Appeal Against Rejection of Nursing Care Claim in Petah Tikva

What is a Nursing Care Claim and How is it Rejected?

A nursing care claim is a civil claim filed by an accident victim (road accident, workplace accident, public negligence) or by their insurance provider or employer to obtain monetary compensation for nursing care expenses incurred as a result of bodily injuries. Nursing care includes assistance with daily activities, medical supervision, personal care, and any service required to maintain a reasonable quality of life for the victim.

A nursing care claim may be rejected for various reasons: insufficient medical documentation, different assessment of nursing care costs compared to the claimant's proposal, lack of proof of causation between the accident and the bodily injuries, or an assessment that the victim does not require professional nursing care as claimed. In some cases, rejection is based on a different assessment by the National Insurance or insurance company regarding the degree of disability or the scope of required nursing care.

In Petah Tikva and the central region, rejections of nursing care claims are a particularly common issue in National Insurance and private insurance claims. Mandelbaum, Gor, Witzman-Gor & Co. specializes in filing successful appeals against such rejections, increasing the claimant's chances of prevailing.

Who is Entitled to File a Nursing Care Claim?

Any victim of a road accident, workplace accident, or resulting from public negligence (such as a fall on a public sidewalk, injury from a public structure, and the like) who sustains bodily injuries requiring professional nursing care or ongoing assistance is generally entitled to file a nursing care claim. Entitlement depends on proving the causal connection between the accident and the bodily injuries, and proving the necessity for nursing care as a direct result of those injuries.

Nursing Care Claim Rejection — The Most Common Reasons

Rejection of nursing care claims is a common phenomenon in National Insurance claims and tort claims. National Insurance and private insurance companies use various mechanisms to reduce expenses, and they often reject nursing care claims that are not presented perfectly or that they question the justification for. Below are the main reasons for nursing care claim rejections:

• Insufficient medical documentation: The claim was rejected because detailed medical reports, nursing facility assessments, or expert medical opinions proving the need for nursing care were not presented. National Insurance typically requires concrete documents that specify the scope of required nursing care, the number of hours per day, and the type of treatment.
• Different evaluation of nursing care costs: National Insurance or the insurance company assessed nursing care costs at a significantly lower amount than claimed by the plaintiff. The assessment may be based on predetermined tables or comparison with different market rates than those offered by the plaintiff.
• Lack of proof of causal connection: The rejecting party (National Insurance or insurance company) argues that the damages for which compensation is requested are not directly related to the accident, or that they exist for another reason (pre-existing condition, aging, etc.).
• Different evaluation of disability level: National Insurance or private insurance assessed the percentage of disability of the victim as lower than the plaintiff's assessment, and therefore believe there is no need for full professional nursing care.
• Claim that family nursing care is sufficient: The insurance argues that the victim can manage with nursing care provided by family members and does not require paid professional nursing care.
• Challenge to the type or scope of nursing care: The insurance agrees that nursing care is needed, but argues that the scope of required nursing care is lower than proposed in the claim, or that the type of nursing care offered is not necessary.

In Petah Tikva, as in the rest of the country, these rejections cause considerable frustration among victims awaiting fair compensation. This is where skilled and focused legal appeal becomes essential.