Document ID: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-ca11-15-12135/USCOURTS-ca11-15-12135-0/pdf.json

Parties Involved:
W. A. Griffin
Appellant
Southern Company Services, Inc.
Appellee

Document Text:

[DO NOT PUBLISH]

IN THE UNITED STATES COURT OF APPEALS

FOR THE ELEVENTH CIRCUIT

________________________

No. 15-12135

Non-Argument Calendar

________________________

D.C. Docket No. 1:15-cv-00115-AT

W. A. GRIFFIN, MD, 

 Plaintiff - Appellant, 

versus

SOUTHERN COMPANY SERVICES, INC., 

 Defendant - Appellee.

________________________

Appeal from the United States District Court

for the Northern District of Georgia

________________________

(December 30, 2015)

Before MARTIN, JILL PRYOR and ANDERSON, Circuit Judges.

PER CURIAM: 

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Proceeding pro se, Dr. W.A. Griffin appeals the dismissal of her complaint 

under the Employee Retirement Income Security Act of 1974 (“ERISA”), 29 

U.S.C. § 1132(a). After careful consideration, we affirm.1

I.

Dr. Griffin, who operates a dermatology practice in Atlanta, Georgia, treated 

seven patients insured under a Southern Company Services, Inc. (“Southern 

Company”) sponsored group health benefit plan (the “Plan”).2

 Dr. Griffin is an 

out-of-network provider under the Plan. She required each patient to execute an 

assignment of benefits that “assign[ed] and convey[ed]” to her “all medical 

benefits and/or insurance reimbursement, if any, otherwise payable to me for 

services rendered from [Dr. Griffin] . . . , regardless of [her] managed care network 

 

1 Dr. Griffin’s motions for (1) a three-judge panel and a published opinion and (2) 

expedited consideration, a three-judge panel, and a published opinion are also pending before us. 

We deny her motions. Her requests for a three-judge panel are moot because our rules provide 

that she is entitled to a three-judge panel. See 11th Cir. R. 34-2, 34-3(e). As regards her requests

for a published opinion, our rules provide that “[a]n opinion shall be unpublished unless a 

majority of the panel decides to publish it.” 11th Cir. R. 36-2. In this case, the panel decided not 

to publish. Our rules do permit a party to file a motion requesting that a previously unpublished 

order be published but provide that the motion shall be granted only if the panel unanimously 

agrees to publish. 11th Cir. R. 36-3. Construing Dr. Griffin’s motions as requesting publication 

under Rule 36-3, the request is premature, and we deny it. Finally, we deny her request for 

expedited consideration as moot.

2 At the motion to dismiss stage, we accept the well-pleaded allegations in the complaint 

as true and view them in the light most favorable to Dr. Griffin. See Chaparro v. Carnival 

Corp., 693 F.3d 1333, 1335 (11th Cir. 2012). We also consider the Southern Company Health &

Welfare Benefits Plan document, which Southern Company submitted to the district court with 

its motion to dismiss. Although Dr. Griffin did not attach this document to her complaint, we 

may consider it because it is central to the complaint and its contents are not in dispute. See 

Harris v. Ivax Corp., 182 F.3d 799, 802 n.2 (11th Cir. 1999).

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participation status.” Legal Assignment of Benefits (Doc. 7-2).3 Each assignment 

stated that it is “valid for all administrative and judicial review under . . . ERISA.” 

Id.

The Plan is an employee welfare benefit plan under ERISA that provides its 

participants with medical-related benefits. Southern Company is the plan sponsor 

and its Benefits Administration Committee serves as the plan administrator. 

Anthem Blue Cross Blue Shield of Georgia (“BCBSGA”) provides claims 

administration services to the Plan. 

The Plan sets forth the terms and conditions of the agreement between 

Southern Company and its employee participants. The Plan contains an antiassignment clause that prohibits plan participants and beneficiaries from assigning 

benefits:

To the extent permitted by law, the rights or interests of any 

Participant or his beneficiary to any benefits hereunder shall not be 

subject to attachment or garnishment or other legal process by any 

creditor of any such Participant or beneficiary, nor shall any such 

Participant or beneficiary have any right to . . . assign any of the 

benefits which he may expect to receive, contingently or otherwise, 

under this Plan, and any attempt to . . . assign any right to benefits 

hereunder shall be void. Notwithstanding the foregoing, the Plan 

Administer [sic] may pay Plan benefits directly to the provider of 

services. Such payment shall fully discharge the Plan Administrator 

from further liability under the Plan.

Southern Company Health & Welfare Benefits Plan at 26 (Doc. 5-2). 

 

3 Citations to “Doc.” refer to docket entries in the district court record in this case. 

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Dr. Griffin alleges that for three of the patients insured by the Plan, 

BCBSGA processed but underpaid claims she submitted. She filed with BGBSGA

a level one administrative appeal regarding the claims for each of these patients. 

