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Monet v. Mathews

March 5, 2008


The opinion of the court was delivered by: Ricardo M. Urbina United States District Judge

Document No. 13, 19


This matter is before the court on the defendants' motion to dismiss.*fn1 For the reasons stated below, the court dismisses the complaint.*fn2


The Social Security Administration ("SSA") found the plaintiff disabled beginning August 1, 1995. Motion to Dismiss ("Def.'s Mot."), Declaration of Dennis V. Ford ("Ford Decl.") ¶ (3)(a). Ramona Marie Mathews ("Mathews"), the plaintiff's sister, asked to be selected as the plaintiff's representative payee due to the plaintiff's "mental impairment." Id., Ex. C at 1. SSA selected Mathews to serve as the representative payee in July 2005.*fn3 Id. ¶ (3)(e) & Ex. E; see Compl. ¶¶ 13-15. According to the plaintiff, Mathews "converted funds paid by [SSA] to [the plaintiff] and or on behalf of [the plaintiff] for her own use." Compl. ¶ 17; see Amd. Compl. ¶¶ 20, 31 & Ex. 1. SSA opened an investigation regarding Mathews' alleged misuse of benefits and so informed the plaintiff in May 2007.*fn4 Ford Decl. ¶ (3)(f) & Ex. Q.

SSA later determined that the plaintiff was ineligible to receive SSA benefits from March 2005 through September 2006 due to her "confine[ment] in an institution as a result of a court order in connection with a criminal case" which was paid with public funds, resulting in an overpayment of $13,254.80.*fn5 Ford Decl., Ex. F at 1 & Ex. G at 1. Benefits were reinstated effective October 2006 following the plaintiff's release from custody on October 5, 2006. Id. ¶ (3)(c) & Ex. L. SSA granted the plaintiff's request to receive her own benefits directly. Id. ¶ (3)(e) & Ex. O-1 & O-2. In order to recover the overpayments, SSA notified the plaintiff of its decision to withhold $50 each month. Id., Ex. P.

The plaintiff has pursued "the issue of overpayment" administratively, and therefore, that issue is not before the court. Objection of Motion to Dismiss Filed by the United States Attorney ("Pl.'s Opp'n") at 26. "The issues before the court are limited to [the plaintiff's] assertions that Ramona Mathews converted to her own use Social Security benefits paid for the benefit of [the plaintiff] and that the Social Security Administration was negligent in the appointment and supervision of Ramona Mathews as personal representative resulting in the misuse." Id. at 10; see id. at 25-26. In this action, the plaintiff demands an accounting of all SSA benefits that Mathews received in her capacity as representative payee and restitution of any misused funds.*fn6 See Compl. ¶¶ 19, 34-35.


A. Exhaustion of Administrative Remedies

The defendants move to dismiss the complaint, as amended, on the grounds that the court lacks subject matter jurisdiction and that the complaint fails to state a claim upon which relief can be granted. See Defs.' Mot. at 1-2. Specifically, the defendants argue that the plaintiff failed to exhaust her administrative remedies before filing the instant civil action. See id. at 7-15.

Generally, a claimant may seek judicial review "after any final decision of the Commissioner of Social Security made after a hearing to which he was a party, irrespective of the amount in controversy . . . by [filing] a civil action [] within sixty days after the mailing to [the claimant] of notice of such decision." 42 U.S.C. § 405(g). In order to obtain a final SSA decision, a claimant must complete the process of administrative review. See 20 C.F.R. § 404.900(a).

First, SSA makes its initial determination as to a claimant's entitlement to benefits, continuation of benefits, or any other matter, and so notifies the claimant in writing. 20 C.F.R. §§ 404.900(a), 404.904. An initial determination is binding unless the claimant timely requests reconsideration or unless SSA revises the initial determination. 20 C.F.R. § 404.905. Initial determinations include those regarding overpayment of benefits, repayment to SSA of overpayments, selection of a representative payee, payment of benefits to a representative payee, and SSA's negligence with regard to investigating or monitoring a representative payee resulting in the misuse of benefits by that representative payee. See 20 C.F.R. § 404.902.

If a claimant is dissatisfied with the SSA's initial determination, she may request reconsideration. 20 C.F.R. § 404.907. Generally a claimant who is dissatisfied with a reconsidered decision may request a hearing before an administrative law judge. 20 C.F.R. §§ 404.907, 404. 930. The administrative law judge makes his decision based on the record before him, setting forth his findings of fact and reasons for the decision. 20 C.F.R. §§ 404.929, 404.953(a). A dissatisfied claimant may request review of an administrative law judge's hearing decision by the Appeals Council, which may affirm, modify or reverse that decision. 20 C.F.R. §§ 404.955(a), 404.967, 404.979. "The Appeals Council's decision, or the decision of the administrative law judge if the request for review is denied, is binding unless [the claimant files] an action in Federal district court, or the decision is revised." 20 C.F.R. § 404.981.

Here, the plaintiff accuses Mathews of misuse of benefits received on the plaintiff's behalf and alleges that SSA was negligent in selecting and supervising Mathews while she acted as representative payee. Both of these matters call for initial determinations by SSA and are subject to SSA's administrative review process. Without first obtaining an initial ...

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