Claims & Settlements

The Health Care Costs Recovery Act applies to all current legal proceedings – both individual and those under the Class Proceedings Act.

Claims

Information for the Injured Party

You may wish to seek some legal advice with respect to your claim and the requirements of the Health Care Costs Recovery Act and Regulation as they relate to you.  The Third Party Liability office does not provide legal advice regarding this or any other Act.

When a settlement has been reached, or a judgment obtained, the beneficiary has priority over the government in recovering funds – s. 18.

Information for Lawyers

The Health Care Costs Recovery Act and Regulation, together with the Class Proceedings Act are useful reference tools and linked to this site.

Legal proceedings filed before April 1, 2009 when the Health Care Costs Recovery Act came into force:

There is an obligation to:

• provide the Minister with requested information – s. 10(3) and s. 11
• give the Minister notice before settlement – s. 12
• seek consent of Minister for proposed settlements – s. 13

There is no obligation to:

• amend to include a health care services claim – s. 3
• give the Province written notice of the legal proceeding – s. 4
• get Minister’s consent before the action is dismissed or discontinued – s. 5

Legal proceedings filed on or after April 1, 2009: 

This applies to individual proceedings and those under the Class Proceedings Act.

The Plaintiff/Beneficiary has an obligation to:

• include a health care services claim – s. 3
• give the government written notice, including a copy of the originating documents – s. 4
• cooperate with the government to recover the past and future health care costs – s. 11
• provide notice to the Minister before settlement – s. 12
• provide final disposition of a legal proceeding – s. 5
  • the parties must satisfy the court that notice under s. 4, and notice of the application for final disposition have been given to the government, before the court makes a final order – s. 5(3)
  • the Minister’s consent to any discontinuance or CDO must be filed with the court – s. 5(1)

Information for Insurance Companies

Notification requirements:

Please refer to the Health Care Costs Recovery Act and Regulation. In particular, please note Form #1493 Information From Insurer pursuant to s. 10 of the Act, which states in part that:

“(2) An insurer must, within 60 days after learning of the matter described in subsection (1), notify the minister of those circumstances in the prescribed form."

Information for the Public

You may wish to seek some legal advice with respect to your claim and the requirements of the Health Care Costs Recovery Act and Regulation as they relate to you. The Third Party Liability office does not provide legal advice regarding this or any other Act.

Out-of-Province Claims

If a beneficiary receives health care services in another province or territory, the Ministry of Health is billed for those services and they will be included in the health care costs claim.

Out-of-Country Claims

If a beneficiary receives health care services outside of Canada and the Ministry of Health makes payments towards those services, they will be included in the health care costs claim.

Class Action

Is a court action in the Supreme Court that has been certified by a Judge of the Court having determined, among other things, there is a cause of action which includes an identifiable class of 2 or more people whose claims raise common issues. (Class Proceedings Act)

Exclusions

The Health Care Costs Recovery Act does not apply to health care services provided to a beneficiary where the related wrongs are defined under the following Acts:

• Insurance (Vehicle) Act – refer to s. 24(3)(a)
• Tobacco Damages and Health Care Costs Recovery Act – refer to s. 24(3)(b)
• Workers Compensation Act – refer to s. 24(3)(c)

Settlements

A personal injury claim covered by this Act cannot be settled unless:

• written notice is given to the Minister, and
• the Minister consents in writing – s. 13(1).

Section 13 applies to all claims and lawsuits settled after the Health Care Costs Recovery Act came into force, regardless of when the claim or lawsuit was initiated, unless excluded by regulation.

Beneficiary's Duties

At least 21 days prior to entering into a settlement, notify the Minister in the prescribed form – s. 12.

Payor’s Duties

The person legally responsible for making payments under the settlement must:

• notify the Minister of the proposed settlement terms – s. 13(1)
• provide the Minister with requested information to evaluate the proposed settlement – s. 13(3)
• obtain the Minister’s written consent – s. 13(1)(b)
• pay the portion of the settlement allocated to the health care claim to the government within 60 days, or as otherwise agreed – s. 13(6) & (7)

If notice as required by s. 13(1) is not provided, the government has the right to recover, from the person required to give that notice:

• the total cost of past and future health care services related to the personal injury – s. 13(5)
• as a debt due from that person to the government.

Releases – s. 13(8)

The person to whose benefit the release is given must:

• give the Minister written notice of the proposed terms, and
• obtain the Minister’s consent.