ILNews

Judges send Medicaid case back for review

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The Indiana Court of Appeals remanded a Medicaid benefits denial to the Administrative Law Judge because her decision lacked findings of fact making the case mostly unreviewable by the appellate court.

Alesa Pack applied for Medicaid in 2008. Prior to her application, she had been in two car accidents, diagnosed with panic disorder and schizophrenia, and had many surgeries and treatments for her injuries from the accidents. Pack mentioned physical and psychological ailments as her reason for applying. The review team, ALJ, and Family and Social Services Administration denied benefits; the trial court ruled against Pack.

While her appeal was pending, Pack obtained Medicaid benefits, but this issue isn’t moot because the application for benefits at issue covers medical costs from a two-year period during which her newly awarded benefits don’t provide coverage, noted Judge L. Mark Bailey.

In reviewing the ALJ’s decision, the appellate court found no error in her decision regarding Pack’s physical condition. The ALJ found basic facts contrary to Pack’s assertions and concluded through a proper application of the regulations that she wasn’t substantially impaired from walking or light office work. But the ALJ barely touched upon Pack’s psychiatric conditions. The ALJ didn’t apply the functional limitation factors set forth in the state’s Medicaid regulations and her use of the record on Pack’s psychiatric conditions was selective, wrote Judge Bailey in Alesa Pack v. Indiana Family and Social Services Administration, No. 89A05-1004-PL-240.

“We are mindful here of our duty not to reweigh evidence, a function properly assigned to the ALJ,” he wrote. “Yet the ALJ’s findings here leave us without confidence that she weighed Packs’ psychiatric evidence or applied relevant law to that evidence in reaching a decision.”

The judges sent the case back to the ALJ because the decision was issued “without observance of procedure required by law.” The court also addressed the purposes, function, and proper form of findings of fact and conclusions of law in an administrative context because of the number of administrative orders issued each year.

“Yet we are at times confronted with orders that are defective because the agency’s decision lacks support in the record, that do not adequately articulate a basis for the agency’s decision, that recite the contents of evidence presented to an agency without making proper findings of basic fact, or that simply fail to adequately or rationally apply law to found facts,” Judge Bailey wrote. “Failing to follow proper procedures and form for agency orders may reflect an underlying failure to observe due process of law, whether or not due process was actually had by any or all affected parties and whether or not the agency’s ultimate decision is correct.”

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  1. Indiana's seatbelt law is not punishable as a crime. It is an infraction. Apparently some of our Circuit judges have deemed settled law inapplicable if it fails to fit their litmus test of political correctness. Extrapolating to redefine terms of behavior in a violation of immigration law to the entire body of criminal law leaves a smorgasbord of opportunity for judicial mischief.

  2. I wonder if $10 diversions for failure to wear seat belts are considered moral turpitude in federal immigration law like they are under Indiana law? Anyone know?

  3. What a fine article, thank you! I can testify firsthand and by detailed legal reports (at end of this note) as to the dire consequences of rejecting this truth from the fine article above: "The inclusion and expansion of this right [to jury] in Indiana’s Constitution is a clear reflection of our state’s intention to emphasize the importance of every Hoosier’s right to make their case in front of a jury of their peers." Over $20? Every Hoosier? Well then how about when your very vocation is on the line? How about instead of a jury of peers, one faces a bevy of political appointees, mini-czars, who care less about due process of the law than the real czars did? Instead of trial by jury, trial by ideological ordeal run by Orwellian agents? Well that is built into more than a few administrative law committees of the Ind S.Ct., and it is now being weaponized, as is revealed in articles posted at this ezine, to root out post moderns heresies like refusal to stand and pledge allegiance to all things politically correct. My career was burned at the stake for not so saluting, but I think I was just one of the early logs. Due, at least in part, to the removal of the jury from bar admission and bar discipline cases, many more fires will soon be lit. Perhaps one awaits you, dear heretic? Oh, at that Ind. article 12 plank about a remedy at law for every damage done ... ah, well, the founders evidently meant only for those damages done not by the government itself, rabid statists that they were. (Yes, that was sarcasm.) My written reports available here: Denied petition for cert (this time around): http://tinyurl.com/zdmawmw Denied petition for cert (from the 2009 denial and five year banishment): http://tinyurl.com/zcypybh Related, not written by me: Amicus brief: http://tinyurl.com/hvh7qgp

  4. Justice has finally been served. So glad that Dr. Ley can finally sleep peacefully at night knowing the truth has finally come to the surface.

  5. While this right is guaranteed by our Constitution, it has in recent years been hampered by insurance companies, i.e.; the practice of the plaintiff's own insurance company intervening in an action and filing a lien against any proceeds paid to their insured. In essence, causing an additional financial hurdle for a plaintiff to overcome at trial in terms of overall award. In a very real sense an injured party in exercise of their right to trial by jury may be the only party in a cause that would end up with zero compensation.

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