Special Services Guide in National Insurance

What are Special Services in National Insurance?

Special services, also known as special services benefits or special services allowance, are a set of financial benefits and care provided by the National Insurance Institute to victims of traffic accidents and workplace accidents. The benefit is intended to cover expenses required for treating bodily injuries, rehabilitation, and supporting the victim's return to daily routine.

This policy reflects the National Insurance system's commitment to support victims during the critical period following an accident, when physical and psychological injuries may be severe and require special care. Unlike other basic benefits, special services focus on the specific needs of each victim, taking into account the type of injury, severity level, and their personal rehabilitation needs.

In this guide, we will comprehensively review your rights as a victim, the types of benefits you can receive, the legal procedure for filing a claim, and ways to maximize what you get from the system. Mandelboim, Gor, Witzman-Gor and Partners Law Firm, with over 18 years of experience representing claimants in national insurance tort law, will accompany you at every stage of the process.

Who is Entitled to Special Services?

Eligibility for special services in the National Insurance system depends on several key criteria. First, you must be a victim of an accident defined as a traffic accident or workplace accident under the National Insurance Law. Second, you must be insured by the National Insurance at the time of the accident. Third, the accident must cause bodily injury requiring ongoing medical treatment or rehabilitation.

It is important to emphasize that even if the victim is self-employed, a foreign worker, or even lacks a history of National Insurance payments, various mechanisms exist that can ensure eligibility. Each case is examined on its own merits, and often there are alternative ways to obtain benefits. Examining eligibility requires an in-depth legal review of the accident circumstances, insurance records, and damage reports.

Types of Benefits in Special Services

Special services in the National Insurance include a wide range of benefits tailored to the victim's needs. Below is a review of the main categories:

• Medical Treatment and Rehabilitation: Coverage of medical examinations, treatments, surgeries, medications, and physiotherapy. The National Insurance may cover private treatments to a certain extent, provided they are medically necessary.
• Aids and Medical Equipment: If the victim requires devices such as a wheelchair, orthopedic devices, eyeglasses, hearing aids, or similar equipment, the National Insurance may cover part of the expenses.
• Transportation Expenses: Coverage of transportation costs for medical treatments, including special taxis or arranged transportation.
• Vocational Rehabilitation: Support for retraining or training for a new profession if the victim cannot return to their former job.
• Mental and Cognitive Treatment: Psychological, psychiatric, or cognitive treatment in cases of mental or cognitive injuries resulting from the accident.
• Home Assistance Expenses: In some cases, coverage of housekeeping help, childcare, or personal care during rehabilitation.

It is important to note that not every benefit is automatically available. Often, the National Insurance requires prior approval, presentation of medical evidence, or compliance with certain criteria. This is where professional legal counsel plays a crucial role — to ensure you receive all the benefits you are entitled to.

Process of Filing a Special Services Claim

Filing a claim for special services with the National Insurance Institute is a process that requires legal precision and deep knowledge of procedures. Generally, the process begins with submitting a request to the National Insurance Institute within a reasonable time from the accident. Each case is different, but typically it is advisable to initiate the process as soon as possible, while medical evidence and witness testimony are still fresh.

Step 1: Information Gathering and Accident Reporting

The first step is to report the accident to the National Insurance Institute, if not already done. This report must include accurate details about the accident, circumstances, location, time, and a description of the damages incurred. In the case of a traffic accident, reporting to the police is essential, as is obtaining a police report number.

At this stage, it is important to collect all relevant documents: photographs from the accident scene, witness statements, initial medical report, Form 101 from the National Insurance Institute (if distributed), and any other medical documents. These documents will form the basis for assessing your eligibility.

Step 2: Medical Examination and Determination of Injury Severity

Following the report, the National Insurance Institute may require a medical examination to assess the extent of the injury. This examination may be conducted by a doctor appointed by the National Insurance Institute. It is important to be prepared for this examination with complete medical documentation of all treatments you have received to date.

At this stage, you must present all medical complaints, tests performed, results of tests such as CT, MRI or blood tests, and anything relevant to the injury. Your own doctor or medical advisor may also submit a counter-opinion, especially if you dispute the conclusions of the National Insurance Institute's doctor.

Step 3: Submission of Formal Application for Special Services

After all documents and medical evidence have been collected, a formal application is submitted to the National Insurance Institute for special services. This application must include:

• A detailed description of the injury and its current manifestations.
• In-depth medical reports, including expert opinions if necessary.
• Evidence that the injury requires ongoing treatment or rehabilitation.
• An economic assessment of expected treatment costs.
• A clear legal statement of your claims.

