California Blue Shield

716 DECISIONS OF NATIONAL LABOR RELATIONS BOARD California Physicians' Service d/b/a California Blue Shield and Professional , Office and Industrial Union, affiliated with Marine Engineers' Beneficial Association (AFL-CIO).' Cases 20-RC-8579, 20-RC-8636, and 20-RC-8641 September 30, 1969 DECISION, ORDER. AND DIRECTION OF ELECTION BY MEMBERS FANNING, BROWN, AND JENKINS Upon separate petitions duly filed under Section 9(c) of the National Labor Relations Act, as amended, a consolidated hearing was held on February 6, 7, and March 13, 1969, before Bert M. Tomasu. Hearing Officer of the National Labor Relations Board. Following the hearing, pursuant to Section 102.67 of the National Labor Relations Board Rules and Regulations and Statements of Procedure. Series 8, as amended, these cases were transferred to the Board for decision. Thereafter, the Employer and the Petitioner filed briefs with the Board Pursuant to the provisions of Section 3(b) of the Act, the Board has delegated its powers in connection with these cases to a three-member panel. The Board has reviewed the Hearing Officer's rulings made at the hearing and finds that they are free from prejudicial error. They are hereby affirmed. Upon the entire record in this case, the Board finds- 1. The Employer is engaged in commerce within the meaning of the Act, and it will effectuate the purposes of the Act to assert jurisdiction herein. 2. The labor organization seeks to represent certain employees of the Employer. 3. No question affecting commerce exists concerning the representation of certain employees of the Employer [as petitioned for in Cases 20-RC-8579 and 20-RC-8641] within the meaning of Section 9(c)( 1) and Section 2(6) and (7) of the Act. A question affecting commerce exists concerning the representation of certain other employees of the Employer [as petitioned for in Case 20-RC-8636] within the meaning of Section 9(c)(l) and Section 2(6) and (7) of the Act. The Petitioner seeks to represent three units, as amended at the consolidated hearing, of employees essentially engaged in office clerical duties or manual labor in the (1) Medi-Cal, (2) Corporate Communications departments,' and (3) warehouse. The parties joined in stipulation to exclude supervisors, professional and confidential employees in the three units sought. Beyond that the Petitioner also seeks additional departmental and individual exclusions. Thus, the Petitioner would further exclude from the proposed Medi-Cal unit lead clerks, senior clerks, unit heads, and all employees in the production, quality control, medical, dental, and drug audit departments. In the requested Corporate Communications unit, the Petitioner would also exclude all telephone representatives, receptionists, and senior correspondents With regard to the proposed warehouse unit, the Petitioner seeks no additional exclusions aside from those stipulated The Petitioner contends that all the employees it would exclude have higher skills, receive better wages, or possess a greater indicia of supervisory, confidential, or professional status than other employees in the proposed units. As for the departmental exclusions, which also clearly include office clerical support employees, the Petitioner apparently takes the position either that these departments are engaged in operations which have an intimate hearing on personnel policies or that they are primarily staffed by professionally skilled employees. In view of the different geographic locations of the Medi-Cal, Corporate Communications and warehouse operations,' the immediate administrative separateness of the three units sought, and the fact that there is no history of collective bargaining, the Petitioner seeks the three units with the exclusions outlined above In the alternative, the Petitioner seeks as an appropriate and broader unit employees in the so-called Government Programs Division, including the Medicare and the Civilian Hospital and Medical Program, Uniform Services (hereinafter called CHAMPUS) departments, as well as Medi-Cal. The Employer contends that all its operations are so integrated that the only appropriate unit is one covering all regular office and clerical support employees in its several establishments in San Francisco. Alternatively, the Employer argues that all employees in the Government Programs Division (i.e., Medicare, CHAMPUS, and Medi-Cal), the Standard Claims Division and the Corporate Communications department should be included within an appropriate unit. Further, the Employer avers that the separate units sought in the Medi-Cal and Corporate Communications departments are inappropriate, because they represent only a portion of the office clerical and support employees within Medi-Cal and Corporate Communications. With respect to the proposed warehouse unit, the Employer contends, inter alias that this department 'For the purposes of clarity , "department," "section, " or "branch" refers to a portion of the larger administrative "division ' Likewise, a "program" includes one or more divisions. 'The three units sought are located at the following addresses Medi-Cal is at 1520 Stockton Street. Parts of the Corporate Communications department are situated at 720 California Street, 343 and 345 Sansome Street The warehouse occupies a one-story building at 1850 Kearney Street Other buildings housing the employer's facilities are located at 320 California Street and 44 Montgomery Street In general, all of the Employer's offices including the warehouse are located within a I-mile radius of one another in San Francisco. 