Comprehensive Guide to National Accident Insurance: Coverage, Benefits, and FAQs

What is national accident insurance. How does it provide financial support for unexpected injuries. Can accident insurance complement your existing medical coverage. How much does accident insurance cost. Who is eligible for accident insurance coverage. Are benefits paid directly to the policyholder. Is accident insurance portable if employment status changes.

Table of Contents

Understanding National Accident Insurance: A Comprehensive Overview

National accident insurance is a supplemental coverage designed to provide financial support in the event of unexpected injuries. This type of insurance offers a lump sum payment to help cover expenses that may not be fully addressed by traditional medical insurance plans. With the rising costs of healthcare and the potential for unforeseen accidents, accident insurance has become an increasingly popular option for individuals and families seeking additional financial protection.

Key Features of National Accident Insurance

Lump sum payment for covered accidents
Benefits paid directly to the policyholder
Coverage for various types of accidents, including sports injuries and auto accidents
Affordable group rates through employee benefit programs
No medical exam required for enrollment

The Benefits of Accident Insurance: Beyond Traditional Medical Coverage

While many individuals have medical insurance, accident insurance provides an extra layer of financial protection. Why might someone consider accident insurance if they already have health coverage? Accident insurance can help cover expenses that are not typically included in standard medical plans, such as:

Deductibles and copays
Out-of-network care costs
Non-covered services
Transportation expenses
Childcare costs during recovery

By offering a lump sum payment, accident insurance allows policyholders to use the funds as they see fit, providing flexibility and peace of mind during challenging times.

How National Accident Insurance Works: A Real-World Example

To better understand the practical application of accident insurance, consider the following scenario:

Kathy’s daughter, Molly, sustains injuries during a soccer game. She is taken to the emergency room by ambulance and diagnosed with a concussion and a broken tooth. The accident insurance policy provides coverage for various aspects of Molly’s treatment:

Ambulance transport: $300
Emergency care: $100
Medical testing: $200
Concussion diagnosis: $400
Physician follow-up visits: $150
Dental crown for broken tooth: $200

In this example, Kathy would receive a total lump sum payment of $1,350 to help cover these expenses. This financial support can significantly reduce the burden of unexpected medical costs and associated expenses.

Eligibility and Enrollment: Who Can Benefit from Accident Insurance?

Are you wondering about your eligibility for accident insurance? The good news is that accident insurance is typically available to a wide range of individuals. Here are some key points regarding eligibility and enrollment:

Both employees and their eligible family members can enroll
Enrollment is usually offered during specific periods, such as open enrollment
Applicants must be actively at work to qualify for coverage
No medical exam is required, making the enrollment process straightforward
Coverage is guaranteed, regardless of health status

This accessibility makes accident insurance an attractive option for many individuals seeking additional financial protection against unforeseen injuries.

The Cost-Benefit Analysis: Is Accident Insurance Worth the Investment?

When considering any insurance product, it’s essential to evaluate the cost in relation to the potential benefits. How does accident insurance measure up in terms of affordability? Many employers offer accident insurance at group rates, making it a cost-effective option for employees. In fact, some providers claim that coverage can be obtained for less than the cost of a daily medium cup of coffee.

To determine if accident insurance is a worthwhile investment for you, consider the following factors:

Your current health insurance coverage and any gaps in protection
Your lifestyle and potential risk factors for accidents
Your financial ability to handle unexpected medical expenses
The peace of mind provided by additional coverage

By weighing these factors against the cost of premiums, you can make an informed decision about whether accident insurance aligns with your financial goals and risk management strategy.

Portability and Flexibility: Adapting Accident Insurance to Life Changes

One of the advantages of accident insurance is its portability. Can you maintain your coverage if your employment status changes? In most cases, yes. Accident insurance policies are typically designed to be portable, meaning you can take your coverage with you if you change jobs or leave your current employer.

