Rieve v. Coventry Health Care, Inc., Case No. SACV 11–1032 DOC (MLGx).

• Decision Date: 06 August 2012
• Docket Number: Case No. SACV 11–1032 DOC (MLGx).
• Citation: 870 F.Supp.2d 856
• Parties: Julia A. RIEVE, Plaintiff(s), v. COVENTRY HEALTH CARE, INC. and Coventry Health Care Workers Compensation, Inc., Defendant(s).
• Court: U.S. District Court — Central District of California

870 F.Supp.2d 856

Julia A. RIEVE, Plaintiff(s),

v.COVENTRY HEALTH CARE, INC. and Coventry Health Care Workers Compensation, Inc., Defendant(s).

Case No. SACV 11–1032 DOC (MLGx).

United States District Court,

C.D. California.

April 25, 2012.

Order Denying Clarification of Interlocutory Appeal Aug. 6, 2012.

Norman B. Blumenthal, Aparajit Bhowmik, Kyle R. Nordrehaug, Ruchira Piya Mukherjee, Blumenthal Nordrehaug and Bhowmik, La Jolla, CA, for Plaintiffs.

John S. Battenfeld, Los Angeles, CA, Michael J Puma, Philadelphia, PA, for Defendants.

ORDER GRANTING IN PART AND DENYING IN PART DEFENDANTS' SUMMARY JUDGMENT AND SUA SPONTE GRANTING IN PART SUMMARY JUDGMENT FOR PLAINTIFF

DAVID O. CARTER, District Judge.

Before the Court is a Motion for Summary Judgment, or in the alternative, a Motion for Partial Summary Judgment filed by Defendants Coventry Health Care, Inc. and Coventry Health Care Workers Compensation, Inc. (Docket 42) (“Motion for Summary Judgment”). After careful consideration of the moving, opposing, and replying papers, this Court hereby GRANTS IN PART AND DENIES IN PART Defendants' Motion for Summary Judgment. The Court also sua sponte GRANTS IN PART summary judgment for Plaintiff.

I. BACKGROUND

Plaintiff Julia Rieve ¹ (“Plaintiff”) filed the present action on April 11, 2011 in the Northern District of California against Defendants Coventry Health Care, Inc. (“CHC”) and Coventry Health Care Workers Compensation, Inc. (“CHC–WC”) (collectively, “Defendants”). On July 6, 2011, the parties stipulated to transferring venue to the Central District of California. On September 15, 2011, this Court granted the parties' stipulation for leave for Plaintiff to file a First Amended Complaint (“FAC”), which added an additional cause of action for the California Labor Code's Private Attorney General Act (“PAGA”) (Docket 27). On March 19, 2012, this Court granted Plaintiff's Motion for Leave to Amend (Docket 86) and permitted Plaintiff to file the Second Amended Complaint (“SAC”), which is now the operative complaint (Docket 91).

Plaintiff's primary claim against Defendants is that they improperly classified her and others similarly situated as exempt from the overtime requirements of the Fair Labor Standards Act (“FLSA”) and California Labor Code. Plaintiff also asserts claims under California's Unfair Competition Law (“UCL”) based on Defendants' alleged violation of California overtime law and alleged failure to provide meal and rest breaks; California Labor Code § 226 based on Defendants' alleged failure to provide accurate wage statements; and PAGA.

Defendant CHC–WC, which is owned and operated by Defendant CHC, is a corporation that “provides solutions to help its clients, including workers' compensation insurers and employers, reduce the costs associated with workers' compensation injuries, ensure quality care, and improve return to work rates and timing.” Defendants' Reply to Statement of Facts (“Reply to SOF”), ¶ 1. CHC–WC provides its clients with medical field case management services, carried out by employees working in the Field Case Manager—Medical Workers' Compensation position (“FCM–Med” or “FCM”), to help clients' injured workers return to work as quickly, safely, and cost-effectively as possible. Id. at ¶ 2–3. Although Defendants dispute that Plaintiff was employed by CHC, there is no dispute that Plaintiff held the position of FCM–Med during her tenure with CHC–WC ². Id. at ¶ 4. Plaintiff, a registered nurse (“RN”), was required by Defendants to be a state-licensed RN and to have three or more years of case management experience in order to hold the position of FCM–Med. Id. at ¶ 17–20. Despite the RN requirement, Plaintiff was not engaged in direct patient care in her capacity as a FCM–Med. Id. at ¶ 24. While employed by Defendants, Plaintiff earned a fixed weekly salary ranging from $954 to $1096, which she was paid regardless of the hours she worked or the quality of her work. Id. at ¶ 40.

