HEARING - U.S. Senate Special Committee on Aging

136
10,934 New Developments It! ;6
mq,,)ih. h II it nii ind ,tcia ,l iN.,senher
1977 and it SOilr-.trv zieion i rantinghbene
fit, ih; ,I' 1,h 1979. 'Isil It Ixhihit I tTranscrip
in i) . If Wl;dit r F,. This delay is not
atypiirl. I pml ifs' EV.0hiis 14 20.
I1 Conclusions of Law
A. Jurisdiction
As a threshold matter. the defendant, relying
on the decision of the Supreme Court in ieckker
v. Ringer, 466 U.S. 602 (1984) ('Ringef), contends
that the court lacks jurisdiction over this
action pursuant to 42 U.S.C. , 405(g). 6
Section 405(g) requires that a claimant
exhaust administrative remedies before proceeding
in federal court. See Ringer. supra, 466 US.
at 617. There are two requirements for exhaustion
under Section 405(g): First, there is the socalled
"nonwaivable" reqoirement that a claim
for benefits previously must have been
presented to the Secretary. See id.; Mathews v.
Eldridge, 424 U.S. 319, 328 (1976); City of New
suupr.' 4ttd, i S. at t :,rit Nif -V ,rk. supra
742 F.2d1 717,.
'Thr' * i itnriasc i ,,-hith -,.rh judicial
waiver" of the vxhituion ruiremtent may be
appropriat, %srs describhd h v our Court of
Appeals in (;l of c V.rk. cast decided
after Ringer. I'he eourl held that.
Itihe Supreme Court has adoptelld a 1 rctical
approach to section 405(g)'s exhaustion
requirement. The Court has approved judicial
waiver where plaintiff's legal claims are collateral
to the demand for benefits, where
exhaustion would be futile, or where the harm
suffered pending exhaustion would be irreparable.
... In the absence of express guidance
[from the Supreme Court as to whether futility,
collaterality and irreparable harm must
all be present for judicial waiver of the
exhaustion requirementi. we have taken the
view that no one factor is critical. (citation
omitted) We have adopted a more general
approach, balancing the competing considerations
to arrive at a just result under the
circumstances pesentd. City of New York,
supn. 742 F.2r at 736.
In that case, which involved a challenge to an
Improper presumption used by the Secretary to
determine eligibility for Social Security disabilty
benefits, the Court of Appeals held that judicial
waiver was appropriate where irreparable harm
existed, exhaustion would have been futile to
vindicate procedural rights and the claim was at
least "substantially" collateral to the entitlement
to benefits. Id. at 73&737. The court will
York v. Heeckterm 742 F2d 729, 735 (2d Cir.
1984) (Newman, J.) ("City of New York"), afrg
578 F.Supp. 1109 (ED.N.Y. 1984) (Weinstein.
CJ.), cert. granted 106 S.Ct. 57 (1985). There
can be no doubt that the members of the plaintiff
class, who by definition have had claims for
Medicare benefits denied by the Secretary, have
satisfied the presentment requirement. See
Ringer, rupra, 466 US. at 617; City of New
York supra, 742 F2d at 735; Plaintiffs' Memorandum
in Response to Defendant's Memorandum
on the Significance of City of New York v.
Heckler (filed Jan. 7, 1985) at 3-4 (describing consider the application of each of these three
defendant's denial of plaintiffs' claims); Reconm- criteria to the facts of the instant case.
mended Ruling on Motion to Dismiss (filed Dec.
19, 1979) ("Motion to Dismiss Ruling") (Eagan.
First, with respect to the issue of irreparable
M.) at 3 adopted by endorsement ruling
harm, the court holds that in the instant case, as
(entered Dec. 26, 1979) (Clarie, C.J., to whom
in City of ,ew York. supra, 742 F2d at 736, the
"claimants have raised a colorable claim that
this case originally was assigned).
recovery of retroactive benefits would not be
Second. there is the so-called "waivable" fully compensatory." Many of the plaintiffs who
requirement that a claim for benefits must have discontinued their physical therapy prema-
been fully pursued ast the atdministrative leveL turely so as not to exhaust their personal finan-
See Ringer. 5Upri, 4t66 US at 617; City of Ncrw cial resources will never be able to achieve as
York, supr;, 742 F.2d at 735. This exhaustion complete a recovery as would have been possible
req4uirement may bte dispensed with by the had their benefits not initially been denied. See
courts in appropriate circumstatnces. Siee Ringer, Findings of Fact 19, 20. Moreover, for some of
a 42 USC. I 405() prsides. in Psoti-eLt Pars 'lit. r5fiw is rk eprpirallk so the Medicare An by 42
AMY irsdiidlua. cIte any ros decision df the Scrary
mae after a hearing to whkche was a panrtY, irrpective
ad the aemmst in sctetreenY. WY obtain a rree Of Reb
decisi by s d civil actim enemwed within siAty days Atlr
the matiting to him f seticte of seb dedhsw ae within rsorb
farther tiee as the Seretary maY allaws Saa1b aKLIONS shall
e btret hts the distrte cot ot tets United States trf tin
jidieuil iainet in whikb the plaintiff resids or baa is
peinripl pirs of _sse. orr. i he dor ea" rse M" r bave
his prindipdf rt ae he bnos within any such ufidial
dirit. is the United States Distric CAurt far the Disrrit
WM c 1 395ff.
The Sdelndans p isy (and unssccstaully) challenged
the corsurt's jritdictis seer this aeioa, tee ReKsmeoded
Ruliti ng Maxim to Dieisa (tfled De 19.1 979) fEagans
M.) at2.7, doordt'entrswement fli entered De 26
1979) ICisei. C. to whom tshi case eriginally wal
apged). To the eates that the ipplktabte to. baa chraged
sitc the desist of dfendans s mots to dism;is the tane
ot atillis matter Jurindiction, pepey may he entertuined
at Ojffiulcttrm See Ruate 2fh)3i) Fed. F. tCM P. Holeer.
to the etet Oth th sae legal cila arteri ee rrt$1eani.
the c,,lit, rfting ia Ihe . of the eas.
df Columbsa.
ii 35,374
01496, Commerew Clearing Houie. Ins.