Worsham v. Anthem Insurance Companies, Inc.

CourtDistrict Court, S.D. Ohio
DecidedMarch 30, 2023
Docket1:21-cv-00331
StatusUnknown

This text of Worsham v. Anthem Insurance Companies, Inc. (Worsham 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
Worsham v. Anthem Insurance Companies, Inc., (S.D. Ohio 2023).

Opinion

IN THE UNITED STATES DISTRICT COURT FOR THE SOUTHERN DISTRICT OF OHIO WESTERN DIVISION - CINCINNATI ANNA WORSHAM, Case No. 1:21-cv-331 Plaintiff, 2 Judge Matthew W. McFarland v : ANTHEM INSURANCE COMPANIES, INC., et al., Defendants.

ORDER GRANTING DEFENDANTS’ MOTION FOR SUMMARY JUDGMENT

This matter is before the Court on Defendants’ joint Motion for Summary Judgment (Doc. 15). Plaintiff filed a response in opposition (Doc. 17), to which Defendants collectively replied (Doc. 18). For the reasons provided below, Defendants’ motion is GRANTED. FACTS I. Anthem Policies and Procedures Anthem Insurance Companies, Inc. (“Anthem”) is a health insurance provider of, among other things, Medicare and Medicaid health insurance plans. (Chaney Dec., Doc. 15-1, Pg. ID 911.) Anthem’s field sales and services representatives promote enrollment into Medicare and Medicaid plans. (Id.) Each sales representative is assigned a specific geographical location and is required to meet certain monthly enrollment or sales goals as set by the sales representative’s Medicare manager. (Id.; Chaney Dep., Doc. 16, Pg. ID

724.) Failure to meet the sales goals may result in discipline. (Chaney Dec., Doc. 15-1, Pg. ID 911.) All employees at Anthem “are responsible for knowing, understanding and complying with [Anthem] policies and applicable laws.” (Anthem Shared Responsibilities Pamphlet, Doc. 13, Pg. ID 660.) Anthem’s policies acknowledge the company’s “commit[ment] to providing equal employment to individuals with disabilities as required by federal, state or local laws.” (Equal Employment and Affirmative Action Policies, Doc. 13, Pg. ID 667.) Specifically, Anthem’s policies state that the company “is committed to providing reasonable accommodations to enable [disabled] individuals to perform the essential functions of their job.” (Id.) Anthem’s policies additionally state that the company “strictly prohibits any acts of retaliation against associates who report or complain about discrimination or discriminatory harassment, or who participate in investigations of these complaints.” (Id. at Pg. ID 672.) Anthem has Family Medical Leave policies for all employees. (FMLA Policy, Doc. 13, Pg. ID 676.) The policy “applies to all associates who: (1) have been employed by Anthem for at least 12 months prior to the date the leave is to begin, [and] (2) have worked at least 1,250 hours of service . .. during the 12-month period immediately preceding the start of leave.” (Id.) Such policy complies with the Family Medical Leave Act (“FMLA”), thereby allowing employees “to take up to 12 work weeks of job-related unpaid leave in

a rolling 12-month period for certain family and medical reasons.” (Id.) Anthem employees may take FMLA leave “due to a serious health condition that makes an [employee] unable to perform the essential functions of the job.” (Id.) A serious health

condition is defined as “an illness, injury, impairment, or physical or mental condition involving either inpatient care or continuing treatment by a health care provider.” (Id.) Anthem employees must complete a “Request Leave of Absence” form on the employee website to request leave. (FMLA Leave Policy, Doc. 13, Pg. ID 677.) “Leave request(s] should be made within 30 calendar days before the start of leave when foreseen.” (Id.) “Otherwise the request should be made within at least one or two business days after the associate becomes aware of the need for leave.” ([d.) Lastly, if an employee’s requested FMLA leave is due to a serious health condition, “the amount of leave that may be taken depends on the documentation submitted by the treating healthcare provider and [the employee’s] available [leave] balance.” (Id.) Anthem also provides all employees with its corrective action policy, which allows for verbal warnings, written warnings, or termination. (Corrective Action Policy, Doc. 13, Pg. ID 667.) However, the policy allows for any form of corrective action to be taken at

