Griffin v. UAW Retiree Medical Benefits Trust, Committee of et al

Filing 17

ORDER granting 12 defendants' Motion for judgment on the pleadings. Signed by District Judge George Caram Steeh. (MBea)

UNITED STATES DISTRICT COURT
EASTERN DISTRICT OF MICHIGAN
SOUTHERN DIVISION

W.A. GRIFFIN, M.D.,
Plaintiff,
Case No. 16-12002
vs.
HON. GEORGE CARAM STEEH
COMMITTEE OF THE UAW RETIREE
MEDICAL BENEFITS TRUST, and
UAW RETIREE MEDICAL BENEFITS
TRUST,
Defendants.
________________________________/
ORDER GRANTING DEFENDANTS’ MOTION
FOR JUDGMENT ON THE PLEADINGS [DOC. 12]
Plaintiff W.A. Griffin, M.D. filed this action asserting pro se claims against
defendants the UAW Retiree Medical Benefits Trust (“UAW Trust”) and the Committee
of the UAW Retiree Medical Benefits Trust (“UAW Committee”) under the Employee
Retirement Income Security Act of 1974 (“ERISA”). The matter is before the court on
defendants’ motion for judgment on the pleadings. For the reasons stated herein,
defendants’ motion for judgment on the pleadings is GRANTED.
FACTUAL BACKGROUND
Plaintiff W.A. Griffin, M.D., is a dermatologist who is suing defendants under two
purported assignments of benefits from her patient, one from October 2013 and one
dated March 2016. Specifically, plaintiff alleges that defendants failed to pay a benefit
of $2,150 for medical services she provided to a participant in the UAW Trust in 2013
(Count I), failed to provide a fair review of plaintiff’s claim for benefits (Count II), failed to
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provide certain plan documents which allegedly triggered a statutory penalty of
$500,000 (Count III), and breached fiduciary duties owed under ERISA (Count IV).
The UAW Trust is an “employee welfare benefit plan” as defined by ERISA §
3(1). Among the benefits offered by the UAW Trust is medical coverage that is provided
to eligible retirees of General Motors. The UAW GM Retirees Medical Benefits Plan
Document (“Plan Document”) and the UAW Retiree Medical Benefits Trust Summary
Plan Description (“SPD”) identify the UAW Committee as the Plan Administrator as
defined by ERISA § 3(16)(A). The Plan Document provides that “[e]xcept as expressly
authorized by the Plan . . . benefits, claims, coverage or other interests in the Plan may
not be assigned, transferred, or alienated by a Primary Enrollee.” The SPD contains
identical anti-assignment language.
In its role as Plan Administrator, the UAW Committee delegated fiduciary
authority for all medical benefit claims and appeals at issue to Blue Cross Blue Shield of
Michigan or, for out-of-network claims, to the respective Blue Cross Blue Shield plan
operating in the state in which a UAW Trust participant received medical treatment.
Plaintiff operates a medical practice in Fulton County, Georgia. On October 7,
2013, plaintiff treated a patient identified as C.R., a retired General Motors’ employee
who was eligible for benefits under the UAW Trust. As a condition of treatment, plaintiff
required C.R. to sign a document titled “Legal Assignment of Benefits and Designation
of Authorized Representative For The Release of Medical and Health Plan Documents
For The Claims Processing & Reimbursement As Required by Federal and State Laws”
(“October 2013 Assignment”).
Plaintiff billed $5,478.01 for the medical services rendered to C.R., and submitted
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a claim to Blue Cross Blue Shield of Georgia (“BCBS Georgia”) for such amount. BCBS
Georgia paid plaintiff $988.09 on the claim. Plaintiff filed an appeal with BCBS Georgia
on November 4, 2013 for additional amounts she claimed were owed on the claim.
Plaintiff also requested that BCBS Georgia provide her with various plan documents
related to the Plan covering C.R.
On January 22, 2014, BCBS Georgia denied the appeal, explaining that BCBS
Georgia only denied a charge not covered by the Plan and that C.R. was responsible for
paying the difference. Plaintiff did not seek payment from C.R., but instead proceeded
to serve four additional demands for payment and plan documents upon BCBS Georgia
between January and March 2014. With each claim or appeal, plaintiff provided a copy
of the October 2013 assignment of benefits and expressly warned BCBS Georgia that
they could not assert any anti-assignment provisions against her if they did not notify
her of such provisions. On April 21, 2014, after receiving her last appeal decision,
plaintiff wrote BCBS Georgia a note which stated she “will deem all entered appeals
exhausted.”
On March 18, 2016, plaintiff obtained a second assignment of benefits from C.R.,
which purports to be “retroactive” to October 7, 2013. The language in the March 2016
assignment is identical to that of the October 2013 assignment, but additionally contains
a provision purporting to allow plaintiff “to stand in [C.R.’s] shoes and pursue claims for
benefits, statutory penalties, breach of fiduciary duty, any ERISA claim matter, and any
state claim.”
STANDARD FOR JUDGMENT ON PLEADINGS
A motion for judgment on the pleadings under Federal Rule of Civil Procedure
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12(c) is reviewed under the same standard as a motion to dismiss under Federal Rule
of Civil Procedure 12(b)(6). See e.g., Sensations, Inc. v. City of Grand Rapids, 526
F.3d 291, 295-96 (6th Cir. 2008).
Rule 12(b)(6) allows the Court to make an assessment as to whether the plaintiff
has stated a claim upon which relief may be granted. Under the Supreme Court’s
articulation of the Rule 12(b)(6) standard in Bell Atlantic Corp. v. Twombly, 550 U.S.
544, 554-56 (2007), the Court must construe the complaint in favor of the plaintiff,
accept the allegations of the complaint as true, and determine whether plaintiff’s factual
allegations present plausible claims.

