[PUBLISH]

IN THE UNITED STATES COURT OF APPEALS

FOR THE ELEVENTH CIRCUIT

________________________

No. 18-10417

________________________

D.C. Docket No. 1:17-cv-04656-AT

W. A. GRIFFIN, MD,

 Plaintiff - Appellant,

versus

COCA-COLA REFRESHMENTS USA, INC., 

UNITED HEALTHCARE INSURANCE COMPANY, 

 Defendants - Appellees,

UNITED HEALTHCARE OF GEORGIA, INC.,

 Defendant. 

________________________

No. 18-10418

________________________

D.C. Docket No. 1:17-cv-04657-AT

W. A. GRIFFIN, MD,

USCA11 Case: 18-10418 Date Filed: 02/24/2021 Page: 1 of 26
2

 Plaintiff - Appellant,

versus

DELTA AIR LINES, INC., 

UNITED HEALTHCARE INSURANCE COMPANY, 

 Defendants - Appellees,

UNITED HEALTHCARE PLAN OF GEORGIA, INC.,

 Defendant. 

________________________

Appeals from the United States District Court

for the Northern District of Georgia

________________________

(February 24, 2021)

Before BRANCH and MARCUS, Circuit Judges, and UNGARO,∗ District Judge.

BRANCH, Circuit Judge: 

Dr. Wakitha Griffin, a dermatologist in Atlanta, Georgia, has filed many 

appeals in this Court in recent years, all of which have involved her attempts to 

receive in-network payments despite being an out-of-network provider. Our other 

opinions have been unpublished; we choose to publish today in hopes of resolving 

this recurring litigation.

∗ The Honorable Ursula Ungaro, United States District Court for the Southern District of 

Florida, sitting by designation.

USCA11 Case: 18-10418 Date Filed: 02/24/2021 Page: 2 of 26
3

These consolidated appeals arise from Griffin’s treatment of two patients 

who were insured under two separate employee welfare benefit plans which are 

administered by United Healthcare (“United”). The Employee Retirement Income 

Security Act of 1974 (“ERISA”) covers both plans. Because Griffin does not have 

a contract with United whereby she provides services in exchange for 

reimbursement at a negotiated rate, she is an out-of-network provider under both 

plans. Generally, patients are reimbursed at lower rates when receiving healthcare 

services from out-of-network providers rather than in-network providers. 

Eschewing a contractual relationship with United and payment from her 

patients, Griffin instead requested that the two patients assign their benefits under 

their plans to her. They obliged. Griffin then attempted to collect from United the 

same payment that she would have received had she been an in-network provider. 

When United only paid her the benefits she was entitled to as an out-of-network 

provider, Griffin brought two separate lawsuits—one against Coca-Cola 

Refreshments, Inc. (“Coca-Cola”) and United and the other against Delta Air 

Lines, Inc. (“Delta”) and United (collectively, “Defendants”)—asserting various 

ERISA violations. The district court dismissed both cases for failure to state a 

claim because the plans’ anti-assignment clauses prevented Griffin from obtaining 

statutory standing under ERISA to sue on behalf of her patients. Griffin appealed 

both cases to this Court. 

USCA11 Case: 18-10418 Date Filed: 02/24/2021 Page: 3 of 26
4

These consolidated appeals raise an unsettled issue about whether an ERISA 

plan administrator or its claims agent may waive its right to rely on an antiassignment provision in an ERISA-covered plan. We need not reach that issue, 

however. Even assuming that waiver is available in the ERISA context, 

Defendants did not waive their ability to assert the anti-assignment provisions as a 

defense. And regardless of waiver, Griffin’s lawsuit still fails to state a claim: 

United paid her in full, both under the terms of the patients’ assignments and the 

provisions of the healthcare plans. We therefore affirm the district court’s orders. 

I. Background

Although these consolidated appeals implicate two distinct health benefit 

plans, patients, and assignments, the facts giving rise to Griffin’s claims in each 

case are largely the same. A few years ago, Griffin provided medical treatment for 

two patients: Patient J.J., who was insured under the Coca-Cola Plan, and Patient 

G.A., who was insured under the Delta Plan.1

 United is the Coca-Cola Plan’s 

Claims Fiduciary and the Delta Plan’s Claims Administrator. Under the terms of 

both plans, Griffin is an “out of network” physician. Generally, the plans 

reimburse the beneficiary at a higher percentage when he visits an in-network 

physician rather than an out-of-network physician. For example, the Coca-Cola 

1 The Coca-Cola Company Benefits Committee is the Coca-Cola Plan Administrator and 

the Administrative Committee of Delta Air Line, Inc. is the Delta Plan Administrator. 

USCA11 Case: 18-10418 Date Filed: 02/24/2021 Page: 4 of 26
5

Plan provides that when a beneficiary has an office visit with an out-of-network 

physician, the plan pays 60 percent of the cost of service and the beneficiary pays 

40 percent. By contrast, if the beneficiary has an office visit with an in-network 

physician, the plan pays at least 80 percent.

