Work accident victims' rights

 

What accident?

When a person is injured in an accident at work and due to work, or on the way from home to work or on the way back from his home, the accident shall be considered a work accident. In principle, only the NII is authorized to approve whether the accident is a work accident or not. Many victims mistakenly think that if the employer referred them to the infirmary ML form 250 (referral form for medical treatment given to employers for work, to display it to the HMO), or if they received from a hospital medical document entitled "First Certificate victim at work," than the accident was recognized as a work accident. This is not true at all and this is because they are employers, and the medical establishment does not have the knowledge and of course they do not have the authority to decide whether it was a work accident or not. In fact,  if it is recognized by the National Insurance Institute that it is a work accident, there can still be doubt as to whether it was a work accident or not. In case of a disagreement, sometimes there arises between the victim and the National Insurance Institute about whether a work accident or not, will decide on this issue the Labour Court.

 

Victim's rights NII

A victim's rights under the National Insurance Act consist of a few major elements:

 

A. The right to receive medical treatment.

B. The right to payment for loss of Kosher work (injury allowance).

C. The right to grant a work disability pension or disability from work.

D. The right to special benefits or special grant.

E. The right to vocational rehabilitation.

F. The right to receive benefits depending on victim's work.

 

Medical care:

The victim is entitled to receive funding from the National Insurance for medical expenses. Seemingly, in the initial stages after injury victim is not interested in this right, because he lives with a sense HMO pays the medical expenses incurred by him. Indeed HMOs finance the initial phase of medical treatments, but they require a refund from the National Insurance. The NII will agree to finance the medical treatment only if the victim went to the National Insurance in a timely manner (Form Notice of injury at work and its appendices) to recognize the work accident (assuming National Insurance indeed recognized it as a work accident).

 

Please note, when it comes to an accident at work, at the HMO doctor's recommendation of a certain treatment, the National Insurance will fund the same treatment. However, in most cases, doctors are not aware that funds, when it comes to a work accident victim is entitled to receive both treatments are not included in the health basket. Out of habit, HMO doctors avoid recommending the same treatment (as expensive cost, eg performing MRI or CT), which leaves those affected to receive inferior treatment. You should consult with an experienced attorney to guide the victim on how to make medical institutions provide improved medical treatments.

 

 

For example: When the need arises for private medical care such as dental care. For a work accident, HMOs in most cases only provide public dental clinics (dental clinics usually HMO's). If the person wants to be treated by more innovative and private dentists they will face difficulty to get that refund NII.

We suggest it is, in any case in which a medical service, including medical devices (such as prostheses, hearing aids, plaster, plastic, etc. ...) which is not provided directly by the funds, you should call the Work Injury NII place of residence of the victim, and find out there, whether the service provider or supplier of medical accessories accredited by the National Insurance Institute branch. You should do this so that later difficulties do not arise that the NII will not refund.

 

Part of this component, NII funds travel expenses of the victim involved in obtaining medical treatment. This reimbursement will be made by public transport rate unless the doctor specifically wrote HMO, travel for medical treatment must be by ambulance. In this case, the injured party is reimbursed for the cost of the ambulance.

 

Payment for work disability (injury allowance)

National Insurance compensates the injured party for the loss of ability to work in the aftermath of the accident. The compensation rate is 75% the average wage of the injured in the three months before the day of the injury (up to a certain limit).

 

If the fitness incapacity period does not exceeding 12 days, the victim receives money from the employer for the first nine days of the period of incapacity to work. If the period of incapacity exceeds 12 days, the victim receives compensation from the second day of the accident, the employer and part of the National Insurance Institute, and for a period of three months. Payment occurs only if the victim can not actually work on the recommendation of doctors, backed by appropriate medical certificates. If the injured decides not to accept the recommendation of rest given to him by his doctors and goes back to work, he is not entitled to injury benefits from the NII.