This application may be submitted by you personally or, as is strongly recommended, through a lawyer with experience in this field. An attorney can present your case in the most convincing manner, avoid technical errors, and ensure that all legal arguments are strong and well-founded.

Step 4: Examination of the Application by the National Insurance Institute

After submission of the application, the National Insurance Institute examines it according to a fixed protocol. Usually, this takes several weeks to months, depending on the institution's workload. During this examination, the National Insurance Institute may request additional information, further medical examinations, or clarifications.

It is important to follow up on your application and respond promptly to any requests for information. Delay in responding may suspend the decision. During this stage, if you have an attorney, he or she can communicate directly with the National Insurance Institute, request clarifications, and push for a faster decision.

Step 5: Receipt of Decision and Appeal if Necessary

Ultimately, the National Insurance Institute issues a decision—approval or rejection of the application. If the application is approved, you can begin incurring expenses and submitting reimbursement claims. If the application is rejected or partially approved, you have the right to appeal.

The right to appeal is critical. If you dispute the decision, you can appeal to the National Insurance Institute's Appeals Committee, and subsequently to court if necessary. This is a stage where expert legal advice is critical, as appeals require strong legal arguments, new evidence, or refutation of the National Insurance Institute's arguments.

Scenario Comparison — Who is Eligible and What Can Be Received

Eligibility for special services under National Insurance varies depending on the circumstances of the accident, type of injury, and severity level. Below is a table presenting typical scenarios:

As can be seen from the table, eligibility for special services depends on the severity of the injury. More severe injuries typically receive greater benefits, but even lighter injuries may be eligible for substantial support. Each case is examined individually by the National Insurance, and accuracy in medical documentation is key to success.

How are Special Services Benefits Calculated?

The calculation of special services benefits does not follow a fixed formula precisely. Instead, the National Insurance examines the specific needs of each victim, the type of treatment required, the expected duration of treatment, and associated costs. The National Insurance may determine a monthly or annual amount to cover expenses, or approve specific expenses as they arise.

In some cases, the National Insurance sets a cap on the annual or monthly benefit amount. In others, it approves expenses upon request. This is why it is important to work with an attorney familiar with National Insurance procedures who can present arguments that lead to higher benefits.

How Mandelbaum, Gor, and Witzman-Gor & Co. Can Help You

Mandelbaum, Gor, and Witzman-Gor & Co., attorneys at law, based in Ramat Gan (Donosh 1) and Petach Tikva (Yoni Netanyahu 8), specializes in representing claimants in the field of tort law, including claims with National Insurance and special services. The firm was founded in 2008 by Attorney Keren Mandelbaum and has since guided hundreds of injured parties in their journey to obtain fair compensation and benefits to which they are entitled.

When you choose an attorney from our firm, you receive:

• In-depth field experience: Our attorneys have over 18 years of experience representing injured parties in tort law. We are familiar with all the nuances of National Insurance laws, National Insurance procedures, and the best ways to present a case persuasively.
• Full and focused representation: We represent claimants exclusively, which means we are entirely dedicated to your benefit. We do not also serve National Insurance or insurance companies, so there is no conflict of interest.
• Personal and devoted approach: Each case is handled separately, with individual attention. We understand that each injured party has unique needs, and we guide you through every step of the process.
• Open and clear communication: We believe in open communication with our clients. You will always know what is happening with your case, what the next steps are, and what your chances are.
• Free initial consultation meeting: We offer a free initial consultation meeting to discuss your case, assess your chances, and explain the process.

When you approach our firm regarding special services in National Insurance, we will examine the circumstances of your accident, collect all relevant documents, consult with doctors and experts, and prepare a strong and compliant request. If National Insurance denies the request, we will file a strong appeal or represent you in court if necessary.

What Are the Next Steps?

If you believe you are entitled to special services in National Insurance, the first step is to contact us. You can leave your details through the contact form on this page, or call us directly. During the free initial consultation meeting, we will discuss your case in depth, ask questions to understand the circumstances, and give you an initial assessment of your chances.

Then, if you decide to be represented by us, we will start working on your case immediately. We will collect documents, consult with doctors, prepare a request, and follow up with National Insurance until we receive a decision. Throughout the entire process, we will keep you updated and answer all your questions.