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Case Name Hart v. Colvin PB-CA-0046
Docket / Court 3:15-cv-00623-JST ( N.D. Cal. )
State/Territory California
Case Type(s) Public Benefits / Government Services
Attorney Organization Legal Services/Legal Aid
Case Summary
On February 9, 2015, three individuals whose disability benefits had allegedly been denied or terminated based on consultative examinations (CEs) performed by a now disqualified doctor, filed this class-action lawsuit in the U.S. District Court for the Northern District of California. The ... read more >
On February 9, 2015, three individuals whose disability benefits had allegedly been denied or terminated based on consultative examinations (CEs) performed by a now disqualified doctor, filed this class-action lawsuit in the U.S. District Court for the Northern District of California. The plaintiffs sued the Acting Commissioner of Social Security for alleged violations of the Social Security Act and the Fifth Amendment. The plaintiffs alleged that the Commissioner wrongfully relied on CEs performed by a physician, who at the time of this complaint had been disqualified, in denying or terminating their disability benefits.

Specifically, the plaintiffs alleged that the defendant's policy and practice of relying on this disqualified doctor's defective CE reports in denying or terminating disability benefits was in violation of requirement that these determinations be based on evidence from acceptable medical sources. Moreover, the plaintiffs alleged that they and the class members were never notified that the doctor had been disqualified nor provided copies of his reports at the time of their denial or termination. Represented by the National Senior Citizens Law Center, Legal Aid of San Mateo County, and private counsel, the plaintiffs asked the court for declaratory and injunctive relief, class certification, as well as costs and reasonable attorneys fees.

According to the Social Security Act and the subsequent regulations, the defendant "need[s] evidence from acceptable medical sources to establish whether [an individual has] a medically determinable impairment." The SSA also mandated that in order to obtain adequate medical evidence of an individual's disabilities, it is necessary to frequently procure a CE from a qualified medical source. The physician now in question had performed a large volume of CEs in San Francisco and surrounding cities and issued reports that he knew were incorrect or incomplete, including statements that he performed tests he did not in fact perform, and conclusions that here inconsistent with medical evidence already in the record, with no explanation or even acknowledgement of the inconsistency. After numerous complaints over a period of years, this doctor was disqualified from continuing to provide CEs as of December 30, 2013, though his prior CE reports continued to be used as competent evidence by the Social Security Administration (SSA) and used in determinations to deny or terminate SSI and SSDI benefits.

After the plaintiffs filed this complaint, the case was initially assigned to Magistrate Judge Donna M. Ryu. On February 10, 2015, the court ordered alternative dispute resolution. A case management conference was set for May 13, 2015. However, on March 30, 2015, the case was reassigned to U.S. District Court Judge Jon S. Tigar for all further proceedings, and a case management conference was reset for May 20, 2015. After the case management conference on May 20, the court ordered a further case management conference for August 19, 2015.

On June 25, 2015, proceedings on the defendant's motion to dismiss were held before Judge Tigar, who denied their motion to dismiss on July 17, 2015. 2015 WL 4396259. The case management conference set for August 19 was continued to November 19, 2015 because the court set a class-certification briefing schedule and referred the case to a magistrate judge for settlement, which was set for November 17, 2015. The Court granted the plaintiffs' motion for class certification on October 14, 2015.

After a series of settlement conferences held before Magistrate Judge Maria-Elena James, with no resolution, case management proceedings were held before Judge Tigar on February 24, 2016. On March 1, 2016, another settlement conference was set for April 5, 2016. When settlement was still not reached, another hearing was set for April 28, 2016. After another series of settlement conferences, the parties finally came to an agreement on September 19, 2016 and filed notices of their unopposed motion for preliminary approval of class action settlement agreement.

The settlement agreement provides relief to class members through procedural mechanisms that vary depending on the status of their claims and the amount of time since their examination by the disqualified doctor:

Class members with open claims, that is, individuals who received an unfavorable decision or determination of their claim but, as of the date of final approval of this settlement agreement, that determination was not final, were to be notified that their CE reports were flawed and that they had the option to have the report excluded from consideration in a forthcoming adjudication though the adjudicator has the discretion to consider whether ordering an additional CE is appropriate.

