United States District Court, E.D. Virginia, Alexandria Division
W. A. Griffin, M.D., Plaintiff,
Sevatec, Inc., Defendant.
O'Grady United States District Judge
matter comes before the Court on Defendant Sevatec,
Inc.'s Motion to Dismiss Plaintiffs Complaint. Dkt. No.
4. For the reasons outlined below, the Court finds good cause
to GRANT the Motion and DISMISS the Complaint.
Plaintiff is a dermatologist operating a practice in Atlanta,
Georgia. As a condition of service, Griffin requires her
patients to assign their health insurance benefits and rights
to her. Defendant Sevatec administers various aspects of the
self-funded ERISA plans through its agents, including Blue
Cross Blue Shield Healthcare Plan of Georgia ("Blue
Cross of Georgia"). In this suit, Griffin claims that
Sevatec has failed to pay the appropriate ERISA plan
benefits, specifically with regard to a patient identified as
and September of 2013, N.F. went to Griffin's office for
several minor surgical procedures. As Griffin requires, N.F.
signed Griffin's assignment of benefits form. After the
surgeries, Griffin submitted her claims for treating N.F. to
Blue Cross of Georgia. The total charges for the May 2013
surgeries totaled $4, 116.96. Sevatec, through Blue Cross of
Georgia, covered $1, 641.11-of which $798 was paid to Griffin
directly. Griffin asserts that Sevatec should have covered
$2, 881.87 of the charges. The total charges for the
September 2013 surgeries totaled $4, 832.06. Sevatec covered
$1, 471.00-of which $1, 030.00 was paid directly to Griffin.
Griffin asserts that Sevatec should have paid an additional
$2, 352.32. Griffin "appealed" the covered charges
with Blue Cross of Georgia. In these appeals Griffin
requested certain plan documents. Blue Cross denied
Plaintiff filed her Complaint, pro se, in this Court. The
Complaint asserts three causes of action. Count One alleges
that Sevatec has failed to pay the correct amount of benefits
in violation of 29 U.S.C. § 1132(a)(1)(B). Count Two
alleges that Sevatec failed to produce requested documents
"[p]ursuant to 29 U.S.C. §§ 1024(b), 1104, and
1133(2)." Count Three seeks enforcement of 29 U.S.C.
§ 1105(a)(2) to hold Sevatec liable for Blue Cross of
Georgia's alleged failures.
filed the pending Motion to Dismiss on June 30, 2016. Griffin
filed a memorandum in opposition and Sevatec filed a
response. The Motion is now ripe for a decision.
Legal Standard: Motion to Dismiss
survive a motion to dismiss under Federal Rule of Civil
Procedure 12(b)(6), a complaint must contain sufficient
factual information to "state a claim to relief that is
plausible on its face." Bell Atl. Corp. v.
Twombly, 550 U.S. 544, 550 (2007). A motion to dismiss
pursuant to Rule 12(b)(6) must be considered in combination
with Rule 8(a)(2), which requires "a short and plain
statement of the claim showing that the pleader is entitled
to relief, " Fed.R.Civ.P. 8(a)(2), so as to "give
the defendant fair notice of what the ... claim is and the
grounds upon which it rests, " Twombly, 550
U.S. at 555. While "detailed factual allegations"
are not required, Rule 8 does demand that a plaintiff provide
more than mere labels and conclusions stating that the
plaintiff is entitled to relief. Id. Because a Rule
12(b)(6) motion tests the sufficiency of a complaint without
resolving factual disputes, a district court "'must
accept as true all of the factual allegations contained in
the complaint' and 'draw all reasonable inferences in
favor of the plaintiff.'" Kensington Volunteer
Fire Dep't v. Montgomery County, 684 F.3d 462, 467
(4th Cir. 2012) (quoting E.I. du Pont de Nemours &
Co. v. Kolon Indus., Inc., 637 F.3d 435, 440 (4th Cir.
