Determining Disability by a Medical Committee for General Disability (Proceeding)

As part of the General Disability Pension claim process, the applicant's level of medical disability is determined by a General Disability Medical Committee

This page includes details on how disability is calculated as well as links to specific information relevant to specific diseases

For more information see the National Insurance Institute website

As part of the General Disability Pension claim process, the applicant's level of medical disability is determined.

This page details how medical disability is calculated according to the National Insurance Institute Regulations (determining disability level for work accident victims).
This page also provides links to specific information about different types of disabilities and illnesses the applicant may have (including what sections of the regulations are relevant and what documents should be prepared before appearing before the General Disability Medical Committee.
There are various benefits given to people with medical disability that are not contingent on eligibility for the disability pension or level of incapacity.
The diagram below shows the different stages of the disability benefit claim process. Detailed steps are provided in the chart below.

Preparation for Submitting the Claim

Submitting a General Disability Pension Claim through the Regular Track
or
Fast Track for Special Circumstances

Establishing a Medical Disability
through a
medical committee

Establishing the Degree of Incapacity
and receiving a response in the mail

If the response is positive, see: Pension Rates

If you are not satisfied with your response, you can appeal the medical decision
or
appeal the decision regarding incapacity to function

In any case, one can
resubmit a claim

Tip

Before eligibility for the disability benefit is established and until it is received a person can check if he/she is eligible for income support

Tip

There are several ways to receive professional assistance during the process of making a disability claim.

The National Insurance Institute runs Yad Mechuvenet that provides free guidance and assistance for those who are preparing to appear in front of the medical committee.

For more information on other ways to receive assistance see Free Aid for Filing Disability Claims with the National Insurance Institute.

Target Audience and Prerequisites

Insured Israeli residents from age 18 through retirement age that submit a general disability pension claim.

Tip

A person who wants to have (general) medical disability determined by the National Insurance Institute that is not through a general disability claim can submit a request to the Tax Authority to be evaluated by a Income Tax Exemption Medical Committee. For example, a man who suffers from an illness that caused disability after he reached retirement age and therefore he can't submit a disability pension claim because of his age but he is interested in receiving benefits given to those with medical disability (that are not contingent on receiving a disability pension).

Necessary Preparations

Before submitting a claim, all relevant documentation should be prepared.
Those suffering from multiple ailments and disabilities are advised to prepare relevant documentation and tests for each of the disabilities in order to increase the percentage of disability that will be established by the claim.
Required documents for specific illnesses can be found here.

Example

If a person submits the application for a specific disease, such as heart disease, it is recommended to examine thoroughly whether he/she is suffering from another illness /disability that will give him/her additional medical disability percentages.
In the above example, let's say that in addition to heart disease, the person also suffers from diabetes and subsequently submitted to the committee the documents required regarding the diabetes.
Suppose the Medical Board determines :
- 40% disability with respect to the heart disease
- 20% disability with respect to the diabetes
According to these figures, a weighted medical disability of 52% will be determined.
For an explanation of the calculation method and additional information, see weighted medical disability as determined by the National Insurance Institute for multiple diseases

Submitting the Claim

After the discussion in the General Disability Medical Committee is over, the committee's doctor established the degree of disability based on the regulation additions ("Medical Tests Guide").
The doctor also determines the start date of the medical disability and whether is is temporary or permanent.
- If temporary disability is established: Towards the end of the prescribed period, the National Insurance Institute will contact the policyholders to request submission of updated medical information and to invite them to appear before an additional medical committee hearing.
When a person suffers from multiple diseases and disabilities that each have their own established degree of disability, medical disability is calculated based on their weighted calculation.
If the weighted number is not a whole number it is rounded up to the next whole number (for example 89.1% is considered 90%).

Tip

The National Insurance Circular lists cases when it is recommended to determine disability based on the documents submitted and without summoning the applicant to the medical committee Intellectual Disabilities, Oncology Patients, the Blind, Severe Renal Failure, Organ Transplants recipients (kidney, heart, liver, lung ect), Advanced Cardiac Patients, Paralysis, degenerative illness in advanced stages (e.g Parkinson's, Multiple Sclerosis, ALS) Autism, Schizophrenia, extended hospitalization, requires a respirator.

Disabilities that are not taken into account in determining eligibility

There are certain medical conditions that cause medical disability but have been determined not to impact a person's ability to work and earn money and therefore are not taken into account when determining the degree of general disability.
These conditions are detailed in the addendum to the National Health Insurance Regulations (Disability Insurance) (Establishing Degree of Medical Disability, Appointment of Appeals Committees, and other directives)

Example

According to section 17(b) of the National Health Insurance Regulations (establishing disability for work accident victims), removal of the spleen gives a person a medical disability of 10%.
Section 17(b) is part of the list of conditions that don't count toward disability.
Therefore the medical disability of 10% established after the spleen removal is not taken into account when calculating the degree of general disability.

