Sitaram v. Aetna U.S. Healthcare of North Texas, Inc.

152 S.W.3d 817, 2004 Tex. App. LEXIS 11682, 2004 WL 2964013
CourtCourt of Appeals of Texas
DecidedDecember 23, 2004
DocketNo. 06-03-00089-CV
StatusPublished
Cited by23 cases

This text of 152 S.W.3d 817 (Sitaram v. Aetna U.S. Healthcare of North Texas, Inc.) is published on Counsel Stack Legal Research, covering Court of Appeals of Texas primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Sitaram v. Aetna U.S. Healthcare of North Texas, Inc., 152 S.W.3d 817, 2004 Tex. App. LEXIS 11682, 2004 WL 2964013 (Tex. Ct. App. 2004).

Opinion

OPINION

Opinion by

Justice ROSS.

Ram Sitaram and Tom Naug (together, Sitaram1), independent insurance agents, sued Aetna U.S. Healthcare of North Texas, Inc. (AUSHC) and NYLCare Health Plans, Inc. (NYHPI) for breach of a settlement agreement. The trial court granted summary judgment in favor of AUSHC and NYHPI, and Sitaram appeals.

A substantial number of corporate acquisitions by Aetna, Inc. (Aetna), and a divestiture order, resulting from an antitrust action in federal court, led to questions of whether Aetna or one of its subsidiaries became liable under a settlement agreement entered into by Sitaram and Texas Sanus Health Plan, one of the purchased corporations. Ultimately, the issue is whether the summary judgment evidence raised a genuine issue of material fact regarding whether one of Aetna’s corporate entities was a “successor in interest” under the settlement agreement at issue. Because the record does not reveal a fact issue regarding whether one of Aet-na’s corporate entities assumed, either by statute or express agreement, Sanus’ (now NYLCare SW’s) liabilities, we affirm the summary judgment.

I. FACTUAL AND PROCEDURAL HISTORY

A. The GTE Contract and a Settlement Among the Parties (1989-1993)

In 1989, Sitaram obtained GTE (now Verizon) as a client for Sanus. All parties agree that, for approximately five years, Sanus paid Sitaram one percent of the gross premiums paid by GTE for healthcare coverage.

In 1993, Sanus ceased making payments to Sitaram. This caused a dispute between Sitaram and Sanus, which was resolved through a settlement agreement that same year. Sitaram’s claims in the lawsuit underlying this appeal center on three provisions of this 1993 Settlement:

(1) .... The obligations of this Agreement may not be avoided by a change of name or location, sale or transfer of these [GTE] accounts to any parent, subsidiary or affiliate. In the event of a sale, merger, or acquisition of SANUS, this Agreement shall be binding upon the successor in interest.
[[Image here]]
(5) SANUS agrees to future payments equal to one percent (1%) of the net premium received from GTE from October 1, 1993, until such time as GTE is no longer a client of SANUS for all of the GTE divisions doing business with SANUS as of October 1,1993,....
[[Image here]]
(13) It is understood and agreed that this Agreement shall be binding upon and inure to the benefit of the parties [821]*821hereto and their respective heirs, representatives, successors, and assigns.

At some point in the years between 1993 and 1998, Sanus became NYLCare SW. The record does not delve into this transition, and it is not important to the central issue in this appeal other than to identify the parties. Again, the parties do not dispute that NYLCare SW (formerly Sa-nus) paid Sitaram pursuant to the 1993 Settlement through 1998.

B. Aetna’s Acquisition of NYHPI (including NYLCare SW) (1998)

In 1998, Aetna and New York Life Insurance Company entered into an asset purchase agreement (APA) whereby Aetna purchased NYHPI, the parent corporation of NYLCare SW.2 Aetna thereby became the ultimate parent corporation of NYHPI and its subsidiaries, including NYLCare SW. After the transaction was finalized, AUSHC and NYLCare SW, competitors in the North Texas market before 1998, became sister affiliates, and their relationship is the focus of this appeal.

The terms of this purchase are set out in Article 2 of the APA. Sitaram focuses on certain definitions and provisions in the APA between Aetna and New York Life. Specifically, they look to the definition of “excluded liabilities” as, among others, “all Liabilities of [NYHPI] or any Subsidiary of [NYHPI] to the extent they do not arise out of or relate to [NYHPI].”