any time or repeated, based on the individual’s manager’s discretion and consideration of the following factors: “individual circumstances, severity of the behavior, corrective action history, performance history, performance evaluations, and whether the behavior/conduct can be corrected.” (Id.) Certain types of misconduct that may lead to corrective action includes “falsifying or making material omissions on company documents].]” (Id.) Lastly, Anthem’s corrective action policy states that “[t]ermination need not pertain to or be contingent upon the same or similar offense for which any prior documented [v]erbal counseling or [w]ritten warning was issued.” (Id. at Pg. ID 669.) On the contrary, “[t]Jermination may occur without any prior warning or counseling,

depending on the infraction or performance issue.” (Id.) II. Plaintiff’s Employment with Anthem Plaintiff Anna Worsham, an African American woman, was originally hired by Anthem in 2014 as a health plan provider. (Compl., Doc. 2, Pg. ID 35; Worsham Dep., Doc. 13, Pg. ID 430.) Then, in October of 2015, Plaintiff was interviewed by Defendant Anthony Chaney and promoted to field sales and service representative (“FSR”) for the Medicaid central sales team. (Worsham Dep., Doc. 13, Pg. ID 436.) Plaintiff's territory was the Cincinnati and Portsmouth, Ohio geographical regions. (Id. at 441-42.) Plaintiff's direct supervisor during her tenure with Anthem was Chaney, the Manager of Medicare for Kentucky and Ohio. (Chaney Dep., Doc. 14, Pg. ID 720.) Chaney reported directly to Lora Beth Hull, who he identified as his “director.” (Id. at Pg. ID 722.) As an FSR, Plaintiff was required to meet monthly goals by “hold[ing] monthly events at some of [Anthem’s] sales locations, mak[ing] phone calls and set[ting] appointments with potential individuals that were eligible for the Medicare plans that [Anthem] offered.” (Worsham Dep., Doc. 13, Pg. ID 443; FSR Job Description, Doc. 13, Pg. ID 659.) These monthly events are either formal events or “grassroots” events, where an FSR attempts to get “consent to contract” with potential customers. (Chaney Dep., Doc. 14, Pg. ID 736.) Plaintiff held approximately fifteen grassroots events per year, where she would distribute materials that describe Anthem’s Medicare and Medicaid plans, highlight the benefits of Anthem’s plans, and seek enrollment from potential customers. (Worsham, Doc. 13, Pg. ID 445-446.) Plaintiff would then follow up with the potential customers that attended the grassroots events in a hope to have such customers enroll in

one of Anthem’s plans. (Id. at 446-47.) Sales representatives had different sales goals during the “lock-in period” and the annual enrollment period. (Chaney Dep., Doc. 14, Pg. ID 735.) An FSR’s sale goals are higher during the annual enrollment period, which takes place between October 15th through December 7th of every year. (Id. at Pg. ID 735, 739.) FSR’s monthly goals during the lock-in period are lower than during the annual enrollment period because most individuals are locked into their current Medicaid or Medicare plan and may only switch plans for limited reasons. (Id. at Pg. ID 739.) The record is absent of evidence regarding whether Plaintiff received a performance evaluation in 2015 or 2016. However, she did receive performance evaluations in the years 2017 and 2018, each seemingly conducted by Chaney. (Chaney Dep., Doc. 14, Pg. ID 744.) Chaney determined that Plaintiff met Anthem’s expectations in 2017 and 2018. (Id. at Pg. ID 746-47.) During her time at Anthem, Plaintiff only received two verbal warnings, once in 2017 and once in 2019, each due to not meeting her sales goals. (Chaney Dep., Doc. 14, Pg. ID 771, 800.) III. Plaintiff's FMLA Leave Plaintiff was diagnosed with polymyositis in 2010. (Worsham, Doc. 13, Pg. ID 421.) Polymyositis is an autoimmune disease which, as Plaintiff explains, “attacks your muscles.” (Id. at Pg.

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