Is a claims examiner exempt from overtime? Not automatically. Being paid a salary and labeled "exempt" doesn't settle it. If your job is working a disability or leave claims queue against the company's manual, templates and guidelines, with a supervisor signing off on denials, your employer has a hard case to make that you use the independent judgment the administrative exemption requires. Siegel Law Group has sued Matrix Absence Management, Reliance Standard Life, Unum and Symetra on behalf of salaried claims staff.

You work the queue against a manual, and a supervisor checks the boxes. The company calls that "discretion." We've spent years in federal court arguing that it isn't, for people who are doing exactly that job.

Why claims examiners get misclassified

To exempt a salaried employee under the administrative exemption, the employer has to show three things: a salary at or above the federal minimum, office work directly related to running the business, and a primary duty that includes "the exercise of discretion and independent judgment with respect to matters of significance."¹ The third element is where claims examiner cases are won or lost.

The Department of Labor's regulations draw the line. Discretion "must be more than the use of skill in applying well-established techniques, procedures or specific standards described in manuals or other sources."² And the exemption is "not available" for "employees who simply apply well-established techniques or procedures described in manuals or other sources within closely prescribed limits to determine the correct response to an inquiry or set of circumstances."³

That describes a lot of claims work. In the Matrix case in New York, the court's class-certification order described examiners who got short "cheat sheets" summarizing each customer's plan, drafted denial letters from a template, and worked under a rule that "[a] supervisor reviews all determinations to deny a claim, regardless of the TCE's proficiency level."⁴ In the Unum case, the conditionally certified collective was defined by one duty: processing disability claims using the guidelines in Unum's Benefit Center Claims Manual.⁵

What insurers argue

Insurers point to one regulation, and you should know it. It says insurance claims adjusters "generally meet the duties requirements for the administrative exemption" when their duties include work like interviewing insureds and witnesses, inspecting damage, determining liability and the total value of a claim, negotiating settlements, and recommending litigation.⁶ If that is your day, the exemption may fit. If your day is applying a manual to a file and routing the result for sign-off, it is a different job, whatever the title says. The facts of the job decide these cases, not the job title.

Two Supreme Court rulings set the ground rules. Exemptions get "a fair (rather than a 'narrow') interpretation."⁷ And the employer has to prove the exemption by a preponderance of the evidence.⁸ The burden is the employer's, and it's a real one when the work is rule-following.

Cases we've brought

These are federal cases Siegel Law Group has brought for salaried claims staff at disability insurers and absence-management companies. Each line links to the court record or a sworn source.

• Green v. Reliance Standard Life Insurance Co., No. 1:20-cv-03878 (N.D. Ill.). Settled the claims of 202 short- and long-term disability claims examiners who were FLSA opt-ins, members of a Maine state-law class, or both. The court appointed Jack Siegel class counsel.⁹ Read the case
• Weeks v. Matrix Absence Management, Inc., No. 2:20-cv-00884 (D. Ariz.). In October 2020 the court conditionally certified a collective of salaried Claims Examination Employees classified as exempt. Matrix's own class list showed 129 telephone claims examiners who worked in Oregon in the two years before the case was filed.¹⁰¹¹ Read the ruling
• Heckle v. Matrix Absence Management, Inc., No. 7:21-cv-01463 (S.D.N.Y.). On December 14, 2022, the court certified a New York Labor Law class of telephonic claims examiners at Matrix's Hawthorne, New York office and appointed class counsel. The case later settled.⁴ Read the ruling · Read about the settlement
• Loomis v. Unum Group Corp., No. 1:20-cv-00251 (E.D. Tenn.). We won certification for Unum's disability benefits specialists. In May 2021 the court conditionally certified a nationwide collective of salaried disability benefits specialists in Unum's short-term disability, long-term disability and individual disability departments. The case later settled for $14.8 million (final approval Apr. 17, 2025, Doc. 316). The settlement class had 947 members.⁵ Read the ruling · Read about the settlement
• Blier v. Symetra Life Insurance Co., No. 2:21-cv-00692 (W.D. Wash.). Filed May 26, 2021, as a collective and class action for salaried claims examiners who processed disability benefits claims.¹²

These are results in other people's cases. Every case depends on its own facts and law. Prior results do not guarantee a similar outcome.

