Learing v. Anthem Companies, Inc., The

Background

Plaintiff Christine Learing, a registered nurse (RN), was employed by Anthem Companies, Inc. and related entities (collectively, "Anthem") in a "Nurse Medical Management" (NMM) role. NMMs perform utilization review—evaluating healthcare provider requests for service authorizations to determine whether the requested services meet medical necessity criteria. NMMs can approve requests when criteria are met, refer cases to case managers, or recommend denial to a licensed physician medical director (who alone has authority to deny under Minnesota law). NMMs follow specific guidelines and Anthem-mandated processes and are subject to monthly audits and annual Inter-Rater Reliability assessments.

Anthem classifies NMMs as exempt from overtime-pay requirements under the Fair Labor Standards Act (FLSA) and the Minnesota Fair Labor Standards Act (MFLSA), paying them on a salary basis. Anthem also employs licensed practical nurses (LPNs) and licensed vocational nurses (LVNs) in utilization review, but classifies them as non-exempt hourly employees.

Learing filed suit in October 2021, alleging Anthem misclassified her and similarly situated NMMs as overtime-exempt. The court conditionally certified a collective of plaintiffs under the FLSA and later certified a Rule 23 class for the MFLSA claim.

Prior Summary Judgment Ruling (March 2024)

In March 2024, the court granted Learing partial summary judgment, holding that Anthem's two asserted overtime exemption defenses—the "learned professional" exemption and the "administrative" exemption under the FLSA—did not apply. The court applied the then-standard Eighth Circuit formulation requiring Anthem to show that employees fit "plainly and unmistakably" within the exemption's terms and spirit.

Intervening Supreme Court Decision

In January 2025, the U.S. Supreme Court decided E.M.D. Sales, Inc. v. Carrera, 604 U.S. 45 (2025), holding that the preponderance-of-the-evidence standard—meaning more likely than not—governs when an employer seeks to show that an FLSA overtime exemption applies, rejecting any heightened standard. The Supreme Court did not address the "plainly and unmistakably" language used by many courts, including the Eighth Circuit.

Anthem sought leave to move for reconsideration, arguing the March 2024 order had applied a stricter burden than preponderance of the evidence. The court granted leave and limited reconsideration to whether E.M.D. Sales affects its analysis of the learned professional and administrative exemption defenses.

Effect of E.M.D. Sales

The court found that while "plainly and unmistakably" was arguably directed at statutory construction (how to interpret the scope of exemptions) rather than the evidentiary burden of proof, the phrase on its face connotes a higher degree of certainty than preponderance of the evidence. Citing the Tenth Circuit's analysis in Lederman v. Frontier Fire Protection, Inc., 685 F.3d 1151 (10th Cir. 2012)—which traced how the phrase migrated from statutory construction into burden-of-proof language—the court concluded the phrase has in practice operated as a heightened standard.

The court determined that, in light of the Supreme Court's holdings in Encino Motorcars v. Navarro, 584 U.S. 79 (2018) (FLSA exemptions are to be given a "fair reading," not construed narrowly against employers) and E.M.D. Sales (preponderance of the evidence is the correct standard), the more prudent approach is to abandon the "plainly and unmistakably" formulation entirely in FLSA exemption cases. The court emphasized it was not holding that prior Eighth Circuit decisions using that phrase were wrongly decided, but that it must now align with controlling Supreme Court precedent.

Summary Judgment Standard

Summary judgment is appropriate only when no genuine issue of material fact exists. On a motion for summary judgment, the court must view evidence in the light most favorable to the non-moving party, draw all reasonable inferences in that party's favor, and view the evidence "through the prism of the substantive evidentiary burden"—here, preponderance of the evidence.

Learned Professional Exemption

The learned professional exemption under 29 C.F.R. § 541.301(a) requires: (1) the employee's primary duty involves "work requiring advanced knowledge"; (2) in a "field of science or learning"; and (3) the knowledge is "customarily acquired by a prolonged course of specialized intellectual instruction."

Work Requiring Advanced Knowledge

"Work requiring advanced knowledge" means work that is predominantly intellectual, requiring the consistent exercise of discretion and judgment—not merely routine application of established procedures. The use of manuals or guidelines does not automatically preclude the exemption if those materials can only be understood by those with advanced knowledge, but the exemption does not apply to employees who simply apply well-established techniques within closely prescribed limits.

Learing presented evidence that NMMs could only approve requests if predetermined criteria were met, had no authority to deny requests themselves, and described the work as a "matching game" comparing data to criteria. Anthem presented evidence that NMMs exercised clinical judgment in analyzing medical information, decided whether to approve, consult a medical director, or refer to case management, and that Opt-In Plaintiffs testified their RN training was important or "essential" to performing the work.

The court found that, under the correct preponderance-of-the-evidence standard, these competing accounts create genuine issues of material fact that preclude summary judgment on this element.

Prolonged Course of Specialized Intellectual Instruction

RNs generally meet the duties requirements for the learned professional exemption; LPNs generally do not. The exemption is available to employees who attained advanced knowledge through a combination of work experience and intellectual instruction, but not to those who primarily acquired skills through experience rather than specialized instruction.

Learing argued that Anthem historically hired LPNs and LVNs for utilization review, that National Committee for Quality Assurance (NCQA) standards do not require RN-level licensure for utilization reviewers, and that utilization review is not taught in nursing school. Anthem responded that the evidence of LPN/LVN use was over a decade old, that no Opt-In Plaintiff recalled working with LPN or LVN utilization reviewers, and that multiple Opt-In Plaintiffs testified their nursing education was important or essential to their work.

The court again found genuine issues of material fact precluding summary judgment on this element. A reasonable jury could find for either party on this record.

Disposition on Learned Professional Exemption

The court revised the March 2024 order and denied Learing's motion for partial summary judgment as to the learned professional exemption defense. The court did not hold that the exemption applies as a matter of law, and it did not disturb the prior denial of Anthem's own summary judgment motion on this issue. The matter may proceed to trial on the learned professional exemption. The court also noted that three parallel federal district court cases involving similar facts and the same parties reached the same conclusion on the learned professional exemption after E.M.D. Sales: Baker v. Anthem Cos. (N.D. Ga.), Midkiff v. Anthem Cos. (E.D. Va.), and Canaday v. Anthem Cos. (W.D. Tenn.).

Administrative Exemption

The administrative exemption requires that the employee's primary duty is (1) office or non-manual work directly related to the management or general business operations of the employer or its customers, and (2) includes the exercise of discretion and independent judgment with respect to matters of significance.

The March 2024 order had held that Anthem could not show NMMs' primary duties were directly related to managing or assisting in the general business operations of Anthem or its customers. On reconsideration, Anthem's briefing focused almost exclusively on the discretion-and-judgment element (which overlaps with the learned professional exemption) and did not meaningfully address the "directly related to management or general business operations" element that the court found dispositive in the March 2024 order. At oral argument, Anthem's counsel stated Anthem intended to focus on the learned professional exemption, and Anthem did not refute the court's statement that it understood Anthem to be conceding the administrative exemption. The court held that Anthem waived its administrative exemption defense and declined to revisit the March 2024 order on that issue.

Order