Opinion ID: 4662542
Heading Depth: 1
Heading Rank: 3

Heading: analysis

Text: 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. 13 USCA11 Case: 18-10417 Date Filed: 02/24/2021 Page: 14 of 26 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 In numerous unpublished decisions, we have rejected similar claims (all made by Griffin) regarding the assignment of the right to bring non-payment claims like those in Counts 2, 3,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 14 USCA11 Case: 18-10417 Date Filed: 02/24/2021 Page: 15 of 26 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 15 USCA11 Case: 18-10417 Date Filed: 02/24/2021 Page: 16 of 26 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. 16 USCA11 Case: 18-10417 Date Filed: 02/24/2021 Page: 17 of 26 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 17 USCA11 Case: 18-10417 Date Filed: 02/24/2021 Page: 18 of 26 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 18 USCA11 Case: 18-10417 Date Filed: 02/24/2021 Page: 19 of 26 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). 19 USCA11 Case: 18-10417 Date Filed: 02/24/2021 Page: 20 of 26 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 20 USCA11 Case: 18-10417 Date Filed: 02/24/2021 Page: 21 of 26 (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 21 USCA11 Case: 18-10417 Date Filed: 02/24/2021 Page: 22 of 26 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 22 USCA11 Case: 18-10417 Date Filed: 02/24/2021 Page: 23 of 26 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 23 USCA11 Case: 18-10417 Date Filed: 02/24/2021 Page: 24 of 26 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 24 USCA11 Case: 18-10417 Date Filed: 02/24/2021 Page: 25 of 26 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 25 USCA11 Case: 18-10417 Date Filed: 02/24/2021 Page: 26 of 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. 26