4 Information to
be provided by beneficiary
5 Information to
be provided by insurer
8 Aggregate
assessment
9 Repeal
10 Expiry
Interpretation
1(1) In this Regulation,
(a) “Act”
means the Hospitals Act;
(b) “mental
health hospital” means The Alberta Hospital Edmonton, The Alberta Hospital
Ponoka and a mental health hospital as defined under section 18 of the Regional
Health Authorities Act.
(1.1) A
physical therapy service is a health service.
(2) The definitions in sections 1 and 61
of the Act apply to this Regulation.
AR 160/96
s1;152/2001;251/2001
Cost of health
services that have been provided
2 The Crown’s cost of health services for
health services that a beneficiary receives to the date of judgment or
settlement based on the Crown’s right of recovery is the total of the
following:
(a) the
cost of in‑patient services provided to the beneficiary at an approved
hospital calculated in accordance with the formula:
A
+ (A x B)
where
A is the amount that the
beneficiary would have to pay under section 9 of the Hospitalization
Benefits Regulation (Alta. Reg. 244/90) for insured services received as an
in‑patient at the approval hospital if the beneficiary was a resident of
Canada who is not entitled under the Hospitals Act to receive insured
services;
B is a capital cost
surcharge of 25%;
(b) the
cost of out‑patient services provided to a beneficiary at an approved
hospital calculated in accordance with the formula:
C
+ (C x B)
where
C is the amount that the
beneficiary would have to pay under section 9 of the Hospitalization
Benefits Regulation (Alta. Reg. 244/90) for insured services received as an
out‑patient at the approved hospital if the beneficiary was a resident of
Canada who is not entitled under the Hospitals Act to receive insured
services;
B is a capital cost
surcharge of 25%;
(c) the
amount that the Crown pays for health services as defined in the Alberta
Health Care Insurance Act that have been provided to the beneficiary;
(d) the
amount that the Crown pays in respect of air ambulance services provided to the
beneficiary;
(e) the
Crown’s cost for program benefits under the Aids to Daily Living Program, as
established by the Minister responsible for the administration of the Alberta
Aids to Daily Living Program, that have been provided to the beneficiary;
(f) the
Crown’s cost of co‑ordinated home care program services described in the Co‑ordinated
Home Care Program Regulation (Alta. Reg. 239/85) provided to the
beneficiary, being an hourly rate for those services established by the Minister
times the number of hours the beneficiary received those services;
(g) the
cost of in‑patient services provided to the beneficiary at a mental
health hospital calculated in accordance with the formula:
D
+ (D x B)
where
D is the cost of in‑patient
services as established by the Minister;
B is a capital cost
surcharge of 25%;
(h) the
cost of psychiatric, psychological and other mental health services provided to
a beneficiary outside of a mental health hospital, being an hourly rate for those
services as established by the Minister times the number of hours the
beneficiary received those services;
(i) the
amount the Crown pays for health services provided to the beneficiary outside
of Alberta;
(j) the Crown’s cost, as established by the
Minister, of physical therapy services provided to the beneficiary.
AR 160/96
s2;152/2001;105/2006
Cost of future health
services
3(1) In this section, a reference to a judgment or
settlement means a judgment or settlement that is based on the Crown’s right of
recovery.
(2) The
Crown’s cost of health services for health services that a beneficiary will
likely receive after the date that a judgment is obtained or settlement entered
into is calculated in accordance with this section.
(3) The Crown’s cost of a health service
that a beneficiary will likely receive before the end of the year in which a
judgment is obtained or settlement entered into is calculated in accordance
with section 2 as though the health service had been provided on the day that
the judgment was obtained or settlement entered into.
(4) The
Crown’s cost of a health service that a beneficiary will likely receive after
the end of the year in which a judgment is obtained or settlement entered into
is calculated in accordance with the formula:
A x 1
1.025n
where
A is the Crown’s
cost of the health service calculated in accordance with section 2 as though
the health service had been provided on the day that the judgment was obtained
or settlement entered into;
n is the amount obtained
when the year in which the judgment was obtained or settlement entered into is
subtracted from the year in which the health service will likely be provided.
Information to be
provided by beneficiary
4(1) For the purposes of section 72 of the Act, a
beneficiary who consults a lawyer or has someone consult a lawyer on his behalf
in respect of personal injuries suffered by the beneficiary as a result of a
wrongful act or omission of a wrongdoer shall provide the Director with the
following:
(a) the
beneficiary’s name, date of birth and mailing address;
(b) 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;
(c) the
wrongdoer’s name, mailing address, insurer and policy number, if known;
(d) the
beneficiary’s injuries, the health services provided to the beneficiary 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;
(e) the
name and address of the beneficiary’s lawyer;
(f) a
copy of the following, as they are prepared or obtained, that relate to the
beneficiary’s injuries:
(i) pleadings;
(ii) accident reconstruction reports;
(iii) loss of past and future income reports;
(iv) discovery transcripts;
(v) medical reports prepared at the request of the beneficiary’s
lawyer for the purposes of litigation;
(vi) cost of future care reports;
(vii) settlement agreements and judgments.
(2) This
section does not apply if
(a) the
beneficiary’s personal injuries were caused by an act or omission of a
wrongdoer in the use or operation of an automobile, and
(b) the wrongdoer was, when the injuries were
caused, insured under a motor vehicle liability policy.
AR 160/96 s4;251/2001
Information to be
provided by insurer
5(1) For the purposes of section 75 of the Act, an
insurer who is notified of circumstances in which the Crown’s right of recovery
may arise as a result of a wrongful act or omission of its insured shall
provide the Director with the following:
(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.
(2) This
section does not apply if
(a) the
beneficiary’s personal injuries were caused by an act or omission of a
wrongdoer in the use or operation of an automobile, and
(b) the wrongdoer was, when the injuries were
caused, insured under a motor vehicle liability policy.
AR 160/96 s5;251/2001
6, 7 Repealed AR 152/2001 s4.
Aggregate assessment
8(1) The Minister shall establish the aggregate
assessment for 2001 and following years for the purposes of section 82(2)(a) of
the Act in accordance with subsection (2).
(2) Based on information prepared by the Department
of Health and Wellness, actuarial reports and consultations with
representatives of automobile insurers, the Minister shall, in a manner
determined by the Minister, estimate for the calendar year the Crown’s cost of
health services referred to in section 2(a) to (i) for personal injuries
suffered by beneficiaries as a result of wrongful acts or omissions of
wrongdoers in the use or operation of automobiles in that calendar year.
AR 160/96
s8;152/2001;251/2001
Repeal
9 The Crown’s Right of Recovery
(Ministerial) Regulation (Alta. Reg. 116/96) is repealed.
Expiry
10 For the purpose of ensuring
that this Regulation is reviewed for ongoing relevancy and necessity, with the
option that it may be re‑passed in its present or an amended form
following a review, this Regulation expires on April 30, 2011.
AR 160/96
s10;152/2001;105/2006