In exchange for medical treatment and in lieu of payment, the two patients 

executed an assignment of their plan benefits to Griffin. Both assignments are 

identical. By signing, the patient acknowledges that the document is “a direct legal 

assignment of my rights and benefits under this policy and designation of 

authorized representative” and “authorize[s] any plan administrator or fiduciary, 

insurer, and my attorney to release to such provider(s) any and all plan 

documents.” The assignment further provides that the patient has assigned “all 

medical benefits and/or insurance reimbursement, if any, otherwise payable to [the 

patient] for services rendered from such provider(s), regardless of such provider’s 

managed care network participation status.”

Griffin believed that the assignments entitled her to full payment for her 

services, as if she were an in-network provider. She submitted claims to United, 

which she alleges United only partially paid. Griffin appealed United’s payment 

determinations. In her appeals, Griffin made numerous requests, including: (1) 

that United disclose the plan’s unambiguous anti-assignment provision, should the 

USCA11 Case: 18-10418 Date Filed: 02/24/2021 Page: 5 of 26
6

plan have one; (2) copies of the plan documents; and (3) the identification of the 

Plan Administrator.

United denied each appeal and responded directly to the patients, copying 

Griffin on the communications. In each appeal denial, United explained that 

Griffin was not reimbursed the full amount of her charges because of the relevant 

plan’s provisions regarding out-of-network coverage and deductibles. United 

therefore upheld the payment determinations and did not address Griffin’s specific 

requests. Undeterred, Griffin submitted second level appeals for both claims and 

reiterated her requests. United again denied the appeals without addressing 

Griffin’s requests.

After exhausting her administrative remedies, Griffin, proceeding pro se, 

filed two complaints in Georgia state court: one against United and Coca-Cola, for 

her treatment of Patient J.J., and the other against United and Delta, for her 

treatment of Patient G.A. The operative complaints are nearly identical and bring 

the same four claims: failure to pay plan benefits under 29 U.S.C. § 1132 (Count 

1), breach of fiduciary duty under 29 U.S.C. § 1104 (Count 2), failure to provide 

plan documents under 29 U.S.C. §§ 1024(b), 1104, and 1132(2) (Count 3); and 

breach of co-fiduciary duties under 29 U.S.C. § 1105(a)(2) (Count 4). Defendants 

removed both lawsuits to the United States District Court for the Northern District 

of Georgia and moved to dismiss Griffin’s complaints for failure to state a claim.

USCA11 Case: 18-10418 Date Filed: 02/24/2021 Page: 6 of 26
7

Griffin was in familiar territory in the district court. In the last four years, 

Griffin has filed more than two dozen cases either directly in the Northern District 

of Georgia or in state court that were later removed to that district court.2

 All 

involve Griffin seeking reimbursement from health plans through her patients’ 

assignment of benefits. 

2 See Griffin v. Blue Cross and Blue Shield Healthcare Plan of Ga., Inc., et al, No. 1:14-

cv-1610-AT (N.D. Ga. filed May 28, 2014); Griffin v. S. Co. Servs., Inc., No. 1:15-cv-0115-AT 

(N.D. Ga. filed Jan. 14, 2015); Griffin v. SunTrust Bank, Inc., No. 1:15-cv-0147-AT (N.D. Ga. 

filed Jan. 16, 2015); Griffin v. FOCUS Brands Inc., No. 1:15-cv-0170-AT (N.D. Ga. filed Jan. 

20, 2015); Griffin v. Health Sys. Mgmt., Inc., No. 1:15-cv-0171-AT (N.D. Ga. filed Jan. 20, 

2015); Griffin v. Lockheed Martin Corp., No. 1:15-cv-0267-AT (N.D. Ga. filed Jan. 28, 2015); 

Griffin v. Gen. Mills, Inc., No. 1:15-cv-0268-AT (N.D. Ga. filed Jan. 28, 2015); Griffin v. 

Oldcastle, Inc., No. 1:15-cv-0269-AT (N.D. Ga. filed Jan 28, 2015); Griffin v. Habitat for 

Humanity Int’l, Inc., No. 1:15-cv-0369-AT (N.D. Ga. filed Jan 28, 2015); Griffin v. Verizon 

Commc’ns, Inc., No. 1:15-cv-0569-AT (N.D. Ga. filed Feb. 26, 2015); Griffin v. Humana 

Employers Health Plan of Ga., Inc., No. 1:15-cv-3574-AT (N.D. Ga. filed Oct. 8, 2015); Griffin 

v. Aetna Health Inc., et al., No. 1:15-cv-3750-AT (N.D. Ga. filed Oct. 26, 2015); Griffin v. Gen.

Elec. Co., No. 1:15-cv-4439-AT (N.D. Ga. filed Dec. 22, 2015); Griffin v. Navistar, Inc., No. 

1:16-cv-0190-AT (N.D. Ga. filed Jan. 21, 2016); Griffin v. Humana Employers Health Plan of 

Ga., Inc., No. 1:16-cv-0245-AT (N.D. Ga. filed Jan. 26, 2016); Griffin v. Coca-Cola Enters., 

Inc., No. 1:16-cv-0389-AT (N.D. Ga. filed Feb. 9, 2016); Griffin v. Sevatec, Inc., No. 1:16-cv0390-AT (N.D. Ga. filed Feb. 9, 2016); Griffin v. Cassidy Turley Com. Real Estate Servs.s, Inc., 

No. 1:16-cv-0496-AT (N.D. Ga. filed Feb. 17, 2016); Griffin v. Americold Logistics, LLC, No. 

