v.
Comm'r of Soc. Sec.
NOT RECOMMENDED FOR PUBLICATION File Name: 20a0076n.06
Case No. 19-3453
UNITED STATES COURT OF APPEALS FOR THE SIXTH CIRCUIT
FILED Feb 03, 2020 MELISSA COHAN, ) DEBORAH S. HUNT, Clerk ) Plaintiff-Appellant, ) ) ON APPEAL FROM THE UNITED v. ) STATES DISTRICT COURT FOR ) THE SOUTHERN DISTRICT OF COMMISSIONER OF SOCIAL SECURITY, ) OHIO ) Defendant-Appellee. ) )
BEFORE: SUHRHEINRICH, DONALD, and MURPHY, Circuit Judges.
BERNICE BOUIE DONALD, Circuit Judge. In January 2006, following the death of her husband, Plaintiff-Appellant Melissa Cohan (“Cohan”) applied for and was awarded mother’s insurance benefits under Title II of the Social Security Act (“the Act”). At the time she submitted her application for mother’s benefits, Cohan was not employed. After receiving monthly benefits for one year, Cohan sought employment and began earning an income that exceeded the yearly
earnings limit on her benefits, resulting in an overpayment. Cohan requested a waiver of the overpayment recovery, which the Defendant-Appellee Commissioner of Social Security
(“Commissioner”) denied. Pursuant to 42 U.S.C. § 405(g), Cohan sought judicial review of that
decision in the district court, which affirmed the Commissioner’s decision to seek recovery of the overpayment. Cohan now appeals, asserting primarily that recovery of the overpayment defeats
Case No. 19-3453, Cohan v. Comm’r of Soc. Sec. the purpose of the Act and goes against equity and good conscience, thereby entitling her to a waiver of the overpayment under 42 U.S.C. § 404(b)(1). We AFFIRM.
Under the Act, mother’s and father’s benefits are available to the surviving spouse of a decedent who was fully or currently insured at the time of their death if the surviving spouse, among other requirements, has a child of the decedent in their care under the age of sixteen. 20 C.F.R. § 404.339. This monthly benefit is subject to an annual earnings limit, meaning the amount of benefits a claimant receives each month may be reduced if the claimant’s income surpasses the applicable earnings limit for the year in which the benefits are received. Id. § 404.342 (incorporating by reference id. §§ 404.304, 404.415); see also 42 U.S.C. § 403(a)-(b). On January 24, 2006, Cohan submitted an application to the Social Security Administration (“SSA”) for mother’s insurance benefits pursuant to the Act. Cohan’s application for mother’s benefits included the following provisions: I understand that SSA will use the earnings reported to SSA by my employer(s) and my self-employment tax return (if applicable) as the report of earnings required by law, to adjust benefits under the earnings test. I also understand that it is my responsibility to ensure that the information I give SSA concerning my earnings is correct. I also understand that I must furnish additional information as needed when my benefit adjustment is not correct based on the earnings on my record. .... My reporting responsibilities have been explained to me. Admin. R. 489. On January 29, 2006, the SSA issued an award notice to Cohan informing her that she was entitled to receive $1,382.00 in monthly mother’s benefits. Additionally, the award notice stated: Work and Earnings Affect Payments The monthly earnings test applies only to 1 year. That year is the first year a beneficiary has a non-work month after entitlement to Social Security benefits. Our records show that you had or will have at least one non-work month in 2006. If you Case No. 19-3453, Cohan v. Comm’r of Soc. Sec.
[*2]ever go to work, we will pay benefits for each year based on your work and earnings for that year. .... Your Responsibilities Your benefits are based on the information you gave us. If this information changes, it could affect your benefits. For this reason, it is important that you report changes to us right away. We have enclosed a pamphlet . . . [that] tells you what must be reported and how to report. Please be sure to read that part of the pamphlet which explains how work could change payments.
Admin. R. 494-95. In 2006, Cohan received $15,202.00 in mother’s benefits payments.
Cohan was not employed when she applied for and was awarded benefits in January 2006.