With each administrative appeal, she requested at least ten broad categories of 

documents connected to the Plan and demanded that BCBSGA notify her whether 

the Plan contained an anti-assignment clause, warning that if it failed to do so, she 

would argue in litigation that the anti-assignment clause was unenforceable. 

BCBSGA denied each of the level one appeals. Dr. Griffin then filed level two 

administrative appeals for these claims. BCBSGA either denied or failed to 

respond to Dr. Griffin’s level two appeals. 

While the administrative appeals were pending, Dr. Griffin sent copies of 

them to David Settle, a Southern Company employee responsible for compensation 

and benefits. Settle responded by providing Dr. Griffin with copies of the 

summary plan descriptions and informing her that BCBSGA would respond to her 

appeals. Neither BCBSGA nor Southern Company provided Dr. Griffin with the 

documents that she requested with her level one appeals (other than the summary 

plan descriptions) or disclosed that the Plan had an anti-assignment provision.

Dr. Griffin submitted to BCBSGA claims for four other patients covered by 

the Plan, which were never processed or paid. After receiving no response from 

BCBSGA, Dr. Griffin sent a letter to James Garvie, Southern Company’s Director 

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of Benefits, informing him that BCBSGA had failed process the claims. A

Southern Company employee responded that he had forwarded her concerns to 

BCBSGA.

Dr. Griffin sued Southern Company in federal court, bringing ERISA claims 

for unpaid benefits, breach of fiduciary duty, failure to provide Plan documents, 

and breach of contract, seeking money damages, statutory penalties, and 

declaratory relief. Southern Company moved to dismiss the complaint. While the 

motion to dismiss was pending, Dr. Griffin sought leave to amend her complaint to 

add three additional claims based upon co-fiduciary liability under ERISA. The 

district court granted the motion to dismiss and denied the motion to amend, 

concluding that Dr. Griffin lacked statutory standing under ERISA based on the 

Plan’s anti-assignment provision. Accordingly, the district court dismissed the 

case without prejudice. This appeal followed. 

II.

Although courts have long applied the label of “statutory standing” to the 

basis for decisions such as the district court’s here, that Dr. Griffin lacked standing 

under ERISA, the Supreme Court has cautioned that this label is “misleading” 

because the court is not deciding whether there is subject matter jurisdiction but 

rather whether the plaintiff “has a cause of action under the statute.” Lexmark 

Int’l, Inc. v. Static Control Components, Inc., 134 S. Ct. 1377, 1387-88 & n.4 

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(2014) (internal quotation marks omitted). Put differently, we understand the 

district court’s decision that Dr. Griffin lacked statutory standing to be a 

determination that she failed to state a claim under Federal Rule of Civil Procedure 

12(b)(6). See City of Miami v. Bank of Am. Corp., 800 F.3d 1262, 1273-74 (11th 

Cir. 2015). 

“We review de novo the district court’s grant of a Rule 12(b)(6) motion to 

dismiss for failure to state a claim, accepting the complaint’s allegations as true 

and construing them in the light most favorable to the plaintiff.” Chaparro v. 

Carnival Corp., 693 F.3d 1333, 1335 (11th Cir. 2012) (internal quotation marks 

omitted). To survive a motion to dismiss, a complaint must contain sufficient 

factual matter, accepted as true, to “state a claim to relief that is plausible on its 

face.” Bell Atlantic Corp. v. Twombly, 550 U.S. 544, 570 (2007). “[N]aked 

assertions devoid of further factual enhancement” or “[t]hreadbare recitals of the 

elements of a cause of action, supported by mere conclusory statements, do not 

suffice.” Ashcroft v. Iqbal, 566 U.S. 662, 678 (2009) (internal quotation marks 

omitted). Upon review of dismissals for failure to state a claim, “[p]ro se

pleadings are held to a less stringent standard than pleadings drafted by attorneys 

and are liberally construed.” Bingham v. Thomas, 654 F.3d 1171, 1175 (11th Cir. 

2011) (internal quotation marks omitted). 

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III.

Section 502(a) of ERISA provides that only plan participants and plan 

beneficiaries may bring a private civil action to recover benefits due under the 

terms of a plan, to enforce rights under a plan, or to recover penalties for a plan 

administrator’s failure to provide documents. 29 U.S.C. § 1132(a)(1), (c). This 

provision also limits the right to sue for breach of fiduciary duty to plan 

participants, plan beneficiaries, plan fiduciaries, and the Secretary of Labor. Id.