1:16-cv-0497-AT (N.D. Ga. filed Feb. 17, 2016); Griffin v. Applied Indus. Techs., Inc., No. 1:16-

cv-0552-AT (N.D. Ga. filed Feb. 23, 2016); Griffin v. Areva, Inc., No. 1:16-cv-0553-AT (N.D. 

Ga. filed Feb. 23, 2016); Griffin v. FOCUS Brands, Inc., No. 1:16-cv-0791-AT (N.D. Ga. filed 

Mar. 10, 2016); Griffin v. Northside Hosp., Inc., No. 1:16-cv-1934-AT (N.D. Ga. filed June 10, 

2016); Griffin v. Crestline Hotels & Resorts, LLC, No. 1:16-cv-2022-AT (N.D. Ga. filed June 16, 

2016); Griffin v. Verizon Commc’ns, Inc., No. 1:16-cv-2639 (N.D. Ga. filed July 20, 2016); 

Griffin v. RightChoice Managed Care, Inc., et al, No. 1:16-cv-3102 (N.D. Ga. filed Aug. 23, 

2016); Griffin v. Aetna Health Inc., et al, No. 1:17-cv-00077 (N.D. Ga. filed Jan. 6, 2017); 

Griffin v. United Healthcare of Ga., Inc., et al, No. 1:17-cv-4561-AT (N.D. Ga. filed Nov. 13, 

2017); Griffin v.Coca-Cola Refreshments USA, Inc., et al, No. 1:17-cv-4656-AT (N.D. Ga. filed 

Nov. 20, 2017). Griffin v. Delta Air Lines, Inc., et al, No. 1:17-cv-4657-AT (N.D. Ga. Nov. 20, 

2017).

USCA11 Case: 18-10418 Date Filed: 02/24/2021 Page: 7 of 26
8

Similar to her past claims, her allegations here focus on United’s failure to 

disclose to her whether the plans had anti-assignment provisions, even though she

requested them in her claim appeals. And because Defendants did not provide her 

the plan documents containing those provisions, Griffin’s complaints allege that 

they cannot rely on them in defense of their lawsuit.

In their motions to dismiss Griffin’s complaints, Defendants asserted that the 

plans’ anti-assignment provisions rendered the assignment of benefits void. The 

plans each contain anti-assignment provisions. 3

 The Coca-Cola Plan provides: 

9.02 Assignment. If applicable, an Enrolled Person may authorize the 

Plan to directly pay the service provider or hospital that provided the 

Enrolled Person’s covered care and treatment. Except as provided in 

the foregoing sentence, and subject to Section 9.06 of this Plan 

relating to Qualified Medical Child Support Orders, an Enrolled 

Person may not assign or alienate any payment with respect to any 

Benefit which an Enrolled Person is entitled to receive from the Plan, 

and further, except as may be prescribed by law, no Benefits shall be 

subject to attachment or garnishment of or for an Enrolled Person’s 

debts or contracts, except for recovery of overpayments made on an 

Enrolled Person’s behalf by this Plan. 

Another section of the plan states, “While benefits payable at any time may be 

used to make direct payments to health care providers, no amount payable at any 

3 The Coca-Cola Plan has two operative plan documents: the Coca-Cola Company Health 

and Welfare Benefits Plan (“Wrap Document”) and the Summary Plan Descriptions and Benefit 

Policies (“SPD”). The SPD is incorporated by reference into the Plan through the Wrap 

Document. We refer to them together as the “Coca-Cola Plan.” 

The Delta Plan also has two operative plan documents: the Account-Based Healthcare 

Plan (“Wrap Document”) and the Summary Plan Descriptions and Benefit Policies (“SPD”). 

The SPD is incorporated by reference into the Plan through the Wrap Document. We refer to 

them together as the “Delta Plan.”

USCA11 Case: 18-10418 Date Filed: 02/24/2021 Page: 8 of 26
9

time shall be subject in any matter to alienation by assignment of any kind. Any 

attempt to assign any such amount shall be void.” The Coca-Cola Plan further

provides that beneficiaries “may not assign any rights or cause of action that [they]

may have against a third-party to recover medical expenses without the express 

written consent of the Plan Administrator.”

Similarly, the Delta Plan provides:

13.07 Anti-Alienation of Benefits. Except as required by law, no 

benefit, payment or distribution under the Plan shall be subject to the 

claim of any creditor of the Participant, or to any legal process by any 

creditor of the Participant, or to any legal process by any creditor of 

the Participant, and the participant shall not have any right to alienate, 

commute, anticipate or assign (either at law or in equity) all or any 

portion of any benefit, payment or distribution under the Plan except 

to the extent provided herein; provided, however, a Participant may 

make a voluntary and revocable assignment, but only for such 

purposes as the Administrative Committee may from time to time 

specify. 

Another section of the plan states: 

Except as required by law, no benefit, payment or distribution under 

the plans will be subject to the claim of any creditor of a participant, 

or to any legal process by any creditor of the participant, and the 

participant will not have any right to alienate, commute, anticipate or 

assign all or any portion of any benefit, payment or distribution under 

the plans. 

However, a participant may make a voluntary and revocable 

assignment, but only for such purposes as the Plan Administrator may 

specify from time to time. 

