Crown’s right of recovery for health service costs

Overview

The Third Party Liability unit at the Ministry of Health is responsible for recovering health care costs for personal injury matters on behalf of the Alberta government, or 'Crown.'

Personal injury actions in which the Crown's right of recovery may arise include:

• occupiers liability actions
• medical, dental or other health care provider negligence
• product liability actions
• liabilities for animals
• battery or assault actions
• class actions
• some motor vehicle accidents

Crown’s right of recovery

The Third Party Liability unit operates under the authority of Part 1 of the Crown's Right of Recovery Act, SA 2009, c.C-35.

The Crown’s right of recovery applies to all personal injury actions in which an Albertan has received health services as a result of injuries suffered due to the wrongful act or omission of a third party.

This applies except when the injury is caused by a motor vehicle accident and the at-fault driver is insured by an Alberta insurance company that contributes to the aggregate assessment.

The Crown has an independent right of recovery. Section 2(1) of the Crown's Right of Recovery Act states that should an Albertan receive health services for personal injuries suffered as a result of a wrongful act or omission, 'the Crown has the right to recover from the wrongdoer the Crown’s cost of health services.'

Related legislation

• Crown's Right of Recovery Act
• Crown’s Right of Recovery (Ministerial) Regulation
• Crown’s Right of Recovery Regulation
• Crown’s Right of Recovery (President of Treasury Board and Minister of Finance) Regulation

Recoverable health expenses

The types of recoverable health care services expenses include:

• hospital inpatient and outpatient services (including community ambulatory care centres)
• ambulance services
• services provided under the Alberta Health Care Insurance Act
• services provided under the Aids to Daily Living and Extended Health Benefits Regulation
• drug costs
• mental health costs
• services provided under the Co-ordinated Home Care Program Regulation
• the amount the Crown pays for out of province health care costs
• any good or service prescribed to be a health service by the regulations

The Third Party Liability unit can also claim for the future cost of health services.

Motor vehicle accidents

Motor vehicle accidents in which the Crown has no right of recovery

The Crown has no claim arising from motor vehicle accidents if:

• the personal injuries are caused by an act or omission of a wrongdoer in the wrongdoer’s use or operation of an automobile
• the wrongdoer is insured under a 'motor vehicle liability policy'
• this motor vehicle policy applies to and covers the loss, and
• the insurer is licensed in Alberta and contributed to the aggregate assessment for that calendar year, the Crown will not have a claim for health services

A 'motor vehicle liability policy' means a motor vehicle liability policy as defined in the Insurance Act, R.S.A. 2000 c. I-3 indicating a contract of insurance has been made or renewed in Alberta or is deemed under the Insurance Act to have been made or renewed in Alberta [Section 514].

Motor vehicle accidents in which the Crown has a right of recovery

In certain situations, the Crown continues to have a claim when there is a motor vehicle accident. These include:

• if the wrongdoer was not operating an 'automobile' as defined by the relevant legislation
• if the wrongdoer was not insured under a 'motor vehicle liability policy'
• if the wrongdoer's insurer was not licensed in Alberta or did not contribute to the aggregate assessment for the calendar year in which the wrongful act or omission occurred

These situations include, but are not limited to:

• out of province insurers
• some self-insurers
• multiple wrongdoers (tortfeasor) other than those insured under a 'motor vehicle liability policy,' such as claims against commercial/social hosts or claims against municipalities for improper road design or maintenance
• accidents involving farm machinery, etc.

If you are uncertain if a claim can be made, please notify the Third Party Liability unit so the matter can be addressed.

Limitation periods

The Crown’s limitation period extends past that of the injured party. The Crown has an additional 6 months beyond the expiration of the injured party’s limitation period to commence an action, or an additional 6 months after the Third Party Liability unit receives notification of the matter, whichever is later. Refer to Section 7, Crown's Right of Recovery Act.

Information for lawyers

Notifications

Notification requirements

An injured party who consults a lawyer, or has someone consult a lawyer on their behalf about personal injuries suffered as a result of a wrongful act or omission by a third party must notify the Third Party Liability unit. Refer to Section 12 of the Crown’s Right of Recovery Act.

Section 4(1) of the Crown’s Right of Recovery (Ministerial) Regulation indicates the following information that should be reported:

• the injured party’s name, date of birth and mailing address
• the date, location and description of the wrongful act or omission and, if reported, a copy of the police report
• the wrongdoer’s name, mailing address, insurer and policy number, if known
• the injured party’s injuries, the health services provided to the injured party as a result of those injuries, the name of the person who provided those services and, if the services were provided at a hospital, the name of the hospital
• the name and address of the injured party’s lawyer
• a copy of the following, as they are prepared or obtained, that relate to the injured party’s injuries:
  • pleadings
  • accident reconstruction reports
  • loss of past and future income reports
  • discovery transcripts
  • medical reports prepared at the request of the injured party’s lawyer for the purposes of litigation
  • cost of future care reports
  • settlement agreements and judgments

Notification form

Lawyers should submit a Third Party Liability Notification form (PDF, 485 KB) as soon as possible after being consulted by a recipient in the situation where the Crown’s right of recovery may arise.

Claim process

When the notification form is received, the Third Party Liability unit investigates to determine whether or not the Crown has a right of recovery.

The Crown has an initial claim if the:

• injured party sustained injury as a result of the wrongful act or omission of a third party
• injured party is an Alberta resident entitled to health services
• injured party is in receipt of health care services as result of the incident
• incident does not fall within the exemption created by Section 2(3) of the Crown’s Right of Recovery Act

In order to determine if health services have been provided as a result of the wrongful act or omission, a review of health information is necessary.