§ 1132(a)(2). Additionally, only plan participants, plan beneficiaries, and plan 

fiduciaries may bring a civil action to obtain equitable relief to redress a practice 

that violates ERISA or the terms of a plan. Id. § 1132(a)(3). As we have 

explained, “[h]ealthcare providers . . . are generally not ‘participants’ or 

‘beneficiaries’ under ERISA and thus lack independent standing to sue under 

ERISA.” Physicians Multispecialty Grp. v. Health Care Plan of Horton Homes, 

Inc., 371 F.3d 1291, 1294 (11th Cir. 2004). 

There is, however, an exception to this general rule that healthcare providers 

have no right of action under section 502(a). We have recognized that 

“[h]ealthcare providers may acquire derivative standing . . . by obtaining a written 

assignment from a ‘beneficiary’ or ‘participant’ of his right to payment of benefits 

under an ERISA-governed plan.” Id; see also Cagle v. Bruner, 112 F.3d 1510, 

1515 (11th Cir. 1997) (explaining that “neither the text of § 1132(a)(1)(B) nor any 

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other ERISA provision forbids the assignment of health care benefits provided by 

an ERISA plan”). Although ERISA does not prohibit a plan participant or 

beneficiary from assigning benefits to her provider, we have held that an antiassignment provision in a plan, which limits or prohibits a plan participant or 

beneficiary from assigning her right to payment of benefits, is valid and 

enforceable. Physicians Multispecialty Grp., 371 F.3d at 1296. Accordingly, 

when a plan contains an unambiguous anti-assignment provision, a plan participant 

or beneficiary may not assign benefits to a healthcare provider, meaning the 

healthcare provider cannot acquire a cause of action under section 502(a). Id.

A.

In this case, the insureds’ assignments purported to transfer to Dr. Griffin 

their right to payment of benefits from the Plan. We have recognized that when a 

patient assigns to a provider the right to payment for medical benefits, he also 

conveys the right to file an action under section 502(a) of ERISA for unpaid 

benefits. See Conn. State Dental Ass’n v. Anthem Health Plans, Inc., 591 F.3d 

1337, 1352-53 (11th Cir. 2009). Thus, if enforceable, the assignments transferred 

to Dr. Griffin the right to bring a cause of action under section 502(a) for unpaid 

benefits.4

 

 

4 Although the assignments transferred to Dr. Griffin the right to sue under section 502(a) 

of ERISA for unpaid benefits, the assignments contained no provision transferring the right to 

assert claims for breach of fiduciary duty or civil penalties. Because the insureds never assigned 

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The question we face is whether the assignments are enforceable under the 

Plan. The Plan contains an anti-assignability provision that states:

To the extent permitted by law, the rights or interests of any 

Participant or his beneficiary to any benefits hereunder shall not be 

subject to attachment or garnishment or other legal process by any 

creditor of any such Participant or beneficiary, nor shall any such 

Participant or beneficiary have any right to . . . assign any of the 

benefits which he may expect to receive, contingently or otherwise,

under this Plan, and any attempt to . . . assign any right to benefits 

hereunder shall be void. Notwithstanding the foregoing, the Plan 

Administer [sic] may pay Plan benefits directly to the provider of 

services. Such payment shall fully discharge the Plan Administrator 

from further liability under the Plan.

Southern Company Health & Welfare Benefits Plan at 26 (Doc. 5-2) (emphasis 

added). Therefore, the plan unambiguously prohibits assignments of benefits to 

the extent permitted by law. 

Dr. Griffin focuses on the “to the extent permitted by law” language to 

argue that the assignments she received are valid under the Plan because antiassignment clauses are unenforceable under Georgia law. Dr. Griffin relies on 

O.C.G.A. § 33-24-54(a), which provides that “whenever . . . [a] self-insured health 

benefit plan . . . provides that any of its benefits are payable to a participating or 

preferred [licensed] provider of health care services,” the plan must also “pay such 

benefits either directly to any similarly licensed nonparticipating or nonpreferred 

 

to Dr. Griffin the right to bring such claims, she lacks derivative standing to bring these claims 

under section 502 of ERISA. 

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provider who has rendered such services, has a written assignment of benefits, and 

has caused written notice of such assignment to be given . . . or jointly to such 

nonparticipating or nonpreferred provider and to the insured.” O.C.G.A. § 33-24-

54(a). The statute guarantees that if benefits are payable to preferred or 

participating providers under a self-insured plan, the plan must also pay benefits to 

non-participating or non-preferred providers to whom patients have assigned their 

rights. Nothing in the statute explicitly prohibits a health benefits plan from 

barring assignment. Thus, we fail to see how section 33-24-54(a) renders an antiassignment provision unenforceable and decline to hold that the statute implicitly 

bars anti-assignment provisions.5 

 

5 Other states have expressly prohibited anti-assignment clauses. See, e.g., Ala. Code 

§ 27-1-19(b) (“[T]he contract providing coverage to an insured may not exclude the right of 

assignment of benefits . . . .”); Colo. Rev. Stat. § 10-16-317.5(a) (stating that a “contract issued 

pursuant to the provisions of this article shall not prohibit a subscriber under the contract from 

assigning, in writing, benefits under the contract to a licensed hospital or other licensed health 

care provider for services provided to the subscriber which are covered under the contract”); Me. 