“[N]aked assertions devoid of further factual

enhancement” are insufficient to “state a claim to relief that is plausible on its face”.
Ashcroft v. Iqbal, 129 S. Ct. 1937, 1949 (2009). To survive a Rule 12(b)(6) motion for
dismiss, plaintiff’s pleading for relief must provide “more than labels and conclusions,
and a formulaic recitation of the elements of a cause of action will not do.” Ass’n of
Cleveland Fire Fighters v. City of Cleveland, 502 F.3d 545, 548 (6th Cir. 2007) (quoting
Bell Atlantic, 550 U.S. at 555) (citations and quotations omitted). Even though the
complaint need not contain “detailed” factual allegations, its “factual allegations must be
enough to raise a right to relief above the speculative level on the assumption that all of
the allegations in the complaint are true.” Id. (citing Bell Atlantic, 550 U.S. at 555).
ANALYSIS
I. Anti-Assignment Clause in the UAW Plan
Under the ERISA statutory scheme, only the following may bring an ERISA civil
enforcement action: participants of a plan, beneficiaries of a plan, fiduciaries of a plan,
and the Secretary of Labor. ERISA §§ 502(a)(1)(B), (a)(2) and (a)(3). As a healthcare
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provider, plaintiff does not qualify as any of the enumerated parties authorized by
ERISA to sue the UAW Trust or the UAW Committee. Plaintiff asserts instead that she
“has derivative standing [to sue] . . . as an assignee of the member’s benefits and rights
under the health plan . . . .” Complaint ¶ 5.
The relevant Plan Document provides that “[e]xcept as expressly authorized by
the Plan . . . benefits, claims, coverage or other interests in the Plan may not be
assigned, transferred, or alienated by a Primary Enrollee.” In addition, the SPD, which
is distributed to all plan participants, contains identical anti-assignment language. The
majority of federal courts that have considered the issue have concluded that an
assignment is void if the plan contains an anti-assignment provision, reasoning that the
issue of assignability should be left to the agreement of the contracting parties. See,
e.g., Physicians Multispecialty Grp. v. Health Care Plan of Horton Homes, Inc., 371 F.3d
1291, 1295 (11th Cir. 2004) (citing cases).
In response to the argument that the UAW Plan did not consent to C.R.’s
purported assignment, and therefore such assignment is invalid, plaintiff argues that the
UAW waived the right to assert lack of standing. According to plaintiff, each time she
submitted a claim or an appeal, she submitted a copy of the October 2013 assignment
of benefits from C.R. with accompanying language telling the UAW that the Plan would
not be able to assert anti-assignment provisions if they failed to notify her of such
provisions.
To establish equitable estoppel, plaintiff must allege “‘conduct or language
amounting to a representation of material fact’” and “‘an intention on the part of the party
to be estopped [the UAW Trust] that the representation be acted on, or conduct toward
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the party asserting the estoppel [Dr. Griffin] such that the latter has a right to believe
that the former’s conduct is so intended.’” Armistead v. Vernitron Corp., 944 F.2d 1287,
1298 (6th Cir. 1991) (citations omitted), abrogated on other grounds by M & G Polymers
USA, LLC v. Tackett, 135 S.Ct. 926 (2015). In this case, plaintiff has not alleged any
representation by the UAW Trust or the UAW Committee. Instead, plaintiff alleges that
BCBS Georgia, the plan administrator, was silent when confronted with the antiassignment issue. But “estoppel requires more than mere silence.” TWM Mfg. Co. v.
Dura Corp., 592 F.2d 346, 350 (6th Cir. 1979).
Finally, to the extent plaintiff is alleging waiver of the anti-assignment clause,
courts do not recognize waiver in the ERISA context. See Schornhorst v. Ford Motor
Co., 606 F. Supp. 2d 658, 670 (E.D. Mich. 2009). With each claim or appeal, plaintiff
