Work Disability in Ramat Gan — Complete Guide to Insured Rights and Obligations

What is Work Disability? Definition and Types

Work disability is a condition in which an employee or self-employed person suffers from physical or mental injury resulting from a work accident or occupational disease, and as a result, cannot perform their work in full or in part. The legal definition of work disability in Israel is based on the National Insurance Law, which defines disability as the inability to earn income from work due to physical or mental injury.

Work disability is not a univocal concept. It is divided into two main categories: partial disability and total disability. In partial disability, the injured party can continue working in certain capacities but at a lower scope or level. In total disability, the injured party cannot work at all or almost not at all due to the severity of the injury.

It is important to understand that work disability is different from general disability. General disability refers to impairment of a person's functional capacity in all areas (self-care, mobility, cognition), while work disability focuses primarily on the ability to earn income and work.

Types of Work Disability

• Partial Work Disability — The injured party can earn income, but at a lower wage or limited work scope. For example, a worker injured in the hand who can only perform light work.
• Total Work Disability — The injured party cannot earn any income due to the severity of the injury. This occurs in severe injuries such as paralysis, blindness, or severe mental injury.
• Temporary Disability — A temporary condition of inability to work, after which full or partial recovery is expected.
• Permanent Disability — A condition of disability expected to be permanent, with no prospect of significant recovery.

Each type of work disability affects differently the insured's rights and the amount of compensation they are entitled to from the National Insurance or from a civil claim against the party responsible for the accident.

What Causes Work-Related Disability? Causes and Circumstances

Work-related disability arises following an event or health condition related to work. The primary causes are workplace accidents and occupational diseases.

Workplace accidents are single events that cause physical injury. Common examples include: falls from height, cuts from sharp materials, collisions with work tools, electrocution, crushing of body parts, etc. Workplace accidents can be minor or severe, and their impact on work capacity depends on the severity of the injury and the affected body part.

Occupational diseases are illnesses that develop gradually as a result of exposure to hazardous working conditions. Examples include: asbestosis (asbestos exposure), back injuries from handling heavy loads, hearing problems from industrial noise, mental health issues from chronic work stress, etc. Occupational diseases require proof of a causal relationship between working conditions and the illness.

Additionally, there are cases of psychological injury resulting from a workplace event (such as witnessing a serious co-worker accident) or chronic work stress. These conditions may be recognized as work-related disability if they meet the criteria of the National Insurance Institute.

What Conditions Must Be Met to Recognize Work-Related Disability?

For an injury to be recognized as work-related disability, several conditions must be met:

1. Causal connection to work — The injury or illness must be a direct result of working conditions or a workplace accident.
2. Impact on earning capacity — The injury must affect the person's earning capacity, meaning the work they are able to perform and earn from.
3. Medical assessment — There must be a medical assessment (typically by a medical committee of the National Insurance Institute) confirming the degree of disability.
4. Report to the National Insurance Institute — There is an obligation to report the accident or illness to the National Insurance Institute within the prescribed timeframe (typically within 30 days of the accident).

Rights of the Insured in Work-Related Disability

When work-related disability recognized by the National Insurance Institute exists, the insured has several legal and financial rights:

Work-Related Disability Allowance is a monthly payment to which the injured party's family or the injured party themselves are entitled. The amount of the allowance depends on the rate of disability (percentage of disability), the injured party's basic salary, and their family status. This allowance is typically paid monthly and is largely exempt from taxes.

One-Time Compensation may be awarded to the injured party in certain circumstances, particularly if serious injury has occurred or if there is general disability (not only work-related disability).

Coverage of Medical Expenses — the National Insurance Institute typically covers medical expenses related to the injury (treatments, medications, medical equipment), provided they are pre-approved.

Vocational Rehabilitation — the injured party may be entitled to a vocational rehabilitation program if the disability prevents them from continuing their previous work. This may include training for a new profession or assistance in finding alternative employment.

Civil Compensation Claim — Beyond National Insurance

In addition to rights from the National Insurance Institute, an injured party with work-related disability may also be entitled to file a civil compensation claim against the party responsible for the accident. This may be the employer, contractor, manufacturer of defective equipment, or any other party whose duty was to prevent the accident.

In a civil claim, the injured party can sue for:

• Personal injury damages (pain and suffering, additional medical expenses)
• Loss of income (the difference between the salary they would have received and what they currently receive)
• Loss of Earning Capacity in the future
• Additional damages such as impairment of family life or enjoyment of life

It is important to note that a civil claim differs from receiving an allowance from the National Insurance Institute. While the National Insurance allowance is a fixed and known amount, the civil claim depends on proving liability and assessment of damages in court or in a settlement with the insurer.

