Opinion ID: 4517063
Heading Depth: 2
Heading Rank: 2

Heading: Assignment of Benefits

Text: We now turn to the substantive question of whether CSS has established a valid assignment, and therefore has standing. Our court has held that “ERISA health care benefits are assignable. ERISA contains no antiassignment provision with regard to health care benefits of ERISA-governed medical plans, nor is there any language in the statute which even remotely suggests that such assignments are proscribed or ought in any way to be limited.” Hermann Hosp. v. MEBA Med. & Benefits Plan, 845 F.2d 1286, 1289 (5th Cir. 1988) (Hermann I). CSS contends that the contracts assign all rights to CSS, pointing to an example in a document submitted by BCBSLA that reads in relevant part: “I hereby assign all medical benefits to which I am entitled to CSS Ltd., Corp. If insurance payments for CSS are sent directly to me, I will endorse and send to CSS promptly . . . I assume responsibility for payment if insurance claim is denied and for any monies owed for any co-insurance or deductible amounts. I will insure payment of any outstanding balance due after claim is processed.” CSS alleges that this language covers all medical benefits and all rights to payment. Conversely, BCBSLA contends that even assuming these forms are valid and enforceable, they do not assign the right to file suit for benefits or for breach of fiduciary duty, or the right to request plan documents. To support its position, BCBSLA cites to controlling precedent stating that “only an express and knowing assignment of an ERISA fiduciary breach claim is valid.” Texas Life, Acc. Health & Hosp. Serv. Ins. Guar. Ass’n v. Gaylord Entertainment Co., 105 F.3d 210, 218–19 (5th Cir. 1997) (holding that a broad provision assigning the rights of anyone accepting benefits under the relevant 7 Case: 18-31034 Document: 00515347305 Page: 8 Date Filed: 03/17/2020 No. 18-31034 act was insufficient to assign the fiduciary breach claims). Additionally, following CSS’s Rule 26(a) disclosures wherein CSS failed to disclose assignment forms for several of the claimed patients, BCBSLA challenged the factual allegation that CSS had actually obtained valid assignments on behalf of all of the claimed plan participants. Accordingly, the burden then shifted to CSS to produce evidence of valid and enforceable assignments. Yet, despite having leave to amend its complaint and to file supplemental briefs, CSS did not submit any materials attempting to prove subject matter jurisdiction, instead focusing on its contention that it should not have to provide evidence at this stage in the pleadings. However, as our precedent makes clear, Rule 12(b)(1) requires the district court to evaluate jurisdiction, with the burden of proof on CSS. CSS nevertheless failed to attach any of the purported assignments to its complaint, its amended and supplemental complaint, or any of the four briefs submitted in response to the pending motion to dismiss. As the district court noted, this repeated failure undermines the allegation that CSS had obtained valid assignments of rights it asserts herein. Because CSS failed to meet its burden of proving, by a preponderance of the evidence, that it had obtained valid assignments, the district court correctly concluded that BCBSLA is entitled to dismissal. But even assuming arugendo that the language of the form cited by CSS assigns a right to bring suit, there can be no valid assignment because the contract includes anti-assignment language: A Member’s rights and Benefits under this Contract are personal to the Member and may not be assigned in whole or in part by the Member. We will recognize assignments of benefits to Hospitals if both this Contract and the Provider are subject to La. R.S. 40:2010. If both this Contract and the Provider are not subject to La. R.S. 40:2010, We will not recognize assignments or attempted assignments of benefits. Nothing contained in the written description of health coverage shall be construed to make the 8 Case: 18-31034 Document: 00515347305 Page: 9 Date Filed: 03/17/2020 No. 18-31034 health plan or Us liable to any third party to whom a Member may be liable for the cost of medical care, treatment, or services. CSS counters that BCBSLA is estopped from asserting the anti-assignment language.