In February 2007, however, Cohan began working for the City of Worthington and earning an annual income of $31,778.00. Cohan asserts that she reported her employment status change during an in-person visit to her local SSA office. During this visit, Cohan claims that she completed a tax withholding form and was informed that she did not need to complete any additional paperwork to report her income change.
A. 2007 Overpayment
On July 15, 2008, Cohan received a letter from the SSA informing her that, due to her 2007 earnings, she had received an overpayment of benefits. The letter notified Cohan that the SSA had overpaid her $9,405.00 in 2007. The letter also explained that, to recover the money Cohan owed
the SSA, the agency planned to begin withholding Cohan’s benefits payments in September 2008, and that Cohan would begin receiving benefits again in April 2009. Additionally, the letter Case No. 19-3453, Cohan v. Comm’r of Soc. Sec. detailed how the overpayment was calculated,1 instructed Cohan to report any changes in her income or employment status to the SSA, and informed Cohan that she could appeal the SSA’s overpayment decision or seek a waiver of the overpayment recovery.
[*3]In a letter dated September 2, 2008, the SSA reminded Cohan that, due to the overpayment she received in 2007, she would not receive benefits payments for September 2008 through
February 2009, that she would receive a partial payment of her March 2009 benefits, and that her full monthly benefits payments would resume beginning with her April 2009 benefits payment.
Cohan did not appeal the overpayment decision or seek a waiver of the overpayment recovery for the 2007 overpayment. Accordingly, Cohan did not receive any benefits payments for the months of September 2008 through February 2009.
B. 2008 Overpayment
On August 20, 2009, the SSA sent Cohan another letter explaining that, because Cohan had earned more than the earnings limit for 2008,2 Cohan owed the agency $13,193.00 in overpaid benefits for 2008. Further, the letter explained that the SSA would begin withholding Cohan’s benefit payments beginning in October 2009 to recover the 2008 overpayment and that Cohan would begin receiving benefits payments again in July 2010. Again, the agency reminded Cohan Case No. 19-3453, Cohan v. Comm’r of Soc. Sec. of her obligation to report any changes in her income or employment status, her right to appeal its overpayment determination, and her right to seek a waiver of the overpayment recovery.
[*4]C. 2009 Overpayment
On August 26, 2009, the SSA sent Cohan another letter stating that, assuming Cohan’s
2009 income would be the same as her reported income of $39,946.00 in 2008, Cohan’s earnings
would exceed the earnings limit for 2009, which was $14,160.00. Based on this information, the SSA had determined that Cohan had received $11,011.00 in excess benefits between January and August 2009. Additionally, the letter explained that the SSA would cease Cohan’s monthly payments until it had recovered “the money [the SSA] incorrectly paid [Cohan]” in 2009 and then continue to withhold Cohan’s benefits payments to “collect the money [the SSA] overpaid
[Cohan].” Admin. R. 329. The letter further emphasized that this calculated amount was based on Cohan’s expected earnings for 2009, and that the SSA would use Cohan’s actual reported earnings at the end of the year to make its final determination as to how much Cohan was overpaid or what benefits were due to Cohan that she did not receive but was entitled to receive in 2009.
D. Cohan Seeks Waiver of the Overpayment Recovery
Cohan did not appeal the SSA’s determination that she received an overpayment in 2007, nor did she seek a waiver of that overpayment. She did, however, file a timely request for reconsideration appealing the SSA’s decisions determining that she received overpayments in 2008 and 2009 and requesting a waiver from the SSA’s recovery of those overpayments. Cohan’s
claims were denied initially and again upon reconsideration. Cohan then requested a hearing, which was held before Administrative Law Judge K. Michael Foley (“ALJ Foley”) on May 9, 2011. On July 18, 2011, ALJ Foley issued an unfavorable decision, finding that Cohan was overpaid $24,204.00 in benefits between 2007 and 2009 due to her reported earnings during those Case No. 19-3453, Cohan v. Comm’r of Soc. Sec. periods. Further, ALJ Foley declined to waive recovery of the overpayment, finding that Cohan was not “without fault” due to the “untruthful” and “inconsistent” statements Cohan made during the hearing. Admin. R. 19.
