Good-Faith Dispute Over Workers’ Compensation Coverage Defeats Double Damages Suit by Medicare Advantage Plan

by P. Czuprynski

In Bronson Healthcare Group, Inc. v. Conifer Insurance Company, 2026 Mich App Lexis 924, 2026 WL 271561 (decided 2/2/2026), a Medicare Advantage Plan (MAP) was seeking double damages associated with alleged conditional payments related to a claim.

In 2017, a person fell and injured their hip while bartending at a Fraternal Order of Eagles. There was a dispute regarding whether the claimant was a volunteer (and therefore not an employee) at the time of the injury. The claimant filed a workers’ compensation claim with Conifer Insurance Company.

Private Cause of Action
Before any ruling was made by the Workers’ Compensation board, Bronson Healthcare Group filed a private cause of action. Bronson argued the Medicare Secondary Payer (MSP) Act requires the workers’ compensation carrier to reimburse the conditional payments associated with the claim. Since a suit was filed, the MSP Act requires payment of double the amount of any conditional payments (or double damages).

The trial court, in the private cause of action claim, issued an order that awarded double damages but only in the event that the workers’ compensation insurer was deemed responsible for the medical expenses.

After this decision, the workers’ compensation magistrate determined that the claimant was an employee at the time of injury and awarded medical benefits. Conifer, the workers’ compensation insurance company, appealed the decision.

Motions for Summary Judgement
While the appeal regarding the workers’ compensation claim was pending, Bronson and Conifer both filed motions for summary judgement on the issue of double damages under the MSP Act. Conifer argued that because their appeal was pending in the underlying workers compensation claim, the question of compensability had not yet been determined. Due to these circumstances, they argued a stay should be put in place until a decision was rendered by the workers compensation board.

However, the trial court disagreed that a stay was appropriate and ordered Conifer to reimburse Bronson for conditional payments, double damages, and judgement interest. Conifer was given an offset for any payments made. Both parties appealed the decision.

Bronson argued that they were entitled to additional judgment interest starting from the date of the complaint and the offset should not count towards damages.

Conifer argued that a decision regarding compensability of the workers’ compensation claim was still pending appeal. As a result, Bronson’s suit was premature and double damages were not warranted at this time.

The Appeals Court agreed that at the time of Bronson’s suit, responsibility for payment and failure to pay were not demonstrated and Bronson’s suit was dismissed.

Key Take Aways
If there is a good‑faith dispute over whether conditional payments require reimbursement, Medicare or a MAP may be unable to prove demonstrated responsibility, a required element for reimbursement.

Moreover, Medicare’s reimbursement rights are derived from the underlying workers’ compensation claim. Therefore, if charges are not payable under workers’ compensation, Medicare or a MAP would also have no right to reimbursement. Defenses available under the workers’ compensation claim—such as intoxication or an intervening accident—may also defeat a claim of demonstrated responsibility.

As more companies acquire advantage plans’ reimbursement rights for conditional payments, increased litigation is expected in 2026. We will continue to provide updates. If you have any questions about this case, or want to learn more about conditional payments and Medicare Parts C/D, please contact us at [email protected].