Bauserman v Unemployment Insurance Agency – 20.09

Bauserman v Unemployment Insurance Agency
Digest No. 20.09

MCL 600.6431

Cite as: Bauserman v Unemployment Insurance Agency, unpublished decision of the Court of Claims, entered May 10, 2016 (Case No. 15-000202-MM).

Bauserman v Unemployment Insurance Agency, unpublished opinion per curiam of the Court of Appeals, issued July 18, 2017 (Docket No. 333181).

Court: Court of Claims and Court of Appeals
Appeal pending: Yes
Claimant: Bauserman
Employer: N/A
Date of decision: May 10, 2016; July 18, 2017

View/download the full Court of Claims decision

View/download the full Court of Appeals decision

View/download the full complaint

HOLDING: The Court of Claims held that the Agency’s motion to dismiss was denied because plaintiffs complied with the notice provisions of MCL 600.6431, the Court has subject matter jurisdiction, and the plaintiffs’ claims are not barred by governmental immunity.

The Court of Appeals reversed the Court of Claims holding. The case was remanded for entry of an order granting summary judgment for the Agency

The matter is currently under review by the Michigan Supreme Court.

FACTS: Named plaintiff was terminated from his employment and applied for unemployment benefits. He received benefits for a over a year. While he was receiving benefits, he received from his former employer a lump sum deferred payment of his pro rated bonus from the previous year, which he earned prior to his termination. MIDAS detected a discrepancy and concluded that plaintiff received benefits while he was earning income.

The UIA sent a request for information relative to ineligibility or disqualification to plaintiff’s online MiWAM account, however he was not checking the account as he was no longer receiving benefits at the time. When he finally saw the message months later, he began writing to the Agency to explain the lump sum. The Agency never responded.

Eventually, they notified plaintiff that he had been overpaid benefits and would be assessed a penalty. Plaintiff again contacted the Agency explaining the bonus. Then the United States Department of Treasury notified plaintiff that his federal income tax refund had been seized by the State of Michigan to collect on his unemployment debt. Similar action was taken by the State of Michigan Treasury.

Finally, Plaintiff received a redetermination that its earlier fraud determination was null and void. Plaintiff had filed a complaint in the Court of Claims alleging that the Agency’s fraud detection program, and its collection and seizure of assets, violated the due process clause of the Michigan Const 1963, Art 1, § 17.

DECISION: The Court of Claims decided that plaintiffs’ causes of action did not accrue when Agency first notified them of their liability for unemployment but rather when the Agency issued a redetermination which concluded that the plaintiff had not received UIA benefits fraudulently. The administrative process fails to afford sufficient relief to plaintiff’s challenging an entire statute and policy, therefore a constitutional court claim is viable and there is no governmental immunity.  The Agency’s motion to dismiss on lack of standing is denied.

The Court of Appeals decided that the plaintiffs’ cause of action accrued when “the wrong on which they base their claim was done.” The Court decided the garnishment of wages and interception of tax returns was not the initial event given rise to their claim. Rather, when the Agency issued notices of its determinations and the plaintiffs were not given requisite notice or opportunity to be heard was the initial wrong.

RATIONALE: The Court of Claims found that the plaintiffs’ causes of action did not accrue when the Agency first notified them of their liability for unemployment benefits and penalties, but much later. The causes of action accrued when the Agency issued a redetermination that concluded that plaintiffs had not received UIA benefits fraudulently. At the time the Agency issued the redetermination, then plaintiffs could fully allege the elements of the claim. The amended complaint was filed within six months of the redetermination dates, therefore the plaintiffs complied with statutory requirements.

Furthermore, the Court found that the administrative process by which the plaintiffs could appeal within the Agency failed to afford sufficient relief to plaintiffs wishing to challenge the entire statutory and policy scheme. Therefore the Court found no governmental immunity existed in this case.

The Court of Appeals found that the forfeiture of monetary assets was the damage resulting from the wrongful conduct of the Agency and therefore did not rise to the event given cause for a claim. The Court said this is consistent with the Michigan Supreme Court’s recent decision in Frank v Linkner, 894 NW2d 574 (2017) where the court held that the plaintiffs’ argument “conflates monetary damages with harm.” Frank involved a shareholder oppression action not an unemployment benefits action.

