Third party liability for Medicare and hospital services

When a New Brunswicker receives insured services (such as Medicare or hospital services) because of injuries caused by a third party’s negligence or wrongful act and the injured person pursues and recovers compensation from that third party, the province has a statutory right to recoup the cost of those services from the recovery.

Third Party Liability operates under the authority of the Hospital Services Act  and Medical Services Payment Act , particularly sections addressing recovery of costs of entitled services, subrogation, and related provisions.

Types of claims that trigger recovery include:

• occupiers’ liability
• medical/dental/health care negligence
• product liability
• assault/battery
• other negligence or wrongful acts causing personal injuries

Claim process

Where an injured person is usually legally represented, counsel has a duty to notify the Department of Health and ensure that the province’s claim is addressed before settlement funds are distributed or a release is finalized. Otherwise, the injured party must notify the province.

The claim notification must include:

• injured party name
• date of birth
• NB Medicare number
• date of incident
• type of incident
• brief explanation of injuries
• plaintiff authorization (signed) to review and provide their personal health information (PHI) 

Settlements

Any release or settlement must have provincial approval to be binding on the Crown. The injured party (or their lawyer) must reimburse the province for the cost of entitled services from the settlement proceeds. The province may pursue recovery directly if needed. Counsel fees/contingency on the province’s recovery.

Regulations or policy may provide for a percentage recovery fee for counsel.

Statutory recovery fee

When a solicitor recovers money for the cost of insured (entitled) hospital services under section 10 of the Act, their fee is calculated on a sliding scale as follows:

• 15% on the first $5,000 recovered
• 10% on the next $10,000 recovered
• 5% on any amount over $15,000 recovered

Contact the Department for current rates.

Reimbursement

Forward payment (cheque payable to the Minister of Finance or as directed) along with required affidavits within the specified timeframe (e.g., 30 days of settlement).

Details on required documentation will be provided.