Sometimes, part of an injury settlement goes to OHIP.
The good news is this part of the settlement was never “your money”. It is paid by the insurance company specifically for the OHIP claim. Put another way, if OHIP did not make their claim, the insurance company never would have made the payment.
Point being this: the OHIP payment does not affect your bottom line.
What is an OHIP subrogated claim?
Getting injured is expensive. Seriously injured folks miss time from work. They also have significant care expenses – some of which are covered by insurance, and others which aren’t.
Your injuries are expensive for OHIP too. A typical fracture requiring surgical correction can cost $10,000. Long hospital stays can cost $100,000 or more, particularly if the level of care is high.
In Ontario, OHIP has a right of “subrogation”. This means that whenever you sue someone for your losses due to injury, OHIP also sues the person or people that harmed you. They don’t do this on their own, rather, they do it through you. You advance the claim on OHIP’s behalf, as part of your own lawsuit.
There is one big exception to this rule, and that is for people injured in automobile accidents. There are no OHIP subrogated claims in car accident cases. Instead, Ontario auto insurers pay an annual premium to OHIP.
Most of the time, you really don’t have to think about your OHIP subrogated claim. You have a duty to tell OHIP about their claim and advance it, but if we are your lawyers, we take care of that for you.
Logistics of paying OHIP
When it comes time to settle your case, you will hear us talk about paying OHIP. You might ask yourself: “How is this fair, I thought OHIP was free?”
The truth is that there is really no downside to you by paying OHIP. When we negotiate with insurers, they typically accept OHIP’s claim at face value. Similar to any out-of-pocket expenses claim, if you can prove it happened because of the accident, you’re entitled to reimbursement. When there are disputes about certain services provided, we work with OHIP to either remove those services from the claim or justify their inclusion.
OHIP also takes risk and contributory negligence into consideration and will reduce their claim accordingly (the same way the injured plaintiff does).
The important thing to know as an injury victim is that while together on paper, OHIP’s claim is separated from yours. While the settlement comes in one cheque, part of it is specifically for OHIP, and part of it for you.
ROBERT MURPHY
Rob attended law school at Queen’s University and graduated with his Juris Doctor in 2020. He summered at and completed his articles with Weaver, Simmons LLP, a full-service firm in Northern Ontario. During his articles Rob had the opportunity to see personal injury files from both the plaintiff side and the defence side. After articles, Rob practiced injury law and general litigation with Kelly + Kelly Lawyers in Pembroke, until Kelly + Kelly’s civil litigation practice joined Bergeron Clifford in 2023.
