Roe-Midgett v. CC Services, Inc.Roe-Midgett v. CC Services, Inc.
Plaintiffs Paula Roe-Midgett and Paul Decker sued their employer CC Services, Inc. (“CCS”) for overtime wages under the Fair Labor Standards Act (“FLSA”),
Applying the Department of Labor’s so-called “short test” for determining whether employees fall within the FLSA’s administrative exemption, the district court concluded that the primary duties of all four claims-processing positions involved matters (1) “directly related to management policies or general business operations” and (2) “requiring the exercise of discretion and independent judgment.”
On appeal the plaintiffs develop no substantive challenge to the district court’s ruling as it relates to three of the four classes of employees: CCS’s Field Claims Representative II, Field Claims Representative III, and Property Specialist positions. As to these employees, they argue only that material issues of fact preclude summary judgment for CCS. But they failed to identify any real factual dispute specific to these employees. Regarding the final group of employees — those occupying the position of Material Damage Appraiser II — the plaintiffs contend that the duties of this position do not directly relate to CCS’s management policies or general business operations and do not require the exercise of discretion and independent judgment. We disagree.
Material Damage Appraisers provide claims adjustment services for CCS’s insurance company clients up to a $12,000 limit of claims settlement authority and represent the “face” of CCS to the countless claimants with whom they interact. They spend much of their time in the field without direct supervision. They conduct on-site investigations of first- and third-party automobile insurance claims; interview claimants, witnesses, and law enforcement personnel; estimate loss; determine whether parts should be repaired or replaced; negotiate with mechanics and body shops and draft final repair estimates; and settle claims up to the limit of their $12,000 settlement authority. These duties directly relate to CCS’s business operations and reflect a sufficient degree of discretion and independent judgment to qualify for the FLSA’s administrative, exemption. Summary judgment was properly entered for CCS on all four classes of employees.
I. Background
CCS is engaged in the business of processing insurance claims for auto, home,
MDAs draw an annual salary of $36,952 to $55,427 and primarily handle automobile claims. They do not make coverage or liability determinations, which are typically made by Field Claims Representatives or other claims agents. MDAs are responsible for investigating auto accident damage, making repair or replacement determinations, drafting estimates, and settling claims of up to $12,000 where liability has been established and coverage approved. 1 MDAs spend much of their time in the field without direct supervision. Moreover, because 70% of appraisals assigned to MDAs come from the home office and not the local field office, the field office supervisors do not exert much direct daily control over MDAs.
Investigating accident damage entails a physical inspection of the vehicle to ensure the actual damage and its cause correspond to the claimed damage and cause. The cause of the accident often dictates the applicable policy (i.e., comprehensive or collision) and deductible. MDAs may also interview claimants, witnesses, and where relevant, police personnel. If an MDA notes inconsistencies or otherwise suspects fraud, he relays his observations to a CCS superior in charge of final liability and coverage determinations.
After documenting and investigating vehicle damage on a given claim, the MDA prepares an estimate. The first step in this process is determining if the vehicle is irreparably damaged (a “structural total loss” in industry parlance) or if the cost of repair exceeds the vehicle’s value (an “economic total loss”). The latter calculation is performed by inputting the vehicle’s identification number and damage estimate into a software program that “red flags” potential economic losses. If an MDA suspects a structural total loss, he will relay that suspicion along with photos of the damage to a claims representative with final say as to whether the vehicle is a structural total loss.
If the vehicle is not a total loss, the MDA must decide which parts to repair and which to replace. For repaired parts, the MDA estimates the total labor costs based in part on his estimation of the man hours needed to complete the repair. In some instances body shops disagree with the MDA’s projection, and the MDA negotiates for an adjusted hours estimate. MDAs might also adjust a repair estimate to account for “betterment,” a concept intended to reflect the fact that parts that were in good repair cost more to restore to their original preaccident condition than parts already in disrepair at the time of the accident.
MDAs also estimate the cost of replacing any parts they deem beyond repair. They input a description of the part into a software program, which then generates an estimate based on labor costs and part price. In estimating the price for the part, the software detects the availability of used parts and automatically factors in that discount. The MDA may override the software and allow for new parts, but only after documenting the reasons for his devi
After projecting the repair and replacement costs, MDAs draft a final damage estimate. While they are responsible for explaining the estimate to the claimant and answering any questions, MDAs refer dissatisfied claimants to a CCS adjuster with authority to determine coverage and liability. If, however, the claimant is satisfied with the estimate and the claims representative has already determined liability, MDAs may settle claims of up to their $12,000 limit of authority. Claims representatives need not formally approve the actual amount of settlement or underlying estimate, though they informally review an MDA’s work for errors. CCS auditors also periodically audit MDA estimates to ensure compliance with the adjusting guidelines and to gauge each MDA’s “leakage,” that is, the percentage of total claims paid in error.
