W. A. Griffin, M.D. v. Blue Cross Blue Shield Healthcare Plan of Georgia, Inc.

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[DO NOT PUBLISH]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
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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
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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).
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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.
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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.