AR 88/2012 CROWN'S RIGHT OF RECOVERY (MINISTERIAL) REGULATION (no amdt)
ALBERTA REGULATION 88/2012
Crown’s Right of Recovery Act
CROWN’S RIGHT OF RECOVERY (MINISTERIAL) REGULATION
Table of Contents
1 Interpretation
2 Application
3 Cost of health services that have been provided
4 Cost of future health services
5 Information to be provided by recipient
6 Information to be provided by insurer
7 Repeal
8 Expiry
9 Coming into force
Interpretation
1(1) In this Regulation,
(a) “Act” means the Crown’s Right of Recovery Act;
(b) “approved hospital” means a hospital designated by the Minister as an approved hospital pursuant to Part 2 of the Hospitals Act;
(c) “mental health hospital” means Alberta Hospital Edmonton, Alberta Hospital Ponoka, Centennial Centre for Mental Health and Brain Injury and Villa Caritas. (2) The definitions in section 1 of the Act apply to this Regulation.
Application
2 For greater certainty, this Regulation applies only in respect of Part 1 of the Act.
Cost of health services that have been provided
3 The Crown’s cost of health services for health services that a recipient receives to the date of judgment or settlement based on the Crown’s right of recovery is the total of the following:
(a) the cost of in‑patient services provided to the recipient at an approved hospital calculated in accordance with the following formula:
A + (A x B)
where
A is the amount that the recipient would have to pay under section 9 of the Hospitalization Benefits Regulation (AR 244/90) for insured services received as an in‑patient at the approved hospital if the recipient was a resident of Canada who is not entitled under the Hospitals Act to receive insured services;
B is a capital cost surcharge of 10%;
(b) the cost of out‑patient services provided to the recipient at an approved hospital calculated in accordance with the following formula:
C + (C x B)
where
C is the amount that the recipient would have to pay under section 9 of the Hospitalization Benefits Regulation (AR 244/90) for insured services received as an out‑patient at the approved hospital if the recipient was a resident of Canada who is not entitled under the Hospitals Act to receive insured services;
B is a capital cost surcharge of 10%;
(c) the cost of in‑patient services provided to the recipient at a facility that is designated as a facility or that is within a class of facilities designated as facilities for the purposes of this clause by the Minister calculated in accordance with the following formula:
D + (D x B)
where
D is the cost of in‑patient services as established by the Minister;
B is a capital cost surcharge of 10%;
(d) the cost of out-patient services provided to the recipient at a facility that is designated as a facility or that is within a class of facilities designated as facilities for the purposes of this clause by the Minister calculated in accordance with the following formula:
E + (E x B)
where
E is the cost of out-patient services as established by the Minister;
B is a capital cost surcharge of 10%;
(e) the cost of in‑patient services provided to the recipient at a facility that is designated as a facility or that is within a class of facilities designated as facilities for the purposes of this clause by the Minister, being the cost of in-patient services as established by the Minister;
(f) the cost of out-patient services provided to the recipient at a facility that is designated as a facility or that is within a class of facilities designated as facilities for the purposes of this clause by the Minister, being the cost of out-patient services as established by the Minister;
(g) the amount that the Crown pays for health services as defined in the Alberta Health Care Insurance Act that have been provided to the recipient;
(h) the amount that the Crown pays in respect of air ambulance services provided to the recipient;
(i) the Crown’s cost of
(i) extended health benefits, and
(ii) health aids
under the Alberta Aids to Daily Living and Extended Health Benefits Regulation (AR 236/85), as established by the Minister responsible for the powers, duties and functions of the Minister under that Regulation, that have been provided to the recipient;
(j) the Crown’s cost of services referred to in section 2(3) and (4) of the Co‑ordinated Home Care Program Regulation (AR 296/2003) provided to the recipient under a program under that regulation, being an hourly rate for those services established by the Minister multiplied by the number of hours the recipient received those services;
(k) the cost of in‑patient services provided to the recipient at a mental health hospital calculated in accordance with the following formula:
F + (F x B)
where
F is the cost of in‑patient services as established by the Minister;
B is a capital cost surcharge of 10%;
(l) the cost of psychiatric, psychological and other mental health services provided to a recipient outside of a mental health hospital or a facility referred to in clause (c), (d), (e) or (f), being an hourly rate for those services as established by the Minister multiplied by the number of hours the recipient received those services;
(m) the Crown’s cost, as established by the Minister, of physical therapy services provided to the recipient;
(n) the amount the Crown pays for health services provided to the recipient outside of Alberta;
(o) the Crown’s cost of any other health services provided to the recipient as determined by the Minister.
