Hermann Hospital v. Meba Medical and Benefits Plan

959 F.2d 569, 15 Employee Benefits Cas. (BNA) 1241, 1992 U.S. App. LEXIS 8378, 1992 WL 73185
CourtCourt of Appeals for the Fifth Circuit
DecidedApril 29, 1992
Docket91-2120
StatusPublished
Cited by76 cases

This text of 959 F.2d 569 (Hermann Hospital 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.

Bluebook
Hermann Hospital v. Meba Medical and Benefits Plan, 959 F.2d 569, 15 Employee Benefits Cas. (BNA) 1241, 1992 U.S. App. LEXIS 8378, 1992 WL 73185 (5th Cir. 1992).

Opinion

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 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 poliey(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 *572 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 provided 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 Plan 1 (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 concluded 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 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 Her-mann 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 argu *573 ment 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.

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Cite This Page — Counsel Stack

Bluebook (online)
959 F.2d 569, 15 Employee Benefits Cas. (BNA) 1241, 1992 U.S. App. LEXIS 8378, 1992 WL 73185, Counsel Stack Legal Research, https://law.counselstack.com/opinion/hermann-hospital-v-meba-medical-and-benefits-plan-ca5-1992.