The district court dismissed both of Griffin’s complaints for failure to state a 

claim. Regarding her suit against Delta and United, the district court found the 

USCA11 Case: 18-10418 Date Filed: 02/24/2021 Page: 9 of 26
10

Delta Plan’s anti-assignment provisions barred all of Griffin’s claims. In its order 

dismissing the suit against Coca-Cola and United, the district court similarly found 

the Coca-Cola Plan’s anti-assignment provisions indisputably barred Griffin’s 

claim for payment under the plan (Count 1). The court also found that, even if the 

language of the anti-assignment provisions did not bar the remaining non-payment 

claims (Counts 2, 3, and 4), the assignment itself did not include the right to bring 

those non-payment claims. Accordingly, she lacked derivative statutory standing 

to bring those claims as well. The district court did not address Griffin’s waiver 

arguments. Griffin appealed the district court’s orders to this Court.

Griffin presents three issues on appeal. First, did the patients legally assign 

Griffin the right to bring the breach of fiduciary duty and statutory penalties claims 

(the “non-payment-related claims”) as well as benefit claims? Second, do the antiassignment provisions apply to Griffin’s claims for underpayment of benefits 

and/or the non-payment claims? Third, if they do apply to some or all of the 

claims, are Defendants estopped from relying on the anti-assignment provisions or 

have they otherwise waived the right to assert them?

We appointed Griffin counsel sua sponte and set this case for oral argument. 

After reviewing the record, the parties’ briefs, and oral argument, we affirm the 

lower court’s decisions. 

II. Standard of Review and ERISA

USCA11 Case: 18-10418 Date Filed: 02/24/2021 Page: 10 of 26
11

The Court of Appeals reviews “de novo the district court’s grant of a motion 

to dismiss under [Federal Rule of Civil Procedure] 12(b)(6) for failure to state a 

claim, accepting the allegations in the complaint as true and construing them in the 

light most favorable to the plaintiff.” Lanfear v. Home Depot, Inc., 679 F.3d 1267, 

1275 (11th Cir. 2012) (quoting Ironworkers Local Union 68 v. AstraZeneca 

Pharm., LP, 634 F.3d 1352, 1359 (11th Cir. 2011)). 

ERISA, which governs this case, sets the minimum standards for employee 

benefit plans, such as the healthcare plans at issue here. See 29 U.S.C. §§ 1001, 

1002. Section 502(a) of ERISA creates federal causes of action for recovery of 

benefits under such plans. See 29 U.S.C. § 1132(a)(1)(B) (“A civil action may be 

brought . . . by a participant or beneficiary . . . to recover benefits due to him under 

the terms of his plan, to enforce his rights under the terms of the plan, or to clarify 

his rights to future benefits under the terms of the plan[.]”). ERISA also allows 

participants to bring actions under section 502(a) against plan fiduciaries for 

breach of fiduciary duty. 29 U.S.C. § 1104. In addition, section 405(a) of ERISA

imposes co-fiduciary liability on all plan fiduciaries in certain circumstances. Id.. 

§ 1105. Finally, ERISA requires plan administrators, upon request, to provide plan 

information to participants and allows for participants to seek statutory penalties 

for a plan’s failure to do so. Id. § 1132(c)(1). Critically, to maintain an action 

under ERISA, a plaintiff must have standing to sue under the statute. Physicians 

USCA11 Case: 18-10418 Date Filed: 02/24/2021 Page: 11 of 26
12

Multispecialty Grp. v. Health Care Plan of Horton Homes, Inc., 371 F.3d 1291, 

1293–94 (11th Cir. 2004).4

 

In enacting ERISA, Congress broadly preempted state law relating to 

employee benefit plans. Mackey v. Lanier Collection Agency & Serv., Inc., 486 

U.S. 825, 829 (1988); see generally Pilot Life Ins. Co. v. Dedeaux, 481 U.S. 41 

(1987). Where ERISA is silent on an issue, Congress intended for courts to 

fashion a federal common law governing employee benefit plans. Glass v. United 

of Omaha Life Ins. Co., 33 F.3d 1341, 1347 (11th Cir. 1994). We have explained 

the process for determining federal common law under ERISA: 

To decide whether a particular rule should become part of ERISA’s 

common law, courts must examine whether the rule, if adopted, would 

further ERISA’s scheme and goals . . . ERISA has two central goals:

(1) protection of the interests of employees and their beneficiaries in 

employee benefit plans; and (2) uniformity in the administration of 

employee benefit plans. 

Horton v. Reliance Standard Life Ins. Co., 141 F.3d 1038, 1041 (11th Cir. 1998). 

When tasked with shaping federal common law in the ERISA context, this Court 

has explicitly relied on rules found in the Restatement of Contracts, see, e.g., 

Turner v. Am. Fed’n of Teachers Local 1565, 138 F.3d 878, 882 (11th Cir. 1998), 

4 As used in this context, standing is not jurisdictional, Article III standing, but rather the 

right to make a claim under the statute. Physicians Multispecialty Grp. v. Health Care Plan of 

Horton Homes, Inc., 371 F.3d 1291, 1293–94 (11th Cir. 2004).

USCA11 Case: 18-10418 Date Filed: 02/24/2021 Page: 12 of 26
13

and state law, see, e.g., Tippit v. Reliance Standard Life Ins. Co., 457 F.3d 1227, 

1235 (11th Cir. 2006) (using Georgia law to interpret ambiguous plan). 

