Thank you to everyone who helped contribute to this investigation. Unfortunately, at this point, attorneys working with ClassAction.org have decided to close their investigation into this matter. If you have questions regarding your rights, please reach out to an attorney in your area. Most offer free consultations.
The information below was posted when the investigation began and exists for reference only. Our open list of investigations can be found here.
At A Glance
This Alert Affects:
Medical insurance case managers who weren't paid overtime.
What's Going On?
Allegations have surfaced that some case managers are being illegally denied time-and-a-half wages when working more than 40 hours per week.
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.
The court cited the following reasons:
The case managers didn’t have the authority to deny insurance coverage requests. Instead, they had to refer complex claims to a medical director.
The company gave the case managers detailed guidelines to use when evaluating claims to minimize the amount of discretion and independent judgment they exercised.
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.
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
Though a lawsuit, medical insurance case managers who were misclassified as exempt from overtime may be able to:
Recover unpaid overtime wages dating back two to three years
Request a court order that the company change its pay practices so that employees are paid properly in the future
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.