Introduction:

Someone who has lost at least 50% of their capacity to earn a living or function in the home is entitled to a disability pension
The degree of incapacity is assessed after a certain level of medical disability percentage has been established


The degree of incapacity, according to its amount, is what provides eligibility for the General Disability Pension.

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
Warning
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.

Required Preparation

  • 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


Target Audience and Prerequisites

  • Establishment of the level of disability is done for people whom medical disability has been established by a medical committee according to the following levels:
    • Medical disability of at least 40% with at least one impairment at a level of at least 25% disability.
    • Medical disability of at least 60% if no one impairment is at a level of at least 25% disability.
    • Medical disability of at least 50% for a homemaker.

Stages of the Process

  • After a General Disability Medical Committee has established medical disability, a National Insurance Institute claims assessor will decide if the applicant is to be considered disabled, and will determine the degree of earning incapacity after consulting with a specially certified physician and a National Insurance Institute rehabilitation assessor.
    • The degree of earning incapacity is determined according to the impact the medical impairment has with regard to the applicant's capacity to work and earn a living, to return to work and/or to work in a different profession or learn a new vocation (as suitable according to the condition).
    • The degree of incapacity to function in the home is determined according to the impact the medical impairment has with regard to the applicant's capacity to function in the home (see details below).
  • The possible degrees of incapacity are 60%, 65%, 74% and 100%.
  • Those with incapacity of 75% or higher are entitled to receive 100% of the General Disability Pension.
  • Those with incapacity of between 60% and 74% are entitled to receive a partial disability benefit. For example, if incapacity of 60% was established for someone, he would receive 60% of a full pension.
  • Those with loss of capacity below 50% are not entitled to a disability pension.
  • The National Insurance Institute's decision regarding level of incapacity and eligibility for a General Disability Pension is sent to the applicant's home.
  • As long as an applicant's medical condition or functioning capacity is unstable, the National Insurance Institute has the right to establish incapacity for a limited period of time up to two years. At the end of the defined period of time, the degree of incapacity will be reviewed.

Examining the Functioning Capacity of a Homemaker

  • The degree of incapacity to function in the home is determined according to the impact the medical impairment has with regard to a homemaker's capacity to function in a regular home.
  • Examination Location:
    • Capacity to function in the home is assessed in one of the assessment centers which are located at Beit Levinstein, and at Tel Hashomer.
    • However, according to a directive of the National Insurance Institute, in the following circumstances the medical examination and establishment of the degree of incapacity to function in the home will be performed at the National Insurance Institute branch, instead of the the function assessment centers:
      • In a case when the institute doctor believes that the claimant does not have a disability that will entitle her to a pension (meaning, at least 50%).
      • In a case when the institute doctor believes that the claimant complete loss of capacity to function in the home.
  • Examination Process in a Function Assessment Center:
    • The assessment is inter-disciplinary and is performed by a physician, a social worker, and an occupational therapist.
    • The physician assesses functioning capacity according to medical findings, the social worker considers medical information along with personal and family background, and the occupational therapist performs an assessment of functioning in a kitchen which is specially built for this purpose.
    • According to the applicant's limitations, she may be asked to perform basic housekeeping functions (such as cooking, cleaning, and straightening up), in accordance with that which the occupational therapist deems necessary.

Establishing a Temporary Degree of Incapacity

  • As long as the beneficiary's medical condition or functioning is not stable, or the vocational rehabilitation has not been completed, the claims assessor may establish the degree of incapacity for a limited period of time up to two years.
Example
Establishing a temporary degree of incapacity for cancer patients for the period during which they receive oncological treatments.
  • At the end of the determined period, the degree of incapacity will be re-examined according to the beneficiary's condition.

Appealing the Established Degree of Incapacity

  • Those whom it was determined that no capacity to earn a living or function in the house was lost; or those whom it was determined that less than 50% capacity was lost; or those whom less than 74% incapacity was established, are permitted to appeal to the appeals committee.
  • For more details, see Appealing a Decision Regarding Incapacity

Appealing Another Claims Assessor Decision

Continuing the Process

What Now? For More Information Notes
Receiving the Decision
  • Upon finishing all of the examinations, you will be sent in the mail notification of the decision of your appeal with the attached report of the medical committee.
  • Please note that if you were not found eligible for general medical disability, you might still be eligible for medical disability independent of established general disability.
  • 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 level of incapacity was determined.
  • Whoever is eligible for Sick Pay, will begin to receive the allowance upon finishing the period in which he/she receives the sick pay.
  • The allowance will be paid on the 28th of the month to the bank account of the eligible person or to the account of his/her's legal guardian (if one has been appointed).
  • Eligibility for retroactive payment of the allowance will be for a maximum of 12 months before submission of the claim.
*Someone that has an established disability of 100% for a period of at least 6 months is eligible to be a disability allowance from the 31st day from when disability was established.
If you are not satisfied with the decision of the medical committee, you can appeal the decision within 60 days. Appealing a medical decision regarding general disability
  • 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 preferable, to the best of your ability, to submit the appeal in the time established in the law (60 days) but the National Insurance Institute will not defer appeals submitted within 90 days.
If you are not satisfied with the decision of the appeals committee, you may appeal the decision in the regional labor courts (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 to the regional labor courtss (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.).
  • 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, with no waiting period, as long as there has not been a worsening of the medical condition. Reexamination of Disability Pension Eligibility


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