III. Analysis

a. The Scope of the Patients’ Assignments 

We first determine the scope of the patients’ assignments to Griffin—

whether they purport to give her the right to bring both payment and non-payment 

(breach of fiduciary duties and statutory penalties) claims. 

To maintain an action under ERISA, a plaintiff must have statutory standing. 

ERISA limits the right to sue for plan participants, plan beneficiaries, plan 

fiduciaries, and the Secretary of Labor. 29 U.S.C. § 1132(a). “Healthcare 

providers . . . are generally not ‘participants’ or ‘beneficiaries’ under ERISA.” 

Physicians Multispecialty Grp., 371 F.3d at 1294. Still, an assignee may obtain 

derivative standing for payment of medical benefits through a written assignment 

from a plan participant or beneficiary. See Gables Ins. Recovery, Inc. v. Blue 

Cross & Blue Shield of Fla., Inc., 813 F.3d 1333, 1339 (11th Cir. 2015).

5

In this case, no party doubts that the assignments’ language purports to 

convey to Griffin a right to bring the claim for unpaid benefits. But Griffin argues 

that the patients assigned all their rights—including the right to bring fiduciary and 

5 For the reasons discussed herein, we need not decide whether the assignment of nonpayment 

claims provides derivative standing.

USCA11 Case: 18-10418 Date Filed: 02/24/2021 Page: 13 of 26
14

statutory penalty claims—under the plans because the assignments state: “This is a 

direct legal assignment of my rights and benefits under the policy.” That sentence, 

Griffin claims, is enough to transfer the participant’s right to bring claims both for 

unpaid payments and non-payment related claims.

In numerous unpublished decisions, we have rejected similar claims (all 

made by Griffin) regarding the assignment of the right to bring non-payment 

claims like those in Counts 2, 3, and 4. See, e.g., Griffin v. SunTrust Bank Inc., 

648 F. App’x 962, 967 (11th Cir. 2016) (“Nothing in an assignment of benefits 

transfers the patient’s right to bring a cause of action” for similar non-paymentrelated claims.); Griffin v. Health Sys. Mgmt. Inc, 635 F. App’x 768, 772 n.4 (11th 

Cir. 2015). Griffin argues that these prior decisions only examine particular lines 

in the assignment, and we have not considered the exact language she points to in 

this appeal. Because the language Griffin relies on in this appeal assigns both 

“rights and benefits under the policy,” Griffin claims, it expressly assigns the right 

to bring both payment and non-payment-related claims.

Even assuming this “rights and benefits” language evinces the assignment of 

two distinct rights—the right to bring claims for both payment and non-payment—

the assignments themselves contradict Griffin’s argument. The general form 

assignments on which Griffin relies contain 10 separately listed paragraphs 

outlining the scope of the assignments. The patients checked the box next to each 

USCA11 Case: 18-10418 Date Filed: 02/24/2021 Page: 14 of 26
15

one. None of the paragraphs mention breach of fiduciary duty or statutory penalty 

claims. Rather, they provide the details of Griffin’s “right” to receive the patients’ 

“medical information” and “payment of benefits” under the Plan. Therefore, the 

assignments make clear that the patients only assigned their right to bring claims 

for payment pursuant to 29 U.S.C. § 1132. Accordingly, the district court was 

correct to dismiss Griffin’s non-payment claims.

b. The Plans’ Anti-Assignment Provisions

i. Applicability to Griffin’s Payment Claim

We next turn to whether Griffin’s payment claim survives the language of 

the plans’ anti-assignment provisions. We find that her payment claim does not. 

We have held that “an unambiguous anti-assignment provision in an ERISAgoverned welfare benefit plan is valid and enforceable” against healthcare 

providers. Physicians Multispecialty Grp., 371 F.3d at 1296. The anti-assignment 

language in the plans at issue is unambiguous and thus enforceable. The CocaCola Plan says a participant “may not assign or alienate any payment with respect 

to any Benefit,” and “no amount payable at any time shall be subject in any matter 

to alienation by assignment of any kind. Any attempt to assign any such amount 

shall be void.” Similarly, the Delta Plan provides that “the participant shall not 

have any right to alienate, commute, anticipate or assign (either at law or in equity) 

all or any portion of any benefit, payment or distribution under the Plan.” And 

USCA11 Case: 18-10418 Date Filed: 02/24/2021 Page: 15 of 26
16

another provision similarly states: “the participant will not have any right to 

alienate, commute, anticipate or assign all or any portion of any benefit, payment 

or distribution under the plans.” On their face, these provisions restrict a patient’s 

ability to assign his rights and therefore bar Griffin’s claims.

In fact, Griffin “recognizes the weight of authority from this Court affirming 

the dismissals of several cases filed by Dr. Griffin based on the application of antiassignment provisions to similar claims brought by Dr. Griffin under ERISA for 

unpaid benefits.” But she urges this Court to reverse course and follow the Fifth 

Circuit’s lead in its 1992 opinion in Hermann Hospital v. MEBA Medical and 

Benefits Plan, 959 F.2d 569 (5th Cir. 1992), overruled in part on other grounds by 

Access Mediquip, L.L.C. v. United Healthcare Insurance Co., 698 F.3d 229, 230 

(5th Cir. 2012) (en banc).