 

Notably, the employee does not lose the compensation for the first nine days and this is because by law, the employer must compensate the employee for the first nine days, and the National Insurance does not compensate him. I want to stress, according to Sick Pay Law, that every employee is entitled to accrue 18 sick days a year that they can exploit them for any disease (not necessarily work accidents). Since it's a work accident, not the employer, to deduct the payment for those nine days of sick leave balance of sick days credited to the employee on sick pay law.

 

Importantly, when it comes to a work accident victim must receive medical clearance from a hospital called "the first medical certificate work injury." This is the first document which indicated no days of incapacity victim recommended by the doctor. If later, the doctor decides to recommend further period of incapacity to work, it is important that the recommendation is to write a medical document titled "additional medical certificate victim at work." It should be noted that, unlike the fact that we never recommend giving an original document, the only case in which the victim must provide original documents to third parties is when a medical certificate first victim at work, and additional medical certificates victim at work. In the case that the victim shall provide the NII with only copies, NII will not hear the victim, nor will the victim be compensated. So, just in case it has to photograph the original certificate course and the National Insurance Institute to the source when the copy will remain with the victim.

 

Addressing the National Insurance Institute, the victim fills out a notice of injury form at work, in the case of a victim who is an employee, the employer must fill out part of the form. You should not sign a blank form, and trust that the employer or his accountant will complete all details. This recommendation is because the employer (or accountant) does not know the circumstances of the accident, if he makes a mistake in drafting the description of the injury and the circumstances of the accident, it may cause the legal case irreparable damage. The completed form and submission is signed by the National Insurance Institute, and the victim should keep a photocopy of the form.

 

When it comes to institutional employers or workplaces with a large number of employees (telecommunications, electric company, etc.), apply to the workplace regulations Article 22 National Insurance Institute. Meaning of Article 22 is required to be paid directly to the employee 100% average salary. Later, after the work accident has been recognized by the National Insurance Institute, the employer receives a refund from the NII. When it comes to companies with a small number of employees, Regulation 22 National Insurance Regulations does not apply to them. For a victim facing the NII independently, the impact fees will be at the rate of 75% was recognized only after the work accident. Therefore, in this case you should hurry to the NII contributions, since the examination of eligibility for injury lasts several weeks.

 

Please note that if the injured returned to work after the accident (without the utilization of incapacity period), and after several days his doctors recommended that he stop working completely, he shall not be entitled to injury benefits from the NII at all. According to the law, if there is a break in the incapacity period and the victim returned to work even one day and stopped the period, the NII will not continue to pay him. He will have to open a new procedure (action to determine the degree of disability from work), and should not do so without consultation with a skilled lawyer. Authority to approve medical committee over the period of incapacity for three months, by determining temporary disability of 100% for a further period.

 

Work disability grant or work disability

If three months pass, and the victim has not yet recovered, he may apply to the National Insurance to be recognized as disabled from working. It is important to note that this step must be performed only after consultation with a skilled lawyer, and near the end of the period of three months after the accident. Within a short period medical committee meets "by the National Insurance Institute", to discuss the determination of the degree of disability of the victim. In most cases, personal injury permanent disability are not crystallized after only three months, so generally, the commission will determine the victim to have temporary disabilities. If the temporary disability is higher than 9%, the victim receives a disability pension from work for any period during which he established a temporary disability. Of course there is the possibility to appeal the decision of the medical board, but do not do so without consulting with a skilled lawyer.

 

If the person can not yet return to work, and has no other sources of income in addition to temporary disability annuity from work, he is entitled under certain conditions to contact the National Insurance Institute, and ask for recognition as a disabled veteran in need. If the person is recognized as a disabled person in need, he will receive a monthly allowance equal temporary disability from work, at the rate of 100% and that for a period not take more than four months (in consultation with a skilled lawyer can also extend this period). At one point, after the end of the period in which the victim was set temporary disability from work, the victim meets with the medical board, which determines the rate of permanent disability the victim received from the accident. If the extent and degree of disability determined by the Committee victim Medical is 20% or higher, the victim receives a monthly pension calculated according to the degree of medical disability, and is based on the wages paid to the victim in the quarter preceding the injury in an accident (up to a maximum of five times the average wage). If the permanent disability is between 9% and 19%, the victim will receive a one-time bonus at the rate of monthly pension as above (multiplied by the number 43).