In addition to MDAs, CCS’s field offices are also staffed with Field Claims Representatives II and III and Property Specialists. Employees with these titles generally receive a higher salary than MDAs and are authorized to make final coverage and liability determinations and settle higher-value and more complicated claims. For reasons we will explain, further discussion of the day-to-day duties of these positions is unnecessary for purposes of this appeal.
CCS classified its MDAs, Field Claims Representatives, and Property Specialists as “administrative” employees exempt from overtime wages otherwise mandated by the FLSA. Two CCS employees
2
took issue with the classification and brought this “opt-in” collective action under the FLSA.
See
II. Analysis
We review de novo the district court’s grant of summary judgment in favor of CCS.
Allen v. City of Chicago,
The FLSA requires employers to pay overtime wages (i.e., one and one-half times the regular rate) for any hours worked in excess of 40 per week.
In 2004 the Secretary issued a comprehensive set of new regulations addressing the scope of the overtime exemptions. 69 Fed.Reg. 22122, 22260 (Apr. 23, 2004) (codified at
The 2004 regulations also list examples of jobs that generally satisfy the “duties requirements” for administrative employees.
Because the 2004 regulations took effect after the plaintiffs brought this action, the old short test still determines whether they fall within the administrative exemption.
See Kennedy v. Commonwealth Edison Co.,
A. The MDA Position
1. The “Directly Related” Requirement
For MDAs to fall within the administrative exemption, CCS must first establish that their primary duties consist of “work directly related to management policies or general business operations of the employer or the employer’s customers.”
CCS is in the business of processing claims brought by policyholders and other claimants against the insurance policies of its insurance company clients. MDAs handle 60% of all claims processed by CCS. A large percentage of those claims involve auto damage totaling less than $10,000, which MDAs investigate, adjust, and settle with only minimal oversight. In so doing, MDAs are required to analyze “data and draw[ ] conclusions which are important to the determination of ... [CCS’s] policy.”
The plaintiffs do argue, however, that the duties of an MDA are not properly-characterized as “administrative” for purposes of the first aspect of the “directly related” requirement. They contend MDAs are the postindustrial equivalent of production workers and thus are not involved in CCS’s administrative operations. The plaintiffs are correct that the “directly related” test seeks to distinguish exempt administrative work from nonexempt production or sales work.
First, the plaintiffs make too much of the fact that CCS does not actually underwrite or sell insurance policies. The gist of the plaintiffs’ argument is that CCS “produces” claims-processing services (though not the underlying policies) and therefore MDAs are essentially responsible for “producing” CCS’s “product.” This argument hinges on a distinction between in-house claims processing by insurance companies, which the plaintiffs view as ancillary to the “production” of the policies themselves, and outsourced claims processing of the type performed by CC S, which they interpret as a “product” unto itself. Under the Department of Labor’s interpretive regulations, however, this distinction is immaterial, as “administrative operations of a business” may “be those of the employer
or
the employer’s customers.”
See
This conclusion is reinforced by a Department of Labor opinion letter involving a “claims specialist” who processed claims “on behalf of a contracting insurance company.” DOL Wage
&
Hour Div. Op. Ltr. FLSA2005-25, at 4 (Aug. 26, 2005). The administrative exemption turns on how employees spend their day, not who signs their paycheck.
See
Second, the so-called production/administrative dichotomy — a concept that has an industrial age genesis — is only useful by analogy in the modern service-industry context. “The typical example of the ... dichotomy is a factory setting where the ‘production’ employees work on the line running machines, while the administrative employees work in an office communicating with the customers and doing paperwork.”
Shaw v. Prentice Hall Computer Publ’g, Inc.,
This conclusion is supported by an interpretive regulation that lists “claim agents and adjusters” as examples of positions that will generally satisfy the “directly related” part of the short test.
See
2. The “Discretion and Independent Judgment” Requirement
The undisputed evidence also leads us to conclude that MDAs satisfy the short test’s second requirement — the “exercise of discretion and independent judgment.”
