If a person is injured in an accident caused by someone else’s negligence or wrongdoing, and makes a claim for damages or initiates a lawsuit, the Ministry of Health and Long-Term Care can recover its costs for health care and treatment. Each year, the ministry recovers over $12 million from insurance companies through subrogation. Subrogation is a legal term unique to Insurance Law. It means “the right to recover costs for an injury caused by the fault or negligence of another person.” The ministry is notified by the injured person, their legal counsel or by the at-fault party’s liability insurer. The ministry’s right of recovery applies to any incident regardless of the location. This includes other provinces, and foreign jurisdictions that allow subrogation or other reimbursement rights. The ministry can recover costs for:
OHIP insured services including:
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- physician services;
- hospital services including in/out patient, acute and chronic care;
- air ambulance; out-of-country/out-of-province medical and hospital services;
Extended care services typically arranged or provided through Community Care Access Centres in the home, school or community including:
- professional services such as nursing, physiotherapy, occupational therapy, speech-language pathology, social work or nutritional services
- non-professional services:
- personal support including assistance with personal hygiene and homemaking services such as house cleaning, laundry, banking, shopping, preparing meals;
- attendant care services such as assistance with personal hygiene and activities for daily living;
- long-term care accommodation and services in nursing homes, charitable homes and homes for the aged (accommodation costs cannot be claimed in other facilities such as supportive housing).
- community support services such as meals and transportation, caregiver support, adult day programs, home maintenance and repair, social or recreational services.
The ministry recovers the cost from insurance companies (or at-fault parties) for all OHIP insured health services provided up to the time of settlement or judgment. It also claims the costs for future insured health care services that an injured person may need. Where an injured person has been assessed for long-term care services and benefits, funding is provided on a bridge or interim basis until settlement funds have been received. The ministry’s claim includes these costs, and the subrogation unit endeavours to contact the Community Care Access Centres or other funding agencies upon settlement.
