Westberry v. Fisher Plaintiffs' Brief
Public Court Documents
January 1, 1969

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Brief Collection, LDF Court Filings. Westberry v. Fisher Plaintiffs' Brief, 1969. 348848da-c89a-ee11-be36-6045bdeb8873. LDF Archives, Thurgood Marshall Institute. https://ldfrecollection.org/archives/archives-search/archives-item/16f7c477-1fca-4f48-97cb-1e8ccac1caa9/westberry-v-fisher-plaintiffs-brief. Accessed July 06, 2025.
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UNITED STATES DISTRICT COURT DISTRICT OP MAINE SOUTHERN DIVISION RICHARD A. WESTBERRY, ET. ALS. Plaintiffs CIVIL ACTION No. 10-80 DEAN FISHER, M. D . , ET ALS. Defendants PLAINTIFFS' BRIEF IN SUPPORT OF THEIR CLAIM FOR"BENEFITS' ILLEGALLY WITHHELD AND FOR DAMAGES Donald F. Fontaine 156 Danforth Street Portland, Maine 0*1101 William L. Robinson 10 Columbus Circle New York, New York 10019 Attornevs for Plaintiffs UNITED STATES DISTRICT COURT DISTRICT OP MAINE SOUTHERN DIVISION RICHARD A. WESTBERRY, ET. ALS. Plaintiffs CIVIL ACTION No. 10-80 DEAN FISHER, M. D . , ET ALS. Defendants PLAINTIFFS' BRIEF IN SUPPORT OF THEIR CLAIM FOR BENEFITS ILLEGALLY WITHHELD AND FOR DAMAGES Donald F. Fontaine 156 Danforth Street Portland, Maine 0*1101 William L. Robinson 10 Columbus Circle New York, New York 10019 Attorneys for Plaintiffs TABLE OF CONTENTS Page TABLE OF AUTHORITIES...................................... ill ARGUMENT....................................................... 1 I INTRODUCTION ................................... 1 II DEFENDANTS MUST RELEASE BENEFITS WRONGFULLY WITHHELD............... 2 a) Federal and State Administrative Regulations Require payment of benefits wrongfully withheld.............2 b) Federal and State Decisions support plaintiff’s claim to benefits wrongfully withheld....................... 6 III 4 U.S.C. §1983 REQUIRES DEFENDANTS TO RECOMPENSE PLAINTIFFS FOR INCOME LOST C O M P LICATION AND THREATENED APPLICATION OF T H E ~ I X I M U M BUDGET REGULATIONS.......... .9 IV PERSONAL LIABILITY OF THE DEFENDANTS.......11 V CONCLUSION .....................................16 ii T A B L E O F A U T H O R I T I E S CASES Page Board of Social Welfare v. Los Angeles County, 27 Cal. 2d 90, 162 P. 2d 630 (1945). ,. . . . . ,............ 7- 8 Board of Trustees of Arkansas A & M College v. Davis, 396 FT 2d 730 (3th Cir. 1968)....................1 2 , 13 Chambers v. Henderson County Board of Education, 364 F. 2d 139 (4th Cir. 1966)............................ 10 Department of Employment v. United States, 385 U.S. 355 (1966)... ........... . ....................... 7 Ex parte Young, 209 U.S. 123 (1907).................... 12 Ferguson v. N o e , 364 S.W. 2d 650 (Xy. 1963)............ 7 Gregoire v. Biddle, 177 F. 2d 579 (2nd Cir. 1949), cert, d e n . , 339 U.S. 949 (1550)..................11 Hill v. Franklin Countv Board of Education, Nos. 17647 , 17640 ■ and“17649 (6th Cir. decided February 20 , 1968)................. . ...................10 Hogue v. Commissioner of Economic Security, 407 S.U. 2d 437 (Ky. 1366)............... ................ 7 Johnson v. Branch, 364 F. 2d 177 (4th Cir. 1966)...... 9, 10 Lane v. Wilson, 307 U. S. 268 (1939)...................15 Michaud v. City of Bangor, 159 Me. 491, 196 A. 2d 1C6 (1963) ... ...................... ................. 15 Monroe v . Pape, 365 U.S. 107 (1960)..................... 11 Norton v. .IcShane, 332 F. 2d 855 (5th Cir. 1964), Cert, den. ̂ 330 U.S. 981 (1965)..........................11 Pierson v. Ray, 386 U.S. 550 (1967)..................... 13, 14 Public Utilities Commission of Ohio v. United States Fuel Gas Co.' 317 U.S. 456 (1943)............... 4 Rolfe v. County Board of Education, No. 17498 (6th Cir. decided February 19, 1968) . ................. ..10 iii Sherbert v . Verner, 374 U.S. 390 (1963).................. 7 Smith v. Board of Education of Horrilton County^ 365 F . 23 77 0 (8th cir . 1966) . . ........ -........ 10 Thompson v . Shapiro, 270 F. Supp 331 (D.C. Conn. 1967), prob. juris. Noted, 19 L.Ed. 820 (1968).......... 6 , 9 Thorpe v. Housing Authority, ___ U.S.___ , 37 U.S.L.W. 4068 (1969) . .......................... -........ ......... * • • 4 f 5 United States v. Alabama, 362 U.S. 602 (1959)........... 4 United States v. Jefferson, 372 F „ 2d 836 (5th Cir. 1966), aff'd en banc, 380 F. 2d. 385 (5th Cir. 1967) .............. .......................... 6 United States v. Obermeier, 186 F. 2d 243 (2nd C i r . 1950) , cert. d e n .~ 3T0 U.S. 951 (1951)............. 6 ('?all v. Stanley County Board of Education, 378 F . 2d 275 (4th Cir. 1967)... .......................... 9, 10 UNITED STATES CONSTITUTION Eleventh Amendment ...... ...................... 12 STATUTES 42 U.S.C. § 1983 ......................... ................... 2, 9 11, 13 ME. R E V . STAT. ANN., tit.. 22, § 3351 (1964).............14 FEDERAL HANDBOOK OF PUBLIC ASSISTANCE § 6200 (a) (k) , § 6500 (a)............................ ........... ......... 3 ' 4 MAINE PUBLIC ASSISTANCE PAYMENTS MANUAL ChaDter II, Section C, pace 5 ....... ...................... 3, 4 15 TEXTS AND TREATISES Emerson, Haber and Dorsen, Political and Civil Rights in the United States (3rd ed. 196?) Vol. II.... 9 iv Jennings, Tort Liability of Administrative Officers, 21 Minn. L"I Rev „ 263 (1937).......................15 Prosser, Torts (2nd ed . 1555)................ ............... 