In Hermann, the Fifth Circuit held that the defendant plan’s anti-assignment 

provisions were unenforceable against a healthcare provider. The patient in that 

case assigned “all rights, title and interest in the benefits payable for services 

rendered by the [healthcare provider]” to the provider-plaintiff. Id. at 571. The 

anti-assignment provision at issue stated: 

No employee, dependent or beneficiary shall have the right to assign, 

alienate, transfer, sell, hypothecate, mortgage, encumber, pledge, 

commute, or anticipate any benefit payment hereunder, and any such 

payment shall not be subject to any legal process to levy execution 

upon or attachment or garnishment proceedings against for the 

payment of any claims. 

USCA11 Case: 18-10418 Date Filed: 02/24/2021 Page: 16 of 26
17

Id. at 574. The Fifth Circuit held that the anti-assignment clause did not, by its 

terms, void the assignment to the provider because it did not explicitly cover 

healthcare providers. Id. at 575. The court found it would be inequitable to 

prevent providers from recovering for the services they rendered unless the 

participants first sued the plan and the provider then sued the participants. Id. 

Thus, Griffin claims that this Court should find the Coca-Cola Plan’s and Delta 

Plan’s anti-assignment provisions do not bar the assignments because she received 

the assignment in her capacity as a healthcare provider. 

But Griffin effectively asks this Court to invalidate an unambiguous contract 

provision which is valid and enforceable under our precedent based on the policy 

preferences of another circuit. We cannot depart from our precedent. See Wilson 

v. Taylor, 658 F.2d 1021, 1034 (5th Cir. May 1, 1981) (“It is the firm rule of this 

circuit that we cannot disregard the precedent set by a prior panel, even though we 

perceive error in the precedent. Absent an intervening Supreme Court decision 

which changes the law, only the en banc court can make the change.”). Thus, if 

nothing else prevents Defendants from relying on the anti-assignment provisions in 

this litigation, the provisions bar Griffin’s claims for unpaid benefits. 

ii. Void v. Voidable

Before we turn to Griffin’s remaining arguments as to why Defendants 

either waived or are estopped from relying on these anti-assignment provisions, we 

USCA11 Case: 18-10418 Date Filed: 02/24/2021 Page: 17 of 26
18

must address an often-overlooked threshold issue: whether the anti-assignment 

provisions make the assignments void or voidable.6

 If the assignments are void ab 

initio then there is no need to proceed to the equitable claims because each 

assignment is inherently null. On the other hand, if the assignments are merely 

voidable, then they are effective unless and until they are challenged. See, e.g., 

Pitts ex rel. Pitts v. Am. Sec. Life Ins. Co., 931 F.2d 351, 356 (5th Cir. 1991)

(discussing consequences of determining whether insurance policy was void rather 

than voidable). Estoppel and waiver would only be available defenses to a 

voidable anti-assignment clause. 

As discussed above, federal courts fill in the gaps Congress left in ERISA 

with federal common law. Glass, 33 F.3d at 1347. ERISA itself does not give an 

answer to the issue of void versus voidable. Nor have the parties addressed it. 

And federal courts have not discussed the distinction between void and voidable in 

the ERISA context. Courts sometimes even use these concepts interchangeably.7

6 Black’s Law Dictionary defines “void” as “[o]f no legal effect; to null.” Void, Black’s 

Law Dictionary (11th ed. 2019). Something that is “void ab initio” is “[n]ull from the beginning, 

as from the first moment when a contract is entered into. A contract is void ab initio if it 

seriously offends law or public policy, in contrast to a contract that is merely voidable at the 

election of one party to the contract.” Id. The term “voidable” is defined as “[v]alid until 

annulled,” that is, “capable of being affirmed or rejected at the option of one of the parties.” 

Voidable, Black’s Law Dictionary (11th ed. 2019).

7 “[C]ourts have lamented that ‘[t]he distinction between void and voidable is not as 

distinctly defined as could be wished.’ As a result, ‘[c]ourts have used the words “void,”

“voidable,” “invalid,” and “unenforceable” imprecisely’ or even interchangeably.” Jesse A. 

Schaefer, Beyond a Definition: Understanding the Nature of Void and Voidable Contracts, 33 

CAMPBELL L. REV. 193, 194 (2010) (quoting Arnold v. Fuller’s Heirs, 1 Ohio 458, 467 (Ohio 

USCA11 Case: 18-10418 Date Filed: 02/24/2021 Page: 18 of 26
19

Absent other guidance, we may look to the applicable state law to fill in 

ERISA’s gaps. Glass, 33 F.3d at 1347. The Georgia Code renders as void: (1) 

contracts to do immoral or illegal things, (2) contracts against public policy, and 

(3) gambling contracts. O.C.G.A. §§ 13-8-1, 13-8-2, 13-8-3. This definition 

comports with our century-old precedent: in 1906, the former Fifth Circuit 

explained: 

The distinction between ‘void’ and ‘voidable’ in their application to 

contracts is sometimes one of practical importance. A transaction 

may be void as to one party, and not as to another. When entire 

technical accuracy is desired, the term ‘void’ can only be properly 

applied to those contracts that are of no effect whatsoever, . . . or in

contravention of that which the law requires, and therefore incapable 

of confirmation or ratification. 