 

 

If the victim loses the ability to function permanently due to the work injury, for example: a person due to medical disability forced to change professions, resulting in decreased earnings received, it is possible to implement Regulation 15 of the National Insurance Institute. According to this regulation, the rate of medical disability which established the medical board can be increased, plus up to an additional 50% calculated in the prescribed medical disability. This addition will be given only if the "Authority Commission Regulation 15" is convinced that there is also a functional disability in addition to medical disability.

 

 

To avoid confusion, I will clarify that the calculation of Regulation 15 with a numerical example: A victim who received a medical disability of 10% and commission the authority the subject of Article 15 has determined that implement Regulation 15 in its entirety, ie by 50%, will receive the National Insurance Institute grant calculated on the basis of 15% disability, rather than a disability grant calculated on the basis of 10% disability only.

 

If the disability rate set by the medical board is not acceptable to the victim or his lawyer, it is possible to appeal the decision of the medical board ranks first, and ask to be tested again by the Medical Board. The appeal must be submitted within 30 days of the decision of the medical board ranks first. This is a very short time, and it does not always take place in an orderly fashion. However, an experienced attorney can extend the appeal with various techniques. It is advised not to appeal without prior consultation with the lawyer, and without consulting with a qualified doctor. This is because the Medical Board appeal may also reduce the degree of disability determined by the medical board ranks first. It is important to note that the National Insurance Institute has the right to appeal the decision of the medical board ranks first, and that the alleged medical board is an external committee and in many cases exploits the NII of the right question.

 

If the medical appeals decision is not acceptable to either party, either the victim or the National Insurance Institute, it can be appealed to the Labour Court. But the court will only appeal legal issues and medical issues. One should consult with a lawyer about the differences between legal and medical issues.

 

Please note, ostensibly medical boards and committees should be objective, but their objectivity is questionable. This is in part because the National Insurance Institute determines the composition of committees, pays for the work of the doctor authority committee, and the committee activities that take place at the offices of the National Insurance Institute.

 

Many claims have been made on the lack of objectivity of the medical committees, and it has long been the intention of the legislature to transfer control of objective party committees such as the Ministry of Health. However, the wheels of justice are slow and it will take a long time until the medical board becomes objective.

 

 

Special benefit or special grant

For a work disability of 75% or more, and people with disabilities who have difficulty walking and a degree of disability from 65% - 74%, it is possible to get special benefits to cover vehicle maintenance costs (for personal use), travel, personal care and assistance at home. In order to receive this benefit, please contact the National Insurance Institute upon special request. In addition, these disabled people can apply for a special grant to cover one-time arrangements due to disability, such as adjustment of the victim's residence limitations, purchasing a vehicle for personal use, and acquisition of assistive devices.

 

Benefits depend on the victims of work

Extent, and the victim died in a work accident dependents are entitled to certain rights, such as:

A. Dependent allowance - a benefit rate of 40% to 100% for full benefits, which goes to the victim if he were still alive and degree of disability of 100%. This benefit will be calculated according to the number of dependents left by the victim. Not all dependents are eligible to receive dependent benefits. For example, a widow of age 40 is capable of working and supporting herself, and is not entitled to a pension. Allowance recipients and low-income dependents, are also paid a minimum income guaranteed.

B. Grant dependents – A one-time grant in the amount of 36 monthly allowances monthly payment is the full benefit, which goes to the victim he had lived and degree of disability of 100%. The grant is for eligible dependents who are not eligible for dependent benefits.

C. Grant marriage - a widower who was married and received dependent allowance is entitled to receive a lump sum equal to the sum of 36 monthly benefits. The grant is paid in two classes: one, the wedding day, and the other after two years of marriage. Notably, the widow received a grant of marriage, is not entitled to more benefits for dependents. It is important to stress that what is said in this section about the widow is true for the widower.

