Part of our utilization review cases →
In Bellan v. Capital Blue Cross, No. 1:20-cv-00744 (M.D. Pa.), a utilization review nurse sued on behalf of herself and other Utilization Review Employees. She alleged that Capital Blue Cross classified them as exempt and did not pay them overtime. On October 26, 2020, the court conditionally certified the FLSA collective (Doc. 38). Jack Siegel represented the workers.
Conditional certification let notice go out to other Utilization Review Employees. After notice, sixteen people filed consent forms and joined the case as opt-in plaintiffs. The named plaintiff worked as a salaried Medical Management Nurse.
The parties later reached a settlement with the help of a magistrate judge (Doc. 77).
Utilization review nurses check benefit requests against criteria the insurer sets. The workers alleged that this work did not meet any overtime exemption. Capital Blue Cross disputed the claims.
Conditional certification is an early step that lets notice go out. It is not a finding that anyone was misclassified or that the employer broke the law.
As general information, the FLSA requires overtime at one and one-half times the regular rate for hours over 40 in a workweek unless the employer proves an exemption. The administrative exemption requires, among other things, a primary duty that includes the exercise of discretion and independent judgment on matters of significance. A Department of Labor rule says registered nurses generally meet the duties test of the learned professional exemption (29 C.F.R. § 541.301(e)(2)), but the job must still require that advanced knowledge. Whether a review job qualifies depends on the work actually done.
This page describes a 2020 court order. The time to join that collective was set by the court in that case. If you have worked in a similar role, the Siegel Law Group can evaluate your own claims.
Related rulings: Drake v. Tufts, another case for salaried utilization review employees, and Snider v. Quantum Health, another case for salaried utilization review employees.
Conditional certification means the court allowed the case to proceed as a collective action under the FLSA. Other similarly situated UR nurses at Capital BlueCross could receive notice of the lawsuit and choose to join (opt in) to pursue their own claims for unpaid overtime.
It depends on actual duties. A salary and a nursing license do not settle the question. The employer must prove that the work meets every part of an exemption.
Not necessarily. The exemption analysis focuses on the duties actually performed, not the worker's credentials. A licensed nurse who follows standardized protocols and predetermined criteria in performing utilization review may still be entitled to overtime. The professional exemption has specific requirements that many UR positions do not meet.
The administrative exemption is a "white collar" exemption that, if properly applied, allows employers to avoid paying overtime. It requires pay on a salary basis at or above a set minimum and a primary duty that involves the exercise of discretion and independent judgment with respect to matters of significance related to business operations. Whether a utilization review nurse meets this test depends on the actual duties.
Key indicators of misclassification include: following standardized criteria or guidelines for most decisions, requiring supervisor approval for exceptions, having your work regularly audited for compliance, and lacking authority to make significant business decisions. If your daily work involves applying predetermined rules rather than exercising independent judgment, a lawyer can review whether you were misclassified.
Yes. Health insurance companies are subject to the same FLSA overtime requirements as any other employer. The Siegel Law Group has filed overtime lawsuits against health plans, managed care companies and insurance companies.
If you did this kind of work for another employer and weren't paid overtime for hours over 40, 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. Federal law makes it illegal to retaliate against you for asking.
Siegel Law Group PLLC concentrates in unpaid overtime cases under the FLSA and state wage laws. The firm has filed more than 100 federal overtime cases, obtained 50+ class and collective certifications in 20 federal judicial districts across 15 states, and recovered more than $100 million for workers. It has never represented an employer in a wage case. Free consultation. Contingency fee: we advance case costs, and they are repaid from any recovery. No recovery, no fee and no costs. Phone: (214) 790-4454 | Email: [email protected]
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"Certified" means a judge agreed the case could go forward for a group of workers at once, not just the one person who filed it. It is a step in the case, not the end of it.
Attorney advertising. Case information shown is taken from public court filings and court-approved settlements in cases this firm brought. Every case turns on its own facts and on the law of the court where it is heard. Prior results do not guarantee a similar outcome, and a certification or ruling in one case does not guarantee the same result in another. Nothing on this page is legal advice, and reading it or sending a message does not create an attorney-client relationship.
Jack L. Siegel of Siegel Law Group PLLC, Dallas, Texas, is responsible for the content of this page. He appears in federal courts in other states by admission to those courts or by leave of court, and is not licensed in every state shown in this list.
