Court Opinion

ID: 9911098
Source: CourtListenerOpinion
Date Created: 2023-12-19 16:01:39.51493+00
Date Added: 2024-06-11T12:55:51.793050
License: Public Domain

USCA11 Case: 23-11414    Document: 25-1     Date Filed: 12/19/2023   Page: 1 of 5

                                                  [DO NOT PUBLISH]
                                   In the
                United States Court of Appeals
                        For the Eleventh Circuit

                          ____________________

                                No. 23-11414
                          Non-Argument Calendar
                          ____________________

       W. A. GRIFFIN, MD,
                                                     Plaintiﬀ-Appellant,
       versus
       BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF
       GEORGIA, INC.,

                                                   Defendant-Appellee.

                          ____________________

                 Appeal from the United States District Court
                    for the Northern District of Georgia
                    D.C. Docket No. 1:22-cv-01341-SEG
USCA11 Case: 23-11414      Document: 25-1      Date Filed: 12/19/2023     Page: 2 of 5

       2                      Opinion of the Court                  23-11414

                            ____________________

       Before WILSON, LUCK, and ANDERSON, Circuit Judges.
       PER CURIAM:
              W.A. Griffin, M.D., proceeding pro se, appeals an order of
       the district court dismissing her claim under the Employee Retire-
       ment Income Security Act (“ERISA”) against Blue Cross Blue
       Shield Healthcare Plan of Georgia (“BCBSHP”). The court dis-
       missed her claim pursuant to Federal Rule of Civil Procedure
       12(b)(6), based on its finding that she lacked statutory authority to
       bring penalty claims under ERISA. On appeal, Griffin argues that
       her patients assigned her the right to bring statutory penalty claims
       on their behalf, and that ERISA does not preempt O.C.G.A.
       § 33-24-54, which allegedly validates the assignments upon which
       she relies.
               We review de novo a dismissal pursuant to Federal Rule of
       Civil Procedure 12(b)(6). Hoﬀman-Pugh v. Ramsey, 312 F.3d 1222,
       1225 (11th Cir. 2002). “To survive a 12(b)(6) 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.” Stillwell v.
       Allstate Ins. Co., 663 F.3d 1329, 1333 (11th Cir. 2011) (quotation
       marks omitted). The 12(b)(6) plausibility standard requires “plead-
       ing factual content that allows the court to draw the reasonable in-
       ference that the defendant is liable for the misconduct alleged.”
       Mamani v. Berzain, 654 F.3d 1148, 1153 (11th Cir. 2011) (quotation
       marks omitted). However, the plausibility standard requires “more
USCA11 Case: 23-11414      Document: 25-1     Date Filed: 12/19/2023     Page: 3 of 5

       23-11414               Opinion of the Court                         3

       than a sheer possibility that a defendant has acted unlawfully.” Id.
       (quotation marks omitted). In considering a complaint under this
       standard, “[l]egal conclusions without adequate factual support are
       entitled to no assumption of truth.” Id.
              “Pro se pleadings are held to a less stringent standard than
       pleadings drafted by attorneys and will, therefore, be liberally con-
       strued.” Tannenbaum v. United States, 148 F.3d 1262, 1263 (11th Cir.
       1998). However, a pro se litigant is nonetheless “subject to the rele-
       vant law and rules of court, including the Federal Rules of Civil
       Procedure.” Moon v. Newsome, 863 F.2d 835, 837 (11th Cir. 1989).
              Section 502(c)(1)(B) of ERISA states that any administrator
       of an ERISA-governed healthcare plan
             who fails or refuses to comply with a request for any
             information which such administrator is required by
             this subchapter to furnish to a participant or beneﬁ-
             ciary (unless such failure or refusal results from mat-
             ters reasonably beyond the control of the administra-
             tor) by mailing the material requested to the last
             known address of the requesting participant or bene-
             ﬁciary within 30 days after such request may in the
             court’s discretion be personally liable to such partici-
             pant or beneﬁciary in the amount of up to $100 a day
             from the date of such failure or refusal, and the court
             may in its discretion order such other relief as it
             deems proper.
       29 U.S.C. § 1132(c)(1)(B). “[T]o maintain an action under ERISA, a
       plaintiﬀ must have standing to sue under the statute.” Griﬃn v.
       Coca-Cola Refreshments USA, Inc., 989 F.3d 923, 931 (11th Cir. 2021).
USCA11 Case: 23-11414      Document: 25-1     Date Filed: 12/19/2023     Page: 4 of 5

       4                      Opinion of the Court                 23-11414

       However, in this context, standing “is not jurisdictional, Article III
       standing, but rather the right to make a claim under the statute.”
       Id. at 931 n.4.
              To have standing to assert an ERISA claim, a plaintiﬀ must
       be either a “participant or beneﬁciary” of an ERISA healthcare
       plan. 29 U.S.C. § 1132(a)(1). While healthcare providers are gener-
       ally not “participants” or “beneﬁciaries” under ERISA, we have
       stated that a healthcare provider “may obtain derivative standing
       for payment of medical beneﬁts through a written assignment
       from a plan participant or beneﬁciary.” Coca-Cola, 989 F.3d at 932.
       However, we have previously ruled that a written assignment of
       the right to recover beneﬁts provided by an ERISA plan does not
       necessarily transfer the right to pursue non-payment claims, includ-
       ing statutory penalties. Id.). Thus, to assess whether one has trans-
       ferred the right to assert claims for statutory penalties under
       ERISA, we must “ﬁrst determine the scope of the patients’ assign-
       ments to [the healthcare provider]—whether they purport to give
       her the right to bring both payment and non-payment (breach of
       ﬁduciary duties and statutory penalties) claims.” Id.
             When previously considering a similar argument (raised by
       the same appellant), we ruled that, in the absence of more speciﬁc
       language, a patient does not transfer of the right to assert ERISA
       claims for statutory penalties when she executes a written assign-
       ment stating “[t]his is a direct legal assignment of my rights and
       beneﬁts under the policy.” Id. at 932-33.
USCA11 Case: 23-11414         Document: 25-1         Date Filed: 12/19/2023         Page: 5 of 5

       23-11414                   Opinion of the Court                                5

              Here, the district court did not err in ﬁnding that Griﬃn
       lacked statutory standing to bring statutory penalty claims under
       ERISA on behalf of her patients. The assignment in the instant
       case used the same language—i.e. assigning “my rights and bene-
       ﬁts”—as did the assignment in the Coca-Cola case. The court
       properly relied upon our prior decisions in ﬁnding that the assign-
       ments upon which Griﬃn relied did not include suﬃciently explicit
       language to transfer the right to bring non-payment, statutory pen-
       alty suits under ERISA. 1 Accordingly, we aﬃrm. 2
               AFFIRMED.

                1 The district court’s decision concerned only the scope of the assign-
       ments upon which Griffin relied, rather than their underlying validity or en-
       forceability. Thus, we do not address Griffin’s arguments on appeal related to
       ERISA preemption and O.C.G.A. § 33-24-54, as they are irrelevant to the basis
       for the district court’s order. Because we agree with the district court that
       Griffin lacks statutory standing to bring her claims for statutory penalties, we
       need not address BCBSHP’s argument that her claims are barred by the statute
       of limitations.
                2 We note that Griffin’s brief on appeal does not challenge the district
       court’s dispositive ruling; she makes no argument with respect to the specific
       language of the assignment and whether the language is broad enough to as-
       sign claims for statutory penalties. Because this case is controlled in any event
       by our Coca-Cola case, we need not address the issue of whether Griffin should
       be deemed to have forfeited this dispositive issue.