United Healthcare of Texas, Inc., Optum Health Care Solutions LLC D/B/A Optum Healthcare Solutions, Inc., United Healthcare, Inc., D/B/A United Healthcare Insurance Company, United Healthcare Community Plan of Texas, L.L.C., Evercare of Texas, L.L.C., United Healthcare Benefits of Texas, Inc., United Healthcare Services, Inc., and UnitedHealth Group, Inc. v. Low-T Physicians Service, P.L.L.C., Low-T Physicians Professional Association, and Low-T Physicians Group, P.L.L.C.

CourtCourt of Appeals of Texas
DecidedJanuary 5, 2023
Docket02-22-00170-CV
StatusPublished

This text of United Healthcare of Texas, Inc., Optum Health Care Solutions LLC D/B/A Optum Healthcare Solutions, Inc., United Healthcare, Inc., D/B/A United Healthcare Insurance Company, United Healthcare Community Plan of Texas, L.L.C., Evercare of Texas, L.L.C., United Healthcare Benefits of Texas, Inc., United Healthcare Services, Inc., and UnitedHealth Group, Inc. v. Low-T Physicians Service, P.L.L.C., Low-T Physicians Professional Association, and Low-T Physicians Group, P.L.L.C. (United Healthcare of Texas, Inc., Optum Health Care Solutions LLC D/B/A Optum Healthcare Solutions, Inc., United Healthcare, Inc., D/B/A United Healthcare Insurance Company, United Healthcare Community Plan of Texas, L.L.C., Evercare of Texas, L.L.C., United Healthcare Benefits of Texas, Inc., United Healthcare Services, Inc., and UnitedHealth Group, Inc. v. Low-T Physicians Service, P.L.L.C., Low-T Physicians Professional Association, and Low-T Physicians Group, P.L.L.C.) 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
United Healthcare of Texas, Inc., Optum Health Care Solutions LLC D/B/A Optum Healthcare Solutions, Inc., United Healthcare, Inc., D/B/A United Healthcare Insurance Company, United Healthcare Community Plan of Texas, L.L.C., Evercare of Texas, L.L.C., United Healthcare Benefits of Texas, Inc., United Healthcare Services, Inc., and UnitedHealth Group, Inc. v. Low-T Physicians Service, P.L.L.C., Low-T Physicians Professional Association, and Low-T Physicians Group, P.L.L.C., (Tex. Ct. App. 2023).

Opinion

In the Court of Appeals Second Appellate District of Texas at Fort Worth ___________________________ No. 02-22-00170-CV ___________________________

UNITED HEALTHCARE OF TEXAS, INC., OPTUM HEALTH CARE SOLUTIONS LLC D/B/A OPTUM HEALTHCARE SOLUTIONS, INC., UNITED HEALTHCARE, INC., D/B/A UNITED HEALTHCARE INSURANCE COMPANY, 1 UNITED HEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C., EVERCARE OF TEXAS, L.L.C., UNITED HEALTHCARE BENEFITS OF TEXAS, INC., UNITED HEALTHCARE SERVICES, INC., AND UNITEDHEALTH GROUP, INC., Appellants V.

LOW-T PHYSICIANS SERVICE, P.L.L.C., LOW-T PHYSICIANS PROFESSIONAL ASSOCIATION, AND LOW-T PHYSICIANS GROUP, P.L.L.C., Appellees 1 Appellants indicate that United Healthcare Insurance Company was erroneously sued as “United Healthcare, Inc., d/b/a United Healthcare Insurance Company,” but Appellants do not ask this court to revise the style of the case. For consistency, we retain the existing style as it was used by the trial court and by this court in a previous interlocutory appeal. Cf. United Healthcare of Tex., Inc. v. Low-T Physicians Serv., P.L.L.C., No. 02-20-00033-CV, 2021 WL 210846, at *1 (Tex. App.— Fort Worth Jan. 21, 2021, no pet.) (mem. op.). On Appeal from the 342nd District Court Tarrant County, Texas Trial Court No. 342-303717-18

Before Sudderth, C.J.; Wallach and Walker, JJ. Opinion by Chief Justice Sudderth

2 OPINION

After Appellant United Healthcare of Texas, Inc. (working with its affiliated

entities)2 determined that it had overpaid Appellee Low-T Physicians Service, P.L.L.C.

(and its affiliated entities)3 for health-insurance claims, United requested a refund of

more than $2 million, and Low-T attempted to settle the claim by mailing United a

check for approximately $24,000. Low-T also mailed a letter detailing its settlement

proposal to many of the United addresses listed in the parties’ claim-related

correspondence. When United’s check-processing contractor automatically cashed

Low-T’s check, Low-T argued that it was an accord and satisfaction of United’s $2

million claim. The trial court agreed with Low-T, and it issued a declaratory judgment

confirming that the check was an accord and satisfaction under Section 3.311 of

Texas’s codified version of the Uniform Commercial Code (UCC). See Tex. Bus. &

Com. Code Ann. § 3.311.