'The name of the Petitioner appears as amended at the hearing 178 NLRB No. 116 CALIFORNIA BLUE SHIELD functions in close cooperation with the Employer's overall operation on a daily basis, and therefore should be included within a larger unit of the other office and clerical employees. As mentioned above. there is no prior history of bargaining for any of these employees sought in the Petition The Employer is a nonprofit corporation engaged in providing health, accident, medical, hospital and physicians' reimbursement insurance It administers two basic insurance programs, the Standard Claims Program which is financed by the sale of prepaid policies to individual and group subscribers and in which it encounters the same risks as underwriters in the private insurance industry, and the Government Claims Program (including Medicare, Medi-Cal, and CHAMPUS) which is operated on a cost basis provided in yearly contracts with the Federal government and, in the case of Medi-Cal, the State of California. Administratively, the Employer's operation is comprised of twelve divisions The following five divisions report directly to the Employer's president: Internal Audit, Marketing, Provider, Underwriting, and Professional and Public Relations, a department of which is Corporate Communications. The remaining seven divisions report to the president through the executive vice president: Personnel, Finance, Los Angeles Operations, Administrative, Corporate Planning, Standard Claims and the Government Programs. As mentioned before the last named division includes the Medicare, Medi-Cal, and CHAMPUS departments Employment practices, including hiring, firing, setting of salaries and other employee benefits including retirement, health and life insurance are primarily within the province of the above-mentioned Personnel Division. The Employer's salaried, nonsupervisory, regular office and clerical support employees numbering about 2,000, fall within a 34-step schedule and are graded from OA through OJ in job descriptions that range in skill, training, and salary from an OA File Clerk I to an 0.1 Occupational Nurse.' The only perceptible difference appearing in the record in employment policy with regard to employees within the above classifications is that the Personnel Division hires employees for grades OA through OG and then dispatches them to the division where the job vacancy occurs, whereas employees suitable for working in grades OF through OJ are screened by the Personnel Division, referred to the section where the vacancy occurs, Interviewed there, and, if found acceptable by the division manager, returned to Personnel for final processing. Finally, the Personnel Division oversees all recommendations for discipline, promotions and transfers. All notices of job openings where and when they arise are brought to the attention of Personnel Division which is, of course, consistent with its function as sole hiring agent, with the slight modification noted above for employment in OF-OJ jobs. 717 Medi-Cal Unit 20-RC-8579 Returning to the first of the three units sought. Medi-Cal, it is important to review the functioning of this department to comprehend the respective positions of the parties with regard to the individual and departmental exclusions requested, and, on the other hand, the reasons that militate against these exclusions. Medi-Cal. which is separately located from the Employer's other offices. is comprised of thirteen departments or sections: administration, claims inquiry, claims assembly, production, office services, medical audit, drug audit, dental audit, microfilm. third party liability, duplicate claims, quality control, and accounts receivable. Basically these sections function as follows: A claim from a provider (physician. dentist, or other medical services mediary) is received by the office services section where it is designated as a drug, dental, or medical claim From there the claim is delivered to claims assembly, checked for accuracy, and sorted according to the county or district where the service was rendered. If the proper entries have been made the claim is again routed to office services for distribution to the respective audit; namely, drug, dental, or medical. In the audit branch a claims examiner compares the reimbursement sought against detailed charts and schedules of standard community fees allowable under Medi-Cal. Office services again picks up the claim for recording in the microfilm section, but should a claim not clear the audit for some reason the matter is brought to the attention of claims inquiry for further processing.', For example, if it appears that the claim has already been paid or that someone other than Medi-Cal is primarily liable for the medical expense incurred the claim is then delivered to the duplicate claims or third party liability sections, respectively. if in fact the claim has already been satisfied the accounts receivable department is responsible for collecting the overpayment already tendered to the provider. Two of the remaining three departments yet to be discussed, the production and quality control sections, record the volume of work handled and, in the case of the quality control department, determine the efficiency of the overall Medi-Cal operation in processing claims. The 'hereinafter Government Programs refers to Medicare, Medi-Cal, and CIIAMPLS 'Admittedly this document styled as a "Clerical and Support Classification ' is not exhaustive but rather, in the words of Andrew Cochran the Employer's director of personnel , represents "one of our salary structures that involves the clerical and support personnel, and in that salary structure, these are titles that occur throughout the company The omissions in this exhibit are minor and by collating it with others received in evidence in this case it is possible to piece together a composite picture of the Employer' s non-supervisory employees including the relative standing of each Further to avoid confusion it is noted the job classilications run from OA through OJ but there is more than one title in many of the 10 lettered grading,; Finally, it is impossible to determine from the record the total number of office and clerical employees but there are at least 2,000 of which about 340 are in