W. A. Griffin v. Aetna Health Inc., et al.

Whether or not the District court borrowed the appropriate state law for Erisa statutory penalty by applying a one year statue of limitations under O.C.G.A. § 9-3-28, even though the Georgia Supreme Court suggests that the limitation is twenty years under O.C.G.A. § 9-3-22 for aggrieved Georgians. Starting in 2012, ERISA plan beneficiaries authorized their Georgia medical provider to be both the designated authorized representative and assignee of benefits. The original assignment of benefit did not expressly state that the medical provider had been assigned rights to statutory penalties claims. However, during the administrative appeals, the provider, in the dual role as assignee of benefits and designated authorized representative, requested ERISA plan documents from the plan administrator. The plan administrator failed to produce the documents upon certified request. In 2017, the medical provider obtained a retroeffective assignment of benefit that dated back to the original assignment that expressly authorized assignment for statutory penalty claims. Even so, the 11th Circuit stated that the provider never had the authority to request plan documents in 2012. Therefore, the retroeffective assignment could not be valid for statutory penalty claims if the requesting party never had the authority to request plan documents.