Since the parties did not dispute the date of named plaintiff’s notices of redetermination were December 3, 2014, the action filed on September 9, 2015 is well beyond the six months following the event that gave rise to the cause of action.

Digest author: Sara Posner, Michigan Law, Class of 2017
Digest updated: December 5, 2017

 

Hicks v Colvin – 19.17

Hicks v Colvin
Digest No. 19.17

Due Process/Fraud

Cite as: Hicks v Colvin, 214 F Supp 3d 627 (ED KY 2016).

Court: District Court, Eastern District of Kentucky
Appeal pending: Yes
Claimant: Amy Jo Hicks
Agency: Social Security Administration
Date of decision: October 12, 2016

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HOLDING: Due process requires individuals to be able to challenge factual assertions made by the government as part of the government redetermining their eligibility for benefits.

FACTS: Claimant, who suffered several psychological and physical ailments, applied for Social Security disability benefits in 2007 with the help of Attorney Eric Conn. Claimant received benefits until 2014, when the SSA’s Office of Inspector General (OIG) discovered a fraudulent scheme orchestrated by Conn with the help of ALJ Daugherty and several doctors. The OIG ordered the SSA to redetermine 1,787 of Conn’s clients’ cases, hold new ALJ hearings, and disregard any evidence if there was reason to believe fraud was involved. At Claimant’s hearing the ALJ refused to review or admit her medical records because they were based on a template medical form that Conn used in his fraudulent scheme. Because so much time had passed, Claimant was unable to testify regarding her exact medical condition and diagnosis at the time she applied for benefits, so her benefits were cancelled.

DECISION: The OIG policy of ordering the SSA to automatically disregard evidence during the redetermination process if the OIG had reason to believe fraud was involved violated due process because it denied individuals a meaningful opportunity for a hearing at which they could challenge the OIG’s factual assertions of fraud.

RATIONALE: Due process requires the government to give individuals a “meaningful hearing” that will provide them with “a fair opportunity to rebut the Government’s factual assertions before a neutral decisionmaker.” Hamdi v Rumsfeld, 542 US 507, 533; 124 S Ct 2633 (2004). That includes giving the individual the right to present facts and have their case be decided according to those facts. Interstate Commerce Comm’n v Nashville RR Co, 227 US 88, 91; 33 S Ct 185 (1913). The OIG’s policy violated due process because it allowed the SSA to make a factual determination about an individual–that they committed fraud–without explaining its reasons or allowing the individual to challenge the determination. Although the SSA did give Claimant a hearing, because it excluded all her medical evidence and didn’t give her the opportunity to challenge the OIG’s determination that the evidence was fraudulent, her hearing was not “meaningful.”

The Court declined to give the OIG fraud policy Chevron deference because it was a policy, not a rule that had undergone notice-and-comment, and thus lacked the force of law. The Court also explained, citing Loudermill v Cleveland Board of Ed, 470 US 532, 541; 105 S Ct 1487 (1985), that although social security disability is an entitlement, so long as the government operates the program, it cannot take away benefits without due process. The Court held the portion of the OIG fraud policy unconstitutional that required ALJs to disregard the evidence it labelled fraudulent without giving those ALJs deference as the fact-finder to determine whether or not it was fraudulent. The Court suggested that, on rehearing, Claimant should be able to offer whatever evidence she wanted, and allow the ALJ discretion to determine whether it was fraudulent or should be admitted.

Digest author: Sarah Harper, Michigan Law, Class of 2017
Digest updated: December 23, 2017

Wickham v. Adecco CS, Inc. – 18.23

Wickham v. Adecco CS, Inc.
Digest No. 18.23

Section 421.32(a)

Cite as: Wickham v Adecco CS, Inc, unpublished opinion of the Michigan Administrative Hearing System, issued September 28, 2016 (Docket No. 16-021211).

