Part of our utilization review cases →
OrthoNet, a UnitedHealthcare company, employed OrthoCare Managers to review requests for orthopedic procedures and services against medical criteria and company guidelines. OrthoNet classified them as exempt under the administrative exemption. The workers alleged that applying standardized criteria is not the independent judgment the exemption requires.
In Solis v. OrthoNet, No. 1:10-cv-00937-LTS-MHD (S.D.N.Y.), Siegel Law Group served as lead counsel in a combined FLSA collective action and New York Labor Law class action. On October 25, 2011, the court granted conditional certification. The case covered 327 FLSA collective members and 114 New York class members, 441 workers in all. On September 27, 2013, Judge Laura Taylor Swain approved the settlement.
Siegel Law Group also brought Solis v. OrthoNet, LLC, No. 1:19-cv-04678 (S.D.N.Y.), which settled the claims of more than 300 workers classified as exempt under the FLSA and New York Labor Law who reviewed medical claims against medical-necessity criteria.1
The administrative exemption covers employees whose primary duty includes "the exercise of discretion and independent judgment with respect to matters of significance." 29 C.F.R. § 541.200(a)(3). Checking a request against criteria someone else wrote is not that. Whatever the job title, if the work is applying the insurer’s guidelines, the administrative exemption should not apply.
The 2010 case covered 441 OrthoCare Managers through a combined FLSA collective and New York class. The 2019 case settled the claims of more than 300 medical-necessity reviewers.
That OrthoNet classified utilization review workers as exempt even though they applied standardized medical criteria rather than exercising independent judgment.
It pairs a federal FLSA collective action (workers opt in) with a state-law class action (workers are included unless they opt out).
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