Social Security Claims – All you need to Know
Many times, throughout our lives, we need the services of the National Insurance Institute. For example, immediately after birth, in the framework of child benefits and later in various circumstances such as requiring unemployment benefits, after dismissal from work, after an injury at work, or God forbid due to a serious illness.
Our office is often attended by people who are unaware of their rights, we see how these people often lose a lot of money since they simply did not turn or exhaust their social security rights to receive what they deserved, or did not turn at the right time and lost pensions that they deserved due to the statute of limitations. In addition, there are also those who lose money, due to the failure on their behave to prove their their center of life is Israel.
In this post, we will try to answer important questions about exercising rights vis-à-vis Social Security:
What claims can be submitted to the National Insurance Institute?
In what cases may we receive a monthly pension or a monetary grant?
What is a medical committee and in what cases are we required to report to it?
How do I appeal the determination of the medical committee? (Is it recommended to file such an appeal?)
In general, the following post will include information that we believe is important and desirable to know about the rights you deserve if you decide to apply to the National Insurance Institute.
At first, the National Insurance Institute is an official body of the State of Israel, and its job is to maintain the social security of residents and citizens of the country who have been in a complex medical or economic situation and need help.
The role of the National Insurance Institute and its powers are enshrined in the National Insurance Law, according to which every citizen and every permanent resident who reaches the age of 18 is obligated to pay National Insurance contributions. In exchange for those payments, if one day you need help, the National Insurance Institute will assist you, as stated in the National Insurance Institute's slogan. And indeed, this assistance of the National Insurance Institute is provided through allowances, pensions, grants, discounts on current accounts, help in various areas such as child support, rehabilitation benefits, and more.
Most people are not aware of what they are entitled to, and when they act alone, they do not always receive the assistance they hoped for or deserve. Therefore, before referring to National Insurance Institute, it is highly recommended to consult a lawyer who specializes in Social Security claims, who knows how to act and what needs to be done to get you the rights you deserve.
When can I contact the National Insurance Institute?
Unemployment claims, professional illness claims, risk pregnancy benefits, Maternity allowance, disabled child benefits, general disability pension, mobility benefit, alimony, accident fees, personal accidents, work accidents, injury allowance, income support, disability from work, ringworm, polio, old age pension, dependents' allowance, recession allowance, mobility allowance, long-term care.
Sometimes the claims can be legally complex, and the receipt of funds is not automatic and does not end with filling out forms but involves decisions of various committees – quasi-judicial committees, in a way that may require the knowledge and expertise of a lawyer who is specializes in Social Security claims.
For example, in our firm, we believe that a lawyer specializing in Social Security matters and legal experience in medical issues will physically join any medical committee that exists for our client.
What diseases can credit you with a monthly pension or a monetary grant?
Many diseases may credit you with a monthly pension or a monetary grant, such as fibromyalgia, arthritis, Dialysis treatments, cirrhosis of the liver, visual impairments, hearing impairments, heart disease, diabetes, impotence, Crohn's disease, dementia, Alzheimer's disease, cerebral palsy, blood diseases, irritable bowel problems, herniated disc, tendon ruptures, headache/migraine, mental illness, behavioral impairments in children, developmental delay, intellectual developmental disability, autism, Down syndrome and many more.
To further understand this, we will present the following two examples:
A client, a man in his 40s, came into our office and described several medical problems from which he suffers. The man said he had had diabetes for several years, which interferes with his daily functioning and stomach pains, for which he has lacked many working days, as well as describing that he suffers from back pain and general weakness because of the stomach pain.
The client was referred to various doctors to provide us with up-to-date medical documents attesting to his medical condition, and through our office, he filed a disability claim and faced medical committees that discussed the medical problems we presented.
The results of the medical committees were that the client received a percentage of disability and loss of work capacity, for which he received a disability pension, mainly due to diabetes he suffered from. Although the client had retroactively received one-year allowances, if the man had filed a suitable claim years earlier, he would have received the disability rate as well as an allowance even earlier.