D. A widow receiving vocational rehabilitation dependent allowance- The NII confirms that the widow, under an NII account, learns a new profession. During this time, the National Insurance Institute pays living expenses, and pays the expenses of various related studies. Anything said in this section about the widow is true about the widower.

E. Subsistence allowances for orphans – Expenses will be paid for each child whose time is devoted to elementary school, or vocational training, according to the parent's income.

F. Death grant - In the event of the death of a person who received a disability pension from work and had a permanent disability of 50% or more, a person who died the received  dependent benefits, or an elderly disabled person, the partner or children, in the case that there is not a spouse, receives a one-time grant. The amount of this grant is the average wage. 

 

Victim's winnings from employers' liability insurance policy

In many cases, victims of work accidents can also sue the employer under an employers' liability insurance policy. Unlike a claim against Social Security, where it does not matter who is to blame in the accident, the right to receive compensation from the insurance company of the employer is conditional whether the employer is to blame for the accident. In many cases, employers cooperate with the employee and admit their responsibility one way or another for the accident's occurence. However, this is not the case for all employers. In cases where the employer is trying to hide the truth and refuses to cooperate, you have to address the question of the employer's responsibility through various means. You should consult with a skilled attorney in the early stages who will advise you how to establish the question of responsibility.

In many cases, both the employee and the employer have a responsibility for the occurrence of the accident. In such cases, the court determines what the contributory fault of the employee is, and from this determines the amount of damages.

For example, it the court ruled that the value of the portfolio is NIS 100,000 (New Israeli Shekel), and the permanent worker is guilty of contributing at a rate of 20%, then the employer is responsible to compensate the worker NIS 80,000.  

 

 

Relationship between the National Insurance Institute and the employers' liability insurance policy

It is important to note that the rights of the victim of the employer's insurance company look seemingly "inferior" because of the employer's insurance company and the National Insurance Institute "share" the alleged burden of "total compensation" of a victim. One of the basic laws of tort is that it is harmful to restore the financial situation of the victim to normal. If the employer's insurance company compensates the victim in the amount of money which does not relate to payments from the National Insurance Institute, the victim's financial situation may improve, compared to the economic condition of the victim before the accident. However, he will also benefit from the NII benefits he would have received from the insurance company of the employer. We know it is not logical, so there is an act of offsetting.

 

In addition, it should be noted that in many instances the National Insurance Institute is entitled to contact the employer's insurance company and ask it to pay the full compensation that the NII paid to the victim. In this case, the insurance company of the employer deducts the amount of compensation determined in court from the amount of National Insurance benefits. In the event of injury with temporary disability benefits, and even compensation for a disability grant when permanent disability is up to 19%, there is no problem calculating the offset as a one-time amount paid under the National Insurance Institute to the victim. When it comes to disability pension from work at the rate of 20% or higher, the NII calculates the value of all allowances in the victim's future throughout his life, and offsets the amount received from the grand total determined in court (special calculation will be by way of a discount, and after you get the discounted amount you can offset the compensation determined by the court).

 

 

In some cases, "swallowing" can occur. Swallowing is a situation where the national insurance benefits, past and future, reach the value of the case or even exceed the value of the case as determined by the court.

 

For example: Suppose the court determined that a particular person injured in a work accident is entitled to NIS 500,000 of compensation. The extent and value of the compensation that the victim has received and will receive from the NII are a total of NIS 700,000, and the employer's insurance company is not obligated to pay the victim additional compensation. Accordingly, in some cases, lawyers advise victims that since "swallowing" is about to occur, there is no point in suing the employer's insurance company.

 

If you have been in a work accident, read the following posts that are crucial to the work injury:

 

What do you do after work accident

How to choose a lawyer to work accidents

Work accident victims rights

Accident at work accident

Loss of earning a work accident

Claim against the employer in a work accident

Work disability claim

Claim professional department

Claim Mikrotraumh

 

Our firm is a law firm for work accidents. We provide advice free of charge for victims of work injuries. We encourage you to call as soon as possible and get advice.

 

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