National Insurance Guide — Claims and Victims' Rights

National Insurance Guide — Complete Understanding of Your Claims and Rights

When you are injured in a traffic accident or work accident, national insurance is one of the central entities supporting you on your path to recovery and compensation. However, few insured individuals truly understand the scope of their rights, the required procedures, or the steps to take to achieve fair compensation. Mendelboim, Gor, Witzman-Gor and Co. — with over 18 years of experience representing claimants exclusively in tort law — offers this comprehensive guide to help you navigate the complex world of national insurance claims.

National insurance in Israel covers a wide range of bodily injuries — from traffic accidents to work accidents, occupational diseases, and loss of earning capacity insurance. Each category of injury leads to different rights, and claiming compensation requires a deep understanding of the law and the facts of your case.

What is National Insurance and Why is it Essential for Injured Parties?

National insurance is a social security system designed to provide economic protection to Israeli citizens when they encounter circumstances that prevent them from earning income. For accident victims, national insurance provides funding for medical treatment, monthly allowances, one-time compensation, and additional assistance according to the severity of the injury. Unlike common tort law claims (where you must prove liability and causation), national insurance rights stand independently, provided the circumstances meet the criteria established by law.

However, the process of filing a national insurance claim is not simple. It involves medical examinations, assessments of disability level, comparison between competing claims, and potential appeals if the decision is unsatisfactory. Therefore, understanding your rights and the full procedure is critical to ensure you receive the compensation you are entitled to.

Who is Eligible for a National Insurance Claim?

National insurance claims are generally available to individuals injured under certain circumstances. Main categories include:

• Traffic Accident Victims: Any person injured in an accident on a public road, typically while traveling to or from work, or in any other public place. National insurance covers physical injuries resulting from the accident.
• Work Accident Victims: Employees injured while working or traveling to/from work. National insurance covers all injuries related to a work accident, including medical care, allowances, and more.
• Occupational Disease Sufferers: Employees who developed a disease resulting from occupational exposure, such as lung rehabilitation or certain chronic conditions.
• Loss of Earning Capacity: Individuals who lost their ability to earn income due to a medical condition or accident.

Types of Compensation in National Insurance

National insurance rights are divided into several main categories:

• Monthly Allowance: If the injured party is determined to suffer from permanent disability, they are entitled to a monthly allowance from national insurance. The amount of the allowance depends on the percentage of disability determined, the victim's prior income, and age.
• One-Time Compensation: In certain circumstances, the victim may receive one-time compensation in addition to or instead of the monthly allowance, depending on the severity of the injury and the circumstances of the case.
• Medical Expenses: National insurance covers all medical expenses related to treating the injury caused by the accident, including examinations, medications, and rehabilitation treatment.
• Vocational Rehabilitation Allowance: If the victim needs to undergo retraining because they cannot return to their previous job, national insurance may cover training expenses.
• Dependent Allowance: In certain cases, such as the victim's death, family members are entitled to an allowance from national insurance.

The Complete Process of National Insurance Claims

Filing a claim with National Insurance requires understanding multiple stages. Each stage is critical and requires individual attention to ensure your claim is processed correctly and on time.

Stage 1: Notification of the Accident

Following an accident, National Insurance must be notified as soon as possible. The notification should include basic details about the accident — when, where, how it occurred, and who witnessed it. In work accidents, the employer must notify National Insurance. In traffic accidents, the victim or their family can file the notification. This notification starts the clock on processing your claim.

Stage 2: Initial Medical Examination

After notification, National Insurance requests the victim to undergo a medical examination. This examination is designed to assess the extent of physical damage resulting from the accident. It is important to participate in this examination and present all relevant medical evidence — medical reports, imaging, laboratory tests, and so forth. An accurate medical assessment is the foundation for all future decisions on the claim.

Stage 3: Assessment of Disability Percentage

Based on medical findings, National Insurance determines a disability percentage. This percentage directly affects the amount of monthly allowance and lump-sum compensation you are entitled to. Disability percentages are determined according to a standard table, but may vary according to the specific circumstances of the case.

Stage 4: Claim Decision

After disability assessment, National Insurance makes a decision on the claim. This decision includes the amount of monthly allowance (if any), the lump-sum compensation, and coverage of medical expenses. This decision is sent to the victim in writing, including the reasons for the decision.