15 v UNITED STATES DISTRICT COURT DISTRICT OF MAINE SOUTHERN DIVISION RICHARD A. TTESTBEP.RY, ET ALS . ) CIVIL ACTION ) Plaintiffs ) No. 10-30 ) V o ) ) DEAN FISHER. M. D „, ET AMS. ) ) Defendants ) PLAINTIFFS' BRIEF IN SUPPORT OF THEIR CLAIM FOP BENEFITS"'!:LLEGALLY VITIiHELr AND FOR DAMAGES ARGUMENT I . Introduction This is a class action pursuant to F. R. Civ. P. 23 (b) (2 ) for a declaratory judgement that the maximum grant' and maximum budget regulations contained in the Maine Public Assistance Policy Manua l • Chapter III, Sec tion A, pages 2, 4 and 5 as more particularly described in the amended complaint, violate the Eoual Protection, Due Process and Privileges and Immunities Clauses of the Fourteenth Amendment to the United States Constitution, certain provisions of Federal Civil Rights and Social Se- -2- curity Acts,, and certain provisions of the Maine welfare statutes. Plaintiffs also seek injunctive relief. These issues have been fully briefed and were araued before this court on October 25, 1963. This brief considers the question of damages. Cer tain federal and state regulations and certain cases re quire the defendant Department of Health and Welfare to release moneys unconstitutionally withheld. (Point II). A federal statute, 42 U.S.C. S 1903, in addition, requires the individual defendants to compensate plaintiffs in the same amount and for the damages sustained as a result of the illegal action. (Point III). Neither the Eleventh Amendment to the United States Constitution, nor the doc trine of sovereign immunity, bars this relief against the defendants. ITor are the individual defendants personally immune u.naer re : nt case law. (Point IV) . The conclusion is that this court may order the defendants to compute damages with each member of the class in his individual circumstances. II. Defendants Must Release Benefits T’ronafullv withheld — ------------------------------ ——-——— ------------- - - a) Tederal and State administrative regulations reauire paymentcof benefits wrongfully withheld. During the pendency of this action, administrative regulations by the. United States Department of Health, E d u cation and Welfare and the Maine Department of Welfare -3 have become effective. These regulations provide for fair hearinas ana retroactive payments of benefits wrongfully denied. The HEW regulation is contained in the Federal Handbook of Public Assistance and is attached as Appendix A. It provides f 6200 Requirements for State Plans A state plan for . . . AFDC . . . must provide that (a) The State aaency will be r e sponsible for fulfillment of fair hearinas provisions, and shall specify the hearing authority. (k) Then the hearing decision is favorable to the claimant, or when the agency decides in favor of the claimant prior to the hearing, the aaency will make the correct pay ments retroactively to the date the incorrect action was taken. § 6500 Fed e r a l Financial Participation Federal financial participation is available in (a) Payments made to carry out h e a r ing decisions,- or to take corrective action prior to the hearing, includ ing corrected payments retroactively to the date the incorrect administra tive action was taken. Handbook Transmittal Mo. 140, February 2, I960. (Effective date.- July 1, 1968) The Maine Department of Welfare Administrative reau- lations providing for fair hearings and retroactive pay ments of benefits wrongfully witheId nrovide -4- If the agency's original action is reversed or in any other way nodified’ causing a decision favorable to the claimant, the agency will take im mediate steps to insure that within the CO day period that corrected pay ments are made retroactively to the date the incorrect action was taken or to the date of application, which ever was later. J. -aine Public As sistance Payments Manual C h „ I , Section C, p. 5 fp.ev. 7/1/63) . Numerous decisions of the United States Supreme Court hold that a court must apply the law in effect at the tine it renders decision. Thorpe v. Housing Authority, Ho. 20, decided January 13, I960 United States v. Ala bama , 362 U.S. 602 (1959) Public Utilities Commission of Ohio v. United States Fuel has C o ., 317 U.S. 456 (1943) In Thorpe the court held that the Housing Authority for the City of Durham was obligated to follow eviction pro cedures contained in a regulation enacted by the Depart ment of Housing and Urban Development while the case was on appeal. The court wrote Chief Justice Marshall explained the rule over 150 years ago as follows: [I]f subsequent to the judge ment and before the decision of the appellate court, a lav; intervenes and positively changes the rule which gov erns, the law must be obeyed or its obligation denied. If the lav; be constitution al, . . .1 know of no court which can contest its obli gation. It is true that in mere private cases between -5- inclivicluals, a court will and ought to struggle hard against a construction which will, by a retrospective operation, af fect the rights of parties, but in great national con cerns . . . the court must d e cide according to existing lavs, and if it be necessary to set aside a judgement, rightful when rendered but which cannot be affirmed but in violation of law, the judgement must be set aside. This same reasoning has been applied where the change was constitutional, statutory, and judicial. Surely it ap plies with equal force where the change is made by an administrative acrencv act ing pursuant to legislative authorization. L v7. 406S (1965), footnotes omitted. This court- which has not yet rendered a decision in the instant case is a fortior required to give effect to the HE '/7 and state regulations and order defendants to grant plaintiffs corrected payments to the date the in correct administrative action vas taken. Even if the court rejects plaintiffs argument that it is bound to give effect to the federal and state regula tions, the regulations lend strong persuasive support for the position that the court should award plaintiffs retro active payments of benefits wrongfully withheld back to the date the incorrect action was taken. In these rerrula tionsf the state and federal agencies responsible for ad ministering the AFDC program recognize the recipient's -G- right to receive benefits wrongfully withheld retroac tively to the date the incorrect action was taken. Ad ministrative reaulations are presumed valid and the court should give areat weight to the regulations of the agencies responsible for administering the program, in question. United States v. Obermeier, 13 6 F . 