2011)). Accordingly, a complaint may survive a motion to
dismiss "even if it appears 'that a recovery is very
remote and unlikely."' Id. (quoting
Scheuer v. Rhodes, 416 U.S. 232, 236 (1974)).
when considering a motion to dismiss under Rule 12(b)(6),
"a court may not consider any documents that are outside
of the complaint, or not expressly incorporated therein,
" without converting the motion into one for summary
judgment. Witthohn v. Federal Ins. Co., 164
Fed.Appx. 395, 396 (4th Cir. 2006); Rollins v. Kjellstrom
& Lee, Inc., 109 F.Supp.3d 869, 873 (E.D. Va. 2015).
However, in reviewing a Rule 12(b)(6) motion for dismissal,
the court may consider "matters of which a court may
take judicial notice, " Tellabs, Inc. v. Makor
Issues & Rights, Ltd., 551 U.S. 308, 322, 127 S.Ct.
2499, 2509, 168 L.Ed.2d 179 (2007), such as "matters of
public record." Philips v. Pitt Cty. Mem 7
Hosp., 572 F.3d 176, 180 (4th Cir. 2009). The court
can "also consider documents attached to the complaint,
see Fed. R. Civ. P. 10(c), as well as those attached
to the motion to dismiss, so long as they are integral to the
complaint and authentic." Id.
first argue that this case should be dismissed based on the
doctrine of res judicata, or claim preclusion. "Res
judicata precludes the assertion of a claim after a judgment
on the merits in a prior suit by parties or their privies
based on the same cause of action." Meekins v.
United Transp. Union, 946 F.2d 1054, 1057 (4th Cir.
1991) (citing Harnett v. Billman, 800 F.2d 1308,
1312 (4th Cir. 1986)). "[T]he essential elements of the
doctrine are generally stated to be (1) a final judgment on
the merits in an earlier suit, (2) an identity of the cause
of action in both the earlier and the later suit, and (3) an
identity of parties or their privies in the two suits."
Nash Cty. Bd. of Ed. v. Biltmore Co., 640 F.2d 484,
486 (4th Cir. 1981); see also Clodfelter v. Republic of
Sudan, 720 F.3d 199, 210 (4th Cir. 2013). Res judicata
may be raised in a Rule 12(b)(6) motion when the facts
supporting the defense clearly appear on the face of the
complaint. Andrews v. Daw, 201 F.3d 521, 524 n. 1
(4th Cir. 2000) (quoting Richmond, Fredericksburg &
Potomac R. Co. v. Forst, 4 F.3d 244, 250 (4th Cir.
1993)). "[W]hen entertaining a motion to dismiss on the
ground of res judicata, a court may take judicial notice of
facts from a prior judicial proceeding when the res judicata
defense raises no disputed issue of fact." Id.
filed an almost identical suit against Sevatec in the
Northern District of Georgia on March 10, 2016.
1:16-cv-390-AT. This suit identified the same procedures
conducted on the same patient-N.F.-that Griffin claims were
not adequately covered by Sevatec. The suit also asserts the
same three causes of action against Sevatec. On May 26, 2016,
district judge Amy Totenberg dismissed the case. Id.
Dkt. No. 19. Judge Totenberg concluded that the case was
"squarely governed by the Court's prior
decisions" in suits mat had been filed by Griffin.
Id. at 2 (citing Griffin v. Health Sys. Mgmt.,
Inc., 157 F.Supp.3d 1282, 2015 WL 9920821 (N.D.Ga.),
affd, 635 F.App'x 768 (11th Cir. 2015)). In
other words, Griffin had filed several similar suits in the
Northern District of Georgia. The Northern District of
Georgia had concluded, and the Eleventh Circuit had
confirmed, that the "plan documents clearly and
unambiguously prohibit assignments of benefits 'except as
specifically provided' in a list of three situations,
none of which applie[d]." Id. Because the
patient's assignment of benefits to Griffin was not
valid, the Court concluded that Plaintiff did not have a
cause of action against Sevatec. Id. at 3.
now argues that Judge Totenberg's decision precludes this
Court from considering this case. Griffin admits that the
second and third elements of res judicata (same claims and
same parties) are satisfied here. The only question for the