Haggart v. Wilczinski, 143 F. 22, 27 (5th Cir. 1906). The assignments here are not 

illegal. Nor do they contravene public policy. See Cagle v. Bruner, 112 F.3d 

1510, 1515 (11th Cir. 1997) (“[N]either § 1132(a) nor any other ERISA provision 

prevents derivative standing based upon an assignment of rights[.]”). And they 

have nothing to do with gambling. Accordingly, the assignments here are merely 

voidable rather than void ab initio and thus are enforceable unless and until 

Defendants raise the anti-assignment provisions. To put it another way, the 

1824) and Daugherty v. Kessler, 286 A.2d 95, 97 (Md. 1972)). This confusion is noted in 

Black’s Law Dictionary: “the word [void] is often used and construed as bearing the more liberal 

meaning of ‘voidable.’” Void, Black’s Law Dictionary (11th ed. 2019).

USCA11 Case: 18-10418 Date Filed: 02/24/2021 Page: 19 of 26
20

existence of those provisions did not automatically nullify the assignments, and 

thus equitable doctrines are available. Having said all that, we can turn to Griffin’s 

waiver and estoppel arguments. 

c. Waiver

Griffin argues that Defendants waived their right to rely on the antiassignment provisions because they did not alert her to their existence prior to 

litigation. We disagree. 

“Waiver is the voluntary, intentional relinquishment of a known right.” 

Glass, 33 F.3d at 1347; see also Pitts, 931 F.2d at 357; Appleman, Insurance Law 

and Practice, § 9251, at 488–89 (1981). Waiver can be express or implied from 

conduct. In re Garfinkle, 672 F.2d 1340, 1347 (11th Cir. 1982). “Where a party 

alleges an implied waiver, ‘the acts, conduct, or circumstances relied upon to show 

waiver must make out a clear case’” of intentional relinquishment. Witt v. Metro 

Life Ins. Co., 772 F.3d 1269, 1279 (11th Cir. 2014) (quoting In re Garfinkle, 672 

F.2d at 1347). 

Because ERISA does not address waiver, courts have fashioned federal 

common law to address cases where a defendant relies on a contractual provision

to defeat a claim. But various circuits have approached the problem differently. 

For example, the Fourth Circuit considers waiver to be a “prohibited concept” with 

respect to ERISA. Gagliano v. Reliance Standard Life Ins. Co., 547 F.3d 230, 239 

USCA11 Case: 18-10418 Date Filed: 02/24/2021 Page: 20 of 26
21

(4th Cir. 2008). Other circuits have reached the opposite conclusion. See, e.g. 

Glista v. Unum Life Ins. Co. of America, 378 F.3d 113, 132 (1st Cir. 2004) 

(insurance company waived its right to raise a policy’s clause for the first time in 

litigation). This circuit has “left open the question of whether waiver principles 

might apply under the federal common law in the ERISA context,” Witt, 772 F.3d 

at 1279, and we do so again today because we need not decide it. 

Even if the doctrine applies in the ERISA context, waiver would not be 

available under the facts of this case. None of the Defendants expressly 

relinquished its right to assert the anti-assignment clauses in litigation. And Griffin 

does not allege any acts that would indicate they intentionally did so. Boiled 

down, Griffin alleges that defendants ignored her pre-litigation requests for plan 

documents and any anti-assignment provisions, if they existed. Evidence that an 

insurance plan’s claims administrator ignored a third party’s pre-litigation request 

for information about a contract with another party, without more, is insufficient to 

show that the claims administrator or provider voluntarily or intentionally 

abandoned a contractual defense to litigation. Thus, even if waiver applied, 

Griffin’s allegations are insufficient to establish that the Defendants waived the 

anti-assignment provisions. 

d. Estoppel 

USCA11 Case: 18-10418 Date Filed: 02/24/2021 Page: 21 of 26
22

As an alternative to her waiver claim, Griffin argues that Defendants are 

equitably estopped from relying on the anti-assignment provisions because they 

did not respond to her pre-litigation inquiries as to whether the Coca-Cola Plan and 

the Delta Plan contained such provisions.

In the ERISA context, equitable estoppel applies 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 ambiguity.” Jones v. Am. Gen. Life & Acc. 

Ins. Co., 370 F.3d 1065, 1069 (11th Cir. 2004). Equitable estoppel in the ERISA 

context is “very narrow.” Id. 

The anti-assignments provisions in the two plans at issue here are not 

ambiguous. Even if they were, Griffin does not submit any evidence, or even 

allege, that Coca-Cola, Delta, or United made any representation to Griffin that 

informally interpreted the provision. A straightforward application of the narrow 

ERISA estoppel doctrine compels this Court to find that Griffin cannot turn to it 

here. 