Questions claims examiners ask us

Are disability claims examiners exempt from overtime?

Some are, many aren't. The answer turns on your actual primary duty. Applying a claims manual, templates and set criteria within prescribed limits is not exempt work under the Labor Department's regulations.²³ Investigating, negotiating and valuing claims with real authority looks more like the adjuster example the regulations treat as exempt.⁶

My supervisor reviews my decisions. Does that help my case?

It helps, but it isn't enough by itself. The regulations say an employee can still exercise discretion even when decisions are reviewed at a higher level.¹³ What matters is the whole picture: whether you're choosing among real options or applying a rule, whether you can deviate from guidelines, and whether every denial needs a sign-off.

My title says "analyst" or "specialist," not "examiner." Does that matter?

No. Titles don't decide exempt status. The courts in these cases defined the groups by duties: processing disability and leave claims under the company's guidelines, whatever the title on the paycheck.¹⁰⁵

How far back can I recover?

Under federal law, generally two years of unpaid overtime, or three years if the violation was willful, plus an equal amount in liquidated damages in most cases.¹⁴ State law can reach further. The clock keeps running until you file, so waiting costs money.

Can my employer retaliate if I ask about this?

Federal law makes it illegal to fire or discriminate against an employee for filing a complaint or taking part in an overtime case.¹⁵ If it happens, that's a separate claim.

If you do this job somewhere else

If you were paid a salary to work claims against a manual and routinely worked past 40 hours, tell us your job title, your employer and the state you worked in. We'll tell you plainly whether we think you have a case. See also the administrative exemption trap, am I misclassified as exempt?, employers we've taken to court and retaliation protections.

Attorney responsible: Jack L. Siegel, Siegel Law Group PLLC, 11341 W. US Hwy 290, Bldg. 2, Austin, TX 78737. Licensed in Texas. This page is general information, not legal advice. These are results in other people's cases. Every case depends on its own facts and law. Prior results do not guarantee a similar outcome.

Notes

1. 29 C.F.R. § 541.200(a); 29 C.F.R. § 541.202(a).
2. 29 C.F.R. § 541.202(e).
3. 29 C.F.R. § 541.704 (use of manuals).
4. Heckle v. Matrix Absence Mgmt., Inc., No. 7:21-cv-01463, Doc. 72 (S.D.N.Y. Dec. 14, 2022) (granting class certification on New York Labor Law claims and appointment of class counsel); docket.
5. Loomis v. Unum Grp. Corp., 539 F. Supp. 3d 898 (E.D. Tenn. 2021) (granting conditional certification in part, May 13, 2021); Doc. 316 (E.D. Tenn. Apr. 17, 2025) (final approval of FLSA and class action settlement); Doc. 313 (joint final-approval motion: settlement payment of up to $14,800,000; 947 Settlement Class Members); docket.
6. 29 C.F.R. § 541.203(a) (insurance claims adjusters).
7. Encino Motorcars, LLC v. Navarro, 584 U.S. 79 (2018).
8. E.M.D. Sales, Inc. v. Carrera, No. 23-217 (U.S. Jan. 15, 2025).
9. Declaration of Jack Siegel ¶ 13(c)–(d), Weeks v. Matrix Absence Mgmt., Inc., No. 2:20-cv-00884 (D. Ariz. July 6, 2022) (Green: settled claims of 202 disability claims examiners; class counsel appointment).
10. Weeks v. Matrix Absence Mgmt., Inc., 494 F. Supp. 3d 653 (D. Ariz. 2020) (order signed Oct. 14, 2020, filed Oct. 15, 2020) (conditionally certifying a collective of salaried Claims Examination Employees classified as exempt); docket.
11. Declaration of Jack Siegel ¶ 12, Weeks v. Matrix Absence Mgmt., Inc., No. 2:20-cv-00884 (D. Ariz. July 6, 2022) (129 telephone claims examiners in Oregon, per defendant’s class list).
12. Blier v. Symetra Life Ins. Co., No. 2:21-cv-00692 (W.D. Wash. filed May 26, 2021) (docket).
13. 29 C.F.R. § 541.202(c).
14. 29 U.S.C. § 255(a); 29 U.S.C. § 216(b).
15. 29 U.S.C. § 215(a)(3).