Workers Hit EmblemHealth with OT Misclassification Suit

Two insurance grievance specialists sued their employer, EmblemHealth, in New York federal court, saying the company misclassified them as overtime-exempt, causing them to miss out on time-and-a-half pay while they clocked up to 70-hour weeks.

Dasya María Cordova and Ada Casasus sued EmblemHealth Inc. and EmblemHealth Services Co. LLC last week, accusing the company of violating the Fair Labor Standards Act and the New York Labor Law by withholding overtime pay from grievance and appeal specialists. They said specialists had no leadership responsibilities or managerial control, qualities that could exempt them from receiving overtime pay.

"Plaintiffs bring this putative class and collective action to recover stolen overtime wages, which Emblem unlawfully denied to scores of employees that it knowingly misclassified as overtime exempt for decades merely to save labor costs and fatten its bottom-line profit margins," the suit said.

Cordova said she worked at EmblemHealth for 23 years — from 2014 on as a senior grievance and appeal specialist. Casasus said she worked for EmblemHealth for 15 years and has served as a grievance and appeal specialist since 2007 for the company, which is known as one of the largest nonprofit health insurers in the nation.

The Plaintiffs claimed specialists were often expected to work beyond 40 hours a week in order to meet their job expectations, which entailed processing appeals and grievances on insurance claims. They said the specialists oversaw collecting the records and details about the claim and passing that information on to the decision makers, such as doctors and nurses, who decided whether the appeal or grievance should be denied or granted.

Cordova and Casasus said they had no decision-making power over the appeals and grievances, which could exempt them from overtime under the FLSA's so-called white-collar exemption. That exemption precludes administrative or executive employees from earning overtime.

They also said they would not propose solutions to appeals, nor did they have any power over matters of significance at EmblemHealth. They also had no authority to hire and fire employees, they said.

Cordova and Casasus said they regularly worked over 40 hours per week and sometimes clocked 60-70 hours to meet up with the demands of the appeals and grievances. They said they would sometimes start work at 7:30 a.m. and end at 10 p.m.

"Plaintiffs were routinely told by their managers in the middle of a workday that they had to complete the processing of dozens of outstanding cases by close of business that day," the suit said.

"These types of sudden, often completely unreasonable demands left plaintiffs with no choice, lest they lose their jobs, but to work well into most evenings and on most weekends, and certainly well over 40 hours a week," it said.

EmblemHealth willfully violated the FLSA and NYLL by underpaying specialists’ overtime, Cordova and Casasus said. They said they were routinely contacted by management after hours and were also required to send emails and submit reports well past normal business hours.

They also claimed EmblemHealth did not provide accurate wage statements to employees that recorded all the hours they worked and their accurate rates of pay. They also said they did not receive wage notices.

Cordova and Casasus said they're looking for injunctive relief against EmblemHealth as well as damages, pre- and post-judgment interest, litigation costs and attorney fees.

Tanvir H. Rahman of Rahman Law PC, who represents the workers, told Law360 on Monday that the specialists do not fall under any recognized exemptions to the federal and state overtime requirements.

"EmblemHealth, as we allege, has prioritized fattening its bottom line over lawfully paying its dedicated workers, and our clients intend to hold the company accountable for its unlawful policies and practices," Rahman said.