Class members with closed claims, that is, individuals who received an unfavorable decision or determination of their claim and, as of the date of final approval of this settlement agreement, that decision or determination was finalized, could be eligible for relief through a readjudication process without consideration of the CE reports created by the disqualified doctor. The individual would also have the opportunity to submit supplemental evidence relating to the previously-adjudication period, and receive back benefits or payments if found to have been disabled for all, or any part of, the previously-adjudicated period.

This relief would not be granted to individuals in "current pay status," who were receiving benefits, or individuals whose claims were denied with no weight afforded to the disqualified doctor's report.

The defendant agreed to begin a study of the processes through which it monitors the California DDS' engagement, review, and retention of empaneled consultative examiners to identity mechanisms to improve the monitoring process. The defendant also agreed to pay attorneys fees in the amount of $490,000 and the plaintiffs agreed to dismiss the case with prejudice.

After preliminarily approving the settlement on November 9, 2016, 2016 WL 6611002, on March 16, 2017 the court held a final hearing on the settlement. On March 17, the parties submitted a joint stipulation of dismissal with prejudice subject to the terms of the settlement agreement.

Judge Tigar granted final approval of the class action settlement on April 17, 2017. Because the settlement provided only injunctive relief, the court was not obligated to require the parties to notify the class members. Nonetheless, the parties requested, and Judge Tigar ordered, that the parties provide some public notice. Since class members would have to take some affirmative steps to reopen their claims, the Court ordered the defendant to publish a notice in newspapers and the plaintiffs' counsel to provide notice to organizations that were likely to interact with class members. The court maintained jurisdiction over the case to ensure implementation and enforcement of the settlement.

On April 25, 2017, Judge Tigar granted an order to amend the settlement. Specifically, the new settlement:
1. Replaced "Administrative Law Judges" with "Social Security Administration";
2. Extended the deadline for mailing request forms;
3. Clarified language concerning enforcement mechanisms;
4. Defined the class as: “all persons whose SSI or SSDI benefits were either denied or terminated and for whom a consultative examination was prepared by Dr. Frank Chen, and all persons who received a partially favorable decision or determination on their claim for SSI or SSDI benefits and for whom a consultative examination was prepared by Dr. Chen.”

