Hermann Hosp. v. MEBA Medical and Benefits Plan

CourtCourt of Appeals for the Fifth Circuit
DecidedMay 20, 1992
Docket91-2120
StatusPublished

This text of Hermann Hosp. v. MEBA Medical and Benefits Plan (Hermann Hosp. v. MEBA Medical and Benefits Plan) is published on Counsel Stack Legal Research, covering Court of Appeals for the Fifth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

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Hermann Hosp. v. MEBA Medical and Benefits Plan, (5th Cir. 1992).

Opinion

United States Court of Appeals,

Fifth Circuit.

No. 91–2120.

HERMANN HOSPITAL, Plaintiff–Appellant,

v.

MEBA MEDICAL AND BENEFITS PLAN, Defendant–Appellee.

April 29, 1992.

Appeals from the United States District Court for the Southern District of Texas.

Before WILLIAMS and WIENER, Circuit Judges, and LITTLE, District Judge.*

WIENER, Circuit Judge:

Hermann Hospital (Hermann) brought suit to recover payment for services it provided to a

patient whose husband was a participant in an ERISA-governed welfare benefit plan. Hermann

claims entitlement to the payments as an assignee of the covered patient. The district court rendered

a take nothing judgment, holding that Hermann did not have standing to bring suit as no valid

assignment had occurred. Finding that the district court erred, we reverse and render judgment in

favor of Hermann.

I.

FACTS AND PROCEEDINGS

In May 1982, Patricia Nicholas was admitted to Hermann for cancer treatment. She remained

hospitalized there and continued to receive treatment until her death in November of that year. Mrs.

Nicholas' husband was a participant in the MEBA Medical and Benefits Plan (alternatively, MEBA

or the Plan) and had designated Mrs. Nicholas as a beneficiary. The Plan contained an

anti-assignment provision, but MEBA's policy was to recognize authorizations by participants and

beneficiaries for MEBA to pay medical providers directly for their services. At the time of her

admission to Hermann, Mrs. Nicholas signed a document prepared by Hermann entitled "Assignment

* District Judge of the Western District of Louisiana, sitting by designation. of Insurance Benefits." That document provided, in pertinent part:

THE FOLLOWING AUTHORIZATION PERTAINS TO THE PATIENT ... AND TO THE ADMISSION/OCCASION OF SERVICE INDICATED.

ASSIGNMENT OF INSURANCE BENEFITS

I hereby irrevocably assign and transfer to Hermann Hospital (hereinafter referred to as the "Hospital"), all rights, title and interest in the benefits payable for services rendered by the Hospital, provided in any insurance policy(ies), under which I am insured.... Said irrevocable assignment and transfer shall be for the purpose of granting the Hospital, an independent right of recovery on said policy(ies) of insurance, but shall not be construed to be an obligation of the Hospital to pursue any such right of recovery. Provided, however, this assignment and transfer shall not take away my standing to make claim or sue for benefits individually should coverage be denied by any insurance company(ies).

I hereby authorize all insurance company(ies) under which I am insured, to pay directly to the Hospital, all benefits due under said policy(ies) by reason of services rendered therein.

A day or so later, Mr. Nicholas, as the family member who was actually a participant in the Plan,

signed a "Statement of Claim for Dependents." That form, prepared by MEBA, provided that

"[b]enefits payable may be assigned providing [sic] proper authorization is completed (Part IV) or

submitted with statement." Mr. Nicholas completed Part IV of that statement, entitled "Assignment

of Benefits," which provided, "I hereby authorize payment of medical benefits directly to the provider

of services indicated."

MEBA did not pay Hermann for the medical services it had provided to Mrs. Nicholas, which

totalled $341,921. According to MEBA, that amount constituted the largest claim ever submitted

to the Plan.

Hermann brought suit against MEBA pursuant to ERISA to recover payment for the benefits

it had pro vided to Mrs. Nicholas under the ERISA-governed welfare benefit plan. Hermann's

complaint also asserted state common law claims of negligent misrepresentation and fraud. The

district court dismissed the complaint, holding that Hermann did not have standing to sue under

ERISA either in its own right or derivatively as an assignee of Mrs. Nicholas and that ERISA

preempted Hermann's state law claims. The district court entered a take nothing judgment and taxed costs of $37,900 against Hermann.

In Hermann Hospital v. MEBA Medical and Benefits Plan1 (Hermann I ), we noted that

Hermann did not contend that it was a plan "participant," "beneficiary" or "fiduciary"—the

"enumerated parties" allowed to pursue an action under Section 502(a)2 of ERISA.3 We held that

Hermann had no standing to sue as a "non-enumerated party" as Section 1132(a) constitutes an

exclusive jurisdictional grant.4 We also held, however, that if Mrs. Nicholas had made a valid

assignment to Hermann of her right to receive payments for benefits under the Plan, Hermann would

have derivative standing as an assignee to sue MEBA.5 As the district court had not determined

whether a valid assignment had been made, we remanded the case for the district court to decide that

issue. We also affirmed the district court's holding that ERISA preempted Hermann's state law

claims.6

On remand, the district court in a second bench trial held that Mrs. Nicholas did not make a

valid assignment of her Plan benefits to Hermann because she specifically reserved the right to sue,

thus retaining control over the subject matter of the assignment. In an alternative holding against

Hermann, the district court found ambiguous the document Hermann claimed was an assignment of

Mrs. Nicholas' benefits to Hermann. Thus the district court considered evidence of Mrs. Nicholas'

and Hermann's intent and co ncluded that the parties intended the document merely to authorize

MEBA to make direct payment to Hermann, not to assign to Hermann Mrs. Nicholas' right to

payments for benefits furnished by Hermann. Therefore, held the district court, Hermann was not an

1 845 F.2d 1286 (5th Cir.1988). 2 29 U.S.C. § 1132(a) (1976). 3 Hermann I, 845 F.2d at 1287. 4 Id. at 1288–89. 5 Id. at 1290. 6 Id. at 1291. assignee and thus lacked standing to sue MEBA. The district court entered a take nothing judgment

and taxed costs of $37,900 against Hermann, from which Hermann appeals.

II.

ANALYSIS

A. Validity of Assignment.

The district court held that Mrs. Nicholas' reservation of the right to sue was fatal to the

purported assignment of her benefits under the Plan because Mrs. Nicholas retained control over the

subject matter of the assignment. Hermann argues that, as Mrs. Nicholas reserved the right to sue

only in the event that coverage was denied, Hermann as assignee received, among other rights, the

right to sue to recover payment for covered benefits under the Plan in all other situations. As MEBA

did not deny coverage, the argument continues, Mrs. Nicholas did not retain any control over the

subject matter of the assignment and her reservation did not render the assignment invalid, thereby

placing the right to sue for payment of covered benefits solely in Hermann's possession. We agree.

We review conclusions of law by the district court de novo.7 The district court cited Pape

Equipment Co. v. I.C.S., Inc.,8 in support of its holding. In Pape, the plaintiff alleged that it had

received an assignment of a cause of action against the defendant. However, the agreement that

purportedly assigned the cause of action contained no words of assignment and provided that the

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