Subrogation claims are a concept which is unique to insurance law. The Ontario Ministry of Health has the right to be reimbursed for the cost of medical treatment for injuries provided as the result of someone else’s negligence.
How Subrogation Claims Work
The injured person gets medical treatment for his or her injuries. The Ontario Health Insurance Plan (OHIP) pays the doctor or hospital directly for services covered under the Plan. When the injured person receives a settlement for the injuries and damages sustained in the accident, the Ministry of Health is entitled to be reimbursed for the amount it paid out for medical care. Why can’t an injured person simply pocket the full amount of the settlement? The money received as compensation for personal injuries is meant to restore the injured person to the state he or she was in before the accident occurred. Keeping money received as compensation for medical bills amounts to “double dipping” and an accident victim cannot benefit in this manner.
Subrogation Claim Covered Services
A number of health care services are covered under a subrogated claim made by the Ontario Ministry of Health, including the following:
- OHIP covered services (doctor’s visits, hospital care, air ambulance and health services provided in another province or country)
- Home health care services provided through Community Care Access Centres (nursing care, physiotherapy, occupational therapy, personal support for activities of daily living, adult day care, community transportation or meals services)
The Ministry of Health can also recover the cost of future health care services the injured person may need as a result of the accident. The cost of future non-professional health care services, such as a personal support worker or homemaking services is not subject to subrogation claims, and the injured person will need to make sure that his or her claim includes an amount which will be used to purchase these services personally.
How a Lawyer Can Help with a Subrogation Claim
Subrogation rules allow The Ministry of Health to recover millions of dollars spent on health care costs annually. Mississauga insurance defense lawyers like Petrillo Law can advise clients about what the true cost of their personal injury claim should be so that the subrogated claim is included in the damages sought. As experienced insurance lawyers, we can review your case and offer expert advice about your personal situation. We serve clients across Mississauga, the Greater Toronto Area (GTA) and Ontario.