Work Disability Claim Filing Process

If you are suffering from work disability, there are specific steps you must take to file a claim with the National Insurance Institute and potentially also a civil claim:

Step 1: Immediate Reporting to the National Insurance Institute

Immediately following a work accident or discovery of an occupational disease, you must report to the National Insurance Institute. Generally, the report must be submitted within 30 days of the accident. The report is submitted using Form 101 (Work Accident Report) or another appropriate reporting form. This obligation falls on the employer, but the insured party may also report independently if the employer fails to do so.

Step 2: Initial Medical Examination

The National Insurance Institute will refer the insured party for medical examination. This examination may be conducted by a National Insurance Institute physician or by a private physician on behalf of the National Insurance Institute. The purpose of the examination is to confirm the injury and assess its severity.

Step 3: Issuance of Initial Decision

Based on the medical examination, the National Insurance Institute will issue an initial decision regarding recognition of the accident or occupational disease. If the decision is affirmative, the process of assessing the degree of disability will commence.

Step 4: Assessment of Disability Degree

In this complex process, the National Insurance Institute will assess the percentage of disability (what percentage of the 100% injured party cannot earn income). This assessment is based on a medical disability table, discussion with the injured party regarding their work capacity, and additional medical examinations if required. This is a critical step, as the disability percentage determines the amount of the benefit.

Step 5: Decision on Benefit

Following the assessment of the disability percentage, the National Insurance Institute will decide on the amount of the monthly benefit. The benefit is calculated based on the injured party's average salary in the year prior to the accident, multiplied by the disability percentage, multiplied by a fixed coefficient.

Step 6: Appeal and Grievance

If the injured party or employer disputes the National Insurance Institute's decision, they may file an appeal (request for reconsideration) or approach the National Insurance Institute's appeals committee. The appeals committee will review the decision and may modify it if there is new evidence or if the previous decision was incorrect.

Comparison: Work Disability vs. General Disability vs. Loss of Earning Capacity

These concepts are related but distinct from each other, and it is important to understand the differences:

The important point is that a person may be entitled to several of these concepts simultaneously. For example, a person injured in a work accident may be entitled to a work disability allowance from the National Insurance Institute, and also to a civil claim for future loss of earning capacity.

Calculating the Allowance Amount — How Does the National Insurance Institute Determine Compensation?

The calculation of the monthly allowance for work disability is based on a mathematical formula defined in the National Insurance Law. The formula includes three main components:

1. Average wage — the average monthly income of the injured party in the year preceding the accident (or the discovery of the occupational disease).
2. Disability percentage — the percentage of disability assessed by the National Insurance Institute (between 0% and 100%).
3. Allowance coefficient — a fixed coefficient in the law (varies according to marital status, age, etc.).

The basic formula is: Monthly allowance = Average wage × Disability percentage × Allowance coefficient

For example, if a worker earned an average of 8,000 NIS per month, and was assessed a disability percentage of 30%, and the coefficient is 0.5, the monthly allowance would be: 8,000 × 0.30 × 0.5 = approximately 1,200 NIS per month (the numbers are examples only and the actual calculation may differ).

It is important to note that this allowance may change over time if the injured party's condition changes (improvement or deterioration). Additionally, an allowance from the National Insurance Institute is not limited in time — it is paid as long as the conditions for recognition of work disability continue to be met.

Why Is It Important to Consult with a Work Disability Lawyer?

The process of filing a work disability claim and dealing with the National Insurance Institute can be complex and requires deep legal and insurance knowledge. Here are several reasons why it is important to seek the help of a lawyer:

• Understanding Your Rights — A lawyer will explain all your rights as a victim of work disability, including a pension from the National Insurance Institute, a civil claim, vocational rehabilitation, and more.
• Proper Preparation of the Claim — Incorrect reporting or missing documents can result in claim rejection. A lawyer will ensure that all required documents are submitted on time and in the correct format.
• Protection Against the National Insurance Institute — The National Insurance Institute may attempt to reduce the compensation amount or underestimate the degree of disability. A lawyer will protect your rights and advocate on your behalf.
• Assistance with Appeals and Objections — If the National Insurance Institute rejects your claim, a lawyer will ensure that the appeal or objection is filed at the correct time and in the proper format.
• Civil Claim — If there is another party responsible for the accident (employer, contractor, manufacturer, etc.), a lawyer can file a civil claim against them and pursue full compensation.
• Protection of Your Rights in the Future — A lawyer will ensure that your pension is adjusted according to changes in your medical condition, and that you receive all your additional rights (vocational rehabilitation, coverage of medical expenses, etc.).

At Mandelbaum, Gor, Witsman-Gor and Co. in Ramat Gan, we specialize in personal injury claims, and our experience since 2008 enables us to provide professional and dedicated representation to work disability victims. We offer a free initial consultation so you can understand your rights and decide whether you would like to work with us.