A general disability allowance is a financial allowance paid by the National Insurance Institute every month to an insured person who suffers from a physical, mental or mental impairment resulting from an illness, accident or birth defect. , except that the same problem impairs his ability to work significantly.
In fact, the amount of the disability allowance depends mainly on the degree of incapacity from which the insured suffers, and therefore in this point lies the main difficulty for the General Disability Branch at the National Insurance Institute, to prove that there has been a decrease in the insured's working capacity to the extent that justifies receiving an allowance. Also, there is often a dispute regarding the established period of incapacity, since the National Insurance Institute may consider that the medical and functional condition of the insured is temporary at most, and that in the future there may be a certain benefit in his condition which will affect his earning capacity and, accordingly, his entitlement to an allowance.
Many Parkinson's patients apply to the general disability branch of the National Insurance to exercise their rights to an allowance, and more than once are rejected for one reason or another.
In light of these difficulties, I will review the eligibility conditions in this article for a general disability pension, the process that must be followed in order to receive the allowance as well as the options available to an insured who does not agree with the National Insurance Institute's decision regarding his entitlement to a disability allowance.
Eligibility conditions for disability allowance
Eligibility for a general disability allowance is conditional on meeting 4 cumulative conditions. First condition is age and residency. Only residents of Israel may be entitled to the pension, starting from the age of 18 (and in some cases even from the age of 16) until the retirement age, as of 2021, 62 for women and 67 for men. Second condition is income from work, when entitlement to an allowance is relevant for insured persons who do not work or whose income from work, whether as employees or self-employed, is less than 60 percent of the average wage in the economy (that is, less than 6,331 NIS per month, as of January 1.1.2020, XNUMX). Here we are talking about technical conditions only, a sort of threshold condition. As we will see below, the last two conditions are the essential conditions that are a breeding ground for difficulties with the National Insurance Institute and unfortunately for quite a few insured, lead to many rejections.
The third condition Pertains to the medical disability caused by the medical deficiencies the plaintiff suffers from. Now the question arises: How is the medical disability determined? Well, the National Insurance Law therefore determines what the appropriate medical disability rate is for each impairment, from the list of existing medical impairments, according to its severity. Even if the plaintiff's situation is not clear enough, a certain deficiency clause can be adjusted to his actual situation.
And back to the eligibility conditions. In fact, there are two options to meet the third condition - the medical disability. One, those who will be recognized with a medical disability weighted at a rate of 60 percent or higher, the number of impairments and the rate of disability that each of them provides has no significance. And the second, those who are recognized with a weighted medical disability of 40 percent or higher, when they suffer from several deficiencies, at least one of which gives at least 25 percent.
As stated above, it is not enough to prove the appropriate medical disability, but it must be met in an additional condition, fourth, Perhaps the most complex, degree of incapacity. As part of this condition, the claimant must prove that he lost his ability to work by at least 50 percent. It is important to emphasize that the National Insurance Institute examines the ability to work in a broad sense and not only with regard to the plaintiff's specific work. It should be noted that a married woman who meets the definition of a "housewife" will be tested in a different way, which will entitle her to a general disability allowance for a housewife, if she proves that due to her medical condition she has lost at least 50 percent of her ability to function in the household. In order to meet the definition of "housewife", the claimant must meet the criteria established by the National Insurance Institute, including the period in which she did not work, shared residence with her spouse, and more.
In many cases, there is no overlap between the medical disability and the functional one, so it is possible that the insured suffers from a high medical disability, but has not lost his ability to work at the rate that qualifies for an allowance, and vice versa. These situations create great uncertainty and difficulty in dealing with the path to receiving a general disability allowance, however, this means that the higher a medical disability is determined, the greater the chance that the degree of incapacity will be proportionally determined accordingly.
The amount of the general disability allowance
As mentioned above, the amount of the disability allowance depends mainly on the degree of incapacity determined for the claimant by the medical committee of the National Insurance. In fact, as long as the claimant meets the first three conditions, the determination regarding the degree of his incapacity is the one that will actually determine what the amount of the allowance will be.
The National Insurance Institute determined four degrees of incapacity: 60 percent, 65 percent, 74 percent and 100 percent. In this regard, it is important to note that a claimant who meets the first three conditions and who has been determined to have a degree of incapacity of 75 percent or higher will receive a full general disability allowance, in the amount of 3,321 NIS (disability as of January 1.1.2020, 60) every month, while a claimant who has been determined to have a degree of incapacity Fitness at a rate of 1,908 percent, will receive a monthly general disability allowance of only NIS XNUMX.
Alongside this, in some cases, recipients of a general disability pension will be entitled to various supplements to the pension. Thus, for the duration, a supplement is paid for the first two children, provided that they have not yet turned 18 years old or they are serving in the army or national service and have not yet turned 24 years old. An additional supplement is given for spouses, especially if the spouse earns no more than NIS 6,014 per month and does not receive any other allowance. The amount of the aforementioned supplements also depends on the level of incapacity determined for the claimant, so that the higher the level of incapacity, the higher the supplement to the pension. It is important to note that in levels of incapacity lower than 75%, the claimant will be entitled to a full supplement For children and/or spouse, if he earns more than NIS 2,216 per month.
get an allowance and go to work
Another issue that arises among quite a few pension recipients is a situation where, on the one hand, the pension recipient wants to go to work in order to increase his income, and on the other hand, is afraid to do so lest he lose his entitlement to the pension. In 08/2009 he enacted an amendment to the National Insurance Law, known as the "Laron Law", whose purpose, among other things, is to regulate the integration of those entitled to a general disability allowance into the labor market, and at the same time to preserve their rights.
