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Employment

GuideWell Mutual Holding Corporation, and Health Options, Inc.

Riviere et al. v. Blue Cross and Blue Shield of Florida, Inc.
Case No. 1:20-cv-23709 (Southern District of Florida)

On September 4, 2020, we filed a lawsuit on behalf of utilization review nurses who worked or work for Blue Cross and Blue Shield of Florida, Inc. (“BCBSF”), GuideWell Mutual Holding Corporation (“GuideWell”), and/or Health Options, Inc. (“Health Options”) (collectively “Defendants” or “Florida Blue”), alleging violations of federal overtime laws.  The named plaintiff in the case brought the case on behalf of herself and all others similarly situated, nationwide, who worked for Florida Blue during the applicable statutory period. 

The Complaint alleges that Defendants violated the Fair Labor Standards Act by failing to pay their utilization review nurses for the overtime hours they worked.   Utilization review nurses with the primary job duty of conducting medical necessity reviews may have varying job titles including but not limited to the following: Registered Nurses, Concurrent Review and Discharge Nurses, Medicare Pre-Service Medical Review Nurse RNs, Medical Review Nurses, Transitional Review Nurses, Medical Review Nurse LPNs, Concurrent Review RNs, and/or Clinical Review Nurses.  The lawsuit was filed on behalf of all utilization review nurses regardless of their job title and regardless if they were paid by salary.  

According to the Complaint, utilization review nurses spend their workday collecting and reviewing medical information and comparing that information to pre-determined guidelines and/or other established policies located in an online computer system to determine whether the authorization request meets the criteria for medical necessity and therefore covered by insurance. If the requested service or treatment satisfies the coverage criteria under a member’s health plan, the online application indicates this with the color green.  If the request does not meet the established criteria, the nurses do not have the authority to deny the request and are instead required to refer the request to the medical director/physician reviewer.

The nurse further allege that Florida Blue purposefully misclassified their utilization review nurses to avoid paying overtime wages in violation of under federal law.  The lawsuit was filed as a collective action under the federal Fair Labor Standards Act in the Southern District of Florida. The plaintiff brought the case seeking to recover unpaid overtime compensation, liquidated (double) damages, and other statutorily-permitted relief for herself and other similarly situated Utilization Review Nurses.

Our firm has partnered with Janett Varnell from Varnell & Warwick, and Sarah R. Schalman-Bergen, Camille Rodriguez, and Krysten Connon from Berger Montague PC.  in representing the plaintiffs in this case.

Type of Case

Unpaid Overtime

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Am I eligible?

You may be eligible to make a federal law claim in this case if you worked for Florida Blue at any time within the past three years in any state as a utilization review nurse in any of the job titles listed above, primarily performed utilization reviews, and were not paid an overtime premium for the hours you worked over 40 per week. 

Additional Information

Is This a Class Action? What Does that Mean?

This case is a potential collective action under federal law. The idea behind a collective action is that is allows one or more people to sue on behalf of themselves and other similarly situated people who have similar claims. To proceed as a group, though, the Court must certify the collective. Because we are in the early stages of the case, this has not happened yet, but we intend to seek the company’s agreement or file a motion at the appropriate time asking the Court to authorize notice of this lawsuit to be sent to other similarly situated utilization review nurses. 

Which Locations Are Included?

This case seeks to include all utilization review nurses who work or have worked for Florida Blue anywhere across the country within the past three years. 

How Do I Join This Case?

To make a claim in this case for any unpaid overtime under the FLSA, the federal law, you must complete a consent form and return it to our office. You can sign up electronically by clicking here.

What Time Frame Does This Case Cover?

The claim has what is called a statute of limitations, which allows workers to recover unpaid overtime wages within specific time periods.  Under federal law, the statute of limitation is two years back from when the worker signs up to join the lawsuit by completing and returning the written consent form referenced above. If we can prove that Defendants intentionally or recklessly violated the law, then statute of limitations may be extended to three years.

Do I Have to Pay Anything?

You do not have to pay anything if you join the lawsuit. We are handling this case on a contingency fee basis. This means we will only be paid if the lawsuit is successful in obtaining relief either through a settlement, award, or a final judgment, and that payment will only come out of that settlement, award, or final judgment.

How Do I Prove I Worked Overtime?

If you have records of the hours you worked, please preserve and keep them until we ask you for them. However, you do not need to have records of your work hours to make a claim for your overtime pay in this case. If Defendants did not keep accurate time records, most courts will permit you to make a good-faith estimate of your work hours. Through this lawsuit, we will seek any records the company may have of your hours worked as well.

What About Retaliation?

It is against the law for an employer to retaliate against a person for joining a lawsuit to reclaim unpaid wages. If you currently work for Defendants and you believe you may be the victim of retaliation for joining or participating in this lawsuit, contact the case clerk, Christina Houston, at (612) 256-3238 or Christina Houston, at (612) 256-3238 or chouston@nka.com immediately.

How Long Will This Case Take?

The length of this kind of lawsuit varies from case to case, but they typically last one to three years.

Is There Money Available Now?

No. This is a pending lawsuit. There is no money currently available and there is no guarantee that you will receive money for joining the lawsuit.

How Can I Help?

If you know any utilization review nurses interested in making a claim for unpaid overtime, they should contact the case clerk, Christina Houston, at (612) 256-3238 or chouston@nka.com to sign up. 

How Do I Learn More?

To learn more about this case, feel free to contact the case clerk, Christina Houston, at (612) 256-3238 or chouston@nka.com.

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