California Blue Shield

National Labor Relations Board - Board Decisions

Sep 30, 1969

178 N.L.R.B. 716 (N.L.R.B. 1969)

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