Bates v. Anthem Insurance Companies, Inc.

CourtDistrict Court, S.D. Ohio
DecidedAugust 10, 2020
Docket1:18-cv-00502
StatusUnknown

This text of Bates v. Anthem Insurance Companies, Inc. (Bates v. Anthem Insurance Companies, Inc.) is published on Counsel Stack Legal Research, covering District Court, S.D. Ohio primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Bates v. Anthem Insurance Companies, Inc., (S.D. Ohio 2020).

Opinion

IN THE UNITED STATES DISTRICT COURT FOR THE SOUTHERN DISTRICT OF OHIO WESTERN DIVISION – CINCINNATI

TAMARA S. BATES, : Case No. 1:18-cv-502 : Plaintiff, : Judge Matthew W. McFarland : v. : : ANTHEM INSURANCE COMPANIES, : INC., : : Defendant. : ______________________________________________________________________________

ORDER GRANTING MOTION FOR SUMMARY JUDGMENT (DOC. 16) ______________________________________________________________________________ This case is before the Court on the Motion for Summary Judgment (Doc. 16) filed by Defendant Anthem Insurance Companies, Inc. (“Anthem”). Plaintiff Tamara Bates alleges that Anthem, her former employer, is liable for (1) disability discrimination; (2) wrongful termination in violation of public policy; (3) retaliation in violation of the Family and Medical Leave Act (“FMLA”); and (4) intentional infliction of emotional distress. Anthem argues that it should be granted summary judgment on Bates’s claims because she has not come forward with evidence creating a genuine issue of material fact as to her entitlement to relief. Bates filed a memorandum in opposition to Anthem’s Motion, in response to which Anthem filed a reply. (Docs. 18, 19.) This matter is therefore fully briefed and ripe for review. As discussed below, the Court agrees that there are no genuine issues of material fact precluding judgment in Anthem’s favor. Accordingly, its Motion for Summary Judgment is GRANTED. FACTS Anthem is an insurance company providing life, dental, vision, disability, and health insurance services across the United States. To administer its insurance services,

Anthem employs Utilization Management Representatives (“UMR”) in various departments who are responsible for, among other things: managing incoming calls; determining contract and benefit availability; providing authorization for inpatient admission, outpatient pre-certification, prior authorization, and post-service requests; and referring cases for review for clinicians. (Doc. 16-1.) Put simply, UMRs take

incoming phone calls and then “build cases,” or enter data necessary to authorize care or confirm insurance coverage. (See Doc. 16-2 at 138:3.) Upon hire, UMRs receive six to eight weeks of on-the-job training to ensure that they are able to access and utilize all of the telephonic and computer software programs necessary to perform their duties and properly direct calls. (See Doc. 16-2 at 42-46; Doc. 16-1 at 53:10-20.) UMRs also undergo

ethics and compliance training. (Doc. 16-2 at 45:12-21; Doc. 16-1 at 53:10-20.) UMRs employed in Anthem’s Behavioral Health department are responsible for taking three types of incoming calls: member, provider, and crisis. (See Doc. 16-2 at 56-60; see also Doc. 16-1 at 34-36.) Members are individuals who have Anthem insurance coverage, while providers

are facilities like hospitals, physicians’ offices, and outpatient care centers that provide behavioral health services. (See Doc. 16-2 at 56:6-10.) The most critical type of call is a crisis call, which involves an individual having a behavioral health crisis (e.g., threatening harm to others or suicide). (See id. at 57:9-58:12.) When a UMR receives a crisis call, the call must immediately be directed to an Anthem clinician. (See id. at 58:13, 59:1.) UMRs cannot determine before they answer a call whether it is a member,

provider, or crisis call. (Doc. 16-1 at 34:13-15.) Anthem’s Corrective Action policy delineates examples of unacceptable conduct that interferes with company operations. (See Doc. 16-2, Ex. 7 at 2.) One example of unacceptable conduct is “intentionally disconnecting a customer/member call, call avoidance, or disrupting customer service.” (See id.) Under this policy, Anthem may terminate an associate at any time, “without following any formal system of corrective

action or progressive discipline,” if an associate engages in any sort of unacceptable conduct. (Id. at 1.) Anthem maintains a specific policy to explain and address call avoidance. (Doc. 16-2, Ex. 8.) The policy defines the “failure to appropriately service all calls” as call avoidance, and provides several examples of call avoidance, including transferring calls

that the associate is trained to handle back into the telephone queue. (Id.) Due to the serious impact of call avoidance on the company’s ability to service its customers, Anthem’s call avoidance policy is “zero tolerance.” (Id. at 2.) If it is determined by detailed review of call trace reports or other monitoring that an associate has been avoiding calls, the associate can be terminated. (Id.) Bates recalls reviewing multiple

