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The Third Party Liability Unit is responsible for recovering health care costs when an Albertan is injured due to a third party's wrongful act or omission.

The following are examples of personal injury actions in which the Crown's right of recovery may arise:

• occupiers liability actions;
• liabilities for animals;
• medical, dental or other health care provider negligence;
• product liability actions;
• battery or assault actions.

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Third Party Liability operates under the authority of Part 5 of the Hospitals Act, RSA 2000 Chap. H-12.

The Hospitals Act was amended on August 1, 1996, to repeal Section 58 pertaining to the Crown’s subrogated claim. Claims with a date of loss prior to August 1, 1996 are governed by Section 58 of the prior legislation. For claims arising on or after August 1, 1996 the Crown has an independent right of recovery. Section 62(1) of the Hospitals Act stipulates 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".

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, except when the injury is caused by a motor vehicle accident and the negligent driver is insured by an Alberta insurance company.

The scope of services that Third Party Liability is able to recover was expanded through Section 61(h) of the Hospitals Act and the Crown’s Right of Recovery (Ministerial) Regulation #160/96. The following services are now recoverable:

• hospital inpatient and outpatient services;
• air 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;
• future health care 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.

Third Party Liability is also able to claim for the future cost of health services on claims arising on or after August 1, 1996.

For claims with a date of loss prior to August 1, 1996 only hospitalization services are recoverable (i.e. inpatient and outpatient services).

Motor Vehicle Accidents

1. Motor Vehicle Accidents in Which the Crown Has No Right of Recovery

The Crown no longer has a claim arising from motor vehicle accidents in the circumstances outlined in Section 62(3) of the Hospitals Act. If the personal injuries are caused by an act or omission of a wrongdoer in the use or operation of an automobile and the wrongdoer is insured under a "motor vehicle liability policy" 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 Chap. I-3 evidencing a contract of insurance that has been made or renewed in Alberta or that is deemed under the Insurance Act to have been made or renewed in Alberta [Section 12(1)].

In addition, Section 97(1) of the Hospitals Act extinguishes the Crown’s claim for all motor vehicle accidents with a date of loss prior to August 1, 1996.

2. Motor Vehicle Accidents In Which the Crown Has A Right of Recovery

There are certain situations in which the Crown continues to have a claim when there is a motor vehicle accident. If the accident did not involve an "automobile" as defined by the relevant legislation or the wrongdoer was not insured under a "motor vehicle liability policy" the Crown continues to have a claim. These situations include, but are not limited to:

• out of province insurers;
• self-insurers;
• multiple tortfeasors other than those insured under a "motor vehicle liability policy".

Limitation Periods

The Crown’s limitation period extends past that of the injured party. Section 67 of the Hospitals Act, allows the Crown an additional six months beyond the expiration of the injured party’s limitation period to commence an action.

• HOSPITALS ACT

  • Crown’s Right of Recovery Regulation
  • Crown’s Right of Recovery (Ministerial) Regulation
  • Crown's Right of Recovery (Provincial Treasurer) Regulation (AR 219/96)

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CONTACT INFORMATION

The Third Party Liability Unit is part of the Financial and Administrative Services Branch of the Finance & Corporate Services Division of Alberta Health and Wellness.

The Hospitals Act grants the Minister of Health and Wellness the statutory authority to appoint a Director of Third Party Liability to perform the necessary functions in the recovery of health care claims.

Claim values OVER $75,000

Wayne Maday. B.A. (Hons), LL.B.
Director
Phone: (780)415-0203
E-mail: wayne.maday@health.gov.ab.ca

Suzanne Maier, B.Comm. LL.B.
Senior Claims Officer
Phone: (780)415-1499
E-mail: suzanne.maier@gov.ab.ca

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

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

Sarah Settingiano, Claims Officer
Phone: (780)427-4538

Faye Wilson, Claims Officer
Phone: (780)415-0206

Donna Cameron de Jimenez
TPL Office Co-ordinator
Phone: (780) 427-0224

Mailing Address

16th Floor, Telus Plaza North Tower
PO Box 1360, STN. Main
10025 - Jasper Avenue
Edmonton, AB
T5J 2N3
Fax: (780)427-0752

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ADDITIONAL INFORMATION FOR LAWYERS

Notification Requirements

Section 72 of the Hospitals Act stipulates that an injured party who consults a lawyer or has someone consult a lawyer on his behalf with respect to personal injuries suffered as a result of a wrongful act or omission by a third party must notify the Third Party Liability Program.