Saeeda Joseph-Charles - 12/05/2016
Gabriela Hybel - 06/01/2017


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Issues and Causes of Action
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Issues
Benefit Source
SSDI
SSI
Constitutional Clause
Due Process
Content of Injunction
Implement complaint/dispute resolution process
Preliminary relief granted
Required disclosure
Defendant-type
Jurisdiction-wide
Disability
disability, unspecified
Discrimination-area
Medical Exam / Inquiry
Discrimination-basis
Disability (inc. reasonable accommodations)
General
Government Services (specify)
Pattern or Practice
Public benefits (includes, e.g., in-state tuition, govt. jobs)
Plaintiff Type
Private Plaintiff
Type of Facility
Government-run
Causes of Action 42 U.S.C. § 1983
Defendant(s) Acting Commissioner of Social Security
Plaintiff Description Disabled individuals who claim that their social security benefits were denied or terminated based on medical examinations performed by a physician who is now disqualified.
Indexed Lawyer Organizations Legal Services/Legal Aid
Class action status sought Yes
Class action status granted Yes
Prevailing Party Plaintiff
Public Int. Lawyer Yes
Nature of Relief Injunction / Injunctive-like Settlement
Source of Relief Settlement
Form of Settlement Court Approved Settlement or Consent Decree
Order Duration 2017 - 2020
Case Ongoing Yes
Docket(s)
3:15-cv-00623-JST (N.D. Cal.)
PB-CA-0046-9000.pdf | Detail
Date: 05/11/2017
Source: PACER [Public Access to Court Electronic Records]
General Documents
Class Action Complaint [ECF# 1]
PB-CA-0046-0001.pdf | Detail
Date: 02/09/2015
Source: PACER [Public Access to Court Electronic Records]
Order Denying Motion to Dismiss [ECF# 36] (2015 WL 4396259 / 2015 U.S.Dist.LEXIS 93391) (N.D. Cal.)
PB-CA-0046-0002.pdf | WESTLAW| LEXIS | Detail
Date: 07/17/2015
Source: PACER [Public Access to Court Electronic Records]
Plaintiffs' Notice of Motion and Motion for Class Certification; Memorandum of Points and Authorities [ECF# 40]
PB-CA-0046-0003.pdf | Detail
Date: 08/06/2015
Source: PACER [Public Access to Court Electronic Records]
Order Granting Class Certification [ECF# 50] (310 F.R.D. 427) (N.D. Cal.)
PB-CA-0046-0004.pdf | WESTLAW| LEXIS | Detail
Date: 10/14/2015
Source: PACER [Public Access to Court Electronic Records]
Amended Settlement Agreement [ECF# 79]
PB-CA-0046-0006.pdf | Detail
Date: 11/08/2016
Source: PACER [Public Access to Court Electronic Records]
Order Granting Motion for Preliminary Approval of Class Action Settlement [ECF# 81] (2016 WL 6611002) (N.D. Cal.)
PB-CA-0046-0005.pdf | WESTLAW | Detail
Date: 11/09/2016
Source: PACER [Public Access to Court Electronic Records]
Order Granting Final Approval of Class Action Settlement [ECF# 88] (N.D. Cal.)
PB-CA-0046-0007.pdf | Detail
Date: 04/17/2017
Source: PACER [Public Access to Court Electronic Records]
Stipulated Request to Amend Order Granting Final Approval of Class Action Settlement and Order [ECF# 90] (N.D. Cal.)
PB-CA-0046-0008.pdf | Detail
Date: 04/25/2017
Source: PACER [Public Access to Court Electronic Records]
Judges James, Maria-Elena (N.D. Cal.) [Magistrate]
PB-CA-0046-9000
Tigar, Jon Steven (State Trial Court, N.D. Cal.)
PB-CA-0046-0002 | PB-CA-0046-0004 | PB-CA-0046-0005 | PB-CA-0046-0007 | PB-CA-0046-0008 | PB-CA-0046-9000
Plaintiff's Lawyers Balassone, Elizabeth Gilmore (California)
PB-CA-0046-0003 | PB-CA-0046-0006 | PB-CA-0046-0008 | PB-CA-0046-9000
Lang, Kathryn Rose (District of Columbia)
PB-CA-0046-0006 | PB-CA-0046-9000
McIntyre, Gerald Andrew (California)
PB-CA-0046-0006 | PB-CA-0046-9000
Nakamura, Hope Gisele (California)
PB-CA-0046-0006 | PB-CA-0046-9000
Petraglia, Robert Travis (California)
PB-CA-0046-0003 | PB-CA-0046-0006 | PB-CA-0046-0008 | PB-CA-0046-9000
Phan, Trinh (California)
PB-CA-0046-0006 | PB-CA-0046-9000
Rich, Anna Margaret (California)
PB-CA-0046-0006 | PB-CA-0046-9000
Stern, William Lewis (California)
PB-CA-0046-0001 | PB-CA-0046-0003 | PB-CA-0046-0006 | PB-CA-0046-0008 | PB-CA-0046-9000
Vetesi, Claudia Maria (California)
PB-CA-0046-0003 | PB-CA-0046-0006 | PB-CA-0046-0008 | PB-CA-0046-9000
Defendant's Lawyers Mizer, Benjamin C. (District of Columbia)
PB-CA-0046-0006
Subar, Judry S (District of Columbia)
PB-CA-0046-0006 | PB-CA-0046-0008
Zee, M. Andrew (District of Columbia)
PB-CA-0046-0006 | PB-CA-0046-0008 | PB-CA-0046-9000

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