[*5]The Appeals Council denied Cohan’s request for review of ALJ Foley’s decision, and Cohan sought relief in federal court under 42 U.S.C. § 405(g). In response, the Commissioner moved for a voluntary remand to allow for additional development of essential factual issues that
remained unresolved and for reconsideration of Cohan’s case under the proper standard of review, which the district court granted. On March 11, 2015, the Appeals Council issued a remand order
vacating ALJ Foley’s decision and specifying the appropriate standard of review to be used in the new hearing as follows:
Upon remand, the Administrative Law Judge will evaluate the record to assess whether the evidence shows that the claimant reported her work activities and earnings to the field office during the overpayment period and, if not, whether her failure to report or accept an erroneous payment was due to one of the specific circumstances articulated under 20 CFR 404 .510.
Admin. R. 459.
ALJ Paul Yerian (“the ALJ”) held a hearing on July 25, 2016, at which Cohan appeared and testified. On May 3, 2017, the ALJ issued an unfavorable decision, finding that Cohan was overpaid benefits in the amount of $24,204.00 and that waiver was not appropriate. Cohan appealed the ALJ’s decision to the Appeals Council, which denied her request for review on
November 14, 2017. Accordingly, the ALJ’s decision became the Commissioner’s final decision.
Cohan sought review of the ALJ’s decision in the United States District Court for the Southern District of Ohio. The magistrate judge issued a report and recommendation recommending that that the district court enter judgment in favor of the Commissioner, finding that the ALJ’s decision was supported by substantial evidence. Despite Cohan’s objections to the Case No. 19-3453, Cohan v. Comm’r of Soc. Sec.
[*6]magistrate judge’s recommendation, the district court adopted the report and recommendation, affirmed the Commissioner’s decision, and dismissed Cohan’s case. Cohan filed a timely appeal.
A. Standard of Review We review de novo an appeal from a district court’s order concerning social security benefits, however, our review is limited to determining whether the ALJ’s underlying findings are supported by substantial evidence. Valley v. Comm’r of Soc. Sec., 427 F.3d 388, 390 (6th Cir. 2005). An ALJ’s decision is supported by substantial evidence where a “reasonable mind might accept the relevant evidence as adequate to support a conclusion.” Blakley v. Comm’r of Soc. Sec., 581 F.3d 399, 406 (6th Cir. 2009) (quoting Warner v. Comm’r of Soc. Sec., 375 F.3d 387, 390 (6th Cir. 2004)). We “will not try the case de novo, resolve conflicts in evidence, or decide questions of credibility.” Stankoski v. Astrue, 532 F. App’x 614, 618 (6th Cir. 2013) (citing Smith v. Halter, 307 F.3d 377, 379 (6th Cir. 2001)). Accordingly, we may affirm even if the record could support an opposing conclusion. Hernandez v. Comm’r of Soc. Sec., 644 F. App’x 468, 473 (6th Cir. 2016). B. Statutory Framework Under the Act, when a claimant receives an overpayment of social security benefits, “proper adjustment or recovery shall be made.” 42 U.S.C. § 404(a)(1). An overpayment occurs when the amount of benefits paid to a claimant exceeds the amount of benefits the claimant was entitled to receive under the Act. 20 C.F.R. § 404.501(a). The amount of the overpayment is the difference between the amount paid to the claimant and the amount the claimant was entitled to receive. 20 C.F.R. § 404.504.
[*7]Case No. 19-3453, Cohan v. Comm’r of Soc. Sec.
There are two types of overpayments: an “entitlement overpayment” and a “deduction overpayment.” An entitlement overpayment occurs when an individual receives a benefit payment under the Act even though the “individual [] fails to meet one or more requirements for entitlement to such payment” or the benefit payment amount is greater than the amount the individual is
entitled to receive. 20 C.F.R. § 404.510a. A deduction overpayment occurs when the amount of benefits a claimant is entitled to decreases––due to a change in the claimant’s employment status, for example––but the claimant still receives the full amount of benefits. Id. § 404.415(c); see also id. § 404.423.
If an overpayment has been made, “there shall be no adjustment of payments to, or recovery by the United States from, any person who is without fault if such adjustment or recovery would defeat the purpose of this subchapter or would be against equity and good conscience.” 42 U.S.C.
