Many medical providers have their patient sign a form assigning the right to all benefits
under their health plan to the provider as part of the consideration for services rendered. This
allows the doctor then to stand in the patient’s shoes and sue the healthcare plan directly should
the need arise. In the case, Griffin v. Focus Brands Inc., (11 th Circuit December 30, 2015) Dr.
Griffin claimed she stood in the shoes of her patient and sued the health plan directly for failing
to pay benefits. The plan had an anti-assignment provision to prevent this. (No doubt the Plan
thought few individuals would be able to pursue litigation.) The doctor relied in part upon a
Georgia statute which she argues barred the plan’s anti-assignment provision. The court,
however, held that the statute did not explicitly bar anti-assignment provisions and therefore Dr.
Griffin had no standing to assert a cause of action for benefits under ERISA. Her case was
dismissed. She had also filed several other cases under this same theory and they all were
dismissed for similar reasons.
While state laws regulating insurance are enforceable under ERISA, unless the law is
unambiguous and clear, plan provisions will be strictly followed by the courts in the 11 th Circuit.
Need legal assistance? Call a ERISA lawyer of Tuscaloosa today for a consultation!