Furthermore, when the client received the results of the medical committee, he admitted that if he had turned to the National Insurance Institute alone, he would not have submitted the documents for diabetes because he did not know he could receive an allowance because of it.
The rights that people with diabetes can receive are General Disability Pension, medical disability rights regardless of disability pension, and various rights for those who are not eligible for a disability pension.
To receive a disability pension, you must file a claim to the National Insurance Institute to receive a disability percentage. A hearing of the medical committee determines the disability percentage according to the loss of medical fitness of the patient. In accordance with the percentage of disability and loss of fitness that will be determined, the allowance and/or rights that the patient is entitled to receive will be determined.
The percentage of medical disability that can be given for diabetes is: 0%, 10%, 20%, 40%, 50%, 65%, 100%.
Another case that illustrates people's lack of knowledge about their eligibility for a National Insurance allowance are spouses from Jerusalem, parents to four children, and the second son, at the age of 11, who attends a particular education school due to a developmental delay.
The couple came to our office to deal with another legal matter related to arranging status with the Ministry of Interior. When questioned by a lawyer from our office, it became clear that their second son was suffering from developmental problems. When asked if they were receiving Social Security benefits for the son, they admitted that they had never applied to the National Insurance Institute to realize their eligibility.
The couple immediately met with a lawyer from our firm, specializing in Social Security claims, and he filed a disability child claim for their son. And within a short time, the claim was approved, and his parents began receiving a monthly allowance and a large one-time payment for retroactive benefits from the years before the claim.
If the couple had not contacted our office, they would not have known that they were entitled to disability benefits for their son.
In what cases may we be credited with a monthly pension or a monetary grant?
In life, unexpected events may also entitle us with benefits or grants such as work injury, a car accident at work and abroad, head injury, back injury, neck injury, mental disability, unemployment, post-traumatic stress disorder, and more.
For example, we will present a few cases in which the victim can be acquitted of National Insurance rights:
National Insurance benefits due to work injury: When it comes to work-related injuries, physical or mental, it is possible to receive compensation, allowances, benefits, and reliefs from the National Insurance Institute.
A work injury, including one during work, on the way to or from work, may entitle an employee to many rights by law. The rights available to those injured at work are:
- 1. the right to receive primary medical care.
- 2. complementary medicine.
- 3. injury allowance.
- 4. disability benefits from work or a one-time disability grant.
What rights can you receive from the National Insurance Institute for head, neck, and back injuries?
Head injurys, neck injurys, and back injurys can occur anywhere from workplace injury to street injury if it is a pedestrian, or as part of a car accident, motorcycle accident, fall, and more.
Head, neck, and back injuries may, unfortunately, manifest themselves in open and closed head injuries, skull fracture, concussion, traumatic head injury, trauma, dizziness, unconsciousness, internal intracranial hemorrhage, infections, amnesia, epilepsy, spinal sprain, fracture of the back vertebrae, herniated disc and even death.
When a head, neck, or back injury has occurred, it is body damage that grants the affected person rights from the National Insurance Institute such as medical treatments, payment of expenses for the injury, the estimated cost for future expenses, loss of work capacity, determination of disability, loss of income, and more.
To obtain these rights, you must submit a claim to the National Insurance Institute following the damage caused to you.
What rights can you receive from the National Insurance Institute due to a mental disability?
Mental disability is an injury to the person's psyche that includes mental disorders and illnesses such as depression, mood swings, schizophrenia, and more. Mental disorders can be congenital or develop due to some event, illness, or injury, which can occur within the framework of personal life or at work and be a trigger for mental illness.
A person who has a mental disability, which is recognized as having a chronic disorder that lasts for a period of more than three months, may be entitled to receive a disability benefit, rehabilitation, special services, an allowance, and more, depending on the percentage of disability and loss of fitness that is determined.
Mental disability is received after a hearing by the medical committee, whose job is to determine the percentage of medical disability and loss of work capacity, and accordingly, you will receive an appropriate allowance.
When is it possible (or more specifically or correctly) to submit a claim to the National Insurance Institute?
