Long-Term Care Insurance Claim in Ramat Gan

What is Long-Term Care Insurance and Who is Entitled to Claim?

Long-term care insurance is a type of health insurance that covers nursing care expenses for a person injured in a traffic accident or workplace accident, or who has contracted a serious illness and suffered bodily injury requiring ongoing nursing care. The insurance covers expenses such as nursing assistant wages, medical equipment, home modifications to accommodate the injured person's needs, and additional treatments necessary to maintain their quality of life.

In Israel, long-term care insurance is part of the legal support framework for accident victims. A person is entitled to file a long-term care insurance claim if they suffer from a disability or bodily injury requiring regular nursing care, provided they were insured at the time of the accident or the accident was covered by compulsory insurance or national insurance.

Mandelboim, Gor, Witzman-Gor and Co. specializes in representation of claimants in tort law, including long-term care insurance claims. With more than 18 years of experience (since 2008), we assist accident victims in securing the full compensation they are entitled to.

How Does a Long-Term Care Insurance Claim Work?

A long-term care insurance claim begins with submitting a demand to the insurance company. This demand must be accompanied by detailed medical documentation proving the need for nursing care, such as medical reports, functional assessments, and a care provider log documenting the required hours of care. The insurance company will review the demand and decide whether to approve or reject it.

If the insurance company rejects the claim or offers insufficient compensation, a lawsuit can be filed in court. In litigation, you must prove the need for nursing care, actual expenses incurred, and a causal connection between the disability and the accident. Typically, such legal proceedings require strong medical evidence, expert testimony (physicians, therapists), and accurate documentation of all expenses.

In a long-term care claim, you can sue the insurance company for expenses already incurred (retrospective) and for expected future expenses (prospective). This means you can receive compensation both for nursing care expenses you have already paid in the past and for nursing needs expected to continue for years to come.

What Does Long-Term Care Expenses Include?

• Nursing Assistant Wages: Wages for a professional nursing assistant or family member caring for the injured person, based on daily required care hours.
• Medical and Therapeutic Equipment: Medical bed, wheelchair, elevators, air purification systems, and other equipment necessary for treating the injured person.
• Home Modifications: Installation of an elevator, door widening, renovations to make the home accessible for a person with a disability.
• Medications and Treatments: Limited medications, physiotherapy treatments, additional treatments (psychological therapy, occupational therapy, speech therapy, etc.).
• Transportation: Vehicle modification or purchase of a vehicle adapted for an injured person with a disability.
• Day Care: Day care centers for patients, rehabilitation and therapy centers.

Long-Term Care Insurance Claim in Ramat Gan - Complete Legal Procedure

A long-term care insurance claim is a complex claim that requires deep understanding of insurance law, tort law, and the National Insurance Law. The professionals at Mandelbaum, Gor, Yitzman-Gor and Partners law firm in Ramat Gan are familiar with the nuances of such claims and know how to navigate them successfully.

Stages of the Claim:

Stage 1 - Initial Assessment: At a free initial consultation meeting, we listen to your case story, examine the circumstances of the accident, and assess the strength of the claim. We check whether long-term care insurance exists, what is covered, and what the coverage amount is.

Stage 2 - Collection of Medical Documentation: We will obtain complete medical records from all treatments you received, physician reports, functional assessments, and documentation of all expenses incurred for long-term care. This is the heart of every long-term care claim.

Stage 3 - Filing a Demand on the Insurance Company: We will contact your insurance company and submit a formal demand for acknowledgment of liability and compensation payment. This demand will include all medical documentation, expense calculations, and legal arguments for the claim.

Stage 4 - Negotiation: If the insurance company agrees in principle, we will proceed to negotiate the compensation amount. Insurance companies sometimes attempt to offer an amount lower than what is due, and our role is to protect your rights and obtain full compensation.

Stage 5 - Legal Proceedings (if necessary): If an agreement is not reached, we will file a lawsuit in court. In legal proceedings, we will represent you before a judge, present medical evidence, examine expert witnesses, and provide legal arguments to achieve a judgment in your favor.

Common Challenges in Long-Term Care Claims

Insurance companies often oppose long-term care claims for various reasons. They may argue that long-term care is not necessary, that expenses are exaggerated, or that the connection between the disability and the accident is not sufficiently clear. Additionally, insurance companies often attempt to limit long-term care to short periods rather than acknowledge the need for long-term coverage.

Our firm is familiar with these tactics and knows how to deal with them. We bring strong medical evidence, assess costs in a precise and detailed manner, and vigorously argue for your rights in court if necessary.

Types of Disability Eligible for Long-Term Care

Not every disability qualifies for recognition of long-term care needs. The disability must be of a type that requires ongoing long-term care - that is, assistance with daily activities such as eating, dressing, personal hygiene, mobility, etc. Generally, a disability in the range of 20% or higher may entitle a person to long-term care, but this depends on the type of disability and the victim's level of independence.

For example, a victim of a traffic accident who suffered a spinal cord injury and now uses a wheelchair, or a victim of a work accident who lost an arm and requires assistance with daily activities - both may be entitled to long-term care. Similarly, a person who suffered a head injury with significant cognitive damage may be entitled to long-term care even if the formal disability rating is relatively low.

Comparison Table - Types of Insurance and Disability Claims

To better understand the differences between various types of claims, here is a comparative table:

As can be seen, a nursing care claim is a category of its own with unique characteristics. It requires detailed evidence of the need for nursing care, and the value of the claim can be very substantial, especially if the injured party is young and has a long life expectancy.