Overtime Lawsuits for Medical Insurance Case Managers

Attorneys are investigating whether class action lawsuits can be filed against companies that fail to pay overtime wages to their medical insurance case managers.

What Started the Investigation into These Lawsuits?

Over the past several years, a number of companies have been sued for failing to pay their medical insurance case managers overtime pay. These lawsuits claim that certain managed care and health insurance companies are illegally misclassifying these employees as ineligible to receive overtime.

What Does It Mean to Be Misclassified Under Federal Wage Laws?

Under federal law, certain employees are considered “exempt” from overtime regulations. This means they’re not owed any extra pay when working overtime. Most workers, however, don’t fall under these exemptions and should therefore receive time-and-a-half wages when working more than 40 hours a week.

In July 2016, a court came down with a ruling in a case against managed care company Centene. The ruling said that Centene’s medical insurance case managers were wrongly classified as exempt and, as a result, were being illegally denied overtime wages. The court found that the workers were owed overtime because they were not required to attend a specialized intellectual institution and did not have significant decision-making powers. (You can read the ruling here.)

How Do I Know If I’ve Been Misclassified? Should I Be Getting Overtime?

The fact is most employees should be getting overtime when working more than 40 hours per week. Only under certain circumstances is an employee exempt from this extra pay. To be exempt, the worker must meet a certain salary threshold and perform a number of “exempt” duties as part of their job.

The suit against Centene alleged that the medical insurance case managers were being wrongly classified under the “administrative” and “learned professional” exemptions.

The Administrative Exemption

To be truly exempt from overtime wages under the administrative exemption, the employee must meet three specific criteria. One of these criteria requires that the employee exercise “discretion and independent judgment” regarding significant work matters. For example, this “discretion and independent judgment” may include the ability to hire and fire employees.

According to the Centene ruling, medical insurance case managers do not meet this criterion and are therefore entitled to overtime pay.

It’s important to note that most insurance adjusters are exempt from overtime; however, it is believed that medical insurance case managers job duties require significantly less discretion than a typical insurance adjuster and should therefore receive time-and-a-half wages.

The Learned Professional Exemption

Like the administrative exemption, the “learned professional” exemption also has a set of three strict criteria.

One of these requires that the employee learns his or her trade through a “prolonged course of specialized intellectual instruction” and that this advanced knowledge is a requirement for work. This exemption most often applies to lawyers, doctors and scientists.

Some companies may require their medical insurance case managers to hold a license as a registered, practical or vocational nurse and have a few years of clinical experience. However, because these advanced degrees are typically not required for those working as case managers (as they would be, for instance, for nurses caring for patients in a hospital), courts have found that medical insurance case managers do not meet the “advanced knowledge” criteria and should therefore be earning overtime.  

How a Class Action Lawsuit Can Help Case Managers

If you’re not receiving overtime working as a medical insurance case manager, you may be able to participate in a class action lawsuit with fellow employees and recover any money you are owed.

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