As a rule, it is possible to submit a claim to the National Insurance Institute when there's reasoning to submit the claim; the approval of the claim depends on the general condition of the health or the economy.
For example, a person who has been injured in a work accident and has lost work capacity, in whole or in part, may receive a monthly allowance that will ensure an alternative to their income from work.
In addition, if a person has contracted certain diseases such as cancer, diabetes, professional diseases, post-traumatic stress disorder, hearing loss, irritable bowel, Crohn's disease, headaches, herniated discs, and more, the National Insurance Institute can claim a variety of rights that will help them cope with the illness or the injury.
How do you work with the National Insurance Institute when it comes to a claim involving appearing before a medical committee?
As we explained, you can obtain some rights from the national security institute by filling and submitting a few forms. Still, when it comes to medical rights, it isn't so simple. The manner of receiving them involves submitting approvals, documents, medical opinions, appearing for examinations in medical committees, and standing up for its conclusion.
What are the medical rights?
Medical rights apply to people who have received a percentage of disability or loss of ability to work from the national security institute. And as a result, they are entitled to some benefit or allowance.
To receive the benefit or allowance, you must submit a claim to the National Insurance Institute, each claim per the form intended for it that can be found on the National Insurance Institute website.
What is the medical committee?
As we explained, after submitting the claim with all the necessary documents, you must report to the Medical Committee of the National Insurance Institute, the type of committee varies according to the kind of claim.
During the hearing, the medical committee will examine the claim and all documents attached to it to determine the appropriate percentage of disability.
During the committee hearing, the plaintiff must present his medical condition, describe what happened to him, if he contracted the disease/ had a car accident/ suffered physical damage/ mental damage/ he suffered a disability, as well as how the illness or injury affects his life and daily functioning.
The committee may investigate the plaintiff and ask him questions about his health, how he functions in daily life, and how he performs such and other actions.
In addition, if the committee is not satisfied with the findings that arose from the contents of the claim and the documents attached to it, it may ask the plaintiff to undergo a medical examination by a doctor on her behalf. Thus, the committee will determine its conclusions based on the claim, the documents attached, the committee hearing, and the medical examination.
What is a medical examination on behalf of the Medical Committee of the National Insurance Institute?
When it comes to a medical matter, if the Committee is not satisfied with the claim and the documents submitted, a doctor on its behalf will decide if a physical examination is necessary.
If an examination is needed, it is carried out concerning the problems raised by the plaintiff in the claim. For example, if this is a general disability claim, the claimant may be required to show how he performs daily activities – how he dresses or undresses, how he gets up from the chair and sits on it, how he moves from lying down to standing, and more.
The plaintiff can be examined in the presence of a lawyer and can request to be reviewed only by the doctor without committee members.
It is essential to know that the physical examination is done only to determine the percentage of disability or degree of disability, and a doctor on behalf of the Committee cannot respond to any requests from the claimant or discuss his condition, the medical treatment given to him, and more.
After the medical assessment, the committee doctor conducts an opinion regarding the findings that arose in the examination and writes his conclusions in the Committee's protocol. The protocol is essential since it allows to appeal the decisions of the Committee.
What happens after the medical committee hearing?
After the assessment, the committee examines the claim, medical opinions attached, conclusions, and findings that arose during the committee hearing. Accordingly, they determine the percentage of disability or degree of disability the claimant deserves, whether he's entitled to a temporary or permanent disability, and when the disability begins.
How to prepare for the medical committee?
The committee's hearing time varies and is flexible, but in any case, it is essential to prepare for a hearing in advance since its findings will determine the percentage of disability of the claimant and accordingly the amount of the allowance you receive.
For you to arrive ready for the committee, you should prepare accordingly and come with a detailed medical opinion that presents the current medical condition, with all the relevant documents for your situation, including a list of all the medical problems that have struck you and how they affect your daily functioning.
It is recommended to arrange all medical documents, including receipts of medical treatments, photographs, decoding of photographs, and any other relevant document relating to your situation, and bring copies of the important documents if the committee asks you for a copy.