One of the main points of the amendment is intended to deal with the case in which a pension recipient decides to go to work, and states, as a general rule, that the total amount received from the pension and work will be higher than the amount of the pension alone. Therefore, the amendment to the law encourages pension recipients to go to work and increase their income. It is important to emphasize that although the amount of income from work may have an effect on the amount of the allowance starting from a certain amount (depending on the degree of incapacity), this is only a certain amount, which is determined according to the original amount of the allowance. Therefore, there may certainly be cases where the insured will benefit from work and the disability allowance to which he is entitled will not be reduced. It will be clarified, in the event that the recipient of the allowance goes to work and earns more than the threshold set for the payment of the allowance in addition to his salary from work, his allowance will be denied, but he will continue to receive the supplements he is entitled to for children/spouse for three years from the date of cessation of the allowance.
Filing a claim for a general disability allowance
There are several ways to submit the claim for general disability allowance, including online through the website of the National Insurance Institute. The documents to be submitted include the relevant claim form and medical documentation describing the claimant's medical and functional condition. In addition, it is possible to attach medical evaluations by expert doctors who determine what the medical disability is that should be determined by the medical committees in each and every field. The claim must also be attached to the claimant's salary certificates from work, documents indicating non-work income as well as documents about sick pay that the claimant received from his employer or as a result of illness.
After filing the claim, all documents will be reviewed by the claims clerk and a doctor from the National Insurance Institute to determine whether the claimant meets the threshold conditions for eligibility to receive an allowance (age, residency and income from work), and then, usually, the claimant will be sent an invitation to relevant medical committees according to the deficiencies he suffers from At the same time, in certain circumstances, especially in cases where the medical condition is severe, it will be determined that the medical documentation attached to the claim is sufficient to determine the percentage of disability, without the need for an invitation to a medical committee.
To the extent that the medical committee determines that the extent of the plaintiff's medical disability may entitle him to a general disability allowance, the National Insurance will decide, in consultation with a specialist doctor and a rehabilitation official, what is the degree of incapacity the claimant has and thus in fact the claimant's entitlement to the allowance and its amount will be decided. Furthermore, when determining the degree of disability rate and the degree of incapacity, it will be decided whether it is a permanent or temporary situation, which requires a new examination of the situation at the end of the period to be determined.
How does the medical committee work?
As mentioned, after the claimant submits his claim, he will usually be summoned to appear before a medical committee that will determine the rate of his disability. The committee consists of at least one specialist doctor with expertise in the field of medicine that is the subject of the lawsuit and a meeting secretary whose job it is to record the committee's report and protect the plaintiff's rights. If the plaintiff suffers from several deficiencies, the committee may be composed of several doctors with relevant areas of expertise, or alternatively the plaintiff will be summoned to separate committees accordingly for his deficiency in any medical field.
The doctors who sit on the committee receive the medical documentation for their review before it begins and in the committee itself the plaintiff is asked to describe his medical condition orally. It is important that the claimant present the full medical documentation to the committee, so that current, physically relevant medical documents can be submitted to the committee, if they were not attached to the claim. Later, in most cases, the plaintiff will undergo a physical examination to examine whether his medical condition actually matches his complaints. At the end of the committee, after the claimant leaves the committee room, it will be decided whether the claimant should be invited for further examination by the committee or sent for further examinations before the decision regarding the rate of disability is made, or whether the rate of medical disability can be determined, and in such a review the doctor will dictate to the secretary his findings and the appropriate medical disability that arises from the findings presented to him. After a few days to weeks from the date of the commission, its decision will be sent to the plaintiff, as well as details and an explanation about the continuation of the proceedings in his case. It is important to note that the claimant has the right to be represented in the medical committee by a lawyer. Professional accompaniment and representation by a lawyer dealing in the field may detail and correctly present his claims before the medical committee, make sure that all members of the committee refer to the full medical documentation in the case and conduct the plaintiff's medical examination properly.
Filing an appeal and taking legal proceedings
To the extent that the claimant believes that the medical disability and/or degree of incapacity determined for him are not consistent with his actual medical or functional condition, then in certain circumstances he may file an appeal against these determinations. A claimant may file an appeal against the medical committee's decision if less than 80 percent disability was determined for him. At the same time, the claimant has the right to file an appeal even on the degree of incapacity determined for him, if it does not exceed 74 percent. In addition, to the extent that the claims clerk determines that the claimant does not meet the first eligibility conditions for a general disability allowance (see above, conditions 1 and 2), this can also be appealed.
The medical committee's decisions regarding the rate of disability as well as the claims clerk's decision regarding the incapacity can be appealed before the medical committee for appeals and before the National Insurance Appeals Committee, respectively, within 60 days from the date the plaintiff received the written decision. The appeals committee usually consists of two or three doctors from different fields of practice. When filing an appeal, it is important to understand that just as the committee has the authority to change its determinations in favor of the appellant, it also has the authority to change them against his benefit.
Of course, even in the appeal committee, the petitioner may be represented by a lawyer and assert all his claims regarding the degree of his medical disability and/or inability to work, and at the same time present where in his opinion the first medical committee erred.
The decisions of the aforementioned committees can therefore be submitted to another appeal, but this will be submitted to the Regional Labor Court, and on a legal question only (not a medical one). For example, if the committee did not justify its decision as accepted or the claimant was not examined by an appropriate specialist doctor , after all, this is a deviation from the proper procedure and can be appealed to the court to correct the injustice.
In any case, as seen above, the procedure before the general disability branch at the National Insurance Institute can be complex, long and sometimes involves heartache for the claimant who did not succeed in his claim. Counseling and legal guidance by an attorney knowledgeable in the field, right from the start, will help build the case in an optimal way, arrive ready for the medical committees and thus maximize the rights due to the insured.