Despite the parties' varied interpretations of the nature of Plaintiff's duties, a close analysis shows that the substance of her tasks is actually undisputed. For example, Defendant asserts that Plaintiff “was responsible for assessing and analyzing an injured employee to evaluate the medical needs required to facilitate the patient's appropriate and timely return to work.” Id. at ¶ 42. Plaintiff's primary dispute with this statement rests on a more restricted interpretation of the words “assess,” “analyze,” and “evaluate.” The Court does not need to determine which party's interpretation is correct to determine that this is not a material fact dispute.When it comes to the substance of Plaintiff's tasks, the parties differ only in their vocabulary. Indeed, at oral argument, despite the parties' vehement disagreement about whether Plaintiff's job duties qualify her for exemption, neither party challenged the Court's factual recitation of Plaintiff's tasks.

Plaintiff's job duties were undisputedly “to provide ongoing, day-to-day case management services for Defendants' customers by documenting the costs of care, preparing reports regarding a plan of care, and identifying and implementing medical services to meet the needs of Defendants' customers.” Opposition, 5; Rieve Decl., ¶ 4. Plaintiff explains that she monitored and reported whether patients were receiving medical services in accordance with the medical orders issued by the attending physician, although it was the physicians who had the decision-making power to order a course of treatment and the claims adjusters who had the power to eliminate such treatment. Reply to SOF, ¶ 42. Defendants do not dispute that Plaintiff did not have any authority to order treatment, nor to eliminate, deny, suspend, or modify any treatment ordered by a physician. Id. Plaintiff explains that FCMs do not make decisions about reducing costs but “only document ‘achieved cost savings' in Defendants' CMD/Win program which is an ‘inflexible’ system comprised of preformatted templates.” Id. at ¶ 71. Plaintiff characterizes her role as the “eyes and ears” of Defendants' customers, the claims adjusters. Id. at ¶ 42.

Plaintiff testified in her deposition that she spent more than fifty percent of her time communicating with doctors, patients and claims adjustors in order to understand the patients' conditions, determine what medical care was being provided and evaluate whether it was appropriate. Id. at ¶ 51, 69. When Plaintiff interviewed patients, she would try to understand their injuries or conditions and their previous care so that she could consider other alternatives and advise them accordingly. Id. at ¶ 48. Plaintiff also explained in her deposition that she sought to understand and synthesize the medical status and work demands of a patient “through communication with the physician, including any necessary clarification of the client's physical capacity for returning to work.” Id. at ¶ 52. Plaintiff was guided in her duties by the Field Case Management Manual (“FCM Manual”), which provided step-by-step instructions she must follow when assigned a case, although Plaintiff explained that she only needed to look at it occasionally. Id. at ¶ 114–15.

Plaintiff has stated that “in order to have the best possible outcomes, healthcare systems and facilities need highly qualified, certified individuals performing the vital function of care coordination” and explained that “[t]hrough their knowledge and expertise, case managers provide oversight and coordination across settings and providers.” Id. at ¶ 56, 59. The FCM Manual provides that the FCMs' duties involve “a skilled professional's critical evaluation of a claimant's medical progress followed by case management actions that facilitate recovery.” Reply to SOF, ¶ 45. Although Plaintiff did not have the power to eliminate unnecessary treatment, she did work to identify unnecessary procedures and treatments. Id. at ¶ 72. Plaintiff also, at least in one particular case, educated a patient on how to identify symptoms of post-traumatic stress disorder. Id. at ¶ 65.

Defendants seek summary judgment on Plaintiff's overtime claims on the grounds that she falls into the professional and administrative exemptions under both federal and state law. Defendant also seeks summary judgment on Plaintiff's UCL, wage statement, and PAGA claims, in additionto seeking summary judgment on all claims against CHC on the grounds that Plaintiff was not employed by CHC.³

II. LEGAL STANDARD

Summary judgment is proper if “the movant shows that there is no genuine dispute as to any material fact and the movant is entitled to judgment as a matter of law.” Fed.R.Civ.P. 56(c). The court must view the facts and draw inferences in the manner most favorable to the non-moving party. United States v. Diebold, Inc., 369 U.S. 654, 655, 82 S.Ct. 993, 8 L.Ed.2d 176 (1962); Chevron Corp. v. Pennzoil Co., 974 F.2d 1156, 1161 (9th Cir.1992). The moving party bears the initial burden of demonstrating the absence of a genuine issue of material fact for trial, but it need not disprove the other party's case. Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 256, 106 S.Ct. 2505, 91 L.Ed.2d 202 (1986); Celotex Corp. v. Catrett, 477 U.S. 317, 323–25, 106 S.Ct. 2548, 91 L.Ed.2d 265 (1986). When the non-moving party bears the burden of proving the claim or defense, the moving party can meet its burden by pointing out that the nonmoving party has failed to present any genuine issue of material fact. Musick v. Burke, 913 F.2d 1390, 1394 (9th Cir.1990).

Once the moving party meets its burden, the opposing party must set out specific facts showing a genuine issue for trial; merely relying on allegations or denials in its own pleading is insufficient. See Anderson, 477 U.S. at 248–49, 106 S.Ct. 2505. A party cannot create a genuine issue of material fact simply by making assertions in its legal papers. S.A. Empresa De Viacao Aerea Rio Grandense v. Walter Kidde & Co., Inc., 690...