2d. 243 (2nd Cir. 1950) cert. den. 340 U.S. 951 (1951) United States v. Jefferson, 372 F.2d. 336 (5th Cir. 1966) , a f f ‘d en banc, 330 F.2d. 395 (5th Cir. 1967). cert. den. sub. n o n ., Caddo Parish School Board v. United States, 339 U.S. 340 (1967). Plaintiffs submit that the court should adopt the rationale of the federal and state regulations and or der retroactive payment of benefits wrongfully withheld back to the date the incorrect actions were taken pursuant to the maximum budget and maximum grant regulations. (b) Federal and State decisions support plaintiffs' claim to benefits vronafully withheld. Decisions of federal courts support plaintiffs' claim to retroactive payments for benefits wrongfully with held . In Thonpson v. Uhap i r o , 27 0 F. Supp 331 (D.C. Conn.) prob. juris, noted, 19 L.ed 2d 320 (1963). the case most similar to the case at bar, a three-judge district court declared unconstitutional the Connecticut statutes reguir- -7~ ing a fartilv to reside in the state for one full year prior to receipt of ADC payments. Significantly, the court also awarded plaintiff retroactive payment of moneys unconstitutionally withheld because of the unconstitutional statutes. See Sherbert v . V e r n e r • 374 U.S. 398 (1S63) c f . Department of Emplovr.ent v. United States, 38 5 U.S. 3 55X 7 7 (1966) . Decisions by the highest courts in several states also support plaintiffs ; prayer for retroactive payments back to the date the incorrect action was taken. board of Social T7elfara v. L03 Angeles County, 20 Cal. 2d 90, 162 p „ 2d 630 (1945) Perguson v. doe 3C4 S.T’. 2d 650 (Kv. 1963) Hogue v. Commissioner of Economic Security, 407 S.I7. 2d 437 (Ky. 1965). In Board of Social welfare v. Los Angeles County, supra, the Supreme Court of California considered several cases involving a claim for retroactive payments and issued a peremptory writ of mandate ordering the county board to make assistance payments retroactive to the date the reci pients were erroneously denied public assistance. In ana lysing one of the cases the court wrote 1./ Liability to make payment of moneys unconstitutionally withheld may also be based on 42 U.E.C. § 1983. See Point III of this Brief. -8 In the case now before us we are of the view that the provisions for appeal . to the State Social Welfare Board and for the payments, if awarded, to com mence from the date the applicant was first entitled thereto' likewise sub serve a clear public purpose by se curing to those entitled to aid the full payment thereof from the date *** [they were] first entitled there to regardless of errors or delays by local authorities. It was the mandatory duty of the county to fur nish aid according to the plan there for which is laid down bv the ap plicable provisions of the v’elfare and Institutions Code [citations omitted]. The obligation to may became a debt due from the county!to the applicant as of the date the lat ter was first entitled to receive the aid [citations omitted]. The bare fact that an applicant has by one means or another managed to ward off starvation pending receipt of the pavments to which he was previously entitled provides no sufficient ex cuse for a county to refuse to make such payments. To hold otherv/ise wou l d , as suggested by petitioner herin, pro/ide a money-saving device for tiie counties at the expense of these of our citizenry least able to bear the burden thereof. 165 p. 2d at 633. T h u s , federal and state decisional lav; supports plaintiffs' claim for benefits wrongfully denied. Plaintiffs submit that this court should adopt the rationale of’ other federal courts and of the Supreme Courts of California and Kentucky and exercise its broad equity powers to order the Commissioner of Welfare to award retro active payment of the benefits wrongfully withheld pursuant to the maximum grant and maximum budgeted requirements regu lations . -9- III. 42 U.S.C. § 1933 Requires Defendants to Recompense Plaintiffs for Income Lost by Application and Threatened Application of the Ilaximun Budget P.egu- latxons. The purpose of § 1983 is to put the injured party in the position they would have held but for the constitu tional action of persons acting under color of state lav;. § 1983 provides that: Every person , who, under color of any statute, ordinance, custom or usage of any State subjects, or causes to be subjected, any citizen of the United States or other person within the jurisdiction thereof to the depriva tion of any privileges or immunities secured by the Constitution or lav;, shall be liable to the party .injured in an action at law, suit in equity, < : or other proper proceeding for re dress. (R.S. 1979 Force Act of 1871, 17 Stat. 13.) Emphasis added Federal courts have frequently awarded money damages to oersons deprived of thier privilecres and immunities in £_• / violation of § 1933. In Johnson v. Branch, 364 F. 2d 177 (4th Cir, 1966), the court, finding that the school board had refused to renew the contract of a Negro teacher because of her civil rights activities, remanded the case directing the district court to order the board to renev; her contract and determine her damages. In Uall v. Stanley County Board 2./ Thompson v . Shapiro, surra.: See generally, Emerson, Haber and Dorsen, Political and Civil Eights in the United States, (3rd Ed. 1367, Little, Brown and"Co., Poston) Vol. II, pp. 1447-1454. “10- of Education,, 378 F.2cl 275 (4tii C i r . 1557), the court found that Mrs. Mali, a Negro teacher, was refused employment by the Stanley County Board of Education because of her race. The court ordered the board to put her bach on the roster of teaching applicants and that she be given objective con sideration for employment and further ordered the board to pay her damages for her loss of earnings; Mrs. Nall managed to secure employ ment elsewhere for the school year 1965-66. Proper damage elements will include salary differences, if any, and moving expenses to her new residence. If she should be re-em-- ployed in the Stanley Countv system for the school year 1967-60, she should also be awarded the reasonable expense of moving back to Stanley County. 