It can take up to 2 months to receive a response from the various health providers. It is important to contact the unit of a Crown’s potential right of recovery as soon as possible.

Once a claim is developed, it is sent to your office along with a request to act. Alternatively, we will forward our claim directly to the insurer and advise you accordingly.

Pleadings

As the Crown’s Right of Recovery Act specifies that the Crown has a right of recovery, it is important that our legal counsel pleads 'Her Majesty the Queen in Right of Alberta' as a party to the action.

However, legal counsel should contact us prior to including 'Her Majesty the Queen in Right of Alberta' in the pleadings so we can determine if the Crown has a right of recovery for which we will be seeking recovery and if the Crown will be retaining their law firm to recover the Crown's claim.

Legal fees

If legal counsel is retained to act on behalf of the Crown who also represents the plaintiff, the Crown's Right of Recovery Regulation sets out the payment of legal fees.

• The maximum amount for legal counsel acting for both the plaintiff and the Crown is 15% of the first $20,000 payable to the Crown and 10% on the remainder of the amount payable to the Crown, excluding reasonable disbursements.
• Disbursements must be reasonable, directly related to the Crown's claim and prior approval is also required.

If counsel is acting only on behalf of the Crown, an agreement will be entered into with counsel to pay reasonable fees, costs and disbursements.

Note: the Alberta government is not subject to the goods and services tax (GST) or the harmonized sales tax (HST).

Information for insurers

Since August 1996, an annual direct payment system for automobile insurers was established which replaced the recovery of health care costs on a claim by claim basis for most motor vehicle accident situations.

For each calendar year, the Minister of Health establishes an aggregate assessment payable by automobile insurers based on an estimate of the Crown’s cost of health services for personal injuries incurred by Albertans as a result of the wrongful acts or omissions of third parties in the use or operation of automobiles in that calendar year.

Notifications

Notification requirements

In accordance with Section 15 of the Crown’s Right of Recovery Act, an insurer is required to notify the Crown of any circumstances in which the Crown’s right of recovery may arise.

In accordance with Section 5(1) of the Crown’s Right of Recovery (Ministerial) Regulation the information that should be provided includes:

• the wrongdoer’s name, date of birth and mailing address
• a copy of the wrongdoer’s insurance policy
• the date, location and description of the wrongful act or omission and, if the act or omission was reported to the police, a copy of the police report
• the recipient’s name and the name and address of the recipient’s lawyer, if known
• a copy of the following, as they are prepared or obtained, that relate to the recipient’s injuries:
  • accident reconstruction reports
  • loss of past and future income reports
  • medical reports on the recipient prepared at the request of the insurer for the purposes of litigation
  • cost of future care reports
• the recipient's name, recipient’s date of birth, the date of loss, the type of loss, and the injuries sustained by the recipient

Notification form

Insurers should submit a Third Party Liability Notification form (PDF, 485 KB) as soon as possible in every personal injury accident in which the Crown’s right of recovery may arise.

Claim process

When a notification form is received, the Third Party Liability unit investigates to determine whether or not the Crown has a right of recovery.

The Crown will initially have a claim if the following conditions are satisfied:

• the injured party sustained injury as a result of the wrongful act or omission of a third party
• the injured party is an Alberta resident entitled to health services
• the injured party is in receipt of health care services as result of an incident
• the incident does not fall within the exemption created by Section 2(3) of the Act

Upon a review of health information, the Crown's claim will be developed and a copy of the claim will be forwarded to the insurer or alternatively to our legal counsel.

The Crown has an additional 6 months after the expiration of the recipient's limitation period to begin an action against the defendant, or an additional 6 months after the Third Party Liability unit receives notification of the matter, whichever is later. See Section 7 of the Crown’s Right of Recovery Act.

Compliance provisions

If an insurer fails to provide notification of an incident in which the Crown may have a right of recovery, a court order may be issued requiring the insurer to provide the necessary information. See Section 19 of the Crown’s Right of Recovery Act.

• An insurer who fails to comply with an order is guilty of an offence and is liable to a fine of not more than $10,000. See Section 20 of the Crown’s Right of Recovery Act.

Contact

Connect with the Third Party Liability unit:
Hours: 8:15 am to 4:30 pm (open Monday to Friday, closed statutory holidays)
Phone: See list of contacts below
Toll free: 310-0000 before the phone number (in Alberta)
Fax: 780-427-0752

Address:
Alberta Health
Corporate Services Branch
Third Party Liability Unit
PO Box 1360, Station Main
Edmonton, Alberta  T5J 2N3

Couriers:
Deliver to mailroom
15th floor, ATB Place North Tower
10025 Jasper Avenue NW
Edmonton, Alberta  T5J 1S6

Claim values more than $75,000

Suzanne Maier, B.Comm. LL.B., Director
Phone: 780-415-1499
Email: [email protected]

Rod Murray, B.Comm., LL.B, Senior Claims Officer
Phone: 780-415-0203
Email: [email protected]

Michael O'Connor, B.A. LL.B, Intermediate Claims Officer
Phone: 780-427-3523
Email: [email protected]

Claim values less than $75,000

Greta Stan, Claims Officer
Phone: 780-427-4538

Gulzar Abbas, Claims Officer
Phone: 780-415-0205

Rita Garland, Claims Officer
Phone: 780-415-1557

Joanne Massey, Claims Officer
Phone: 780-415-0207

Shelli Walker, Claims Officer
Phone: 780-644-2040

Dorothy McNeil, Administrative Support
Phone: 780-644-3164

Presentations

Let us know if you would like a representative from the Third Party Liability unit to visit your office to present a seminar on our program and governing legislation.