Third Party Liability

The government can recover the cost of health services when an Albertan is injured due to a third party's wrongful act or omission.

The Third Party Liability unit at Alberta Health is responsible for recovering health care costs for personal injury actions on behalf of the Alberta government, or "Crown."

Examples of personal injury actions in which the Crown's right of recovery may be enforced include:

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

The Crown’s right of recovery

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.

  • This applies except when the injury is caused by a motor vehicle accident and the negligent driver is insured by an Alberta insurance company that contributes to the Aggregate Assessment.

The Crown has an independent right of recovery.

  • Section 2(1) of the Crown's Right of Recovery 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 Minister of Health has the authority to appoint a Director of Third Party Liability to perform the necessary functions in the recovery of health care claims.
  • The Third Party Liability Unit operates under the authority of Part 1 of the Crown's Right of Recovery Act, SA 2009, c.C-35.

Related legislation

Recoverable health care services

The scope of recoverable health services expenses include:

  • hospital inpatient and outpatient services (including community ambulatory care centres)
  • 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

The Third Party Liability unit is also able to claim for the future cost of health services on claims.

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 2(3) of the Crown's Right of Recovery Act.

  • If the personal injuries are caused by an act or omission of a wrongdoer in the use or operation of an automobile, the wrongdoer is insured under a "motor vehicle liability policy," and the insurer contributed to the Aggregate Assessment for that calendar year, 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. 1-3 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 514].

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 wrongdoer was not operating an "automobile" as defined by the relevant legislation
  • if the wrongdoer was not insured under a "motor vehicle liability policy"
  • if the wrongdoer's insurer was not licensed in Alberta or did not contribute to the Aggregate Assessment for the calendar year in which the wrongful act or omission occurred

These situations include, but are not limited to:

  • out of province insurers
  • some self-insurers
  • multiple tortfeasors other than those insured under a "motor vehicle liability policy," such as claims against commercial/social hosts or claims against municipalities for road design or maintenance
  • accidents involving farm machinery, etc.

If you are uncertain if a claim can be made, contact the Third Party Liability unit.

Limitation periods

The Crown’s limitation period extends past that of the injured party. Section 7 of the Crown's Right of Recovery Act, allows the Crown an additional 6 months beyond the expiration of the injured party’s limitation period to commence an action, or an additional 6 months after the Third Party Liability unit receives notification of the matter, whichever is later.

Information for lawyers

Notification requirements

Section 12 of the Crown's Right of Recovery Act stipulates that an injured party who consults a lawyer or has someone consult a lawyer on their 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 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 PDF icon should be submitted as soon as possible by a lawyer whenever he or she is consulted by a recipient 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, the Third Party Liability unit will investigate to determine whether or not the Crown has a right of recovery.

The unit 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
  • injured party is an Alberta resident entitled to health services
  • injured party is in receipt of health care services as result of the incident
  • the incident does not fall within the exemption created by Section 2(3) of the Crown's Right of Recovery Act

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.

  • It can take up to 2 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.

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 accordingly.

Pleadings

As the Crown's Right of Recovery Act 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.

However, 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 the Crown's Right of Recovery Regulation 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.
  • Disbursements must be reasonable, directly related to the Crown's claim and prior approval is also required.

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: Alberta Health is not subject to the goods and services tax (GST).

Information for insurers

In August 1996, an annual direct payment system for automobile insurers replaced the recovery of health care costs on a claim by claim basis for most motor vehicle accident situations.

The Minister of Health 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 Albertans as a result of the wrongful acts or omissions of third parties in the use or operation of automobiles in that calendar year.

Notification requirements

Under Section 15 of the Crown's Right of Recovery 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 is:

  • the wrongdoer’s name, date of birth and mailing address
  • a copy of the wrongdoer’s insurance policy
  • 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
  • the beneficiary’s name and the name and address of the beneficiary’s lawyer, if known
  • a copy of the following, as they are prepared or obtained, that relate to the beneficiary’s injuries:
    1. accident reconstruction reports
    2. loss of past and future income reports
    3. medical reports on the beneficiary prepared at the request of the insurer for the purposes of litigation
    4. cost of future care reports

Notification Form

A Notification Form PDF icon 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 sent to the Third Party Liability unit as soon as possible.
  • It is important that it include the recipient's name, recipients's date of birth, the date of loss, the type of loss, and the injuries sustained by the recipient.

Claim process

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

The unit 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
  • the injured party is an Alberta resident entitled to health services
  • the injured party is in receipt of health care services as result of an incident
  • the incident does not fall within the exemption created by Section 2(3) of the Crown's Right of Recovery Act

Upon a review of medical records and health information, the Crown's 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 7 of the Crown's Right of Recovery Act, the Crown has an additional 6 months after the expiration of the recipient's limitation period to commence an action against the defendant, or an additional 6 months after the Third Party Liability unit receives notification of the matter, whichever is later.

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 19 of the Crown's Right of Recovery Act).

  • Pursuant to Section 20 of the Crown's Right of Recovery Act, an insurer who fails to comply with an order obtained under Section 19 of the Crown's Right of Recovery Act is guilty of an offence and is liable to a fine of not more than $10,000.00.

Contact

Contact the Third Party Liability unit of Alberta Health with questions, claims or for more information.

Presentations

Let us know if you would like a representative from the Third Party Liability unit to visit your office to present a seminar on our program and governing legislation.

Claim values OVER $75,000

Suzanne Maier, B.Comm. LL.B.
Director
Phone: 780-415-1499
Email: suzanne.maier@gov.ab.ca

Rod Murray, B.Comm., LL.B
Senior Claims Officer
Phone: 780-415-0203
Email: rod.murray@gov.ab.ca

Michael O'Connor, B.A. LL.B
Intermediate Claims Officer
Phone: 780-427-3523
Email: michael.r.o'connor@gov.ab.ca

Claim values LESS THAN $75,000

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

Rita Garland, Claims Officer
Phone: 780-415-1557

Donna Cameron de Jimenez, Claims Officer
Phone: 780-427-0224

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

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

Shelli Andreson, Claims Officer
Phone: 780-644-2040

Dorothy McNeil, Administrative Support
Phone: 780-644-3164

Mailing address

Alberta Health
Corporate Services Branch
Third Party Liability Unit
P.O. Box 1360, Stn. Main
Edmonton, AB T5J 2N3
Fax: 780-427-0752