Appeal pending: No
Claimant: Margaret M. Wickham
Employer: Adecco CS Inc.
Date of decision: September 28, 2016

View/download the full decision

HOLDING: Under Michigan law, when pleading a cause of action involving fraud, the circumstances alleged to must be stated with particularity. In addition, in a fraud case, due process of law is violated when a claimant is not apprised of when, why, or how her actions constitute intentional misrepresentation of material fact.

FACTS: Claimant received a November 21, 2014 adjudication that concludes that Claimant’s “actions” indicate that she intentionally misled and/or concealed information to obtain benefits to which she was not otherwise entitled.

DECISION: The November 21, 2014 adjudication is facially defective as a matter of law, so it is void, set aside, vacated, and dismissed. Therefore the Agency’s denial of reconsideration concerns an invalid underlying adjudication, so it must also be set aside, vacated, and dismissed as a matter of law.

RATIONALE: The November 21, 2014 adjudication includes no factual assertions in support of the vague generalized legal conclusion that Claimant’s “actions” indicate that she intentionally misled and/or concealed information to obtain benefits to which she was not otherwise entitled. The Agency’s omission of particularized factual assertions in support of its legal conclusions violates Michigan law concerning the pleading of causes of action including fraud. Kassab v Michigan Basic Property Insurance Association, 441 Mich 433 (1992) requires that, when pleading a cause of action involving fraud, the circumstances alleged to must be stated with particularity. Section 421.32(a) requires the Agency to examine claims and render determinations on the facts; the Unemployment Insurance Agency lacks jurisdiction to render adjudications containing summary legal conclusions unsupported by factual assertions. In addition, the November 21, 2014 adjudication violates the demands of due process of law by failing to apprise Claimant of when, why, and how her “actions” constitute intentional misrepresentation of material fact.

Digest author: Winne Chen, Michigan Law, Class of 2017
Digest updated: November 26, 2017

 

Hicks v. Randstad – 18.26

Hicks v. Randstad
Digest No. 18.26

Section 421.54 & Section 421.62

Cite as: Hicks v Randstad Employment Solutions LP, unpublished opinion of the Michigan Compensation Appellate Commission, issued July 14, 2016 (Docket No. 15-064475-248535W).

Court: Michigan Compensation Appellate Commission
Appeal pending: No
Claimant: Derrick Hicks
Employer: Randstad Employment Solutions LP
Date of decision: July 14, 2016

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HOLDING: Even though Claimant did not have good cause for the late protest, the fact that the Agency dismissed the fraud charges overrides the lack of good cause for late protest. The ALJ should have reversed the adjudications or held them void.

FACTS: On August 12, 2015, the Agency issued a determination that found Claimant subject to restitution and fraud provisions of the MESA. Claimant had until September 11, 2015 to file a protest. However the Agency did not receive a protest until December 9, 2015. On December 15, 2015 the Agency issued a redetermination that Claimant did not have good cause for the late protest. Claimant timely appealed the redetermination and had hearing before an ALJ on February 20, 2016. At the hearing, the Agency informed the ALJ that it was no longer pursuing fraud charges against Claimant because there was no indication that he intentionally misled the Agency or concealed information. Nevertheless, the ALJ affirmed the redetermination.

DECISION: The Appellate Commission decided that the fact that the Agency wished to dismiss the fraud charges overrides the lack of good cause for late protest. The Appellate Commission reversed the ALJ’s decision as well as the determination and redetermination. The Appellate Commission further decided that Claimant is not subject to penalties.

RATIONALE: While the claimant had no good cause for the late protest, since the Agency wished to dismiss the fraud charges, there was no need for a showing of good cause.

Digest author: Sara Posner, Michigan Law, Class of 2017
Digest updated: December 26, 2017

 

Proulx v. Horiba Subsidiary, Inc. – 18.21

Proulx v. Horiba Subsidiary, Inc.
Digest No. 18.21

Sections 421.27, 421.33(1), 421.54(b), and 421.62(a)

Cite as: Proulx v Horiba Subsidiary, Inc, unpublished opinion of the Michigan Compensation Appellate Commission, issued October 1, 2014 (Docket No. 14-00680-241108).

