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SLR v. Saul

United States District Court, N.D. Indiana, Fort Wayne Division

August 15, 2019

SLR, a minor, by and through her parents, CAR and CDR, and CAR and CDR on their own behalf, Plaintiffs,
v.
ANDREW SAUL, Commissioner of SSA, [1]Defendant.

          OPINION AND ORDER

          HOLLY A. BRADY JUDGE

         This case comes before the Court on Defendant Andrew Saul, Commissioner of the Social Security Administration's (the “SSA”), Motion to Remand for Further Administrative Proceedings and Development under Sentence Four of 42 U.S.C. § 405(g) (the “Motion”) (ECF No. 17). The Motion asks the Court to remand this matter back to the ALJ to fix what the SSA concedes are significant deficiencies in the way the proceedings below were handled. Plaintiffs object to the Motion, see ECF No. 19, arguing that the preliminary question on appeal, the propriety of the SSA's decision to reopen Plaintiffs' benefit determination, is an issue of law that this Court can and should decide. Instead, Plaintiffs ask this Court to remand this matter for the reinstatement of the prior award of benefits based on CDR's earnings record and to vacate the claimed overpayment. After a thorough review of the record, the Court concludes that the SSA has wholly failed to address the legal arguments advanced by Plaintiff. As a result, the Court will remand with instructions to reinstate the prior award of benefits and to vacate the SSA's claimed overpayment.

         I. FACTS AND PROCEDURAL HISTORY

         CAR, mother of SLR, has been married to CDR since July 30, 1980. SLR was born on October 21, 2003. Around the time of SLR's conception, CAR had a sexual relationship with another man, Carl, while she was in Kentucky for work.

         In April 2010, CDR filed an application for Social Security retirement benefits (ECF No. 9 at 29-32) and named SLR as his child. SLR began receiving benefits as CDR's child in July 2010. In September 2014, Carl filed an application for Disability Insurance benefits (Id. at 37-38), and in that application, he indicated that he did not have any children. Carl amended his application on December 31, 2014 (Id. at 41-42), to list SLR as his child.

         As part of the processing of Carl's application, an SSA representative, Rose Hatch, completed a Report of Contact (Id. at 49) on January 9, 2015. The Report of Contact recounted two key events. The first was a telephone call that occurred on December 31, 2014. The Report of Contact states that, during that call, both CDR and CAR stated that Carl was SLR's father.

         The second event was a visit by CDR and CAR to their local SSA branch on January 9, 2015. During that visit, the Report of Contact states that CDR and CAR again identified Carl as SLR's father. They presented SLR's birth certificate which showed no father listed. While at the office, CDR signed a form stating that SLR lived in his home since birth and that he and CAR had been the only support of SLR during her lifetime.

         The Report of Contact also contains statements of Carl, although it is not clear where these statements came from. According to the Report of Contact, Carl stated that he had an affair with CAR in 2003 that produced a child, SLR. Carl further stated that he was at the hospital when SLR was born. The Report of Contact ends with a question, “[W]hat is [SLR's] status as a child and is she entitled to benefits on [CDR's] record?”

         On February 19, 2015, CDR sent a letter to Hatch regarding the support and living arrangements of SLR. (Id. at 54). According to the letter, CDR and CAR were married, but maintained separate homes. CAR and SLR would occasionally live with CDR, sometimes as much as three days a week and weekends. CDR reported that he made most significant purchases for SLR, paid school fees, provided transportation, and was “there to help with any type of need that [SLR] has.” It appears that, shortly after receiving this letter, Hatch placed a note in SLR's file directing that her benefits not be reinstated because she was not the child of CDR. There is no record indicating that SLR, CDR, CAR, or Carl were contemporaneously made aware of Hatch's determination.

         At some point in early June 2015, CDR and CAR returned to their local SSA branch to get an update on the status of SLR's benefits. Following that visit, a Special Determination (Id. at 55) was made by a different SSA employee, Melissa Lai, on June 9, 2015. Lai determined that, because CDR and CAR were married at the time of SLR's birth, SLR would be presumed to be CDR's child and benefits would be reinstated. According to Lai, “SSA is not going to reopen the prior decision that [SLR] is the child of [CDR]. This case does not meet one of the exceptions.”

         The next day, June 10, 2015, Hatch entered her own Special Determination. (Id. at 56). Relying on CDR and CAR's January 9, 2015, statements regarding Carl's status as SLR's father, the fact that SLR did not live with CDR, and the assertation that CDR “is not providing ½ support, ”[2] Hatch concluded that SLR's “claim should have been denied on April 13, 2010.” Therefore, Hatch directed that “the claim be reopened and denied” because “[t]here is no relationship established between [CDR] and [SLR].” Hatch's determination was communicated to CDR via letter also issued on June 10, 2015 (Id. at 57), in which CDR was advised that the June 9, 2015, determination of Lai was made “in error.” CDR received more formal determination letters on June 26, 2015, August 17, 2015, and August 26, 2015, stating that SLR would not be paid monthly benefits going forward until the SSA was fully repaid $64, 332.00 in overpayments.

         On September 11, 2015, CAR filed a Request for Reconsideration (Id. at 71-74) on SLR's behalf. CAR supported the Request with a letter in which she reiterated that she and CDR were married on August 2, 1980, and had never been divorced. Although paternity had never been established by any formal testing, CAR asserted that CDR should be considered SLR's father under Indiana law due to the existence of the marriage at the time of SLR's birth. Also attached to the Request was a Wisconsin Certificate of Vital Record (Id. at 74) showing CDR as SLR's father. The SSA responded to the Request for Reconsideration via letter on October 6, 2015. (Id. at 78). The entirety of the factual basis for the SSA's decision was contained in the following sentence: “Since [Carl] and [CDR] both acknowledge [SLR] as being the biological child of [Carl], we should not have paid her any benefits on [CDR's] record.” (Id.).

         A Request for Hearing by Administrative Law Judge (Id. at 81) was filed on behalf of SLR on October 29, 2015. Pursuant to that Request an administrative hearing was held on August 19, 2016. The ALJ began the hearing by cautioning the witnesses not to dispute Carl's paternity. The ALJ stated:

I just want to caution you, however. There is other evidence in this record that there were statements made to Social Security administration by both [CAR] and [CDR] and [Carl] that ...

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