Section 4 (1) of the Crown's Right of Recovery (Ministerial) Regulation #160/96 outlines the following information that must 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:

1. pleadings;
2. accident reconstruction reports;
3. loss of past and future income reports;
4. discovery transcripts;
5. medical reports prepared at the request of the injured party’s lawyer for the purposes of litigation;
6. cost of future care reports;
7. settlement agreements and judgments.

NOTIFICATION FORM

A Notification Form should be submitted as soon as possible by a lawyer whenever he or she is consulted by a beneficiary regarding personal injuries suffered as a result of a third party’s wrongful act or omission in which the Crown’s right of recovery may arise.

Claim Process

Upon receipt of a Notification Form, Third Party Liability will investigate to determine whether or not the Crown has a right of recovery.

Third Party Liability will initially have a claim if the following conditions are satisfied:

• Injured party sustained injury as a result of the wrongful act or omission of a third party; and
• Injured party is an Alberta resident entitled to health services; and
• Injured party is in receipt of health care services as result of an accident; and
• The accident did not occur during the use or operation of an automobile by a defendant who was insured under an Alberta motor vehicle liability policy at the time of the accident.

In order to determine if health services have been provided as a result of the wrongful act or omission, a review of medical records and health information is necessary. Please note that it often can take up to two months before we receive a response from the various health providers. As such, it is important that you advise our office of a Crown’s potential right of recovery as soon as possible so that it does not delay settlement.

Once our claim is developed it will be forwarded to your office along with our request to act. Alternatively, we will forward our claim directly to the insurer and advise you as such.

Pleadings

As the Hospitals Act now 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 for all injuries with a date of loss on or after August 1, 1996.

Legal counsel should contact our office prior to including "Her Majesty the Queen in Right of Alberta" in the pleadings so that we may 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, we are bound by Alberta Regulation 163/96 with respect to the payment of legal fees. The maximum amount for legal counsel acting for both the plaintiff and the Crown is 15% of the first $20,000.00 payable to the Crown and 10% on the remainder of the amount payable to the Crown, excluding reasonable disbursements. Reasonable disbursements will require prior approval before payment of same.

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 that Alberta Health & Wellness is not subject to the goods and services tax.

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New legislation was passed in August 1996, that established an annual direct payment system for automobile insurers which replaced the recovery of health care costs on a claim by claim basis.

The Minister of Alberta Health and Wellness establishes for each calendar year an aggregate assessment payable by automobile insurers based on an estimate of the Crown’s cost of health services for personal injuries suffered by an Albertan as a result of the wrongful act or omission of a third party in the use or operation of an automobile in that calendar year.

Notification Requirements

Under Section 75 of the Hospitals Act, an insurer has a statutory obligation to notify the Crown of any circumstances in which the Crown’s right of recovery may arise.

The required information as per Section 5(1) of the Crown's Right of Recovery (Ministerial) Regulation (AR160/96) is as follows:

(a) the wrongdoer’s name, date of birth and mailing address;

(b) a copy of the wrongdoer’s insurance policy;

(c) 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;

(d) the beneficiary’s name and the name and address of the beneficiary’s lawyer, if known;

(e) a copy of the following, as they are prepared or obtained, that relate to the beneficiary’s injuries:

(i) accident reconstruction reports;

(ii) loss of past and future income reports;

(iii) medical reports on the beneficiary prepared at the request of the insurer for the purposes of litigation;

(iv) cost of future care reports.

Notification Form

A Notification Form should be submitted by an insurer in every personal injury accident in which the Crown’s right of recovery may arise. The Notification Form should be forwarded to Third Party Liability as soon as possible. It is important that it include the beneficiary’s date of birth beneficiary's name, the date of loss, the type of loss, and the injuries sustained by the beneficiary.

Claim Process

Upon receipt of a Notification Form, Third Party Liability will investigate to determine whether or not the Crown has a right of recovery.

Third Party Liability 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; and
• The injured party is an Alberta resident entitled to health services; and
• The injured party is in receipt of health care services as result of an accident; and
• The accident did not occur during the use or operation of automobile by a defendant who was insured under a motor vehicle liability policy at the time of the accident.

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

Pursuant to Section 67 of the Hospitals Act, the Crown has an additional six months after the expiration of the beneficiary’s limitation period to commence an action against the defendant.

Compliance Provisions

If an insurer fails to provide notification of an incident in which the Crown may have a right of recovery, we may apply for a court order compelling the insurer to provide the necessary information (Section 79 of the Hospitals Act). Pursuant to Section 80 of the Hospitals Act, an insurer who fails to comply with an order obtained under Section 79 of the Hospitals Act is guilty of an offence and is liable to a fine of not more than $10,000.00.

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If you would like a representative from Third Party Liability to visit your office to present a seminar on our program and governing legislation, please contact us.

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