Guide to Occupational Injury Benefits from National Insurance

What are Occupational Injury Benefits from National Insurance?

Occupational injury benefits from National Insurance are monetary payments granted to a person injured in a work accident or traffic accident during travel to or from work. This is part of Israel's social security system designed to compensate injured parties for bodily damage resulting from an accident, without the need to prove liability or negligence on the part of the other party.

Occupational injury benefits are not a substitute for a civil tort claim; they constitute a basic payment from the state, while a tort claim may also be filed against the party responsible for the accident in order to obtain additional compensation for damages incurred.

Who is Entitled to Occupational Injury Benefits?

Entitlement to occupational injury benefits from National Insurance exists for insured persons injured in an accident that meets certain legal criteria. Not every injury or illness qualifies for occupational injury benefits; a direct connection must be established between the accident and the injury or illness that resulted.

To be entitled to occupational injury benefits, you must be insured under National Insurance at the time of the accident. This includes salaried employees, self-employed individuals, farmers, and additional categories of insured persons. It is important to note that a claim for occupational injury benefits from National Insurance is not dependent on the determination of civil or criminal liability on the part of the party that caused the accident.

Types of Occupational Injury Benefits and Their Conditions

National Insurance provides several types of occupational injury benefits, depending on the extent of the damage and the duration of the impact on the injured party's work capacity:

• Temporary occupational injury benefits — paid when the injured party is temporarily unable to work as a result of the injury. They are paid until the injured party returns to work or until a permanent disability percentage is determined.
• Permanent occupational injury benefits — paid when the injury causes permanent disability. The amount depends on the percentage of disability determined by a medical committee.
• Occupational injury benefits for loss of work capacity — determined based on the reduction in the injured party's income following the injury.
• Occupational injury benefits for death — paid to the family of the deceased in case of death resulting from the accident.

Each type of occupational injury benefit is calculated differently and depends on specific case details, such as income prior to the accident, percentage of disability, and age of the injured party.

Process for Filing an Occupational Injury Benefits Claim with National Insurance

Filing a claim for occupational injury benefits from National Insurance is a structured process with clear steps to follow. Understanding the process helps ensure that your claim is handled with priority and accuracy.

First Step: Reporting the Accident

The accident must be reported as soon as possible following the incident. In the case of a work accident, the employer or the institution where the accident occurred is required to report it to National Insurance. In the case of a traffic accident, a report may be filed independently. Immediate reporting is important because it initiates the clock on the treatment process and the injured party's rights.

Second Step: Initial Medical Examination

Following the report, National Insurance will refer the injured party for a medical examination by a physician on behalf of the Insurance. This examination is intended to assess the extent of the injury and determine the type of occupational injury benefits to be granted. It is important to cooperate with the physician and accurately describe the injury and symptoms.

Third Step: Determination of Disability Percentage (In Case of Permanent Disability)

If the injury causes permanent disability, National Insurance will refer the injured party to a medical committee that will determine the percentage of disability. This percentage directly affects the amount of permanent occupational injury benefits. The injured party has the right to appeal the committee's decision if they believe the decision is incorrect or does not reflect the actual situation.

Fourth Step: Receipt of Decision and Determination of Entitlement

National Insurance will make a decision regarding your entitlement to occupational injury benefits. This decision will include the type of benefit, the monthly or one-time amount, and the date payment begins. If the National Insurance decision is negative, you have the right to appeal within a defined time frame.

Fifth Step: Receiving Payment

Following a positive decision, payments will begin to be deposited into the injured party's account. Temporary occupational injury benefits are typically paid on a weekly or bi-weekly basis, while permanent occupational injury benefits are typically paid on a monthly basis.

When Should You Consult with an Attorney?

