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What is an OHIP Subrogated Claim?

If you are injured due to the fault of another person or entity, and you want to be compensated for your losses, the Ministry of Health and Long-Term Care is also entitled to recover from the at-fault party the amounts that it paid on your behalf through OHIP (the Ontario Health Insurance Plan). This is known as a subrogated claim. The exception is when your injuries are caused by a motor vehicle collision. The Ministry’s right to recover is contained in the Health Insurance Act and its Regulations, and also the Long Term Care Act.

The Ministry is entitled to claim for all insured services that were incurred on your behalf, up to settlement or judgment at trial. Often the Ministry will have a claim for future expenses if you have significant ongoing health care needs.

Even if your lawyer is able to settle your claim without commencing a lawsuit, the OHIP subrogated claim must still be paid. As the injured party, you are obligated to protect the Ministry’s right of recovery and advance a claim on its behalf. Your lawyer will do this for you.

It is important to understand, however, that the amounts that are to be repaid to the Ministry do not come out of your compensation. You must advance the Ministry’s claim as part of your claim, but it is assessed and paid as part of a settlement or judgment, distinct from the other types of claims you are advancing.

In a personal injury action, for example, you may have a claim for pain and suffering damages, which is one head of damages; for income losses, which is another head of damages; and the OHIP subrogated claim, which is yet another distinct head of damages.

Think of the OHIP subrogated claim like a Tim Horton’s run. You are going to Tim Horton’s to get a coffee but before you go, you ask your neighbour if you can get something for her as well. Your neighbour says yes and gives you $5 to cover her order. You go to Tim Horton’s, you buy your coffee with your money, and you buy your neighbour’s order with her money, and bring her order back to her. You are not out of pocket. You were simply the entity through which the transaction occurred. The same is the case for the OHIP subrogated claim. The claim flows through you, but the outcome does not impact your bottom line.

This article was written by a member of the Personal Injury Team at McKenzie Lake. If you require assistance with a personal injury matter or wish to speak to a personal injury lawyer at McKenzie Lake Lawyers LLP, please call (519) 672-5666.