Rev. Stat. Ann. tit. 24, § 2332-H (“All contracts providing benefits for medical or dental care on 

an expense-incurred basis must contain a provision permitting the insured to assign benefits for 

such care to the provider of the care.”); N.H. Rev. Stat. Ann. § 420-B:8-n (requiring insurance 

contracts to “contain a provision permitting the enrollee to assign any benefits provided for 

medical or dental care on an expense-incurred basis to the provider of care”); Tenn. Code Ann. 

§ 56-7-120 (“[W]henever any policy of insurance issued in this state provides for coverage of 

health care rendered by a provider . . . , the insured or other persons entitled to benefits under the 

policy shall be entitled to assign these benefits to the healthcare provider and such rights must be 

stated clearly in the policy.”); Va. Code Ann. § 38.2-3407.13 (prohibiting certain insurers from 

“refus[in]g to accept or make reimbursement pursuant to an assignment of benefits made to a 

dentist or oral surgeon by an insured, subscriber or plan enrollee”). Georgia law contains no 

such provision.

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B.

Dr. Griffin argues that even if the Plan’s anti-assignment provision is 

enforceable, Southern Company cannot rely on the provision because it failed to 

inform her of the provision after she asked whether the Plan contained such a term. 

Liberally construed, Dr. Griffin’s argument is that because Southern Company and 

BCBSGA failed to disclose the anti-assignment term after she asked them about it

in her administrative appeals for three patients, Southern Company either is 

equitably estopped from relying on the anti-assignment term or has waived it not 

only for those three patients but also for other patients. We disagree.

Under ERISA, equitable estoppel applies only when “the plaintiff can show 

that (1) the relevant provisions of the plan at issue are ambiguous, and (2) the plan 

provider or administrator has made representations to the plaintiff that constitute an 

informal interpretation of the ambiguity.” Jones v. Am. Gen. Life & Acc. Ins. Co., 

370 F.3d 1065, 1069 (11th Cir. 2004). Because the anti-assignment provision is 

unambiguous, equitable estoppel cannot apply here. 

We have “left open the question of whether waiver principles might apply 

under the federal common law in the ERISA context.” Witt v. Metro. Life Ins. Co., 

772 F.3d 1269, 1279 (11th Cir. 2014). But even if we assume that waiver could 

apply in the ERISA context, Dr. Griffin has failed to plead sufficient facts to show 

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that Southern Company waived the anti-assignment provision. “[W]aiver is the 

voluntary, intentional relinquishment of a known right.” Id. (internal quotation 

marks omitted). We have explained that waiver may be express or implied, but to 

find implied waiver, “the acts, conduct, or circumstances relied upon to show 

waiver must make out a clear case.” Dooley v. Weil (In re Garfinkle), 672 F.2d 

1340, 1347 (11th Cir. 1982).

As an initial matter, Dr. Griffin makes no allegation that Southern Company 

expressly waived the anti-assignment provision. With respect to implied waiver, 

Dr. Griffin alleges that she demanded that BCBSGA notify her whether the Plan 

had an anti-assignment provision and sent Southern Company copies of her 

administrative appeals filed with BCBSGA. We understand Dr. Griffin’s 

argument to be that Southern Company waived the anti-assignment provision 

because both Southern Company and BCBSGA failed to inform her about the antiassignment provision after receiving copies of her administrative appeals. Even 

liberally construing her pleadings and accepting her allegations as true, we find 

these allegations insufficient to establish a “clear case” that Southern Company

intentionally and voluntarily relinquished its rights under the anti-assignment 

provision. Id.6

 

 6 We express no opinion about whether Dr. Griffin’s allegations would be sufficient to 

plead that BCBSGA waived the anti-assignment provision, as that question is not before us. 

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IV.

We conclude that the Dr. Griffin failed to state a claim because she failed to 

allege facts sufficient to support a cause of action under § 502(a) of ERISA. 

Accordingly, the district court committed no error in dismissing her complaint 

against Southern Company.

7

 

AFFIRMED. 

 

7 Dr. Griffin also argues that the district court erred in denying her motion to amend her 

complaint to add an additional claim under ERISA. We review the district court’s denial of a 

motion to amend a complaint for abuse of discretion, but we review de novo whether the

proposed amendment to the complaint would be futile. See Harris v. Ivax Corp., 182 F.3d 799, 

802-03 (11th Cir. 1999). Because of the anti-assignment provision, Dr. Griffin has no right of 

action under ERISA; thus, the proposed amendment would be futile, and the district court 

properly denied the motion to amend. 

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