Though the old regulations are silent as to whether employees who adjust insurance claims exercise discretion and independent judgment, the Department of Labor (through agency opinion letters) and the circuits that have confronted the question generally regard “claims adjusters” as exercising sufficient discretion to trigger the administrative exemption. DOL Wage & Hour Div. Op. Ltr. FLSA2002-11, at 2 (Nov. 19, 2002) (“Wage and Hour has long recognized that claims adjusters typically perform work that is administrative in nature.”);
see In re Farmers,
In addition to performing the core duties of a claims adjuster, MDAs routinely use their discretion and independent judgment to make choices that impact damage estimates, settlement, and other “matters of significance.”
For example, at her deposition Roe-Midgett testified that if she noticed damage indicative of a collision with a deer as opposed to another vehicle, she would “let the adjuster ... know that they may need to look into it a littler further” because “there’s a coverage difference.” Roe-Mid-gett acknowledged that deer-vehicle collisions would be covered by the claimant’s “comprehensive” rather than “collision” policy, which may carry different deductibles. She also explained that if she felt certain damage was preexisting, she would “let the file handler know that this damage is not part of this claim” because “we don’t pay for claims we do not owe.” In other words, MDAs like Roe-Midgett make coverage recommendations to their superiors. The applicable regulations explain that “decisions made as a result of the exercise of discretion and independent judgment may consist of recommendations for action rather than the actual taking of action.”
The balance of an MDA’s day-to-day responsibilities mirror the duties the new regulations attribute to exempt “claims adjusters,” namely: “interviewing insureds [and] witnesses ...; inspecting property damage; reviewing factual information to prepare damage estimates; evaluating and making recommendations regarding coverage of claims; [and] determining ... [the] total value of a claim.”
We recognize
The plaintiffs counter that MDAs are so constrained by CCS’s adjusting manual and estimating software that there is no room for independent judgment. But independent judgment is not foreclosed by the fact that an employee’s work is performed in accordance with strict guidelines.
Kennedy,
The plaintiffs further contend that MDAs simply draw on their skill and experience in inspecting damage and estimating repair costs. They are correct to the extent that “appraisers who merely inspect damaged vehicles to estimate [repair costs] ... are guided primarily by their skill and experience” and thus are not exercising discretion and independent judgment.
In re Farmers,
We could find no appellate cases or opinion letters in which a claims-processing employee with similar responsibilities to the MDA’s was found to be nonexempt. All the appellate cases involving claims-processing employees have arrived at the same conclusion we have reached here.
See In re Farmers,
The plaintiffs cite only three district court cases in support of their argument that MDAs do not exercise discretion and independent judgment. The first,
In re
B. The Field Claims Representative and Property Specialist Positions
The plaintiffs’ only argument on appeal regarding the Field Claims Representative and Property Specialist positions is that triable issues of fact preclude summary judgment for CCS. However, they identify no issues of material fact specific to either of these positions. At oral argument we asked plaintiffs’ counsel for an example of a factual dispute involving either position. Counsel cited the fact that CCS’s adjusting manual and estimating software significantly limited the degree of discretion and judgment exercised by these employees. This is not a factual dispute. There is no disagreement about whether CCS’s adjusting manual and estimating software govern the claims adjustment process; they do. The parties’ dispute is about the legal consequences of that undisputed fact: that is, whether the manual and software so limit the employees’ discretion as to make the administrative exemption inapplicable.
See Wor-thington,
We have already determined that the manual and software do not eliminate the discretion and judgment exercised by an MDA; the plaintiffs have not offered any additional argument specific to the Field Claims Representative or Property Specialist positions. Accordingly, the plaintiffs have failed to develop a meaningful challenge to the district court’s order granting summary judgment to CCS with respect to these two positions.
See Smith v. Ne. Ill. Univ.,
AFFIRMED.
Notes
. The average MDA payout on auto damage claims is far less than the $12,000 limit. From January to November 2002, for example, the average monthly payout ranged from $1750 to $2400.
. Roe-Midgett was an MDA; Decker was a Field Claims Representative and Property Specialist.
. This is not to say all white-collar employees in service industries necessarily perform "work of substantial importance” sufficient to meet the "directly related” test. The regulations make clear that “bookkeepers, secretaries, and clerks of various kinds” do not generally perform such work because "routine clerical work” is not of substantial importance to the employer's business operations.