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Griffin v. Areva, Inc.

United States District Court, W.D. Virginia, Lynchburg Division

August 10, 2016

Lynchburg Division W.A. Griffin, Plaintiff,
v.
Areva, Inc., Defendant.

          MEMORANDUM OPINION

          NORMAN K. MOON UNITED STATES DISTRICT JUDGE.

         This 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 decision.[1]

         Because 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.

         FACTS AS ALLEGED

         Griffin’s 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.

         On 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.

         To 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.

         Instead 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.[2] Id. ¶ 24.

         Griffin 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.

         STANDARD OF REVIEW

         When 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).

         DISCUSSION

         I. Res Judicata

         Griffin 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, ...


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