Subrogated Claims

SUBROGATED CLAIMS

If you are involved with a personal injury claim, some benefits you receive will be subject to claims for reimbursement by the service providers. In insurance law, this right to reimbursement is known as subrogation, and it could affect the amount of damages you may receive in a settlement or judgment. You won’t see their names as parties to a claim as they will be advancing their claims through you in a lawsuit.

Several agencies that commonly provide services to persons with personal injury claims may make subrogated claims in your matter:

OHIP

Under s.30(1) of the Health Insurance Act, OHIP can make a subrogated claim for costs incurred or future costs of treatment for injuries arising from the negligence or wrongdoing of another. This covers almost all personal injury claims except motor vehicle accidents, which are paid out of separate funds insurers pay to OHIP.

Private Insurers

Group insurance, disability and travel insurance policies often contain clauses granting the insurer the right to bring a claim in your name, at its expense, to recover from third parties the costs of benefits paid out to you.

Many long-term disability insurers will require you to reimburse them for LTD benefits out of any settlement or judgment you receive, regardless of how the monies you receive are allocated (pain and suffering, loss of income, etc.)

WSIB

In most cases, the Workplace Safety and Insurance Board will require you to choose between starting a civil lawsuit or collecting benefits. There are some cases in which you can do both, in which case WSIB will require you to make a subrogated claim on its behalf. Be careful though; If you start collecting WSIB benefits and then start a lawsuit, WSIB will require you to reimburse them regardless of what you may receive, or not, in a settlement or damages.

ODSP and Ontario Works

While ODSP and Ontario Works have a statutory right of subrogation, most often they will seek an assignment of monies received. This difference can have a significant affect on the amount of money you receive at the end of a settlement or trial.

Subrogated claims are usually over and above what you get for damages. If you receive $50.000.00, but there are $5,000 in subrogated claims, you get the $50,000 and the subrogated claimants get $5,000.00. If, however, there are another $5,000.00 in assignments, you will be left with $45,000.00 once the assignments are paid.

Injuries sustained in any accident are already stressful enough to deal with and recover from. You should not be left out of pocket because of them. The lawyers at Alemi Law Group can advise you on the various claims that can arise from a personal injury claim and how to resolve them without costing you your fair compensation.

 

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