37 8 F2d at 27 3 3_./. In the instant case, plaintiff, June Martin, qualified for and willing to accept work as a nurse's aide which was a • vailable in the community, was prevented from continuing her employment by virtue of the enforcement of the maximum budgeted requirements regulation just as the Negro teachers in Johnson v. Branch, supra. and Wall v, Stanley, supra, were prevented from working by the actions of the school board. (Defendants5 Answer, Para. 12). Plaintiffs --Submit that the court should similarly require the Commissioner of Welfare to recompense her for her lost earnings. 3 / Additional cases awarding damages under £ 1583 to Negro teachers refused employment because of their race a r c • Hill v. Franklin County Board of Education Nos. 17647, 1764 3 and 1764 9 (6th Cir. decided Feb. 20. 1968) Folfe- v . Countv Board of Education, No. 17456 (6th Cir. decided "Feb"." 19, i960) •“ — Smith v. Board of Education of Morrilton County, 3G5 F.2d. 770 (8th Cir.. 1966)° Chambers v. Henderson County Board of E d u cation, 364 F. 2d 1C? (4th C i r . 1966) . 11 Other members of the class have also suffered in jury as a result of the challenged regulations. For ex ample, some persons, precluded from receiving AFDC assistance solely because of the maximum budget regulation? are unable to receive medicaid and must obtain loans or for go other necessities to obtain medicare and meciical car^. These injuries and the resulting damages will, o£ course? vary for each individual member of the class, however, the defendants are personally liable for such damages under § 1933 . See PointjV of this brief. IV. Personal Liability of the Defendants: Once a cause of action has been proved under 4 2 U.S.C. § 1933 - Congress has plainly authorized damages against the defendants as well as injunctive relief. Persons are liable to the partv injured in an action at law. 42 U.S.C. c 1983„ This section does not include federal offices. Gregoire v. Biddle? 177 F„ 2d 579 (2nd Cir. 1949)... cert. d e n . 339 u.S. 942 (1350) Horton v. lie Shan e ,, 332 U.S. 931 (1365) . But it does include the actions of the state officers whether or not their acts are authorized by state lav7. Monroe v . Pape, 365 U.S. 107, 184-137 (1960). It is sufficient that the allegedly illegal act was made possible only because the wrong.doer was clothed with the authority of state law. The acts of the defendants in the instant case are not immunized from liabilities because tney were exercising -12- the sovereign power of the state, since the state cannot afford one immunity to violate the United States Consti tution, Ex parte Young , 20? U.S. 123 (1907). Board of Trustees of Arkansas A £ ?■ College v. Davis, 396 F. 2d 730 (3th Cir. 1963). The latter case was an action by a former faculty member against a beard of trustees of a state college for damages following the termination of plaintiff;s status as a faculty member. A three-circuit judge court held that the suit was not barred by the Eleventh Amendment. It wrote 1 Plaintiff does not dispute that Arkan sas A €i ] 1 College is a state agency. He- stands on the proposition, how ever, with which we agree, that sov ereign immunity does not extend to state or federal officials who act beyond their authority or in viola tion of the United States Constitu tion . The foundation case is Ex parte Young, 209 U.S. 123, S. Ct. 441, 52 D.Ed. 714 (1903), where the Supremo Court held that a suit against the Attorney General of Minnesota to en join the enforcement of an unconsti tutional state statute did not violate the prohibition of the Eleventh Amend ment. In rejecting the claim of state immunity the court announced this basic principle, The act to be enforced is alleged to be unconstitutional, and if it be so, the use of the name of the state to enforce an unconstitution al act to the injury of complain ants is a proceeding without the authority of and one which does not affect the state in its -13- sovereign or governmental capacity. It is simply an i l legal act upon the part of a state official in attempting, by the use of the name of the state, to enforce a legislative enactment which is void be cause it is unconstitutional. If the act which the state at torney general seeks to en force be a violation of the Federal Constitution, the of ficer, in proceeding under such enactment, comes into conflict with the superior authority of that Constitution, and he is in that case stripped of his official or representative character and is subjected in his person to the consequencas of his individual conduct. The state has no power to impart to him any immunity from respon sibility to the supreme authority of the United States. 396 F. 2d 730, 732 (8th Cir. 1S68), footnotes omitted. The general rule, therefore, of 42 U.S.C. § 1983 is personal liability. The exception is immunity. Recently, the United States Supreme Court in Pierson v. R a y , 386 U.S. 550 (1867) ha3.d a Mississippi police officer immune from personal tort liability for false arrest where he has acted with probable cause and good faith under an act he reason ably believed to be constitutional. The court w r ote: A policeman's lot is not so unhappy that he must choose between being charged with dereliction of duty if he does not arrest when he has pro bable cause, and being mulcted in damages if he d o e s . Although the -14- matter is not entirely free from doubt the same consideration would seen to require excusing him from liability for acting under a statute that he reasonably believed to be valid but that was later held unconstitutional, on its face or as applied. 