Introduction:

Determining disability for a person with mental illness is either done as part of the National Insurance General Disability Pension claim process or through a psychiatrist that is certified to do so - for someone who wants the Ministry of Health's Rehabilitation Basket services only without having to go through the National Insurance Institute
The disorders and percents of disability determined for each one are found in sections 33 and 34 of the Additions to the National Insurance Regulations (establishing the degree of disability for work accident victims), 1956
A person who is determined to have a medical disability, but is not eligible for the pension, may be entitled to benefits that are not contingent on the disability pension


Determining disability for a person with mental illness is either done as part of the National Insurance General Disability Pension claim process or through a psychiatrist that is certified to do so - for someone who wants the Ministry of Health's Rehabilitation Basket services only without having to go through the National Insurance Institute.

Target Audience and Prerequisites

Determining Disability by a Certified Psychiatrist

  • Someone who is interested in receiving services that are part of the Ministry of Health's rehabilitation basket, without having to go through the entire National Insurance Institute process to determine eligibility, may request a diagnostic test by a psychiatrist that is on the list of psychiatrists certified by the Ministry of Health.
  • A person who meets the referral criteria of the local rehabilitation committee will receive a diagnostic appointment.
  • The level of disability established by the psychiatrist is valid only for services provided in the Ministry of Health's rehabilitation basket and does not grant the applicant benefits from any other agencies.
  • If the person already has had his/her disability determined by the National Insurance Institute (General Disability or Workplace Disability), he/she can not request a psychiatrist's diagnosis.

Determining Disability through the National Insurance Institute

  • Medical disability that is necessary to receive the rehabilitation basket can be determined by a General Disability Medical Committee as part of the National Insurance Institute's General Disability Pension claim process.
  • According to the National Insurance Institute Circular, in cases of schizophrenia, disability can be established without requiring the applicant to appear before the medical committee.
  • Someone who is determined to have a disability of at least 40% on the basis of mental issues, can contact the local rehabilitation committee to request the services granted through the Ministry of Health's Rehabilitation Basket for the Mentally Ill.
  • People suffering from a number of disorders or illnesses in addition to mental disorders, may have a higher level of disability determined for them that is comprised of all of their disabilities (weighted disability) and may be relevant for benefits that are not connected to the rehabilitation basket.
  • A person must have a medical disability of at least 60% or at least 40% (in a case where one of the disabilities is at least 25%) or at least 50% (for a homemaker), in order to establish the degree of incapacity (a condition necessary to be eligible for a disability pension.
  • The doctor also determines the start date of the medical disability and whether is is temporary or permanent.
  • There are various benefits given to people with medical disability that was established by the National Insurance Institute that are not contingent on eligibility for the disability pension or level of incapacity.
Example
  • Someone who is determined to have a permanent medical disability of at least 20%, is eligible for vocational rehabilitation and educational assistance. (Someone who is eligible for a rehabilitation basket from the Ministry of Health can also request vocational rehabilitation from the National Insurance Institute.)
  • Someone who is determined to have a medical disability of 100% (or above 89% according to a special calculation), may be eligible for an income tax exemption.
  • 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.

    Necessary Preparations

    Medical Documentation

    • Psychiatrist's opinion
    • Hospitalization summaries if there were.

    Additional Documentation

    • 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


    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.
    • 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:
      1. the decision that you did not lose the ability to work, or work less than 50%.
      2. 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.
    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

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