General disability allowance - Adv. Navot
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General disability allowance - what it is and who is entitled to it
Written by Adv. Navot Barak
A general disability allowance was born to help disabled people who are not entitled to compensation and/or compensation from any other source.
The purpose of the allowance is to compensate the disabled person for the loss of his ability to function and not for the mere existence of the disability.
A general disability allowance is given to residents of Israel from the age of 18 until the age of retirement from work (in accordance with the Law on Retirement from Work). Up to the age of 18, a disabled child's benefit is given in appropriate cases. And beyond retirement age, an old age pension is given.
Housewives who suffer from disabilities are also entitled to compensation for having lost their ability to function in their household.
In order to receive a general disability benefit, the insured must meet two cumulative criteria, the first, the rate of medical disability and the second, degree of incapacity. Since the requirement is for cumulative conditions, it is possible that a victim whose medical disability rates are high and meet the requirements of the regulations, will not receive a disability benefit since he has not lost his ability to get drunk and therefore does not meet the conditions of the second test.
In order for the insured to be entitled to a disability benefit (general disability) he must have a 60% medical disability for the total of all the medical deficiencies from which he suffers in a weighted manner. Alternatively, if the insured suffers from one impairment that gives him a medical disability at the rate of 25%, then it is sufficient for the insured to have a 40% weighted medical disability.
The medical disability is weighted and not cumulative and is determined by a doctor according to the law of the National Insurance Institute and its regulations. The rates of disability are found in the National Insurance Regulations (Determining the Degree of Disability for Work Injuries) 1956 - Supplement.
Only an insured person for whom the institution's doctor has determined that he is unable to work - the process will end for him at this stage and he will receive a general disability benefit.
An insured whose weighted disability rate does not reach this threshold does not pass the medical disability test and therefore his claim for general disability will be rejected already at this stage.
The second test is, as mentioned, the degree of incapacity, only if the insured met the first condition of an appropriate medical disability rate, will he pass to the test of the second condition.
A general disability benefit will be paid to the insured who due to the medical disability does not have the ability to earn a living and alternatively whose ability to earn has decreased by 50% or more. For example, an air conditioner installer, who due to an illness had to reduce his working hours considerably and as a result his salary decreased by 60%, fulfills the condition according to which his ability to earn has been reduced by 50% or more and will be entitled to a general disability benefit.
Even an insured person who has never worked will have to meet the second criterion and his ability to earn will be tested according to a special arrangement (depending on his education) and derived, among other things, from an index influenced by the average wage in the economy.
If the institution's doctor has determined that the insured is able to work part-time or full-time, he will be transferred at this stage for examination by another doctor to check for incapacity, a rehabilitation official and a social worker. In light of the results of the tests and taking into account the earnings data of the insured, it will be decided what the degree of incapacity of the insured is.
That is, the person who determines that he has not lost his ability to work will not receive a disability benefit even if his medical disability is high.
The amount of a general disability benefit is derived from the average salary in the economy and it depends on the rate of disability determined for the insured, the number of dependents of the insured (wife, children), his income and other parameters.
On the decision of a medical committee regarding the rate of medical disability, an appeal can be submitted to an appeals committee.
The appeals committee consisted of 2-3 doctors whose field of expertise is in the matters of injury to the insured. The committee may change any decision determined by the first-level medical committee, whether the appeal concerned this decision or not. Also, the committee may discuss any decision made by the first-level committee, whether the appellant is the National Insurance Institute or the insured. But if the committee wishes to issue a decision that will harm the insured, it must warn him in advance.
The decision of the incapacity committee can be appealed to an appeals committee to determine the degree of incapacity in which a number of experts sat including a doctor, a rehabilitation specialist and an occupational expert.
Another way to obtain the decision of the National Insurance Institute's medical appeal committees is through an appeal on a legal question only, which can be submitted to the Regional Labor Court. The court discusses such cases exclusively on legal questions such as the committee's disregard of a medical opinion presented to it and/or incorrect medical composition.
It is important to remember that the deadlines for filing an appeal, on a legal or medical question or degree of incapacity, are limited. Also, the appeal letter should include the reasons for the appeal. That is why it is important to consult with a lawyer who specializes in National Insurance law before filing an appeal in order to examine the chances of the appeal and the reasons which it is important to put forward in the written appeal.
The insured has the right to file a renewed claim for the worsening of the situation if six months have passed since the degree of disability was last determined by the National Insurance Institute. The National Insurance Institute may also apply for a re-examination of the insured. It is advisable to consult a lawyer and a doctor regarding the chances and risks of submitting a request for an aggravation of a condition. Because in the committee's examination, it can and will determine that the insured's condition has actually improved and not worsened, and therefore the committee will reduce the rate of his disability (after giving a warning). If a higher degree of disability is determined for the insured, it will be calculated from the date of submission of the request for reconsideration.
This article is for general and preliminary information only and is in no way intended to be used as legal advice and/or as a substitute for legal advice for each case and its circumstances. Do not rely on the aforementioned without consulting a lawyer who deals in the field before taking any action or making any decision.
Recipients of a general disability allowance may be entitled to discounts and benefits in various institutions:
- Local authorities - property tax discount.
- Ministry of Transport - discount on public transport.
- Ministry of Construction and Housing - assistance with rent or buying an apartment.
- Ministry of Social Affairs - discount on meter readings and telephone installation fees.
- Health insurance funds - exemption from payment for visits to certain doctors, commitment to a hospital and visits to outpatient clinics.
- Ministry of Finance / Income Tax - purchase tax discount.
- Israel Lands Administrator - exemption or discount on consent fees.
