Yamasaki, Exhibit A.
. The pertinent parts of the initial notice were virtually the same as those reprinted in note 7, supra.
. The three subclass two Plaintiffs, acting upon advice of counsel, eventually did complete and file the requisite forms after the initial thirty clays had elapsed. Trial testimony indicates, however, that timely completion of the forms would not have altered the Plaintiffs’ current status. See also note 9, supra. ,
.
See
. The Administration’s own Claims Manual § 5000 states, “Most people who get an RSDI check depend upon it for the necessities of life.”
. For example, Plaintiff Elliott was forced to seek emergency welfare assistance from the State of Hawaii after her social security payment for June 1972 was withheld.
.
. Whether
. The court does not decide the
. This traditional requirement is sometimes stated as a duty plainly and positively ascertained, and free from doubt. Wilbur v. United States ex rel. Kadrie,
. In
Mead,
a case wherein the adequacy of a prison library was challenged, the Ninth Circuit held that
. In Knuckles v. Weinberger,
. In Richardson v. Wright,
The cases cited by the Defendant are clearly distinguishable. It is true that in Kelly v. Wyman,
Recently, when the recipient of unemployment compensation was given an informal personal interview prior to the termination
*970
of benefits and the record reflected the absence of a factual dispute or the misapplication of rules and regulations, the Ninth Circuit reversed the lower court and held that a full evidentiary hearing prior to benefit termination as in
Goldberg
was not required. Crow v. Cal. Dep’t. of Human Resources Dev.,
. See note 17, supra.
. The Supreme Court has found an adverse impact sufficient to impose a prior hearing requirement in circumstances far less dire than when necessities of life are concerned, namely, when a deprivation of property was involved. Though a hearing was afforded only three days after the repossession of goods
(i. e.,
a stove and stereo), the Court held that due process was violated because there was no hearing prior to the repossession. Fuentes v. Shevin,
. It has been suggested that
Goldberg
may be distinguishable from other cases because it involved terminations of benefits, not reductions.
See
Wheeler v. Montgomery,
. See also Note, Procedural Due Process and The Termination of Social Security Disability Benefits, supra note 25.
. “ . . . fiscal considerations are always relevant, but seldom if ever decisive in cases of this sort.” Crow v. Cal. Dep’t. of Human Resources,
. See text accompanying note 16, supra. While the court finds that a prior oral hearing is constitutionally necessary when requested, the Administration may still use its current “paper” hearing wherein documents *971 filed by the claimant are reviewed to select out those cases which may be reversed without a hearing. The Administration has claimed that the increased cost of continuing benefits until a hearing is had could be $35 million. However, this figure makes two dubious assumptions, namely that everyone subject to recoupment will request a hearing, and that all will take two years to complete the appeals process. The first assumption is questionable in light of current statistics on recipients who contest overpayment determination. See text accompanying note 16, supra. The second “two year” assumption assumes that the current time for the full appeals process could not be shortened somewhat by the Administration itself.
.
Compare,
Richardson v. Wright,
supra
note 25,
. See text accompanying note 16, supra. These figures of course should not be taken to impugn the competence of the Administration ; rather, they attest to its fairness and the complexity of making initial overpayment determinations.
. See text accompanying note 16, supra.
. Under the procedure challenged in Goldberg, a welfare termination decision was made only after the recipient discussed the case with a caseworker (a safeguard not present in this case). A unit supervisor then reviewed the caseworker’s termination decision. If the supervisor concurred, the recipient was given seven days to request another review by a higher official. Like the Plaintiffs here, the welfare recipient could submit a written statement supporting his case to this higher official. If the higher official felt termination was warranted, welfare aid stopped immediately. The welfare recipient, like the Plaintiffs here, could then request a post-termination hearing.
. The
Goldberg
Court apparently limited its holding to situations where issues of fact are present,
.
See
Richardson v. Wright,
supra
note 25,
. The Plaintiffs due process right to a hearing may of course be waived by them. It is for the Administration to decide whether obtaining written waivers of the right to a hearing in all, some, or no cases is advisable, but the court notes in passing that written waivers would minimize litigation over whether a recipient knowingly and intelligently decided not to request a hearing.
. At first blush the need for a prior hearing in annual report cases (subclass one) may be doubtful because the reports are filed by the claimants themselves and over-payments are determined by the mechanical application of a statutory earnings standard. However, this is but another way of saying that annual report cases involve “more reliable” evidence than others. Even if this supposed reliability were a factor, nothing • makes a report more unreliable than when its own author says it is a mistake. In fact, it may be that because overpayments based on annual reports present relatively straight forward fact issues, the claimant will seek an oral hearing only when a mistake is clear.
. The Plaintiffs have no due process right to a hearing on partial adjustment because they have no protected property interest in it. In Bd. of Regents of State Colleges v. Roth,
Furthermore, since no due process right covers the partial adjustment problem, this court cannot say that partial adjustment or the form needed to file for it, must as a constitutional matter be mentioned in the initial overpayment notice.
. See text accompanying notes 11-12, supra.
. Normally when an administrative agency is about to take action adverse to a citizen, due process requires that the citizen be informed of the evidence upon which the agency relies so that he can rebut that evidence effectively.
See
Langevin v. Chenango Court, Inc.,
. While the text for procedural due process is one of fundamental fairness in the light of the total circumstances, due process always requires that a reasonable opportunity be given the individual to prepare for and meet the case against him.
See e. g.,
Whitfield v. Simpson,