Griffin asks this Court to rely on the Fifth Circuit’s decision in Hermann and 

the Sixth Circuit’s dicta in Sprague v. Gen. Motors Corp., 133 F.3d 388, 404 (6th 

Cir. 1998) to find that equitable estoppel’s ambiguity requirement does not apply 

to Griffin. We are unpersuaded. In Hermann, the Fifth Circuit held that the 

USCA11 Case: 18-10418 Date Filed: 02/24/2021 Page: 22 of 26
23

defendant was estopped from asserting that the anti-assignment clause applied 

because Hermann, the medical provider, “was not privy to” the plan documents 

and it was the defendant plan’s “responsibility to notify Hermann” of the antiassignment clause. 959 F.2d at 574. Similarly, in Sprague, the Sixth Circuit 

observed that the party asserting estoppel’s reliance “can seldom, if ever, be 

reasonable or justifiable if it is inconsistent with the clear and unambiguous terms 

of the plan documents available to or furnished to the party.” 133 F.3d at 404 

(emphasis added). But the facts of Hermann differ from the facts here. In that 

case, the payor repeatedly made false representations to the provider. See 

Hermann, 959 F.2d at 574. And in Sprague, the Sixth Circuit clarified that in 

order to assert an estoppel claim, “there must be conduct or language amounting to 

a representation of a material fact.” 133 F.3d at 403. Here, none of the Defendants 

made any representations directly to the provider: they communicated with the 

beneficiaries and copied Griffin on the communications. And while United did not 

provide Griffin with the requested information, neither did it lie to her.

Further, Griffin’s estoppel argument is foreclosed by our precedent. In the 

years following Herman and Sprague, this Court has never disregarded the 

ambiguity requirement. See, e.g., Jones, 370 F.3d at 1070 (“[W]hether proceeding 

on a breach of contract or equitable estoppel theory, an ERISA plaintiff can only 

succeed . . . if he can establish that the plan at issue is at least ambiguous with 

USCA11 Case: 18-10418 Date Filed: 02/24/2021 Page: 23 of 26
24

respect to the relevant benefits for which he claims entitlement.”). And, in the past 

five years, we have addressed Griffin’s estoppel argument in a series of 

unpublished decisions relating to similar claims based on similar facts. Each time, 

we held that equitable estoppel does not apply. See Griffin v. United Healthcare of 

Ga., Inc., 754 F. App’x 793, 797 (11th Cir. 2018) (“[E]quitable estoppel cannot 

apply” where plan documents were not provided); Griffin v. Coca-Cola Enters., 

Inc., 686 F. App’x 820, 822 (11th Cir. 2017) (same); Griffin v. Habitat for 

Humanity Int’l, Inc., 641 F. App’x 927, 932 (11th Cir. 2016) (same); Griffin v. 

Verizon Commc’ns, Inc., 641 F. App’x 869, 874 (11th Cir. 2016) (same); Griffin v. 

S. Co. Servs., 635 F. App’x 789, 795 (11th Cir. 2015) (same); Griffin v. Focus 

Brands, Inc., 635 F. App’x 796, 801 (11th Cir. 2015) (same); Griffin v. Health Sys. 

Mgmt., Inc., 635 F. App’x 768, 773 (11th Cir. 2015) (same). A decades-old case 

from another circuit does not disturb that conclusion. Equitable estoppel does not 

prevent plan administrators or claims fiduciaries from relying on anti-assignment 

provisions simply because they did not alert the provider of such provisions. 

In sum, although the assignments gave Griffin statutory standing pursuant to 

ERISA to bring claims for payment for the services she provided, the Defendants’ 

anti-assignment provisions made the assignments voidable. Even assuming waiver 

is available in the ERISA context, Defendants did not waive their ability to assert 

the anti-assignment provisions when Griffin filed claims against them. Neither 

USCA11 Case: 18-10418 Date Filed: 02/24/2021 Page: 24 of 26
25

does estoppel aid Griffin in avoiding the effect of the anti-assignment provisions. 

Therefore, the anti-assignment provisions deprived Griffin of her ability to bring

these ERISA claims. 

e. Failure to State a Claim

We make a final observation about Griffin’s claims before concluding. 

Assuming, arguendo, that Defendants’ plans did not have enforceable antiassignment provisions and Griffin had statutory standing to bring claims for 

payment pursuant to ERISA, Griffin would still fail to state a claim because she is 

not entitled to any more compensation than she already received. 

Recall that each assignment at issue is “a direct legal assignment of [the 

patient’s] rights and benefits under this policy and designation of authorized 

representative.” They also state: 

In considering the amount of medical expenses to be incurred, I, [the 

patient], have insurance and/or employee health care benefits 

coverage, and hereby assign and convey directly to the above named

healthcare provider(s), as my designated Authorized 

Representative(s), all medical benefits and/or insurance 

reimbursement, if any, otherwise payable to me for services rendered 

from such provider(s), regardless of such provider’s managed care 

network participation status. 

Griffin’s “managed care network participation status” is critical. The patients 

visited an out-of-network provider—Griffin. Had they paid Griffin out of pocket 

and filed a claim for reimbursement with United, United would have been 

obligated to reimburse the patients according to their policies for out of network 

USCA11 Case: 18-10418 Date Filed: 02/24/2021 Page: 25 of 26
26

providers. That analysis does not change simply because the patient assigned the 

payments to Griffin.

8

 Because the patients have no right to full reimbursement for 

the charged services, neither does Griffin. The assignment changes nothing. 

Either way, Griffin does not have a claim against Defendants. 

We therefore AFFIRM the district court’s orders. 

8 For example, Griffin charged Patient J.J. $129.96 for the office visit. Patient J.J.’s plan 

covered 60 percent of that charge. Therefore, United directly paid Griffin $77.98. United paid 

Griffin exactly what it would have paid the Patient J.J. if that patient had followed the process 

above. 

USCA11 Case: 18-10418 Date Filed: 02/24/2021 Page: 26 of 26