Humana Insurance Company Accused by Policyholders Over Workers’ Compensation Coverage Dispute

In a complex legal battle involving insurance claims and contractual obligations, Humana Insurance Company finds itself embroiled in an appellate court decision that could set significant precedents for insurance law. On January 21, 2026, the Court of Appeals in Wisconsin heard an appeal filed by Humana Insurance Company against Jack Mani and Rose Mani, following a circuit court’s mixed ruling on their crossclaims related to medical payments made after a car accident.

The case originated from a 2015 incident where Jack Mani was injured in a car accident while working. Initially, his employer’s workers’ compensation carrier, AmTrust North America, Inc., covered his medical expenses but later ceased payments citing pre-existing conditions. Consequently, Mani turned to his personal health insurer, Humana, which paid for his treatment. In 2017, Mani pursued legal action against several parties including the underinsured motorist and insurers involved. Humana entered the fray with crossclaims asserting its right to reimbursement based on subrogation principles.

However, the legal landscape shifted when Humana altered its strategy by filing new crossclaims not grounded in subrogation but instead alleging breach of contract due to a policy exclusion related to workers’ compensation coverage. This pivot raised questions about whether the “made whole” doctrine—typically applied in subrogation cases—should limit Humana’s recovery efforts. The doctrine ensures that insured parties are fully compensated before insurers can claim any recovery from settlements.

Humana argued that it was entitled to reclaim payments made for excluded claims directly from Mani because the injuries occurred during employment and were thus not covered under their policy. The circuit court had previously dismissed these crossclaims citing unresolved factual disputes and applying the made whole doctrine. On appeal, however, Judge Geenen noted that since Humana’s claims were based on a contractual exclusion rather than subrogation rights, they were not subject to this doctrine.

Despite this partial victory for Humana regarding the applicability of the made whole doctrine, their motion for summary judgment was denied due to outstanding factual issues such as whether payments were indeed mistakenly made or if they fell under voluntary payment doctrines. These complexities underscore ongoing tensions between equitable doctrines like being made whole and contractual stipulations within insurance policies.

The appellate court’s decision remands parts of the case back to Milwaukee County Circuit Court under Judge Pedro A. Colon for further proceedings concerning potential judicial estoppel implications—a principle preventing parties from taking contradictory positions in litigation—and other unresolved matters.

Representing these intricate interests are attorneys from various firms: with Judge White presiding alongside Judges Donald and Geenen overseeing Appeal No. 2023AP905; this case exemplifies nuanced intersections of insurance law where policy language meets equitable doctrines head-on.