§ 404(b)(1). A claimant is considered “without fault” unless the overpayment resulted from:
(a) An incorrect statement made by the individual which he knew or should have known to be incorrect; or (b) Failure to furnish information which he knew or should have known to be material; or (c) With respect to the overpaid individual only, acceptance of a payment which he either knew or could have been expected to know was incorrect.
20 C.F.R. § 404.507. If it is determined that a claimant is “without fault” for an overpayment, the ALJ must then determine whether “adjustment or recovery would defeat the purpose of [the Act] or would be against equity and good conscience.” 42 U.S.C. § 404(b)(1).
If a claimant is deemed at fault, she is not entitled to waiver of the overpayment and the Act mandates that the SSA seek recovery of the overpaid benefits and cease benefit payments to
the claimant until the claimant has either refunded the overpayment or the amount of the overpayment has been withheld from the claimant’s benefits. 42 U.S.C. § 404(a)(1); 20 C.F.R.
§ 404.502(a).
[*8]Case No. 19-3453, Cohan v. Comm’r of Soc. Sec.
C. Recovery of the Overpayment of Benefits Incurred Prior to July 2008
The ALJ determined that Cohan was not at fault in causing or accepting the overpayment made prior to July 2008. The ALJ further concluded, however, that recovery of the overpayment does not defeat the purpose of the Act and is not against equity or good conscience, rending waiver
of the overpayment made prior to July 2008 inappropriate. We find that substantial evidence in the administrative record supports the ALJ’s determination and accordingly affirm.
Whether Recovery of the Overpayment Defeats the Purpose of the Act
Cohan contends that the ALJ ignored substantial evidence that supports a finding that recovery of any overpayments made prior to July 2008 would defeat the purpose of the Act, thus entitling her to a waiver of the overpayments under 42 U.S.C. § 404(b). An adjustment or recovery
defeats the purpose of the Act if it would “deprive a person of income required for ordinary and necessary living expenses.” 20 C.F.R. § 404.508(a). Further, an “[a]djustment or recovery will defeat the purposes of [the Act] in (but is not limited to) situations where the person from whom recovery is sought needs substantially all of his current income (including social security monthly benefits) to meet current ordinary and necessary living expenses.” Id. § 404.508(b). Upon review of Cohan’s current income and ordinary and necessary living expenses, the ALJ found that Cohan
has an income sufficient to cover more than her ordinary and necessary needs. Accordingly, the ALJ concluded that recovery of the overpayment incurred prior to July 2008 does not defeat the purpose of the Act.
[*9]Case No. 19-3453, Cohan v. Comm’r of Soc. Sec.
Cohan first asserts that the ALJ improperly excluded evidence regarding her legal fees under 42 U.S.C. § 406(a) and 20 C.F.R. § 404.508(a)(4).3 The Commissioner argues that the ALJ properly determined that, because there was no evidence in the record that the SSA had approved the fee agreement between Cohan and her counsel, the legal debt she claimed is not presently a valid debt. We agree with the Commissioner.
Under the Act, an attorney must obtain the SSA’s authorization prior to charging or collecting legal fees in connection with a proceeding before the SSA. 42 U.S.C. § 406(a). The Act states that “[t]he Commissioner of Social Security may, by rule and regulation, prescribe the maximum fees which may be charged for services performed in connection with any claim before the Commissioner of Social Security under this subchapter, and any agreement in violation of such rules and regulations shall be void.” Id. § 406(a)(1); see also Culbertson v. Berryhill, 139 S. Ct.
517, 520 (2019) (noting that id. § 406 regulates the fees attorneys may charge under Title II of the Social Security Act). As there is no evidence that the SSA has approved the legal fees Cohan claims she owes, Cohan is not presently obligated to repay any legal fees in connection with her
proceedings before the SSA. Thus, the ALJ properly declined to consider the alleged legal fees in his calculation of whether the overpayment recovery would defeat the purpose of the Act.
Additionally, Cohan argues that the ALJ failed to consider substantial evidence regarding her financial position at the time of her first hearing. When conducting a “defeat the purpose” assessment, the ALJ must evaluate the claimant’s “current” income with financial information that