It is recommended to consult with an attorney immediately following the accident or when treatment of the claim begins. An attorney with experience in National Insurance claims will be able to assist you in the process, ensure that you do not miss deadlines, appeal unfair decisions, and file a civil tort claim if relevant. Our firm, Mandelboim, Gor, Witzman-Gor & Co., specializes in representing claimants in National Insurance claims and tort claims, and offers a first consultation meeting at no cost.

Factors Affecting the Amount of Injury Compensation

The amount of injury compensation you receive depends on several legal and economic factors. Understanding these factors helps you estimate the expected compensation and ensure that the amount offered by the National Insurance is fair.

Income Before the Accident

Your income before the accident is one of the most critical factors in calculating injury compensation. The National Insurance uses this income as the basis for calculating temporary injury benefits and compensation for loss of earning capacity. Higher income typically leads to higher compensation amounts. It is important to present accurate evidence of your income, such as pay slips, tax reports, or accounting documents.

Disability Percentage

In case of permanent disability, the disability percentage determined by the medical committee directly impacts the amount of permanent injury compensation. A higher disability percentage leads to higher compensation amounts. The disability percentage is determined based on a medical evaluation of the extent of the injury and its impact on the injured person's working capacity. In any case, every injured person has the right to appeal the disability percentage if they believe it does not reflect their actual condition.

Age of the Injured Person

The age of the injured person affects the calculation of civil damages compensation and, in some cases, National Insurance compensation as well. A younger injured person with high future earning potential may be entitled to higher compensation than an older injured person.

Duration of Disability

If the disability is temporary only, injury compensation is paid only for the period during which the injured person cannot work. If the disability is permanent, injury compensation is typically paid for life or until a certain age, depending on National Insurance laws. This duration significantly affects the total value of the compensation.

Causal Connection Between the Accident and the Injury

To receive injury compensation, there must be a direct causal connection between the accident and the injury or illness that resulted from it. The National Insurance examines this connection with high priority. If there is doubt about the causal connection, the National Insurance may reject the claim or limit the compensation. Strong medical documents and medical records can clearly prove this connection.

Type of Accident and Its Circumstances

The type of accident (occupational accident, commuting accident, occupational disease) affects eligibility and the compensation amount. For example, a work accident while performing regular work may be treated differently from an accident that occurred under unusual circumstances or due to the injured person's own dangerous behavior.

Common Mistakes in Injury Compensation Claims

When handling a claim for injury compensation from the National Insurance Institute, it is important to avoid common mistakes that could affect your eligibility or the compensation amount you receive.

Failure to Report the Accident Immediately

One of the most common mistakes is failing to report the accident immediately to the National Insurance Institute. Immediate reporting is important because it initiates the processing procedure and ensures the validity of your rights. Delay in reporting may lead to complications in proving the connection between the accident and the injury.

Failure to Maintain Medical Documentation

It is important to preserve all medical documentation related to the accident and injury. This includes medical reports, test results, prescriptions, and documentation of all medical treatment you received. This documentation serves as evidence to support your claim and is essential for determining the percentage of disability.

Failure to Cooperate with the Medical Committee

When the National Insurance Institute refers you to a medical committee, it is important to fully cooperate. Failure to appear for examination or failure to cooperate with the committee may result in rejection of your claim or determination of a lower disability percentage.

Failure to Appeal in a Timely Manner

If the National Insurance Institute rejects your claim or determines a disability percentage that you dispute, it is important to appeal in a timely manner. There are defined time periods for filing an appeal, and missing this deadline may limit your options. It is recommended to file an appeal as soon as possible with strong evidence supporting your claim.

Failure to Report Changes in Circumstances

If your circumstances change (for example, you return to work, your income changes, or your medical condition improves), it is important to notify the National Insurance Institute. Failure to report may result in overpayment or misalignment of the compensation amount.

Failure to Consult with a Lawyer

In complex claims, it is recommended to consult with a lawyer experienced in National Insurance Institute claims. A lawyer can help you avoid mistakes, file an appeal if necessary, and obtain the full compensation you are entitled to.