Weeks v. Matrix Absence Management Incorporated

CourtDistrict Court, D. Arizona
DecidedMay 25, 2023
Docket2:20-cv-00884
StatusUnknown

This text of Weeks v. Matrix Absence Management Incorporated (Weeks v. Matrix Absence Management Incorporated) is published on Counsel Stack Legal Research, covering District Court, D. Arizona primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Weeks v. Matrix Absence Management Incorporated, (D. Ariz. 2023).

Opinion

1 WO 2 3 4 5 6 IN THE UNITED STATES DISTRICT COURT 7 FOR THE DISTRICT OF ARIZONA 8

Tina We eks, et al., ) No. CV-20-00884-PHX-SPL ) 9 ) 10 Plaintiffs, ) ORDER vs. ) ) 11 ) Matrix Absence Management ) 12 Incorporated, ) 13 ) ) 14 Defendant. )

15 Before the Court are Defendant’s Motion for Summary Judgment (Doc. 136) and 16 Plaintiffs’ Motion for Partial Summary Judgment (Doc. 138). The Court rules as follows. 17 I. BACKGROUND1 18 Plaintiffs Tina Weeks, Michael McDonald, Cassandra Magdaleno, and Samantha 19 Stocklein bring a claim against Defendant Matrix Absence Management Incorporated for 20 violation of the Fair Labor Standards Act (“FLSA”) for failure to pay overtime. (Doc. 60 21 at 18–21). Plaintiff Stocklein also brings a claim against Defendant for violation of 22 Oregon Wage Law for failure to pay overtime. (Doc. 60 at 21). On November 22, 2022, 23 the Court granted Defendant’s Motion for Decertification of Collective Action and 24 denied Plaintiffs’ Motion to Certify Class, so Plaintiffs have only individual claims 25 remaining. (Doc. 128). 26 Defendant is a licensed third-party administrator that processes leave of absence 27