Appeal pending: No
Claimant: Brian D. Proulx
Employer: Horiba Subsidiary, Inc.
Docket no.: 14-00680-241108
Date of decision: October 1, 2014

View/download the full decision

HOLDING: Redetermination by the UIA requires fact finding in support of the agency’s decision. When the Agency merely makes a conclusory statement in support of its ruling, such a decision is procedurally deficient and will not be upheld on appeal. Secondly, when a claimant fails to appear at an appeal by the Agency, the ALJ has jurisdiction both to dismiss the proceedings and to “take other action considered advisable”. Thus, the ALJ has “broad discretion to address the matter.” Finally, the notice for the hearing, delivered to the claimant, was required to include ”the issues and penalties involved”. (This requirement has been altered by Michigan Administrative Code (MAC) Rule 792.11407. This rule requires a “short and plain statement of the issues involved”, while related rules require a 20 notice, compared to the usual 7, and a witness list and copy of all documentary evidence related to fraud.)

FACTS: After being discharged by Horiba Subsidiary, Claimant applied for and received benefits under Section 27. A rehearing, on March 28, 2014, by the Unemployment Insurance Agency accused Claimant of fraud or misrepresentation, found him ineligible for Section 27 benefits, and subject to restitution under Section 62(a). A separate rehearing on the same day assessed penalties under Section 54(b). Claimant then failed to appear at an ALJ hearing of this matter on July 10, 2014. The notice of this hearing provided to Claimant read “SECTION 27(c) & 48 – WHETHER OR NOT CLAIMANT IS ELIGIBLE FOR BENEFITS UNDER THE REMUNERATION, EARNINGS OFFSET PROVISION. CLAIMANT MUST PAY RESTITUTION/DAMAGES TO AGENCY UNDER SECTION 54(b)-INTENTIONAL MISREPRESENTATION. SECTIONS THAT MAY APPLY ARE: 62(a), 62(b), 20(a).” This notice did not include the penalties involved as required by the Michigan Administrative Code (MAC) Rule 421.1110(1). (Note that this rule has since been superseded and altered by Rule 792.11407.)

Because of Claimant’s failure to appear, the ALJ dismissed Claimant’s appeal of the Section 27, and Section 62(a) rehearings, but remanded the Section 54(b) rehearing to the Agency because their accusations in that rehearing were merely conclusory and didn’t provide supporting fact-finding. The Unemployment Insurance Agency appealed this remand decision to the Michigan Compensation Appellate Commission, and the Commission reviewed both of the orders of the ALJ.

DECISION: The ALJ’s dismissal of Claimant’s appeal is set aside and remanded for a full hearing. The ALJ’s remand of the Agency’s 54(b) ruling is affirmed.

RATIONALE: An ALJ does not lack jurisdiction over an appealed UIA hearing simply because the appellant failed to appear at the appeal. Section 33(1) provides that “If the appellant fails to appear or prosecute the appeal, the administrative law judge may dismiss the proceedings or take other action considered advisable.” Since the ALJ may “take other action considered advisable”, a dismissal based on the appellant’s failure to appear is an error of law. A second reason for setting aside the ALJ’s dismissal of the appeal is the insufficiency of the notice provided to Claimant. Michigan Administrative Code (MAC) Rule 431.1110(1) required the notice to include a description of the penalties involved. Since the notice form provided to Claimant lacked this information, it was not sufficient and his failure to appear can’t be held against him.

Secondly, and Agency determination of fraud or misrepresentation on the part of a claimant can’t be sustained without fact-finding on the record to back up that determination. Merely supplying conclusory statements as to Claimant’s alleged fraud does not meet this burden. Therefore, when the Agency fails to provide appropriate factual backing for its findings, it must reconsider its determination.

Digest author: James Fahringer, Michigan Law, Class of 2018
Digest updated: 3/30/2016

 

Gordon v. Miller Apple – 16.82

Gordon v. Miller Apple
Digest No. 16.82

Section 421.54

Cite as: Gordon v Miller Apple, unpublished opinion of the Michigan Compensation Appellate Commission, issued October 3, 2012 (Docket No. B2011-11754-RM9-228743W).