386 U.S. at 555. (Footnote omitted). Defendant Fisher, Commissioner of the Depart-ent of Health and Welfare, however, is in an entirely different position that was officer Fay. Fisher was not required by state statute to deprive plaintiffs of moneys, whereas officer Ray was required to make an arrest. On the contrary, de fendant Fisher promulgated and approved the very regulations that were used as the basis of depriving plaintiffs herein, although he had the power and the duty to make . . . neces sary rules and regulations for the administration of this aid. that were legal and constitutional. ME. REV. STAT. ANN. tit. 22, § 3351 (1964). Accordingly, the commissioner should not be given the benefit of the Pierson doctrine. Even if he receives benefit of the Pierson doctrine, the commissioner should be held to a higher standard of reasonableness. Plaintiffs concede that the spirit of Pierson v. R a y , supra., would seem to immunize defendant social workers Tierney, Jenny, Holloway, and Smith, who were faced with the possible choice of following the Department's regulations or dereliction of duty. However, it is far from clear that at common law such lower echelon administrators would be immune -15- from liability. Lane v. Wilson, 307 U.S. 268 (1939) Proeser. Torts 732-733 (2d. ed_._1955) _ Jennings, Tore Liability of A d ministrative Officers, 21 WINN. L. REV. 263 (1937). It is clear that the liability of both Commissioner Fisher and the other defendants will turn upon the reasonableness of their action as revealed by all the facts. Defendants have pleaded no facts that entitle them to immunity, except that the state is entitled to spend its welfare money the way it chooses. See Brief of Defendants. July 10, 1968, pp. 3-6. If this were the basis of defendant's action, it is as a matter of law unreasonable and lends no immunity to them. Not only are the individual defendants not immune as agents of the sovereign, but to the extent of moneys wrongfully withheld, the State of Maine has waived its sovereign immunity and consented to suit. It has adopted regulations allowing retroactive corrected payments and authorized judicial review of fair hearing decisions. See Point II of this Brief and Maine Public Assistance Payments Manual, Ch. I, Section C n. 5. Maine law itself permits recovery against the sovereicn for torts which high administrative officials direct. Michaud v . City of Bangor, 159 Me. 491, 196 A. 2d 106 (1963). - 16- V. Conclusion: For the reasons stated in the foregoing memorandum, the court should rule that the defendants are liable to return moneys illegally withheld and to comnensate plaintiffs for damages sustained. Further, the court should order defendants (1 ) to notify all members of the class of the courts' decision in this case; (2 ) to invite said persons to confer with the department: (3 ) and to compute with each such person a just and reasonable amount of compensation for said damage. Respectfully submitted, Donald F. Fontaine William L. Robinson Handbook of Public Assistance Administration Part IV Eligibility, Assistance,, and Services ------------------- “ 2/0/00Table of Contents - IV-6000 Fair Hearings Provisions of the Act Requirements for State Plans Criteria for the Administration of the Plans Interpretation (a) Opportunity for a Fair Hearing (b) Publication of Hearing Procedures (c) Informing the Claimant of His Right to a Hearing (d) Convenience of the Claimant Considered (e) Impartiality of Official Conducting the Hearing (f) Impartiality of the Hearing Authority (g) Prompt, Definitive, and Final Action (h) Opportunity to Examine the Official Record (i) Judicial Review 6000 6100 6200 6300 6 ^ 0 Federal Financial Participation 6500 Handbook of Public Assistance Administration Part IV 6000-6999 Eligibility, Assistance, Fair Hearings_______________ and Services ______2/ f i M 6000. Fair Hearings ; 6100. Provisions of the Act (a) Sections 2(a)(4), 402(a)(4), 1002(a)(4), 1402(a)(4), and 1602(a)(4) read as follows; "A State plan . . . must . . . "provide for granting an opportunity for a fair hearing before the State agency to any individual whose claim for . . . ^aid or assistance under the plan7 is denied or is not acted upon with reasonable promptness." (b) Sections 6(a)(5), 4o6(b)(2)(E), 1006(5), 1405(5), and 1605(a)(E) authorize Federal financial participation in protective payments "but only with respect to a State whose State plan . . . includes provision for . . . "opportunity for a fair hearing before the State agency on the determination . . . Jot need for protective payment^ for any individual with respect to whom it is made." 6200. Requirements for State Plans A State plan for OAA, AFDC, AB, APTD, or AABD must provide that: (a) The State agency will be responsible for fulfillment of fair hearings provisions, and shall specify the hearing authority. (b) An opportunity for a fair hearing before the State agency will be granted to any individual requesting a hearing because his claim for assistance is denied, is not acted upon with reasonable promptness, or because he is aggrieved i by any other agency action affecting his receipt or termination of assistance, or by agency policy as it affects his situation. (c) Decisions by the hearing authority, rendered in the name of the State agency, will be binding on the State and local I agency. The State agency will establish and maintain a 6200-p .2 3 1 » - #> & V*1PM X V; Handbook of Public Assistance Administration Part IV 6000-6999 ______Eligibility, Assistance, and Services Fair Hearings 2/6/68 6200. Requirements for State Plans ((c) Continued) method for informing, at least in summary form, all logfel agencies of all fair hearing decisions by the hearing authority, and the decisions will be accessible to the claiman , their representatives, and the public (subject to provisions relating to safeguarding public assistance irjformation). (a) (e) ( f ) The hearings will be conducted by an impartial official (or officials) of the State agency. Hearing procedures will be issued and publicized by the State agency for the guidance of all concerned. Every claimant will be informed in writing at the time of application and at the time of any agency action affecting his claim ( 1) (2) (3) of his right to a fair hearing; of the method by which he may obtain a hearing; that he may be represented by others including legal counsel; and ( k ) of any provision for payment of legal fees by the agency. (g) The hearing will be conducted at a time, date, and place convenient to the claimant, and adequate preliminary written notice will be given. (*) When the hearing involves medical issues, a medical assess ment other than that of the person o<r persons involved in making the original decision will be obtained and made a part of the record if the hearing officer or the appellant considers it