You must attend the committee hearing with an ID card, and you can also arrive with a chaperone or lawyer who can represent you during the hearing and even answer questions in your place if requested.
It is very worthwhile to come accompanied by an expert lawyer for Social Security claims, who has expertise in medical committees and knows how to represent you best in front of the committee. The lawyer best describes to the committee what medical problems you suffer from and how they affect your daily functioning, thereby maximizing and increasing the chances of receiving an allowance or grant.
What’s the process after the medical committee hearing?
After the hearing and medical examination are complete, the committee determines the percentage of disability or degree of disability based on the claim, documents, committee hearing, and the medical examination findings according to the doctor's opinion.
As we wrote above, it is essential to arrive prepared for the hearing because if the committee is not satisfied with the findings that arose in the hearing and the examination, it may send the claimant to undergo additional assessments or to provide up-to-date medical documents to determine the percentage of disability or degree of disability, which may delay the process for a long time.
Barring complications or need for further assessment, the committee will determine the percentage of medical disability or degree of disability of the claimant, the date of the beginning of the disability, and whether it is a temporary or permanent disability.
At the end of the entire procedure, the plaintiff will receive a letter with the committee's contentions along with the medical report if one has been completed.
What do you do if the medical board rejects the claim?
If you are unsatisfied with the medical committee's assertions, whether it rejected the claim or set a disability rate lower than you think you deserve, it is possible to appeal its decisions to the Medical Appeals Committee of the National Insurance Institute.
What assertions of the medical committee can be challenged?
A person whom the medical committee has rejected is entitled to appeal the following issues:
● Date of start of disability.
● Establishment of temporary disability.
● Determining permanent disability
● Percentage of disability determined.
● Percentage of job loss.
What is important to know before submitting the appeal to the Medical Appeals Committee?
Before submitting an appeal to the appropriate committee for your case, it is essential to know that the reasons submitted as part of the appeal should be written with care, as the tenure of the medical appeals committee may be based on those reasons.
In addition, the appeal submitted to the Medical Appeals Committee may be the last chance to get the claim approved since the decisions of the medical appeals committee can be appealed only in legal matters and not on medical issues.
Therefore, when deciding to appeal to the Medical Appeals Committee, it is recommended to use a social security claims lawyer. Such an attorney can formulate your appeal in a reasoned, detailed way, following the law, the ruling, and based on all your medical documents – so that you can obtain the rights you aspire.
When can the appeal be filed?
Each claim has a different time frame within you can file an appeal. For example, when it comes to general disability claims, you can file an appeal within 60 days, and in disabled child claims, you can file an appeal within 90 days. It is important to pay attention to the different time frames, and when in doubt, it is worth consulting with a lawyer who specializes in Social Security matters.
Why should you use a social security claims lawyer before filing a claim?
An experienced and expert lawyer will know how to guide you, file the claim for you, and accompany you hand in hand to receive what you deserve.
Many claims can be submitted to the National Insurance Institute, ranging from claims after injury or accident at work to claims due to an illness. Some claims and requests involve submitting documents only, and some involve proceedings with various state entities.
Each claim has different threshold requirements, and the committees focus on various aspects of the medical and functional condition. Therefore, it is easy to get confused and invest a lot of time and energy in marginal issues or medical problems that do not affect the percentage of disability or loss of work capacity.
A lawyer specializing in Social Security claims can help you best execute the procedure with the National Insurance Institute. Using a lawyer who specializes in Social Security claims will make sure that you focus on the correct medical issues, and he will promote your claim in the best possible way.
At our law firm, Mor & Co, there's a department that deals with Social Security claims. Our lawyers will accompany you throughout all proceedings while adhering to high legal standards and excellent customer service.
We invite you to consult with us on any questions or matters related to social security-related claims.
To arrange a meeting without any obligation, call:02-500-1133.
Mor & Co. Law Firm, Jaffa 216, City Gates Building, 2nd floor, Jerusalem