Court: Michigan Compensation Appellate Commission
Appeal pending: No
Claimant: Thomas Gordon
Employer: Miller Apple, LP
Date of decision: October 3, 2012

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HOLDING: The Michigan Compensation Appellate Commission (MCAC) 1) reversed an Administrative Law Judge (ALJ) order denying rehearing, and 2) found the claimant had not committed fraud under Section 54(b).  

FACTS:  The Agency found Claimant disqualified for benefits and liable for penalties under the fraud provision of Section 54(b).  Claimant did not contest his ineligibility, but did deny that he had committed fraud under the statute.  Because both cases involve similar facts and points of law, they were docketed together for a hearing pursuant to Administrative Rule R421.1205.  Because the ALJ was unavailable, those hearings were cancelled and rescheduled for a subsequent date at 11:00am and 12:00 pm respectively.  Claimant’s attorney received only one of these notices of hearing, and thus told Claimant to arrive at noon on the day of the hearing.  When Claimant failed to appear for his 11:00 am hearing, he found the claim had been dismissed.  The ALJ subsequently found no good cause for Claimant’s failure to appear and denied his request for rehearing.  On the question of fraud, Claimant testified that while he did not contest his ineligibility, he did not commit fraud under Section 54(b).  Claimant had not reported his irregular part time earnings, but immediately began reporting them when informed of this requirement.

DECISION: The Commission made two holdings: on the question of Claimant’s request for rehearing, the Commission found good cause for Claimant’s failure to appear and set aside the ALJ order denying rehearing.  On the question of fraud, the Commission reversed the Agency determination finding fraud under Section 54(b), finding that Claimant did not intentionally misrepresent a material fact to obtain benefits to which he was not entitled.

RATIONALE: On the question of Claimant’s request for rehearing, the Commission found that the attorney’s failure to receive both notices of hearing established good cause for Claimant’s failure to appear at his first scheduled hearing.  On the question of fraud, the Commission found Claimant’s testimony credible in showing he did not intentionally misrepresent a material fact to the Agency to obtain benefits he was not entitled to, and thus did not commit fraud within the meaning of Section 54(b).  Here, Claimant incorrectly reported irregular part-time income to the Agency, but called the Agency to determine if and how to report these earnings.  As soon as Claimant discovered his error, he began reporting his earnings.  The Commission thus found that while he remained ineligible for benefits, he did not commit fraud under Section 54(b).

Digest author: Laura Page, Michigan Law, Class of 2018
Digest updated: December 27, 2017

 

Olivarez v Unemployment Insurance Agency – 18.16

Olivarez v Unemployment Insurance Agency
Digest No. 18.16

Section 62 & Section 54

Cite as: Olivarez v Unemployment Insurance Agency, unpublished opinion of the Saginaw County Circuit Court, issued November 17, 2008 (Docket No. 08-000366-AE-3).

Appeal pending: No
Claimant: William Olivarez
Employer: Michigan Unemployment Insurance Agency
Date of decision: November 17, 2008

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HOLDING: The court reversed the fraud decision because there was not competent, material, and substantial evidence to support it.

FACTS: Claimant  worked for the Agency and applied for benefits while on long term disability. The Agency ordered restitution and Claimant won at the ALJ hearing but lost at MCAC.

MCAC held that there was fraud because Claimant collected while on long term disability; he knew there was an issue about whether he could do so; an employee of the disability insurance company told him this was alright; and Claimant should have known to go to Agency with questions about eligibility.

DECISION: Claimant is ineligible for benefits. The Agency did not provide sufficient evidence for fraud.

RATIONALE: On eligibility, there was a doctor’s note that said Claimant could not do any work at all. This was competent, material, and substantial evidence and the court affirmed this decision.

Regarding fraud, there was not sufficient evidence to “support a finding of wrongful, quasi-criminal behavior.” The court went on to say: “Fraud, while easily claimed, is not lightly proven.” Citing Mallery v Van Hoeven, 332 Mich 561, 568; (1952). Fraud must be established by evidence. This was a “skimpy record” and does not “support a finding of serious wrongdoing, even under the relatively light standard of substantial evidence.”

Digest author: Benjamin Tigay, Michigan Law, Class of 2018
Digest updated: December 1, 2017