C. AUSHC and NYLCare SW Relationship: Negotiations to “Renew” GTE Contract (1998-1999)

From March 1998 to June 1999, Sitaram continued to receive payments pursuant to the 1993 Settlement. According to the summary judgment evidence, the process of integrating certain functions of AUSHC and NYLCare SW began after the acquisition in the spring of 1998. Functions such as marketing, sales, and certain administrative services for NYLCare SW were coordinated with those of other Aetna affiliates, including sister affiliate AUSHC.

In the spring of 1999, GTE began to solicit proposals from several Dallas area health plans for its employee healthcare coverage for 2000. In May 1999, AUSHC submitted a proposal to GTE. AUSHC and NYHPI concede NYLCare SW did not initially submit a separate option to GTE. Instead, the AUSHC plan was “jointly presented to GTE on behalf of AUSHC and NYLCare SW.” Negotiations between AUSHC/NYLCare SW and GTE then began. The record contains several hundred e-mail messages from within the corporations regarding the “GTE Renewal Presentation.”

[822]*822D. Antitrust Action and End of NYL-Care SW and GTE Relationship (June-December 1999)

In June 1999, this arguably collaborative effort between AUSHC and NYLCare SW ended when a federal court ordered Aetna and its subsidiaries to divest itself of certain Texas healthcare subsidiaries, NYL-Care SW included.3 Pending the divestiture, Aetna was ordered to hold out those subsidiaries as competing health plans.

It was only after the federal court order when NYLCare SW made a separate proposal to GTE for employee healthcare coverage for the year 2000. Ultimately, GTE, uncertain as to the future of NYLCare SW, rejected NYLCare SW’s separate, later proposal and instead chose to do business with AUSHC. GTE formally ceased doing business with NYLCare SW in January 2000.

From the time the federal court issued its divestiture order until the completion of the divestiture, NYLCare SW “continued to be held out as a competitor” of AUSHC in the Dallas area. NYHPI sold NYLCare SW to Health Care Service Corporation in March 2000.

E. AUSHC’s Business Relationship with GTE and Early Stages of Litigation

GTE continued to do business with AUSHC until January 1, 2002.4 In February 2001, Sitaram filed suit against AUSHC for breach of thé 1993 Settlement. Sitaram alleged that AUSHC became a “successor in interest” under the terms of the 1993 Settlement and that AUSHC was liable to them under that agreement for premiums GTE paid to AUSHC during the years 2000 and 2001.

AUSHC moved for summary judgment on the ground that Sitaram had sued the wrong party. In response, Sitaram moved for leave to join five additional Aetna entities as parties. In an effort to reduce the amount of discovery, the trial court ordered AUSHC to stipulate as to the Aetna entity, if any, that would possibly be liable under Sitaram’s theory of recovery. AUSHC designated in writing that NYH-PI is the only party against whom Sitaram could pursue their claims:

Free access — add to your briefcase to read the full text and ask questions with AI

Related

Robert Primo v. Great American Insurance Company
455 S.W.3d 714 (Court of Appeals of Texas, 2014)
E-Quest Management, L.L.C. and Odyssey OneSource, Inc. v. Robbie Shaw
433 S.W.3d 18 (Court of Appeals of Texas, 2013)
Northwestern National Insurance v. FMC Corp.
845 F. Supp. 2d 697 (W.D. North Carolina, 2012)
Tyco Valves & Controls, L.P. v. Colorado
365 S.W.3d 750 (Court of Appeals of Texas, 2012)
Allied Home Mortgage Corp. v. Donovan
830 F. Supp. 2d 223 (S.D. Texas, 2011)
Lesikar v. EOG Resources, Inc.
236 S.W.3d 457 (Court of Appeals of Texas, 2007)
Harriet Lesikar v. EOG Resources, Inc.
Court of Appeals of Texas, 2007
Sitaram v. AETNA US HEALTHCAREOF NT, INC.
152 S.W.3d 817 (Court of Appeals of Texas, 2005)

Cite This Page — Counsel Stack

Bluebook (online)
152 S.W.3d 817, 2004 Tex. App. LEXIS 11682, 2004 WL 2964013, Counsel Stack Legal Research, https://law.counselstack.com/opinion/sitaram-v-aetna-us-healthcare-of-north-texas-inc-texapp-2004.