EMPLOYMENT LAW

Plaintiff Given Second Chance After Court Finds Commissioner Failed to Consider Evidence

Plaintiff filed for Supplemental Security Income benefits alleging that he suffered from severe migraines. The Commissioner of the Social Security Administration denied the Plaintiff’s claim, and the Plaintiff filed an appeal. Both parties filed summary judgment motions.

The Court reviews the Commissioner’s factual findings for substantial evidence, which means “relevant evidence as a reasonable mind might accept as adequate to support a conclusion.” To determine if a claimant is disabled, the Commissioner looks at five steps. First, the Commissioner must determine whether the claimant currently is engaging in substantial gainful activity. If the claimant is, then the claim will be denied. Second, the Commissioner must determine whether the claimant has a medically severe impairment or combination of impairments. If the claimant does not, then the claim will be denied. Third, the Commissioner compares the medical evidence of the claimant’s impairment to a list of impairments presumed severe enough to preclude any gainful work. If the impairment is equivalent, the claim is granted without further analysis. If the claimant does not suffer from an impairment on the list or its equivalent, the analysis proceeds to steps four and five. Next, the Administrative Law Judge (“ALJ”) is to consider whether the claimant retains the residual functional capacity to perform his past relevant work, which the claimant bears the burden on demonstrating. If the claimant does not meet the burden, the claim is denied.  If the claimant is unable to resume his former occupation, the burden shifts to the Commissioner who must demonstrate that the claimant is capable of performing other work, other jobs which the claimant can perform.

The ALJ found that the Plaintiff has a medically determinable impairment of migraine headache but found that Plaintiff’s testimony concerning the intensity and limiting effects were not consistent with the medical evidence. The ALJ concluded that the Plaintiff’s treating doctors were not persuasive because they may have relied extensively on self-reported symptoms and that Plaintiff’s migraines were much less debilitating than he described. Lastly, the ALJ found that the Plaintiff should be able to work through his pain.

The Plaintiff argued that the ALJ failed to formulate the Plaintiff’s residual functional capacity to adequately account for limitations caused by Plaintiff’s severe migraines. The ALJ discounted Plaintiff’s testimony that he suffered multiple debilitating migraines per month because the doctors’ visits suggested that the Plaintiff showed up for his appointments and was not impaired at the visits. The ALJ also argued that the Plaintiff’s migraines would be reduced in frequency or so mild that he could work through them if he reduced his medication.

The Court granted the Plaintiff’s motion and remanded the matter back to the Commissioner of the Social Security Administration to give further consideration of the evidence that Plaintiff is unable to perform light work when he is suffering from a migraine and explain the weight given to such evidence. The Court found that the fact that the Plaintiff is not debilitated all of the time is not substantial evidence that he is not debilitated some of the time. Further, there was no substantial evidence in the record to support the conclusion that the migraines would be reduced if medication was reduced. For those reasons, the Court remanded the matter.

Should you have any questions regarding this decision, or any liability law questions, please contact any attorney in our Liability Law Department.

McCracken v. Kijakazi, No. 20-cv-01223-JLH (D. Del. December 27, 2021)

LITIGATION CASE LAW

Delaware: Home of Tax-Free Shopping and PIP Benefits

Plaintiff, a Maryland resident, was operating a Maryland registered vehicle, insured (by Defendant Insurer) pursuant to a Maryland automobile policy when she was injured in an accident in Delaware.

Prior to the accident, Plaintiff had declined to obtain Maryland PIP coverage under the policy issued by Defendant Insurer. So, no coverage – no claim. Not quite.

Plaintiff averred she was entitled to PIP coverage under the Delaware PIP statute, which requires out-of-state drivers have PIP coverage in their home state. Defendant Insurer disagreed, arguing Plaintiff waived PIP coverage in accordance with Maryland law, and thus, should not receive a benefit for which she paid no premiums by virtue of the fact the accident occurred in Delaware. Both parties proceeded with dispositive motions on the issue.

The Delaware Superior Court reviewed prior case precedent as well as the plain language of the Delaware PIP statue which requires all vehicles operated in Delaware to maintain insurance equal to the minimum insurance required by the state or jurisdiction where the vehicle is registered. If such State requires no minimum insurance, then such owner must have insurance equal to the minimum insurance coverage required for Delaware motor vehicles.

Ultimately, the Court found the extraterritoriality provision of Plaintiff’s Maryland policy to be determinative. The extraterritoriality provision required Defendant Insurer to provide the “required minimum and types of coverage” when the covered vehicle is involved in an accident in a state that requires non-resident drivers to maintain insurance. Since Delaware requires PIP coverage, which is optional (thus not required) under Maryland law, Defendant Insurer was contractually obligated under the policy to provide PIP coverage pursuant to Delaware law.

For more information on this matter or other legal questions, feel free to contact any attorney in our Liability Department.

Burkhardt v. Progressive Select Ins. Co., 2021 WL 5903310 (Del. Super. Ct. Dec. 13, 2021).