Los Angeles and are not at issue in this Lase `Also there are, in this department, employees who answer inquiries forwarded to them by Corporate Communications In some instances a 718 DECISIONS OF NATIONAL LABOR RELATIONS BOARD quality control department's duties also entail ascertaining the incidence of error and which employees are responsible. The production department, on the other hand, tallies the volume of work handled in Medi-Cal and also functions as part of the claims inquiry section. Finally, the administration office functions, as its name implies, as general overseer of the entire Medi-Cal operation and is immediately answerable to the manager for Government Programs. The Petitioner seeks to exclude in toto the administration, production, quality control, and the three audit departments from the proposed unit even though within these departments there are office clerical and support employees who are in the same categories, grades, and job descriptions as other employees that it seeks to represent in the remaining seven departments of Medi-Cal. Beginning with the departmental exclusions, we do not perceive why the production section should be excluded since it merely tabulates the volume of work received and apparently is under the supervision of the claims inquiry section which the Petitioner would include. As with other departments sought to be excluded by the Petitioner, the production section functions in close cooperation with the other departments and is administratively integrated in the overall Medi-Cal operation. From the record in this case it is manifestly clear that the production section conducts no business which could be classified as confidential and, further, the employees within it certainly possess no indicia of professional or supervisory status but rather share a community of interest common to other clerical employees. Similarly, mass exclusion of the medical, drug, and dental audit departments is arbitrary. While we reserve some doubt as to the professional status of the claims examiners who make up the vast bulk of the work force in these audit departments, we would agree with the Employer that exclusion of the audits' office and clerical support employees is unwarranted. For example, the same clerical personnel in the category of "General Clerk I" graded at OB that the Petitioner seeks to represent in the microfilm, claims inquiry, duplicate claims, and claims assembly sections are excluded by virtue of the Petitioner's proposed wholesale exclusion of the medical audit department. Without laboring the point, there are file clerks, general clerks, and typists in the proposed excluded departments which the Petitioner seeks to include in other Medi-Cal sections. In conclusion, it appears to us that the Petitioner is seeking to represent only a segment of the office and clerical support employees in Medi-Cal, and, pursuant to our policy of finding such exclusions unwarranted we find this proposed unit to be inappropriate.' In the alternative, the Petitioner requests that if the single Medi-Cal unit should be found claims examiner in an audit department may have to be contacted for additional assistance inappropriate, that a larger unit including Medicare, CHAMPUS, and Medi-Cal - the Government Programs-be found appropriate. However, from such alternative unit, the Petitioner would exclude the Standard Claims Division. For the Petitioner's part, the record shows that the Medicare and CHAMPUS programs operate in essentially the same way as does Medi-Cal; all three provide reimbursement insurance programs and are government financed on a cost basis as provided in yearly contracts. Standard Claims, on the other hand, is a private underwriting program with the normal incidence of risk encountered in the prepaid insurance industry. Taken together the three Government Programs employ the same office and clerical support employees including claims examiners. Beginning with the divisional exclusion, the record indicates that Standard Claims involves primarily the same type of work as the Government Programs and that it is functionally an integral part of the overall processing of claims for the following reasons. About two-thirds of the claims filed under Medicare also involve claims compensable under Medi-Cal,' and beyond that there is substantial overlap of coverage that is allowable over and above the government insurance programs. That is, supplemental private insurance provided for by Standard Claims may be added to the public insurance provided for by the Government Programs in particular, with respect to Medicare and Medi-Cal. In short, it appears that although there is some administrative and geographical separateness of one program and staff from another, in fact the actual administration of the insurance programs, public and private, partially overlap at some point. In terms of individual employee exclusions, a unit limited to employees in the Government Programs, but excluding Standard Claims employees, would represent only a segment of the overall complement of office clerical employees involved in the processing of claims. Also there is substantial interchange and transfer of employees from one program to another.' Both Government and Standard Claims employ the same categories of office and clerical support employees: File Clerk II, General Clerk I and II, Typist I and II , Assignment Control Clerk, Special Handling Clerks I and II, and Correspondent. In light of the manifest integration of the Employer's claims operations, and the fact that only a segment of the office and clerical support employees would be covered by the 'See Bank of America , 174 NLRB No 21, El Paso Electric Company, 168 NLRB No 136, General Electric Company, 148 NLRB 811, 815, and cases cited therein at fn 3 See also, E I Dupont and Company, 107 NLRB 734 in the typical situation, 80 percent of a claim is satisfied by Medicare and the remaining 20 