necessary. (i) The claimant or his representative will have the opportunity (l) to examine all documents and records used at the hearing; (2) at his option, to present his case himself or with the aid of others, including legal counsel; H.T. No. lUO if i & 1 1 'r‘A- ' n Part IV________________________ Eligibility, Assistance, and Services 6OOO-6999 Fair Hearings p/8/68* 6200-p.3 Handbook of Public Assistance Administration \ r> 6200. Requirements for State Plans ((i) Continued) ^ (3) to bring witnesses; (U) to establish all pertinent facts and circumstances; (5) to advance any arguments without undue interference; and (6) to question or refute any testimony or evidence. (j) Prompt, definitive, and final administrative action will be taken within 60 days from the date of the request for a fair hearing. The claimant will be notified of the decision, in writing, in the name of the State agency and, to the extent it is available to him, of his right to judicial review. (k) When the hearing decision is favorable to the claimant, or when the agency decides in favor of the claimant prior to the hearing, the agency will make the corrected payments retroactively to the date the incorrect action was taken. | (l) The hearing officer's (or panel's) recommendations shall be based exclusively on evidence and other material introduced at the hearing. The verbatim transcript of testimony and exhibits, or an official report containing the substance of what transpired at the hearing, together with all papers and requests filed in the proceeding, and the hearing officer's or panel's recommendations, will ( constitute the exclusive record for decision by the hearing f , authority and will be available to the claimant at a place V accessible to him or his representative at any reasonable time. 6300. Criteria for the Administration of the Plans (a) The State agency establishes policies and procedures that carry out the purpose and provisions of this policy and that assure equity of treatment in relation to the laws and standards pertaining to assistance. The State agency takes the necessary steps to see that there is uniformity in the application of agency policy in similar situations. (f I fthK » « H.T. No. lUO Part IV ______________Eligibility, Assistance, and Services 6006-69^9 _____________ Fair Hearings_______________________ 2/8/68. 6300. Criteria for the Administration of the Plans (Continued) y(b) A request for a hearing is considered as any clear expression (oral or written) by the claimant (or person acting for him, such as his legal representative, relative, or friend) to the effect that he wants an opportunity to present his case to higher authority. The freedom to make * such a request is not limited or interfered with in any way, and agency emphasis will be on helping the claimant in sub mitting and processing his request, and in preparing his case, if needed . (c) Opportunity for a fair hearing includes: (1) Consideration of any action, or failure to act with reasonable promptness, on a claim for assistance which includes undue delay in reaching a decision on eligibility or in making a payment, refusal to con sider a request for or undue delay in making an adjustment in payment, and suspension or discontinuance of assistance in whole or in part: (2) Consideration of the agency's interpretation of the law, and the reasonableness and equitableness of the policies promulgated under the law, if the claimant is aggrieved by their application to his situation; (3) Consideration of agency decisions regarding; (i) Eligibility for assistance in both initial and subsequent determinations, (ii) Amount of assistance or change in payments, (iii) The manner or form of payments, including restricted or protective payments, even though no Federal financial participation is claimed, and (iv) Conditions of payments, including work require ments . (d) Provision is made for reasonable time in which to appeal agency action. Handbook of Public Assistance Administration 6300-p.3 Part IV &OOO-6999 _________________Eligibility, Assistance, Fair Hearings Handbook of Public Assistance Administration and Services 2/ 8/68 6300. Criteria for the Administration of the Plans (Continued^ (e) Final administrative action is taken within the 60-day limit (IV-62OO, item j), except that where the claimant requests a delay in the hearing in order to prepare his case or for other essential reasons, reasonable time is given and such extra time may be added to the 60 days. (f) The agency does not deny or dismiss a request for a hearing except where it has been withdrawn by the clainant in writing or abandoned. A request for a hearing is considered abandoned only if neither the-claimant nor his representative appears at the time and place agreed upon for the hearing, and if within a reasonable time after the mailing of an inquiry as to whether he wishes any further action on his request for a hearing, no reply is received by either the local or State agency. (g) The hearing authority may be the highest executive officer of the State agency, a panel of agency officials or a hearing officer appointed for that purpose, but no person who participated in the local decision being appealed will participate in a final administrative decision on such case. The hearing authority is responsible for a final administrative decision in the name of the State agency on all issues that have been the subject of a hearing. The decision of the hearing authority is binding on the State and local agency. The State agency is^responsible for seeing that the decision is carried out promptly. Insofar as may be applicable, a decision in favor of the claimant applies retroactively to the date the incorrect action was taken, and also applies prospectively. (h) The impartial official (or officials) of the State agency who is responsible for conducting the hearing has not been involved in any way with the action in question. (i) The issuance of hearing procedures is in the form of rules and regulations, or in some other form in which they will be publicized. H.T. No. 1^0 6300- p. 14- Part IV ____________________ Eligibility. Assistance, and Services 6000-6999 Fair Hearings 2/8/68 Handbook of Public Assistance Administration 6300. Criteria for the Administration of the Plans (Continue^) (j) Written notification and, to the extent possible, oral explanation of the right to and procedure for requesting a fair hearing are given at the time of application. Written notice, and oral explanation as necessary, are 1 given at the time of any agency action affecting the claim for assistance, including change in or termination of assistance. (k) Individuals are informed of their right to be represented at fair hearings by others. At his option, the claimant may be represented by legal counsel or by a relative, friend or .other spokesman, or may represent himself. (l) The convenience of the claimant is considered in setting the date, time, and place for the hearing. Notice is given in writing with adequate preliminary information about the hearing procedure necessary for his preparation for the hearing and effective presentation of his case. He is advised as to the use of witnesses and legal counsel or other representative, as well as any procedure or financial provisions for obtaining legal representation, including availability of fees for legal counsel from the agency. (m) When an assessment by a medical authority, other than the one involved in the decision -under question, is. requested by the claimant, it is obtained, at agency expense, from a medical source satisfactory to the claimant. The hearing officer can also consider the physician's report in the record for can request additional evidence. The assessment of such medical authorities will be reported in writing or by: personal testimony as an expert witness for the hearing record. (n) The claimant or his representative has adequate opportunity to examine material that will be introduced as evidence prior to the hearing as well as during the hearing, to give all the evidence on points at issue he believes necessary without undue interference, to ask for substantiation of any statements made by others, and to present evidence in re buttal . H.T. No. lUO Handbook of Public Assistance Administration 6300-p.5 Part IV 5000-6999 ______Eligibility, Assistance, Fair Hearings_________________ and Services ______2/S/6 8. ^300. Criteria for the Administration of the Plans (Continued) (o) Non-record or confidential information which the claimant does not have an opportunity to hear or see is not made a part of the hearing record or used in a decision on the appeal. The hearing officer does not review the case record, or other material prior to the hearing unless such material is made available to the claimant or his representative. 6^0 0. Interpretation (a) Opportunity for a Fair Hearing Fair hearing procedures, including the conduct of the hearing, are designed to assure the right of every claimant to demand and obtain a fair hearing. The claimant’s freedom to request a hearing, whenever he believes that proper consideration has not been given to al] the circum stances surrounding his claim, is a fundamental right and is not to be limited or interfered with in any way. Since, under the Federal act and the State plan, every ^-SS^i^ved claimant is entitled to the opportunity for a hearing, only the claimant may withdraw his request for a hearing and this is to be in the form of a written withdrawal . Effective complaint and adjustment procedures, whereby corrective action may be easily requested and readily taken without the need for a hearing, are necessary, when indicated. Advance opportunity afforded the recipient to respond to questions which could result in change of grant or termi nation is a significant part of such procedures. So is written, and whenever practical, oral information of the reasons for change, denial, or termination. This is particularly important where the agency decision is based on judgmental factors or eligibility requirements that entail evaluative decisions on the part of workers, as com pared to decisions based on non-debatable facts (such as receipt of OASI, death, etc.). However, the State and locaL agency adjustment procedures cannot be allowed to .interfere with the hearing process . H.T. No. 1 I4O 6 U 0 0 -p .2 Part IV__________________________Eligibility, Assistance, and Services 6000-6999 Fair Hearings 2/8/68 6̂ -00. Interpretation ((a) Continued) y The claimant's right to a hearing includes the privilege of presenting his case in any way he desires. Some will wish to tell their story in their own way, some will desire to have a relative or friend present the evidence for them, I and still others will want to be represented by legal counsel. In many instances the recipient's position can best be presented by an attorney. In order for the claimant to I obtain an attorney, legal fees may need to be provided by the State. Federal financial participation is available in meeting the cost of these fees . States are urged to provide payment for the services of an attorney, or refer recipients to attorneys otherwise available in the comm unity, because of the skill and knowledge of the legal, profession in these matters. Furthermore, the claimant may bring any witnesses he desires to help him establish pertinent facts and to explain his circumstances. The hearing is conducted in an informal rather than formal court-type procedure in order to serve the best interests of the claimant; however, the hearing is to be subject to the requirements of due process . (b) Publication of Hearing Procedures The publication of hearing procedures in the form of rules and regulations or a clearly stated pamphlet hfclpc to emphasize the importance of the procedure. This material is useful to applicants and recipients or to others interested in their behalf. It contributes to the fairness of the hearing procedure, and emphasizes that there is "due process" ( in program administration affecting the right to public assistance. (c) Informing the Claimant of His Right to a Hearing Written notification of the right to a hearing may be on the application form and other