United States District Court, W.D. Virginia, Lynchburg Division
Lynchburg Division W.A. Griffin, Plaintiff,
Areva, Inc., Defendant.
K. MOON UNITED STATES DISTRICT JUDGE.
case is before the Court upon Defendant’s motion to
dismiss. Plaintiff W.A. Griffin (“Griffin”)-a
medical doctor and serial litigant in federal court who is
proceeding pro se-filed this action against
Defendant Areva, Inc. (“Areva”), alleging that
Areva failed to pay benefits due under the terms of its
insurance plan, unlawfully ignored requests to provide plan
documents, and breached co-fiduciary duties owed under the
Employee Retirement Income Security Act
(“ERISA”). Areva argues that Griffin lacks
statutory standing and that her case attempts to relitigate
an identical dispute resolved by a federal district court in
Georgia earlier this year. The motion is ripe for
Griffin’s action is barred by res judicata,
Areva’s motion will be granted. Areva also asks for a
prefiling injunction against Griffin. This is a drastic
sanction which-although plausibly sought in this case-need
not be imposed at this time, because less draconian remedies
may be sufficient.
complaint alleges the following facts. Areva is a health
insurance corporation which administers plans through agent
companies, one of which is Blue Cross Blue Shield HealthCare
Plan of Georgia (“Blue Cross”). (Compl.
¶¶ 4-5). Griffin is a resident of Fulton County,
Georgia, and operates a small dermatology practice in the
area. Id. ¶ 3.
April 30, 2013, A.H., one of Griffin’s patients,
reported to Griffin’s office for surgery, and signed a
document assigning to Griffin all of the rights and benefits
arising under his health insurance policy with Blue Cross.
Additionally, Griffin contacted Blue Cross to verify
A.H.’s insurance coverage. Griffin subsequently
performed the surgery. Id. ¶¶ 21-22.
determine the proper amount to bill a health insurance
provider for services rendered, Griffin consults a national
database called Fair Health, Inc., which furnishes uniform
billing data based upon the particular medical service
provided and the patient’s geography. Id.
¶ 18. According to her complaint, Griffin consulted this
database and determined that the proper billing amount for
the surgery she performed on A.H. was $2, 148.02. Griffin
subsequently submitted a claim for this amount to Blue Cross.
Id. ¶¶ 23.
of paying the full claim amount, Blue Cross only covered $997
of the charge. Griffin was directly compensated $287.72. She
claims that Blue Cross owes her an additional $1, 414.39 on
the claim. Id. ¶ 24.
later sent two requests to appeal the claim to Blue Cross, on
May 17, 2013, and July 6, 2013, respectively. The second
appeal request also included a demand for policy documents.
Each of these appeal requests were ignored by Blue Cross, and
Griffin did not receive any of the documents she requested,
nor has she received any additional compensation.
Id. ¶¶ 26-27.
evaluating a Rule 12(b)(6) motion to dismiss for failure to
state a claim, the Court must accept as true all well-pled
allegations. See Vitol, S.A. v. Primerose Shipping
Co., 708 F.3d 527, 539 (4th Cir. 2013); see also
Erickson v. Pardus, 551 U.S. 89, 94 (2007). “While
a complaint attacked by a Rule 12(b)(6) motion to dismiss
does not need detailed factual allegations, a
plaintiff’s obligation to provide the grounds of his
entitlement to relief requires more than labels and
conclusions, and a formulaic recitation of the elements of a
cause of action will not do.” Bell Atl. Corp. v.
Twombly, 550 U.S. 544, 555 (2007) (internal citations
and quotation marks omitted). Stated differently, in order to
survive a 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.’” Ashcroft v. Iqbal, 556 U.S. 662,
678 (2009) (quoting Twombly, 550 U.S. at 570).
alleges three ERISA claims against Areva. First, she alleges
that Areva violated 29 U.S.C. § 1132(a)(1)(B) by
declining to fully compensate her for A.H.’s surgery.
Second, Griffin claims that Areva violated 29 U.S.C.
§§ 1024(b), 1104, and 1133(2) by failing to
overturn requested plan documents. Finally, Griffin alleges
violation of 29 U.S.C. §1105 (a)(2) by Areva’s
supposed breach of co-fiduciary duties which include,