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Griffin v. Committee of UAW Retiree Medical Benefits Trust

United States District Court, E.D. Michigan, Southern Division

November 16, 2016

W.A. GRIFFIN, M.D., Plaintiff,
v.
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]

          GEORGE CARAM STEEH UNITED STATES DISTRICT JUDGE

         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 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 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 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 ...


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