Anthem policies at the outset of her employment and was aware of both the Corrective Action and call avoidance policies. (See Doc. 16-2 at 63-72.) Bates knew about the consequences for call avoidance. (Doc. 16-2 at 67:1-24.) Bates was also aware that managers could monitor her calls and call activity. (Id. at 81:5-11.) Bates was hired by Anthem in November 2008 as a UMR in the Medical Customer Service department. (Id. at 36:10-13, 41:17-22.) Several years into her

employment, Bates was promoted to the position of UMR-II and transferred to the Behavioral Health department. (Id. at 51-54.) At all times relevant to the claims in this action, Bates worked remotely and was managed by Justin Parcell, Behavioral Health Manager. (Id. at 78:3-8.) Bates only ever met Parcell in person once. (Id. at 78:9-79:4.) Anthem’s records reflect that Bates took leave on multiple occasions during her employment without issue. (Doc. 16-1 Ex. Y.) Specifically, Bates took medical leaves in

2009, 2012, 2014, 2016, and 2017. (See id.; see also Doc. 16-2 at 85:18-86:14.) While Bates has no recollection of the circumstances surrounding her various medical leaves, she does recall taking multiple leaves, and testified that the FMLA leave she took in November 2016 and May 2017 are the only two leaves at issue in this case. (Doc. 16-2 at 85:3-86:14.)

In November 2016, Bates scheduled one day of paid time off for an elective, outpatient tummy tuck surgery. (Id. at 86:15-21, 87:19-24, 88:1-2.) Bates, however, developed an infection after the surgery, resulting in her taking FMLA leave. (See id. at 86:22-87:4.) She spent several days in the hospital and after returning home from the hospital, had to take antibiotics for several months, had a home health nurse visit

several times a week to assist in packing her wound, and temporarily wore a wound vac. (Id. at 89:3-17.) According to Bates, she informed Parcell that she “wasn’t feeling good” and “had a complication” with her surgery, and he contacted Anthem’s Human Resources department to inform them that Bates needed to take FMLA leave. (See id. at 90:1-10.) Bates asserts that Parcell initially disapproved of her request to work half days, but she cites a portion of Parcell’s deposition that has not been filed in the Court’s

docket. (See Doc. 18 at 2, citing Justin Parcell Deposition at 148-149.) Bates testified that she spoke with Parcell and Team Lead Lazenby on several occasions while she was on FMLA leave, but she has no recollection of when those conversations occurred, how many conversations occurred, or the contents of those conversations.” (See id. at 92:23-99:20.) Bates also testified that she was in contact with Human Resources about her surgery, but she does not recall when those conversations

occurred, who she spoke to, or the contents of those conversations. (See id. at 100:22- 104:16.) Bates returned to work from FMLA leave on a part-time basis in February 2017, and eventually transitioned back to full-time. (Id. at 104:24-105:18.) Bates testified that as a result of her tummy tuck surgery, she has a concave “dip” in her stomach that sometimes opens up after it rubs against clothing. (Id. at

Free access — add to your briefcase to read the full text and ask questions with AI

Related

McDonnell Douglas Corp. v. Green
411 U.S. 792 (Supreme Court, 1973)
Anderson v. Liberty Lobby, Inc.
477 U.S. 242 (Supreme Court, 1986)
Jakubowski v. Christ Hospital, Inc.
627 F.3d 195 (Sixth Circuit, 2010)
Ronald A. Landefeld v. Marion General Hospital, Inc.
994 F.2d 1178 (Sixth Circuit, 1993)
Gary Walsh v. United Parcel Service
201 F.3d 718 (Sixth Circuit, 2000)
Joseph Nilles v. Givaudan Flavors Corp.
521 F. App'x 364 (Sixth Circuit, 2013)
Sybrandt v. Home Depot, U.S.A., Inc.
560 F.3d 553 (Sixth Circuit, 2009)
Brown v. BKW Drywall Supply, Inc.
305 F. Supp. 2d 814 (S.D. Ohio, 2004)
Witte v. Rippe & Kingston Systems, Inc.
358 F. Supp. 2d 658 (S.D. Ohio, 2005)
Hanly v. Riverside Methodist Hospitals
603 N.E.2d 1126 (Ohio Court of Appeals, 1991)
Slane v. Metamateria Partners, L.L.C.
892 N.E.2d 498 (Ohio Court of Appeals, 2008)
Gloria Marshall v. Rawlings Co.
854 F.3d 368 (Sixth Circuit, 2017)
City of Columbus Civil Service Commission v. McGlone
697 N.E.2d 204 (Ohio Supreme Court, 1998)
Hancock v. Dodson
958 F.2d 1367 (Sixth Circuit, 1992)

Cite This Page — Counsel Stack

Bluebook (online)
Bates v. Anthem Insurance Companies, Inc., Counsel Stack Legal Research, https://law.counselstack.com/opinion/bates-v-anthem-insurance-companies-inc-ohsd-2020.