Category: Dog Attacks and Bites

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Alberta Health’s right to recover cost of care in certain situations

Alberta Health can recover cost of care from the wrongdoer if they injury a person

What is the Crown’s Right of Recovery?

 It may come as a surprise to many, but in certain situations, the Alberta government can sue you for healthcare costs. An example of this would be when someone suffers injuries as a result of somebody else’s wrongdoing (e.g., slips and falls, social host liability, dog bites, assaults). In this case, the government may sue the at-fault party to recover the healthcare costs of treating the injured person. In Alberta, it is the Crown’s Right of Recovery Act that gives the government or “Crown,” the right to recover healthcare costs. Recoverable healthcare costs include, but not limited to:

 

  • Hospital Services (in-patient and out-patient)
  • Ambulance Services (air and ground)
  • Drug costs
  • Mental health costs
  • Home care
  • Future cost of healthcare
  • Services provided under the Alberta Healthcare Insurance Act

Does the Crown’s Right of Recovery apply to Motor Vehicle Accidents?

In many cases of motor vehicle accidents, the Alberta government will not be able to recover health service-associated costs. The legislation states that the government will not have a claim to recover health service costs for motor vehicle accidents if:

 

  • The personal injuries are caused by the wrongdoer’s operation of a vehicle,
  • The wrongdoer is insured under a “motor vehicle liability” policy,
  • The policy covers the injured parties’ injuries, and
  • The insurer is licenced in Alberta and contributed to the aggregate assessment in the year of the accident, in accordance with division 2 of the legislation.

If any of the above are not satisfied, the government will have a claim to recover the costs of health services provided. The Crown’s right to recover cost may also exist in vehicle accidents involving out-of-province insurance companies and against other defendants not insured under the vehicles’ liability policy.

Duty to notify the Crown

The legislation imposes certain obligations on insurance companies and injured parties. One of these obligations requires insurance companies, and injured parties who receive treatment, to notify the government of a potential claim against an at-fault party.  Insurance companies must notify the government as soon as they learn about a situation, in which the government may have a claim to recover health care costs. An injured party must give notice if they or someone on their behalf talks to a lawyer about injuries they suffered. The injured party must also fully cooperate with the government in their claim against the at-fault party for healthcare costs. If the injured party fails to cooperate, the government may pursue a claim against them for the costs.

How does the Crown pursue a claim?

 The legislation gives the government two main methods to recover healthcare costs from the at-fault party. The government may file its own lawsuit against the wrongdoer to recover the costs they spent treating the injured party. Alternatively, the government can join a lawsuit that the injured party may have launched against the at-fault party. In this case, the government would simply request the injured party or their lawyer to add the healthcare costs claim to their lawsuit. Since the injured party must cooperate, they can either allow the government to join the lawsuit or potentially be personally liable for the healthcare costs.

 

 

 

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Will my personal injury settlement have any impact on my AISH benefits?

Navigating the recovery process after being injured in an accident can be daunting on its own, and you may have additional considerations if you are also receiving AISH benefits. It is important to know and consider how a personal injury pay out can affect your financial situation if you are receiving AISH.

What are the eligibility requirements for AISH?

Assured income for the Severely Handicapped (AISH), is a government program which provides financial as well as health benefits to those with permanent medical conditions, if the medical conditions prevent someone from being able to support themselves.

There are certain eligibility criteria in order to qualify and continue to receive AISH. Typically, your eligibility is determined based on you and your spouse’s income, as well as any assets that you may have. The total value of your assets cannot exceed $100,000.

Certain forms of income and assets are considered exempt when considering eligibility. These exemptions include but are not limited to income tax refunds, or disability savings plan (RDSP) payments.  Other forms of income and assets, however are considered non exempt. A settlement can be an asset which is considered non-exempt, and is counted when it comes to eligibility.

Temporary Asset Exemption

You have 365 days to invest money that is not considered income into an exempted asset, otherwise, the money will be considered non exempt. An option for a client who is receiving AISH and receives a personal injury settlement would be looking into a structured settlement. A structured settlement is when the settlement is paid out regularly, over a period of time. Typically, the payments are once a month.  A structured settlement may be a good option because it is exempt by AISH. Another option could be investing the money into a trust or a Registered Disability Savings Plan, or another exempt asset.

What should I do if I receive a settlement for my personal injuries?

You remain responsible for reporting any changes to your financial or medical situation. If you receive a settlement, it is important to report your settlement to your AISH caseworker. Your settlement pay out may impact your eligibility for AISH, and your caseworker is also typically in the best position to be able to determine this for you.