states that she expressly warned BCBS Georgia that they could not assert any antiassignment provisions against her if they did not first notify her of such provisions.
Based on BCBS Georgia’s silence, plaintiff describes being under the “assumption” that
the UAW plan permitted provider assignments. Waiver is the voluntary or intentional
relinquishment of a known right. Id. Plaintiff has failed to allege any evidence of waiver
by the UAW Trust or UAW Committee, relying entirely on the silence of a third party.
The court finds that the express terms of the Plan’s anti-assignment provision
control and, therefore, plaintiff does not have standing to assert a derivative claim
against defendants under ERISA § 502. Counts I, II, III and IV are dismissed for lack of
standing.
II. 2013 and 2016 Assignments
Even if the October 2013 Assignment is valid notwithstanding the UAW Trust’s
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anti-assignment language, the terms of the 2013 Assignment require dismissal of
Counts II, III, and IV for lack of standing. The 2013 assignment by its express language
states that the patient purports to assign to plaintiff the right to pursue a claim for unpaid
medical benefits. This exact language has been construed by other courts in which Dr.
Griffin brought similar claims based on an assignment from a patient: “Dr. Griffin’s
patient agreed only to ‘assign and convey . . . all medical benefits and/or insurance
reimbursement.’ . . . Nothing in the assignment transferred the patient’s right to bring a
cause of action for breach of fiduciary duty or to seek equitable relief to redress a
practice that violates ERISA or the terms of the Plan.” Griffin v. Lockheed Martin Corp.,
No. 15-13515, 2016 WL 1397707, at *3 (11th Cir. Apr.11, 2016). The October 2013
assignment does not assign any claims by C.R. to enforce ERISA’s claims and appeals
rules (Count II), to pursue claims for statutory penalties (Count III), or to sue for breach
of fiduciary duty (Count IV). Plaintiff’s claim for unpaid medical benefits owed under the
Plan would be capped at $2,501.
Plaintiff relies on the March 2016 assignment, which is broader than the October
2013 assignment, and which is purportedly retroactive to October 2013. The new
provision in the 2016 assignment purports to allow plaintiff “to stand in [C.R.’s] shoes
and pursue claims for benefits, statutory penalties, breach of fiduciary duty, any ERISA
claim matter, and any state claim.” Not only is the 2016 assignment void for conflicting
with the anti-assignment language in the UAW Plan documents, this after-acquired
assignment does not otherwise confer standing. First, this assignment, obtained years
after the medical services at issue were rendered and lacking in consideration, is not a
valid contract. Second, plaintiff did not and could not have presented the new
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assignment to the UAW Trust or BCBS Georgia during the 2013 and 2014 time period
when plaintiff was filing appeals and demanding claim documents for the very reason
that she had not yet obtained it. The 2016 assignment is void and unenforceable and
does not provide a basis for standing.
Having found that plaintiff lacks standing to bring each of the claims in her
complaint, the court grants defendants’ motion for judgment on the pleadings. It is
unnecessary to address the addition arguments made by defendants in support of their
motion.
CONCLUSION
For the reasons stated above, defendants’ motion for judgment on the pleadings
is GRANTED.
Dated: November 16, 2016
s/George Caram Steeh
GEORGE CARAM STEEH
UNITED STATES DISTRICT JUDGE

CERTIFICATE OF SERVICE
Copies of this Order were served upon attorneys of record on
November 16, 2016, by electronic and/or ordinary mail and
also on W. A. Griffin, 550 Peachtree Street NE,
Suite 1490, Atlanta, GA 30308.
s/Barbara Radke
Deputy Clerk

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