United States District Court, N.D. Illinois, Eastern Division
W.A. GRIFFIN, M.D., Plaintiff,
TEAMCARE, a Central States Health Plan, and TRUSTEES OF THE CENTRAL STATES, SOUTHEAST AND SOUTHWEST AREAS HEALTH AND WELFARE FUND, Defendants.
MEMORANDUM OPINION AND ORDER
W. GETTLEMAN JUDGE
plaintiff W.A. Griffin, a doctor, provided medical services
to three patients. Those patients were the beneficiaries of a
health plan administered by defendants TeamCare and Trustees
of the Central States, Southeast and Southwest Areas Health
and Welfare Fund. The patients assigned their health plan
benefits to plaintiff, who billed defendants for the medical
services she rendered. Defendants did not pay the full amount
billed. Plaintiff challenged the payment amounts. She also
requested documents that defendants were required to provide
under the Employee Retirement Income Security Act
("ERISA"), 29 U.S.C. § 1001 et seq.
Defendants failed to timely produce those documents.
filed two suits. In case 18 CV 1772, plaintiff sued for: (1)
failure to pay benefits due, 29 U.S.C. § 1132(a)(1)(B);
(2) breach of fiduciary duties, 29 U.S.C. § 1104; and
(3) failure to provide requested documents, 29 U.S.C. §
1132(c)(1)(B). This court dismissed plaintiffs suit.
Griffin v. TeamCare, 18 CV 1772, 2018 WL 3685511, at
*3 (N.D. 111. June 21, 2018). The Seventh Circuit vacated and
remanded in part, holding that plaintiff had stated claims
for failure to pay benefits due and for failure to provide
requested documents. Griffin v. TeamCare, 909 F.3d
842, 847 (7th Cir. 2018).
remand, plaintiff accepted defendants' offer of judgment
on her claim for failure to pay benefits due, which included
interest. The parties move for summary judgment on the only
remaining claim in case 18 CV 1772: plaintiffs document
request claim under 29 U.S.C. § 1132(c)(1)(B). They also
move for summary judgment on plaintiffs sole claim in case 18
CV 8297: another document request claim with similar alleged
facts, brought under the same statutory provision. For the
following reasons, the court grants plaintiffs motions for
summary judgment in both cases, denies defendants'
motions, and imposes a statutory penalty of $3, 555.
allegations are described in Griffin, 2018 WL
3685511 at *1, and Griffin, 909 F.3d at 844-45. The
court states only the facts relevant to the parties'
summary judgment motions. Those facts are taken from the
parties' L.R. 56.1 statements and exhibits and are not
provided medical services to three patients. Those patients
assigned their plan benefits to plaintiff. Plaintiff billed
defendants for her medical services; defendants did not pay
her the full amount. Plaintiff challenged the payment
amounts. She requested copies of various documents,
including: (1) the summary plan description; (2) fee
schedules used to determine her payment; and (3) an
administration agreement between defendants and Healthcare
Service Corporation, an affiliate of Blue Cross Blue Shield
Association that forwards out-of-network claims to defendants
for defendants to adjudicate.
29 U.S.C. § 1132(c)(1)(B), defendants were required to
mail plaintiff the appropriate requested documents within 30
days. They did not do so. For one patient, plaintiff
requested the summary plan description, fee schedules, and
administration agreement on February 13, 2017. She requested
similar documents for two other patients on March 12, 2018,
and August 8, 2018. Plaintiff received: (1) the summary plan
description on August 18, 2017 (187 days after her first
request); (2) the fee schedules on January 29, 2019 (716
days); and (3) the administrative agreement on February 25,
2019 (743 days).
parties move for summary judgment in both cases. Summary
judgment is proper when no material fact is genuinely
disputed and the moving party is entitled to judgment as a
matter of law. Fed.R.Civ.P. 56(a). A material fact is
genuinely disputed if the evidence would allow a reasonable
jury to return a verdict for the non-moving party.
Anderson v. Liberty Lobby Inc., 477 U.S. 242, 248
(1986). Once the moving party meets its burden, the
non-moving party must go beyond the pleadings and set forth
specific facts showing a genuine issue for trial.
Fed.R.Civ.P. 56(c); Celotex Corp. v. Catrett 477
U.S. 317, 324 (1986). The court draws all justifiable
inferences in favor of the non-moving party.
Anderson, 477 U.S. at 255.
parties raise three issues: (1) whether plaintiff, as an
assignee, has standing to sue for statutory penalties; (2)
whether plaintiff was entitled to the fee schedules or the
administration agreement; and (3) whether the court should
impose statutory penalties-and if so, the amount. The first
issue determines whether plaintiff is entitled to summary
judgment. The second and third issues affect penalties. The
court holds that plaintiff has standing and is thus entitled
to summary judgment. As for penalties, the court holds that
plaintiff was entitled to both documents and imposes a
statutory penalty of $3, 555.
has standing to sue for statutory penalties. See
Griffin, 909 F.3d at 846-47 (7th Cir. 2018) (holding
that because plaintiff needed to know "how Central
States determined the usual, reasonable, and customary rate,
" she "must be a beneficiary able to sue when she
is denied requested information"). Defendants'
argument to the contrary relies on section 11.06 of Central
States' plan: "Any provider of medical or healthcare
services . . . seeking to receive[ ] payment from the Fund
will, in the absence of evidence to the contrary, be presumed
to have claimed a right to do so pursuant to a valid
assignment of benefits . . . ." (emphasis
argue that the phrase "assignment of benefits"
excludes an assignee from claiming statutory penalties. Not
so. Under section 11.06, an assignee may become entitled to a
benefit. A person who "may become entitled to a
benefit" is a "beneficiary." 29 U.S.C. §
1002(8). A beneficiary "can sue for unpaid benefits
under section 1132(a)(1)(B), " so "[i]t follows
that Dr. Griffin also must be a beneficiary able to sue when
she is denied requested information." Griffin,
909 F.3d at 847 (vacating this court's dismissal of
plaintiffs document request claim). Nothing in section 11.06
modifies "assignment of benefits" such that the