percent by Medi-Cal. The Employer is at present undertaking plans to create a separate administrative branch to process the substantial Medicare-Medi-Cal work load 'Over a recent 6-month period some 64 office and clerical employees at various grade levels were transferred out of Medi-Cal into other operations of the Employer, in particular, into the Corporate Communications department CALIFORNIA BLUE SHIELD 719 alternative proposed unit, we deem a unit confined to Medi-Cal, Medicare , and CHAMPUS, but excluding Standard Claims, to be inappropriate.'" Corporate Communications Unit - 20-RC-8641 The second unit petitioned for, as amended at the hearing, is the Corporate Communications department, which is a part of the Professional and Public Relations Division. (As indicated above, Corporate Communications is located in several different places all within fairly close proximity of one another.) All inquiries pertaining to the Employer are received in the Corporate Communications department which includes the following sections: control center, Medicare, Medi-Cal, CHAMPUS, and Standard Claims inquiry units, word processing, provider review, and profile center. The last three sections are basically office machine units where data is transcribed to IBM cards or tapes for later use in developing comprehensive form letter responses. This information is also recorded in an effort to establish standard fees that obtain in the community where a provider is located. The remaining Corporate Communications departments are confined mostly to answering inquiries. The control center screens all the mailed inquiries. Inquiries may be made in person, over the telephone, or by letter. To handle each situation there are receptionists, telephone representatives, and letter correspondents, but if the question raised is beyond their ken an inquiry is made to representatives of the respective claims departments, Medicare, Medi-Cal, CHAMPUS, or Standard Claims. There are approximately 157 employees in Corporate Communications. Aside from personnel stipulated as excludable, the Petitioner further seeks to exclude two receptionists and all telephone representatives of which there are 31. The Employer contends that the letter correspondents which the Petitioner would include within the proposed unit share the same community of interest as the excluded receptionists and telephone representatives. We are in agreement with the Employer that the proposed Corporate Communications unit includes only a segment of the office personnel. The record clearly shows that the skills of the correspondents, receptionists, and representatives are essentially the same. They have basically the same salaries and are covered by the uniform employment policies outlined above in reference to employees in the Medi-Cal department. The requisite skills demanded for any of the three jobs may be reduced to a common denominator, namely, familiarity with the insurance programs administered by the Employer. Certainly, no special training is needed. However, as might be expected, some employees may possess greater facility in composing letters than in answering phones which, on the other hand, would call for the services of one who is pleasant with others over the phone. Naturally a receptionist must possess qualities such as neatness in appearance and pleasantness in manner. Receptionists, telephone representatives, and letter correspondents are interchangeable and transfers often occur. This is particularly true for correspondents and representatives who may, for instance, tire of writing replies and wish to orally communicate with inquirers, and vice versa. It also appears that Employer has plans to expand upon its interchange program for all three classifications of office clericals to maximize their knowledge of Medi-Cal, Medicare. CHAMPUS, and Standard Claims. Moreover, the Employer has definite plans to bring all of the Corporate Communications departments together in one location. In view of the fact that the exclusion of telephone representatives and receptionists is a carving out of a segment of the office and clerical support personnel, and that there is a close working relationship and high degree of integration of the Corporate Communications department, we find that the requested unit is unappropriate." In sum , in all of the above circumstances, we are of the opinion that none of the employees in the Medi-Cal or Corporate Communications departments alone, or together as part of a larger unit including all of the Government Programs, but excluding Standard Claims, has a sufficient community of interest separate from that of all other employees of the Employer to warrant their establishment as a separate appropriate unit for collective-bargaining purposes. We are not unmindful of the separate geographic locations of these requested departments or of the separateness of immediate supervision. but these factors are not sufficient for finding appropriate the units requested where they are limited to only a segment of the office clerical employees.'2 Moreover. the various exclusions and inclusions of office and clerical support employees in both of these requested units appear both inconsistent and arbitrary. Accordingly, we shall dismiss the petitions in Cases 20-RC-8579 and 20-RC-8641. Warehouse Unit - Case 20-R C-8636 In Case 20-RC-8636 the Petitioner seeks to represent certain employees working at the Employer's warehouse. In general. the warehouse is a storage facility for various forms used in filing claims under Medicare. Medi-Cal, CHAMPUS, and Standard Claims. "See authority cItLd at In. 7, supra "id "Bank of America, 174 NLRB No 21 720 DECISIONS OF NATIONAL LABOR RELATIONS BOARD Approximately 90 percent of the warehouse is utilized in stocking these printed forms and schedules; the remainder of the storage space is taken up with office supplies such as pencils, pens, and stationery. The warehouse