Cost of future health services
4(1) In this section, a reference to a judgment or settlement means a judgment or settlement that is based on the Crown’s right of recovery.
(2) The Crown’s cost of health services for health services that a recipient will likely receive after the date that a judgment is obtained or settlement entered into is calculated in accordance with this section.
(3) The Crown’s cost of a health service that a recipient will likely receive before the end of the year in which a judgment is obtained or settlement entered into is calculated in accordance with section 3 as though the health service had been provided on the day that the judgment was obtained or settlement entered into.
(4) The Crown’s cost of a health service that a recipient will likely receive after the end of the year in which a judgment is obtained or settlement entered into is calculated in accordance with the following formula:
A x 1
1.025n
where
A is the Crown’s cost of the health service calculated in accordance with section 3 as though the health service had been provided on the day that the judgment was obtained or settlement entered into;
n is the amount obtained when the year in which the judgment was obtained or settlement entered into is subtracted from the year in which the health service will likely be provided.
Information to be provided by recipient
5(1) For the purposes of section 12 of the Act, a recipient who consults a lawyer or has someone consult a lawyer on the recipient’s behalf in respect of personal injuries suffered by the recipient as a result of a wrongful act or omission of a wrongdoer shall provide the Director with the following:
(a) the recipient’s name, date of birth and mailing address;
(b) 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;
(c) the wrongdoer’s name, mailing address, insurer and policy number, if known;
(d) the recipient’s injuries, the health services provided to the recipient 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;
(e) the name and address of the recipient’s lawyer;
(f) a copy of the following, as they are prepared or obtained, that relate to the recipient’s injuries:
(i) pleadings;
(ii) accident reconstruction reports;
(iii) loss of past and future income reports;
(iv) discovery transcripts;
(v) medical reports prepared at the request of the recipient’s lawyer for the purposes of litigation;
(vi) cost of future care reports;
(vii) settlement agreements and judgments.
(2) This section does not apply if
(a) the recipient’s personal injuries were caused by an act or omission of a wrongdoer in the wrongdoer’s use or operation of an automobile,
(b) the wrongdoer was, when the injuries were caused, insured under a motor vehicle liability policy for the automobile referred to in clause (a),
(c) the motor vehicle liability policy referred to in clause (b) applied to and covered the loss in respect of the recipient’s personal injuries, and
(d) the automobile insurer of the motor vehicle liability policy referred to in clause (b)
(i) was licensed in Alberta, and
(ii) contributed to the aggregate assessment in accordance with Part 1, Division 2 of the Act
for the calendar year in which the wrongful act or omission occurred.
Information to be provided by insurer
6(1) For the purposes of section 15 of the Act, an insurer who is notified of circumstances in which the Crown’s right of recovery may arise as a result of a wrongful act or omission of its insured shall provide the Director with the following:
(a) the wrongdoer’s name, date of birth and mailing address;
(b) a copy of the wrongdoer’s insurance policy;
(c) 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;
(d) the recipient’s name and the name and address of the recipient’s lawyer, if known;
(e) a copy of the following, as they are prepared or obtained, that relate to the recipient’s injuries:
(i) accident reconstruction reports;
(ii) loss of past and future income reports;
(iii) medical reports on the recipient prepared at the request of the insurer for the purposes of litigation;
(iv) cost of future care reports.
(2) This section does not apply if
(a) the recipient’s personal injuries were caused by an act or omission of a wrongdoer in the wrongdoer’s use or operation of an automobile,
(b) the wrongdoer was, when the injuries were caused, insured under a motor vehicle liability policy for the automobile referred to in clause (a),
(c) the motor vehicle liability policy referred to in clause (b) applied to and covered the loss in respect of the recipient’s personal injuries, and
(d) the automobile insurer of the motor vehicle liability policy referred to in clause (b)
(i) was licensed in Alberta, and
(ii) contributed to the aggregate assessment in accordance with Part 1, Division 2 of the Act
for the calendar year in which the wrongful act or omission occurred.
Repeal
7 The Crown’s Right of Recovery (Ministerial) Regulation (AR 160/96) is repealed.
Expiry
8 For the purpose of ensuring that this Regulation is reviewed for ongoing relevancy and necessity, with the option that it may be re‑passed in its present or an amended form following a review, this Regulation expires on March 31, 2017.
Coming into force
9 This Regulation comes into force on the coming into force of section 40(2) of the Crown’s Right of Recovery Act.
