W. A. Griffin v. Coca-Cola Refreshments USA, Inc., et al.

Whether the anti-assignment provision in the CocaCola Plan apply to W. A. Griffin, MD (“Dr. Griffin”). Anti-assignment and anti-alienation provisions contained in employer sponsored group health benefit plans subject to the Employee Retirement Investment Security Act of 1974 (“ERISA”) are usually not applicable to an assignee who is the provider of the services which the plans are maintained to furnish. Dr. Griffin provided health services to Patient J. J., an individual covered by the Coca-Cola Refreshments USA, Inc. (“Coca-Cola”) employer-sponsored group health benefit plan (“Coca- Cola Plan”), and Patient J.J. executed an assignment to Dr. Griffin that states the assignment is a “direct legal assignment of [Patient J.J.’s] rights and benefits under’' the CocaCola Plan. Whether a plan administrator and claims fiduciary can be estopped from asserting, and can waive, an anti-assignment or anti-alienation provision by failing to timely assert the provision. Neither CocaCola, as plan administrator of the Coca-Cola Plan , nor United Healthcare Insurance Company (“United”) , as claims fiduciary of the Coca-Cola Plan, asserted the application of the Coca-Cola Plan’s anti-assignment provision during the process of Dr. Griffin’s appeals from underpayment for provided health services.