In one broad issue, United claims that (1) the great weight and preponderance

of the evidence establishes the applicability of two statutory exceptions to accord and

2 We refer to Appellants—United Healthcare of Texas, Inc., Optum Health Care Solutions, LLC d/b/a Optum Healthcare Solutions, Inc., United Healthcare, Inc., d/b/a United Healthcare Insurance Company, United Healthcare Community Plan of Texas, L.L.C., Evercare of Texas, L.L.C., United Healthcare Benefits of Texas, Inc., United Healthcare Services, Inc., and UnitedHealth Group, Inc.—collectively as “United.” 3 We refer to Appellees—Low-T Physicians Service, P.L.L.C., Low-T Physicians Professional Association, and Low-T Physicians Group, P.L.L.C.—collectively as “Low-T.”

3 satisfaction and (2) the evidence is so weak that it would be manifestly unjust to apply

the due diligence statute that overrides the statutory accord and satisfaction

exceptions. Because the evidence supports application of the due diligence override

provision, and because this override renders the accord and satisfaction exceptions

unavailable, we will affirm.

I. Accord and Satisfaction Under the Texas UCC

Section 3.311 of the Texas UCC codifies the common law doctrine of accord

and satisfaction. 4 See Flores v. Hansen, No. 2-09-465-CV, 2010 WL 3618737, at *3 n.5

(Tex. App.—Fort Worth Sept. 16, 2010, no pet.) (mem. op.); Milton M. Cooke Co. v.

First Bank & Tr., 290 S.W.3d 297, 304–05 (Tex. App.—Houston [1st Dist.] 2009, no

pet.). Generally, a claim that is subject to a bona fide dispute is extinguished by an

accord and satisfaction if the person against whom the claim is asserted tenders a

check 5 to the claimant, the tendered check is in full satisfaction of the claim, the check

(or accompanying correspondence) bears a conspicuous statement to that effect, the

tender is in good faith, and the claimant cashes the check. See Tex. Bus. & Com.

Code Ann. § 3.311(a), (b). Even when these elements are established, though, there

are two statutory exceptions—set forth in Subsection (c) of Section 3.311—that allow

Texas’s version of the UCC is codified in Title 1 of the Texas Business and 4

Commerce Code. See Tex. Bus. & Com. Code Ann. tit. 1. 5 This statute applies to negotiable instruments. See Flores, 2010 WL 3618737, at *3; see also Tex. Bus. & Com. Code Ann. § 3.104(b) (defining “[i]nstrument” as “a negotiable instrument”).

4 claimants to avoid inadvertent acceptance of an accord and satisfaction instrument.6

Id. § 3.311(c), cmts. 5–6. But we need not detail those two exceptions because a

claimant cannot rely on either of them if Subsection (d) applies, i.e., “within a

reasonable time before collection of the instrument was initiated, the

claimant . . . knew that the instrument was tendered in full satisfaction of the claim.”

Id. § 3.311(d). As relevant here, for an organization, “knowledge . . . is

effective . . . from the time it would have been brought to the . . . attention [of the

individual conducting the transaction] if the organization had exercised due diligence.”

Id. § 1.202(f); see id. § 3.311 cmt. 7. This due diligence override forms the dispositive

issue in United’s appeal.

II. Background

The due diligence issue turns on whether and when the United representatives

handling Low-T’s claim should have known that Low-T was tendering its settlement

check in full satisfaction of that claim. See id. §§ 1.202(f), 3.311(d). But this question

is muddied by the numerous mailing addresses that United used throughout the

parties’ correspondence.

6 Generally, the Subsection (c) exceptions allow a claimant to avoid an accord and satisfaction if it either (1) conspicuously designates a person, office, or place to receive debt-related communications and settlement instruments and demonstrates that the designated recipient did not receive the settlement or (2) promptly refunds the inadvertently accepted settlement to the person against whom the claim is asserted. Tex. Bus. & Com. Code Ann. § 3.311(c), cmts. 5–6.

5 A. Claim & Correspondence In December 2017, Michael Berger—an associate general counsel for United—

sent a letter from his Minnesota office to Low-T notifying Low-T that an audited

sample of its United healthcare claims revealed7 that United had overpaid Low-T by

approximately $2,359,902.33. The notice indicated that Low-T should “call the

investigator, Joni Stone at [her phone number] to let her know if you’d like to expand

the audit.” If Low-T wanted to appeal the overpayment determination, it was

directed to do so by submitting its written position and documentation to “United

Payment Integrity[,] Attn: Recovery Investigations” using a mailing address in Forest

Park, Georgia.

Later that month, Low-T’s general counsel,8 David Moraine, responded by

sending a letter to Stone at the Forest Park address and to Berger at his Minnesota

address.

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United Healthcare of Texas, Inc., Optum Health Care Solutions LLC D/B/A Optum Healthcare Solutions, Inc., United Healthcare, Inc., D/B/A United Healthcare Insurance Company, United Healthcare Community Plan of Texas, L.L.C., Evercare of Texas, L.L.C., United Healthcare Benefits of Texas, Inc., United Healthcare Services, Inc., and UnitedHealth Group, Inc. v. Low-T Physicians Service, P.L.L.C., Low-T Physicians Professional Association, and Low-T Physicians Group, P.L.L.C., Counsel Stack Legal Research, https://law.counselstack.com/opinion/united-healthcare-of-texas-inc-optum-health-care-solutions-llc-dba-texapp-2023.