28 1 The Court recites only undisputed facts in the Background section. 1 (“LOA”), short-term disability (“STD”) and long-term disability (“LTD”) claims for its 2 customers according to the policies, procedures, and criteria in customers’ plans. (Doc. 3 140 ¶¶ 2, 13). Plaintiffs were each employed by Defendant as claims examiners. (Doc. 4 140 ¶¶ 6–8; Doc. 60 ¶ 22). Plaintiffs McDonald and Stocklein worked as AMS Claims 5 Examiners, which involved processing both STD and LOA claims filed under 6 Defendant’s customers’ policies. (Doc. 140 ¶¶ 6, 8). Plaintiff Magdaleno worked as an 7 LOA claims examiner, processing LOA claims filed under Defendant’s customers’ 8 policies. (Doc. 140 ¶ 7). Plaintiff Weeks administered LTD claims. (Doc. 137 ¶ 2). 9 Defendant classified Plaintiffs as exempt from the FLSA under the administrative 10 exemption and paid them on a salary basis. (Doc. 140 ¶ 1). 11 Plaintiffs’ main duty was to process claims, which “require[d] them to review 12 information provided by the client, compare it to client’s policies and guidelines and 13 make a decision on whether to approve or deny a claim.” (Doc. 140 ¶ 9 (internal 14 quotation marks omitted)). All decisions to approve or deny a claim had to comply with 15 legal requirements and the terms of the client’s plan or policy. (Doc. 140 ¶ 34). An 16 incorrect claims decision could expose Defendant’s clients to legal or regulatory issues 17 and financial and reputational harm. (Doc. 137 ¶¶ 85–87). Defendant trained and 18 expected Plaintiffs to follow its own internal guidelines, including best practices and 19 standard operating procedures, when processing claims for its customers. (Doc. 140 20 ¶ 10). 21 Plaintiff Weeks’s primary job duty was overseeing stable and mature LTD claims 22 for the Federal Reserve. (Doc. 137 ¶¶ 2, 6). To perform that job, she interpreted and 23 applied the Federal Reserve’s LTD policy, gathered information to determine whether 24 claimants were still disabled, and made a determination by comparing the medical 25 information to the policy. (Doc. 137 ¶¶ 5, 7, 8). She could seek input from nurses, send 26 out and review activity questionnaires, review a claimant’s social media accounts, have a 27 file reviewed by a vocational specialist, and make decisions to conduct independent 28 medical examinations or outside investigations. (Doc. 137 ¶¶ 9, 12, 13, 15, 17, 18). With 1 her supervisor’s approval, Plaintiff Weeks could have a claimant surveilled, which 2 required her to select a vendor and provide the vendor with necessary information. (Doc. 3 137 ¶ 14). She did not have authority to close a LTD claim, but she made 4 recommendations to her supervisor that claims should be closed, which were always 5 followed except when there was medical information missing. (Doc. 137 ¶¶ 21, 22). 6 Plaintiff McDonald reviewed claims against a client’s policy to determine if an 7 employee was eligible for benefits under the policy. (Doc. 137 ¶ 27). His primary client 8 was XPO Logistics. (Doc. 137 ¶ 26). Plaintiff McDonald interpreted clients’ policies but 9 not a claimant’s medical records. (Doc. 137 ¶ 30). Still, he did not send medical records 10 for nurse review when a claim involved an “obvious” condition like pregnancy or a 11 broken bone. (Doc. 137 ¶ 31). Once he had fully processed a claim, Plaintiff McDonald 12 sent a recommendation to his supervisor for approval. (Doc. 137 ¶ 29). When 13 communicating a denial, he exercised judgment regarding how much information to share 14 with the claimant. (Doc. 137 ¶ 32). 15 Plaintiff Magdaleno’s primary duty was administering Family and Medical Leave 16 Act (“FMLA”), California Family Rights Act, and non-protected leave policy claims for 17 employees of the Dignity Health hospital system. (Doc. 137 ¶¶ 34, 35). When processing 18 Dignity Health claims, she reviewed information received from claimants after their 19 claims passed through an automatic screening for certain eligibility criteria. (Doc. 137 20 ¶ 36). Based on that information, Plaintiff Magdaleno either approved or denied the 21 claim. (Doc. 137 ¶ 36). If a claimant was not eligible for protected leave, she would 22 determine whether they were eligible under Dignity Health’s other leave policies. (Doc. 23 137 ¶ 37). Plaintiff Magdaleno had discretion to decide when she needed a supervisor’s 24 input. (Doc. 137 ¶ 43). In her two or three years in her role, she sought input from a 25 supervisor once or twice a week and passed a claim to her supervisor for a decision once 26 or twice a month; otherwise, Plaintiff Magdaleno had complete autonomy in approving or 27 denying the thousands of claims she handled. (Doc. 137 ¶¶ 52–53). After a claim was 28 approved, Plaintiff Magdaleno looked for abuse of leave, and Dignity Health would 1 contact her if it suspected abuse. (Doc. 137 ¶¶ 44–45). When a claim was flagged as 2 suspicious, she analyzed the claim file; prepared a fact-specific inquiry for a claimant’s 3 doctor if such a follow-up was warranted; and presented the complaint, her findings, and 4 a recommendation to her managers, who generally followed her recommendation. (Doc. 5 137 ¶¶ 46–47). 6 Plaintiff Stocklein administered LOA and STD claims, which required her to 7 assess FMLA guidelines and client policies to determine whether an employee was 8 entitled to leave. (Doc. 137 ¶¶ 58–59). She administered claims from three clients, each 9 of which had a different self-insured STD policy that she had to interpret and apply. 10 (Doc. 137 ¶ 60–61). She used a phone-call script she created to gather relevant 11 information from claimants. (Doc. 137 ¶ 66). When processing STD claims, she input 12 information into a computer system that then generated a recommendation for the number 13 of days of leave the disability supported. (Doc. 137 ¶ 67). If the request was consistent 14 with the computer system’s recommendation, Plaintiff Stocklein could approve the claim 15 for that time period. (Doc. 137 ¶ 167). With more complicated claims, she could seek 16 input from a nurse—and was required to do so for mental health conditions—or the 17 Official Disability Guidelines (“ODG”). (Doc. 137 ¶¶ 67–68, 70). Plaintiff Stocklein was 18 not required to follow either the computer system recommendation or the ODG. (Doc. 19 137 ¶ 69). If she disagreed with a nurse’s assessment, she requested a supervisor’s 20 review. (Doc. 137 ¶ 71). Plaintiff Stocklein was responsible for approving or denying 21 STD claims and approved about 75% of claims with no supervisor involvement. (Doc. 22 137 ¶ 75). She could not, however, deny a claim absent supervisor approval and nurse 23 support. (Doc. 137 ¶ 74).

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