Filing a Nursing Care Claim in Ramat Gan — A Complete Guide

What is a Nursing Care Claim and Who is Entitled to It?

A nursing care claim is a legal request to obtain a monthly allowance from the National Insurance Institute or from a defendant (such as a respondent in a traffic accident or workplace accident) due to the need for ongoing nursing care as a result of bodily injury. Entitlement to nursing care benefits arises when a person's health condition is impaired to the extent that they require assistance from another person to perform basic daily activities — such as dressing, bathing, moving the body, moving a wheelchair, preparing food, and attending to other personal needs.

In accordance with the National Insurance laws and tort laws in Israel, any person injured in a traffic accident, workplace accident, public negligence, or other injury, and as a result of which a state of dependence on nursing care is created, is entitled to file a request for nursing care benefits. The benefit is calculated based on the actual need for monthly nursing care hours, the hourly rate of professional nursing care, and the degree of disability recognized by the competent authority.

Generally, entitlement to nursing care benefits begins at 20% disability and above, but in certain circumstances, a request may be submitted even with a lower degree of disability if the need for nursing care is proven in fact. Each case is examined individually by the medical committee or by the court.

What is the Legal Procedure for Filing a Nursing Care Claim?

The procedure for filing a nursing care claim includes several important steps, ranging from preparing the evidence to filing with the competent authorities. In the first stage, all relevant documents must be collected: a detailed medical report from the treating physician, documentation of the accident or injury, a medical committee examination report (if available), invoices for nursing care costs already paid, and expert opinions from a tort specialist or a professional in the field of professional nursing care.

In the second stage, a formal request is submitted to the National Insurance Institute or a civil lawsuit is filed in court (depending on the source of the damage). If the case involves a traffic accident or workplace accident, the request is generally submitted to the National Insurance Institute under the National Insurance Law. If it is a civil claim against a defendant (for example, a contractor who was negligent), the claim is filed in the district court.

In the third stage, the competent authority (medical committee or court) reviews the request, may require an additional medical examination, and within a certain time period (usually a few months) decides on entitlement. If the request is approved, the benefit will be paid monthly or as a lump sum, in accordance with the decision.

Collection of Documents and Evidence

A critical element in filing a nursing care claim is the collection of strong and convincing medical documents. A detailed report must be obtained from the treating physician describing the condition of the injured person, the extent of impairment to their functioning, and their daily nursing care needs. This report must be specific — not merely "injured by a sharp object" but an accurate description of the activities that the injured person cannot perform alone.

Additionally, price quotes must be collected from professional nursing care companies for nursing care hours, actual invoices if nursing care has already been paid, and any documentation of expenses related to nursing care. Evidence may also be presented from family members or caregivers caring for the injured person, and documentation of the hours in which they assist him.

Filing the Request with the National Insurance Institute or Court

After collecting the documents, a formal request is submitted. If it is the National Insurance Institute, the request is submitted to the National Insurance Institute office in writing, with all relevant documents attached. If it is a civil claim in court, a formal complaint must be filed, which describes the facts, the damage, and the legal claims. At this stage, it is advisable to seek assistance from a tort law specialist attorney, who knows how to formulate the claims in a convincing and professional manner.

What are the detailed stages of the procedure?

Stage 1: Initial Medical Evaluation

A medical evaluation is the foundation for filing a nursing care claim. The injured party must undergo a detailed examination by a specialist physician (typically a neurologist, orthopedist, or family physician specializing in tort law), who will issue a medical report describing their health condition, degree of disability, and nursing care needs. The report must be detailed and specific — it must outline all activities the injured party cannot perform independently.

Stage 2: Examination by a Medical Committee

In some cases, the National Insurance Institute or the court appoint an examination by a medical committee consisting of three members (typically two physicians and an expert in the relevant field). The committee examines the injured party, reviews medical reports, and issues an official opinion regarding the percentage of disability and nursing care needs. The medical committee's opinion is highly significant and typically influences the National Insurance Institute's or court's decision.

Stage 3: Filing the Request or Claim

After receiving the medical opinion, a formal request is filed with the National Insurance Institute (in cases of traffic or workplace accidents) or a claim is filed in court (in cases of civil litigation against a defendant). The request or claim must include all relevant documents, legal analysis of eligibility, and a financial calculation of the requested benefit.

Stage 4: Review and Decision

The National Insurance Institute or court reviews the request, may request additional information, and within a certain timeframe (typically 2-6 months) issues a decision. If the request is approved, benefit payment commences. If the request is denied, an appeal or additional claim can be filed in a higher court.

Stage 5: Receiving the Monthly Benefit

Once the request is approved, the benefit is paid to the injured party in monthly installments or as a lump sum, depending on the type of injury and the decision of the competent authority. The benefit covers actual nursing care costs or the amount determined by the court as compensation.