Information on Specific Types of Disabilities

Continuing the Process

What Now?	For Further Details	Notes
Medical Board's Decision	In the following circumstances, your case will be transferred to the claims official in order to determine the degree of disability: If the medical committee established medical disability of at least 60%. If the medical committee established medical disability of at least 40%, and one disability is at least 25%. For a housewife - if the medical board determined medical disability of at least 50%	There are rights given based on percentage of medical disability, independent of the determination of the degree of disability and eligibility for disability.
The Decision of the Claims Official and Establishing the Degree of Incapacity	The claims official will recheck your income, with reference to the percentage of medical disability which has been established. The official determines to what extent your medical disability affects your ability to work and to earn (for a housewife-on her ability to function within household responsibilities) based on recommendations by a doctor and the rehabilitation clerk.	In cases in which a rehabilitation clerk recommendation is necessary, you will be invited to an interview.
Receiving the Decision	* Upon finishing all of the examinations, you will be sent in the mail notification of the decision on your claim with the attached report of the medical committee. Note that even if you are not found to be entitled to a disability pension, it is possible that you will be entitled to medical disability benefits that are not contingent on general disability eligibility	Important Reminder: Your eligibility for the allowance is a result of the established percentage of medical disability determined by a medical committee as well as the level of incapacity to function established by a claims assessor. Both of these decisions can be appealed as outlined below.
Payment of the Allowance for those Eligible	For those who were determined eligible for the allowance, payment for the disability allowance will be 90 days from the date in which the degree of incapacity was determined. The benefit is paid on the 28th of the month to the bank account of the disability benefit recipient or his/her legal guardian (if one has been appointed) Whoever is eligible for Sick Pay, will begin to receive the allowance upon finishing the period in which he/she receives the sick pay. Eligibility for retroactive payment of the allowance will be for a maximum of 12 months before submission of the claim.	*Someone who has an establish disability of 100% for a period of at least 6 months is eligible to receive a disability payment from the 31st day from when the disability was established. Payment for the 31st day and on is paid after the 91st day from when the disability was determined. Those eligible for a dependents' supplement will only receive it from the 91st day (and not for days 31-90). Those who are also eligible for a Special Services Benefit (Attendance Allowance) will receive the higher of the two benefits during this time period.
If you are not satisfied with the decision of the medical committee, you can appeal the decision within 60 days.	Appealing a General Disability Medical Committee Decision	According to the National Insurance Institute Law, in cases in which the medical committee determined disability of less than 80%, one may appeal the decision. Despite this, the courts have ruled that one may appeal the medical committee's decision, even in cases in which a higher degree of disability was established. It is best to submit an appeal within the amount of time prescribed in the law (60 days) but the National Insurance Institute will not reject appeals that are submitted within 90 days.
	If you are not satisfied with the decision of the appeals committee, you may submit an appeal (for legal questions only) within 60 days.	One may request free legal assistance from the Justice Department's branch for free legal assistance.
If you are not satisfied with the level of incapacity determined, in certain cases you can appeal the decision of the claims assessor within 90 days.	Appealing the decision determining incapacity to function	One can submit an appeal for two types of decisions regarding incapacity to function: the decision that you did not lose the ability to work, or work less than 50%. the decision that the inability to function is not more than 74%. In a situation in which the committee is deciding to reduce the level of incapacity, one may cancel the appeal submission and retain the current level of incapacity determined by a claims assessor.
	If you are not satisfied with the decision of the appeals committee, you may submit an appeal (for legal questions only) within 60 days.	One may request free legal assistance from the Justice Department's branch for free legal assistance.
If you would like to appeal the decision of the claims assessor, independent of the level of incapacity determined, for matters such as periods of employment, your age, your level of education, income, etc.).	You can submit Request to the Claims Committee within 6 months from the day in which you received the rejection from the claims assessor. Alternatively, if you are not satisfied with the decision of the appeals committee, you can submit an appeal to the regional labor courtss within 12 months from the day in which you received the decision from the claims officer regarding your allowance.	The claims committee is only authorized to recommend to the claims assessor to reconsider the claim (in cases in which they find this to be correct). In the appeal to the regional labor courts, one can request Free Legal Aid from the Ministry of Justice's Legal Aid Division.
One may submit another claim after 6 months have passed, or if the applicant's medical condition has worsened another claim may be submitted without a waiting period.	Reexamination of Disability Pension Eligibility

Government Agencies

The National Insurance Institute

Laws and Regulations

The National Insurance Law
The National Insurance Regulations (establishing disability level for work accident victims) 1956
National Health Insurance Regulations (Disability Insurance) (Establishing Degree of Medical Disability, Appointment of Appeals Committees, and other directives) 1984
General Director's Circular from 27.06.2016 - Diagnosis and evaluation of dependence based on documents and without summoning the applicant to a medical committee for general disability, special services and a handicapped child.

Credits

Original translation performed by The Shira Pransky Project as part of a grant from The Fellowship Fund.

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