is a one-story, open-spaced building, 27,000 square feet in area located separately from the Employer's other facilities. The warehouse functions in the following manner: All office supplies and business forms are delivered by outside contract carriers to the warehouse, where they are unloaded by the stock clerks and stored in their respective receptacles within the building. Some of the printed forms are sent upon request to providers, but the bulk of the material is forwarded to various divisions within the Employer's operation. In the ideal situation, a requisition slip is filled out, forwarded to the warehouse and there the supervisor checks to determine if the material is in stock. If the requested forms are available the stock clerk packages them and, with the assistance of the driver, loads the package on one of four delivery trucks. The driver is also responsible for unloading the bundled forms when they reach their destination. Without conceding the appropriateness of this requested unit , the Employer joined in a stipulation with the Petitioner that the manager, three supervisors, a Typist 11, and all temporary employees should be excluded. The remaining 12 employees are engaged primarily in manual labor. The Employer emphasizes factors which militate against a finding that the warehouse constitutes an appropriate unit, particularly, (1) the warehousemen sometimes perform their duties in close cooperation with other employees from other departments in that nonwarehouse employees frequently pick up the needed forms from the warehouse; (2) all of the warehouse employees that would be covered in the requested unit are governed by the same personnel policies that apply to all other nonsupervisory employees; and (3) there is some evidence of transfers from the warehouse to other departments and it appears that in the last 8 months two employees were transferred to claims departments. On the other hand, several factors favor the Petitioner's contention that the warehousemen be deemed a unit appropriate for collective-bargaining purposes. The warehouse is geographically separate from any of the Employer's other facilities. Likewise, there is different immediate supervision. Six of the 12 employees sought are in job classifications unique to the warehouse; namely, Truck Driver. Driver's Helper, and Stock Clerk II. Recent past history indicates few transfers into, or out of, the warehouse. Also the Petitioner alludes to the absence of bargaining history at the warehouse. We have indicated in an analogous case dealing with the insurance industry that a separate unit of warehouse or storage employees may be appropriate.[' Such is the conclusion we reach with regard to employees in the proposed warehouse unit. We are not unmindful of the Employer's contentions to the contrary, in particular, that warehouse employees have daily contact with representatives of other departments. However, visitations by nonwarehouse employees does not detract from the fact that the warehousemen are primarily engaged in duties clearly distinct from those of any other employees of the Employer. Accordingly, we find that the following employees, as stipulated by the parties, constitute a unit appropriate for collective bargaining within the meaning of Section 9(b) of the Act: All employees at the Employer's warehouse, 1850 Kearny Street, San Francisco, including truck drivers, but excluding guards, temporary employees, confidential employees (including a Typist Ii), and supervisors as defined in the Act."' ORDER Upon the basis of the foregoing findings of fact and upon the entire record in this case, the National Labor Relations Board hereby orders that the petitions in Cases 20-RC-8579 and 20-RC-8641 be, and they hereby are, dismissed. [Direction of Election15 omitted from publication.] "Reliance Insurance Company. 173 NLRB No. 147 "As a list containing the names and classifications of employees was not available until the day of the hearing and as the Petitioner, during ihc, course of the hearing, sought to exclude certain employees which it did not enumerate on its Petitions, no final showing of interest could be made until the appropriate unit was determined In these circumstances the sulliciency of the Petitioner's showing of interest in the unit as found appropriate is not clear at this time. Accordingly, we direct the Regional Director not to proceed with the election hereinafter directed in this unit until he shall have first determined Petitioner has made an adequate showing of interest among employees in the warehouse storage facility who are eligible to vote in that election after having been alforded a reasonable time to obtain such showing if it does not now have it "In order to assure that all eligible voters may have the opportunity to be informed of the issues in the exercise of their statutory right to vote. all parties to the election should have access to a list of voters and their addresses which may be used to communicate with them Excelsior Underwear Inc. 1 56 NLRB 1236; N L R B v Wyman-Gordon Company, 394 U S. 759 Accordingly, it is hereby directed that an election eligibility list, containing the names and addresses of all the eligible voters, must be filed with the Regional Director for Region 20 within 7 days after the Petitioner presents an adequate showing of interest (fn. 14, above) The list may initially be used by the Regional Director to assist in determining an adequate showing of interest The Regional Director shall make the list available to all parties to the election when he shall have determined that an adequate showing of interest among the, employees in the unit found appropriate has been established No extension of time to file this list shall be granted by the Regional Director except in extraordinary circumstances Failure to comply with this requirement shall be grounds for setting aside the election whenever proper objections are tiled