forms routinely used by the agency which go to applicants and recipients, as well as an explanatory pamphlet distributed by the agency. Oral explanations should also be given regarding the policy on hearings at intake and at time of a change in eligibility. Handbook of Public Assistance Administration H.T. No. lUO Handbook of Public Assistance Administration 6400-P-3 Part IV_________________________ Eligibility, Assistance, and Services 6000-6999 Fair Hearings 2/8/68 6400. Interpretation ((c) Continued) , The purpose of informing the claimant of his right to a hearing, in writing, and whenever practicable orally, is to assure that the claimant fully understands this right. This right is further assured by the agency explaining the right to a hearing in understandable terms and in being helpful as needed in the preparation for and conduct of the hearing. (d) Convenience of the Claimant Considered The agency has not discharged its responsibility for a hearing.unless it has taken all steps necessary to enable a claimant who requested a hearing to attend the hearing in person or to be represented by a person of his own choosing. If the hearing is to be held at a considerable distance from the locality of the claimant's residence, it may be necessary to provide for the transportation and other costs of the claimant, his representative, and his witnesses. Notice to claimant as to the hearing being scheduled in his behalf includes information about the fair hearing as an informal administrative procedure, in which a dissatisfied claimant or his representative m y present his grievance with the help of witnesses or legal representation to show why action or inaction in his case should be corrected by the State agency. (•) Impartiality of Official Conducting the Hearing The person conducting the hearing shall not have been connected in any way with previous actions or decisions on which the appeal is made. For example, a field super visor who has advised the local agency in the handling of a case would be disqualified from acting as the hearing officer. (f) Impartiality of the Hearing Authority The hearing authority shall not have been directly connected with the agency action about which the claimant is appealing. H.T. No. i!+o 6kOO-p.b Part IV__________________________Eligibility;, Assistance, and Services 6060-6999 Fair Hearings 2 / & / 6 Q 6U00. Interpre tat ion ((f) Continued) « For example, a State board member who has participated as a county board member or in another capacity in the local action on a case would disqualify himself from rendering a final decision on the particular case. This does not * preclude the State director or administrative board from signing the decision in the name of the State agency, even though previously involved in the case. (g) Prompt, Definitive, and Final Action The hearing authority is responsible for rendering a con clusive decision. When the hearing authority is different from the hearing officer, such authority may adopt the recommendations of the hearing officer, or reject them and reach different conclusions on the basis of the evidence at hand, or refer the matter back to the hearing officer for a continuation of the hearing, because the materials submitted are insufficient to serve as the basis for a decision. The State agency is responsible for assuring that the decision is carried out. Various methods, such as a report by the local unit to the State agency of action taken to carry out the hearing decision or follow-up by the State office staff, may be used. Remanding the case to the local unit for further consideration is not a substitute for "definitive and final administrative action." The requirement for prompt, definitive, and final adminis trative actfbn means that all requests for a hearing are to receive immediate attention and will be carried through all the steps necessary to completion. The requirement is not met if the State agency dismisses such requests for any reason other than withdrawal or abandonment of the request by the claimant. I The over-all time limit of 60 days between the date of the request for the hearing and the date of the final adminis trative action, will serve as one of the safeguards of prompt, administrative action. Detailed controls of individ ual steps in the hearing process , such as: time limits for accepting, forwarding, and acknowledging a request for a hearing, notice to the claimant, and date of the hearing will facilitate proper administration of the hearing process. Handbook of Public Assistance Administration H.T. No. ilqo Handbook of Public Assistance Administration 6400-p.5 Part IV 6000-6999 Eligibility, Assistance, and Services Fair Hearings 9/30/68 6400. Interpretation (continued) f (h) Opportunity to Examine the Official Record The record of the proceedings at the hearing, which constitutes the official record, is to be made available to the claimant or his representative to examine, if he desires. If any additional material is made a part of the hearing record, this, too, would be made available. (i) Judicial Review In seme States, the right of judicial review may be prescribed by statute specifically authorizing review of the agency decision on the basis of the record of adminis trative proceedings. In other States, even in the absence of statutory provisions, a claimant may be able to invoke the remedy of judicial review on the showing that the agency action was "unreasonable, arbitrary, or capricious." The content of the notice of decision, as regards judicial review, would depend upon the kind of remedy available in the State. 6500. Federal Financial Participation Federal financial participation is available in: (a) Payments made to carry out hearing decisions, or to take corrective action prior to the hearing, including corrected payments retroactively to the date the incorrect adminis trative action was taken. (b) Payments of assistance continued pending a hearing decision. (c) Payments of assistance within the scope of the federally aided public assistance programs made in accordance with a court order. H.T. No.147