Claims Examiners At Tristar Risk File Class Action
By Lonce LaMon - March 12, 2014
On February 25th 2014, a class action lawsuit was filed by claims examiners at Tristar Risk Management in California in Orange County Superior Court for allegedly denying them overtime pay. This is just another of a long string of class action lawsuits that have hit claims departments during these past five years against such companies as Farmers Insurance, State Farm, Liberty Mutual, Keenan & Associates, Intercare Insurance Services, K-Mart, Allstate, and AIG.
This perpetual demand that won’t go away is that claims adjusters are misclassified as salaried employees who are “exempt”. These lawyers with their plaintiffs want to convince the courts and change the law into classifying adjusters as “non-exempt” and make them eligible for overtime pay for more than eight hours a day and forty hours a week.
This new class action lawsuit against Tristar claims Tristar should have paid its claims examiners overtime wages for time in excess of eight hours a day and 40 hours a week. It asserts in a similar manner like all the former lawsuits from the other companies that these Tristar claims examiners failed to meet all the criteria under any of the exemptions to overtime pay in California.
The lead plaintiffs are former Tristar claims examiner employees Valerie Kizer and Sharal Williams. The law firm that filed the suit is the San Diego firm of Blumenthal, Nordrehaug & Bhowmik. They are the same firm that filed the class action on behalf of the examiners of Keenan & Associates in 2011.
Valerie Kizer worked in the Santa Ana claims office of Tristar Risk Management on the County of Los Angeles account from 2010 to 2013. When this writer asked her why she filed this class action, she said, “Because all were complaining and nobody did anything.”
When she was asked why she feels this kind of law suit is being filed by so many departments, she said, “Because they hire inexperienced people. They call them trainees. They give them the same type of work they give us (the experienced examiners). And they don’t know what they’re doing; and it’s part of our job to train them. I have spent so many hours training people until it was just ridiculous...”
Valerie Kizer reported that all the examiners had to work a lot of hours and there wasn’t enough clerical help. She said that everybody in the office was complaining about it.
She expressed, “Even if the payment is for four dollars, you have to take it back, stamp on it, print on it, put it in the basket; then it gets brought back to you. It takes so much time to pay anything. There’s a process for everything that you have to do. It’s just the way the County works; which is the worst.”
Valerie said the supervisors would just tell the examiners that they had to get the work done. Many examiners would take work home. She explained the process for ordering surveillance:
“If you want surveillance on someone (a claimant) you have to go through a list, take the next one on the list, then you have to send out a request and take it to your CA (claims assistant), have her write it out, then you have to fax it over, wait for a confirmation…”
Then Valerie told of how she also had to act as the back-up for an examiner who might be out for the day. Thus, the combination of the cumbersome County procedures along with the time-consuming task of training inexperienced trainees, then taking the statements, covering the phones, and covering for other examiners left no time to ever work the files.
“You don’t have time to really work the files because you just have to paper push.”
Inexperienced examiners would make lots of mistakes, Valerie said, and the supervisors did not want attention drawn to these mistakes. “Like you find a file and the PD (permanent disability) aint been paid at all. It’s a big lump sum and they try to hide it because they don’t want the County to know. Then the supervisor says, ‘No, don’t issue a payment, pay a little sum and put it on cycle until you get it paid. Don’t draw attention.’ Because they would get a penalty.”
Valerie Kizer started her career in claims in Michigan in 1990. She worked for Aetna for three years, then went to Corvel, and then to Sedgwick. Her career with Sedgwick lasted about a decade and it was through Sedgwick while in Michigan that she was offered the opportunity to transfer to California and go to work on the Los Angeles Unified School District account in 2003 at the Pasadena Sedgwick office. Then around 2006 she went to work for Intercare Insurance Services, then Keenan & Associates, and then Tristar beginning in 2010.
Valerie now lives in Anaheim, California. She is not currently employed and is off on a workers’ comp claim herself. She injured her back in 2012 and also had an ankle injury after she twisted it by stepping on an ink pen.
Executives of Tristar were not willing to comment on this case. James Soto, the Vice President of Claims of Tristar in California politely called back and stated that he could not comment. Tom Veale, the president and owner of Tristar did not respond. And the corporate counsel, Tim McIntyre, simply said “no comment” on pending litigation.
lonce@adjustercom.com, Lonce LaMon, journalist; copyright adjustercom and Lonce LaMon, all rights reserved.
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