What are the conditions for eligibility for a nursing care benefit?

To be eligible for a nursing care benefit, several important conditions must be met. First, it must be proven that the injured party suffers from a disability or bodily injury caused by an accident or proven injury. Second, it must be proven that the injured party actually requires continuous care — meaning they cannot perform basic daily activities without the assistance of another person. Third, a causal link must be established between the accident/injury and the need for care.

Generally, a disability rating of 20% or higher constitutes a criterion for eligibility for a nursing care benefit, but in certain circumstances, a request can be filed even with a lower disability rating if the need for care is actually proven. It is important to note that eligibility is not based solely on the percentage of disability, but on the actual need for daily care hours.

Calculating Nursing Care Benefits: How Much Are You Entitled To?

The calculation of nursing care benefits in a nursing care claim is based on a simple yet important formula: monthly nursing hours × hourly rate = monthly benefit. However, in practice, the calculation is more complex and depends on many factors.

Components of Benefit Calculation

• Number of monthly nursing hours required: This is based on the medical committee's opinion and a detailed medical report. For example, a person with complete paralysis may require 12-16 hours of daily nursing care, while a person with a milder disability may require 2-4 hours.
• Nursing care hourly rate: The hourly price varies depending on the type of nursing care (professional medical nursing versus general care), geographic location (prices are higher in Tel Aviv and Ramat Gan than in smaller cities), and scope of service.
• Claim period: Is the benefit paid for a specific period or for life? This affects the total amount.
• Percentage of disability: In some cases, the benefit is calculated based on the percentage of disability recognized by the medical committee.

Calculation Examples

To illustrate, suppose a traffic accident victim requires 10 hours of daily nursing care, and the hourly rate is 80 shekels. The calculation would be: 10 hours × 30 days × 80 shekels = 24,000 shekels per month. If the benefit is approved for a period of 10 years, the total amount would be 2,880,000 shekels.

However, in practice, the benefit may be higher or lower depending on the court's decision, the level of disability, and other conditions. Therefore, it is very important to consult with a specialist attorney who will calculate the benefit accurately and present a convincing financial calculation to the court.

Practical Tips for Submitting a Successful Nursing Care Claim

1. Submit a Detailed and Accurate Medical Report

The medical report is the foundation for submitting a successful claim. Ensure that the report details precisely all activities the injured person cannot perform without assistance, activities they can perform partially, and activities they can perform independently. A general or inaccurate report may lead to rejection of the request.

2. Collect Actual Invoices for Nursing Care Costs

If you have already paid for nursing care, keep all invoices. Actual invoices are the best evidence of the need for nursing care and actual costs. If you have not yet paid, obtain price quotes from professional nursing companies.

3. Document the Need for Nursing Care in Detail

Write a detailed diary of daily activities the injured person needs help with and the number of hours each activity takes. This will prove the need for nursing care in a convincing manner.

4. Submit Your Request in a Timely Manner

Do not wait months or years to submit your request. The sooner you submit, the better. There are certain time limits for tort claims, so it is important to act quickly.

5. Consult with a Specialist Attorney

A nursing care claim is complex and requires legal and insurance expertise. A tort law specialist attorney will guide you through the process, ensure all documents are submitted properly, and represent you before the court or National Insurance Institute if necessary.

Comparative Table: Different Nursing Care Claim Scenarios

Important Note: The figures in this table are estimates only and are based on typical data. Each case is reviewed individually, and actual amounts may vary depending on the circumstances of the case, medical committee opinions, and court or National Insurance Institute decisions. Nursing care prices vary according to geographical area (Ramat Gan, Tel Aviv, Jerusalem, etc.) and type of care (professional versus general care).

Why should you contact Mandelbaum, Gor, Witzman-Gor & Co. regarding a nursing care claim?

Our firm, Mandelbaum, Gor, Witzman-Gor & Co., Attorneys at Law, is a boutique family law firm specializing in tort law since 2008. Over many years, we have represented dozens of injured parties in nursing care claims, traffic accidents, workplace accidents, and public negligence cases. Our experience enables us to understand the nuances of nursing care claims and to present compelling arguments before the court and the National Insurance.

Our branch in Ramat Gan (at Donsh Street 1) serves residents of Ramat Gan, Tel Aviv, Givatayim, Bnei Brak, Petah Tikva, and surrounding areas. We offer a first consultation meeting at no cost, so you can get to know us and understand how we can help you. In this meeting, we will examine your case thoroughly, explain the prospects, calculate the estimated benefit, and provide you with a clear action plan.

Our core values are personal and dedicated attention to each client, legal precision, and achieving maximum compensation that the injured party is entitled to. We believe that every injured party deserves to be represented professionally and reliably, and we do everything to achieve this.