Stage 5: Appeal to the Appeals Committee

If you disagree with National Insurance's decision — whether due to the disability percentage, the compensation amount, or any other reason — you have the right to file an appeal with the National Insurance appeals committee. This appeal must be filed within a certain timeframe (usually within three months of the decision). In the appeal, you can present additional evidence, new medical testimony, or legal arguments challenging the original decision.

Stage 6: Litigation in Court (if necessary)

If the appeals committee rejected your claim, or if you still disagree with the decision, you have the right to approach the court. At this stage, a lawyer experienced in tort law and National Insurance is essential to present your case in the best possible way.

Important Facts Along the Way

Throughout the entire process, it is important to preserve all relevant documents — medical reports, photos from the accident, witness testimonies, and similar items. Every document can be critical in proving your claim or updating your medical assessment.

Scenario Comparison — Practical Examples

To better understand how National Insurance claims work in practice, let us examine several typical scenarios:

This table presents general examples only. Each case is examined individually, and the amount of compensation varies according to specific circumstances, age, previous income, and precise medical condition.

Common Arguments in National Insurance Claims — and How to Address Them

During a National Insurance claim, several challenges or arguments may arise that the National Insurance or another party may raise. Understanding these arguments and knowing how to defend against them is critical:

1. Dispute Over Causal Connection Between the Accident and the Injury

The National Insurance may argue that your injury is not directly related to the accident, but rather to a pre-existing condition. For example, if you had prior back pain, the National Insurance may argue that the accident merely aggravated the existing problem and did not cause it. In such cases, strong medical evidence — such as medical reports before and after the accident — is essential to establish the causal connection.

2. Dispute Over the Degree of Disability

One of the most common arguments in National Insurance claims concerns the percentage of disability. The National Insurance may assess your disability at a lower percentage than you believe is fair. In this case, you can present additional medical evidence, obtain a second opinion from an independent physician, or reference the standard disability percentage table to show that your case is different.

3. Argument That the Injured Party Bears Partial or Full Responsibility for the Accident

In certain traffic accidents, the National Insurance or other parties may argue that the injured party bore partial or full responsibility for the accident. If this is the case, your National Insurance rights may be reduced or even forfeited. However, note that in traffic accidents, liability does not always affect National Insurance rights in the same direct manner as it affects other tort claims.

4. Dispute Over the Scope of Required Medical Treatment

The National Insurance may argue that certain treatment you received is not necessary or is too expensive. In such circumstances, it is important to present medical recommendations from your treating physician, statements from medical experts, and documentation of the need for treatment.

5. Claim Expiration Due to Delay

There are certain deadlines for taking action on a National Insurance claim. If you miss this deadline, your claim may be forfeited. Therefore, it is important to adhere to deadlines and submit requests in a timely manner.

How Mandelbaum, Gor, Witzman-Gor & Co. can help you

Mandelbaum, Gor, Witzman-Gor & Co. is a boutique family law firm specializing in tort law, with over 18 years of experience representing claimants only. We understand the difficulties you face as an accident victim, and we are here to help you obtain the compensation you are entitled to.

Our experience in National Insurance claims includes:

• Representation in initial stages: We assist you in filing your initial National Insurance claim, prepare all necessary documentation, and ensure that your claim is processed correctly and efficiently.
• Appeals before an appeals committee: If National Insurance rejected your claim, or if you believe the compensation you received is unfair, we can file an appeal before a National Insurance appeals committee. We will represent your case as strongly as possible, with medical evidence and legal testimonies.
• Litigation in court: If the appeals committee rejected your claim, we can file a lawsuit in court. At this stage, deep legal experience and knowledge of tort law are critical, and that is exactly what we offer.
• Representation in civil claims: In traffic accidents, we also help you file a tort claim (bodily injury damages) in addition to the National Insurance claim, to ensure you receive full compensation.

We also understand the emotional aspects of being an accident victim. We offer personalized and dedicated service to each client, and we are here to answer any questions you may have and provide you with the peace of mind you need during this time.

Free initial consultation

If you are an accident victim and are unsure what the next steps are, we invite you to a free initial consultation with one of our lawyers. In this consultation, we will listen to your story, assess your case, and provide you with legal advice regarding your options. No commitment, no costs — just straightforward and honest advice.

Our office is located in Ramat Gan, and we are here to serve you with all your legal needs regarding National Insurance claims and tort law in general.