Realizing your rights starts with the full picture

The client sought to activate the long-term care policy provided through her health fund after her eyesight deteriorated. Following two denials, it was necessary to understand precisely which findings the insurer had relied on and which medical and functional information needed to be presented more clearly.

RightEx's specialist team reviewed both denial decisions together with the medical and functional records. We organized the information so that the connection between the loss of vision and the need for help with daily activities was presented clearly and consistently. A geriatric physician accompanied the process without providing a medical opinion.

We organized the client's documents and prepared an exhibit file based on the material she supplied, at no additional charge. We recommended and guided her to submit the material to the Small Claims Court, without the need for representation by a lawyer. The guidance was administrative only and did not include legal advice or representation. After she followed our guidance and filed the organized documents, the insurer contacted her and sought an agreement without a hearing or judgment.

In this case, the client received approximately NIS 70,000 retroactively from the date on which the original insurance claim was filed with the insurer. The amount included interest, indexation, and compensation without proof of damage. She was also approved for a monthly payment of approximately NIS 6,500 for the following 12 months.

At the same time, we worked with the National Insurance Institute to realize her long-term care rights and advanced an application for a blind or visually impaired person's certificate. This meant addressing the situation as a whole rather than as a single claim against one body.

* This is not a legal service and does not include legal advice or representation. The involvement of a medical specialist does not include a medical opinion. Every case is assessed on its individual circumstances, and eligibility or outcomes cannot be guaranteed.

We mapped the event along two separate tracks. The first was the National Insurance work-injury pathway. The second concerned the relevant coverage under her personal accident policy.

For the National Insurance claim, we organized the information about the accident, the period of incapacity, and the lasting impairment. We first pursued injury allowance for 90 days and then advanced the claim for a work-disability determination.

At the same time, we reviewed the personal accident policy and worked to activate the coverage relevant to the event, including a lump-sum payment for accidental disability, coverage for a state of dependency caused by the accident, fracture coverage, and further benefits under the policy terms.

Under the work-injury pathway, injury allowance was approved for 90 days, followed by approval of a permanent work-injury disability benefit. The parallel review prevented the event from being examined through only one body and enabled each right to be pursued through the appropriate pathway.

* This is not a legal service and does not include legal advice or representation. The involvement of a medical specialist does not include a medical opinion. Every case is assessed on its individual circumstances, and eligibility or outcomes cannot be guaranteed.

After the two denials, RightEx's specialist team reviewed the committee decisions and the existing information about the child's mental health and functioning. We examined whether the full effect of the condition on daily life had been reflected in the way the case was presented.

We reorganized the information around the issues relevant to the eligibility assessment and connected the medical documentation with the functional picture. This enabled each document to be presented to the National Insurance Institute as part of a clear, focused, and consistent sequence.

We did not simply resubmit the same material. We continued working with the National Insurance Institute until an additional committee was scheduled, removing the need to apply to the Labor Court.

At the additional committee, the child's eligibility was recognized and the benefit was approved. The case illustrates how a precise review of the reasons for denial and careful organization of the information can enable a more complete eligibility assessment.

* This is not a legal service and does not include legal advice or representation. The involvement of a medical specialist does not include a medical opinion. Every case is assessed on its individual circumstances, and eligibility or outcomes cannot be guaranteed.