The flexibility of accident insurance extends beyond its portability. Here are some key aspects of this flexibility:

Coverage remains active as long as premiums are paid
Benefits can be used for any purpose, not just medical expenses
Policies can often be customized with additional riders or coverage options
Some providers offer multiple levels of coverage to suit different needs and budgets

This adaptability makes accident insurance a valuable component of a long-term financial planning strategy, providing protection that can evolve with your changing circumstances.

Claims Process and Benefit Payment: Streamlining Financial Support

Understanding the claims process is crucial when considering accident insurance. How are benefits paid out, and what can you expect when filing a claim? Here’s an overview of the typical claims process:

The policyholder submits a claim following a covered accident
The insurance provider reviews the claim and supporting documentation
Upon approval, benefits are paid directly to the policyholder
Payments are typically made as a lump sum
Benefits are paid regardless of other insurance coverage

This straightforward process ensures that policyholders receive financial support quickly and efficiently when they need it most. The direct payment to the policyholder allows for maximum flexibility in how the funds are used, whether for medical bills, daily living expenses, or other needs arising from the accident.

Innovations in Accident Insurance: New Products and Enhanced Coverage

The accident insurance market continues to evolve, with providers introducing new products and enhanced coverage options. For example, Washington National Insurance Company recently announced a new Accident Insurance product designed for both individual and worksite sales. This product offers:

Four levels of coverage to suit different needs
Six optional riders for customized protection
Benefits paid directly to policyholders
Coverage for a wide range of accidental injuries

These innovations demonstrate the insurance industry’s commitment to meeting the changing needs of consumers and providing comprehensive financial protection against accidents. As the market continues to evolve, policyholders can expect to see more tailored products and flexible coverage options.

The Future of Accident Insurance

As healthcare costs continue to rise and the nature of work and leisure activities changes, the role of accident insurance is likely to become increasingly important. Future trends in accident insurance may include:

Integration with digital health platforms for easier claims processing
Expanded coverage for emerging risks, such as accidents related to remote work
More personalized pricing models based on individual risk factors
Enhanced wellness programs tied to accident prevention and risk reduction

By staying informed about these developments, consumers can make more informed decisions about their insurance needs and ensure they have the most appropriate coverage for their unique situations.

Making an Informed Decision: Is Accident Insurance Right for You?

Deciding whether to invest in accident insurance requires careful consideration of your personal circumstances, financial goals, and risk tolerance. To help you make an informed decision, consider the following questions:

Do you participate in activities that increase your risk of accidents?
Would an unexpected medical expense cause significant financial strain?
Are there gaps in your current health insurance coverage?
Do you have dependents who rely on your income?
Would additional peace of mind regarding accident-related expenses be valuable to you?

By reflecting on these questions and reviewing the information provided about accident insurance, you can better assess whether this type of coverage aligns with your needs and financial strategy.

Consulting with Insurance Professionals

While this guide provides a comprehensive overview of accident insurance, it’s always advisable to consult with insurance professionals or financial advisors before making a decision. These experts can offer personalized advice based on your specific situation and help you navigate the various options available in the accident insurance market.

Remember that insurance needs can change over time, so it’s important to regularly review your coverage and adjust as necessary. By staying informed and proactive about your insurance choices, you can ensure that you and your loved ones have the financial protection you need in the face of unexpected accidents.

Accident Insurance | National Grid

Accident insurance provides a lump sum payment to help pay for expenses that medical insurance may not cover if you are injured in an accident.

Accident Insurance

Take comfort knowing you have financial support for accidents

When unexpected injuries lead to unexpected expenses, your accident insurance can provide money to help pay for expenses such as medical bills, transportation costs and childcare expenses.

You’ll receive a lump sum payment to use as you see fit, paid directly to you
The plan pays no matter what your medical insurance covers
May cover accident-related events, such as: sports injuries, auto accidents, bicycle accidents, broken bones, knee injuries and falls

With group employee rates, you can get Accident Insurance coverage for less than the cost of your daily medium cup of coffee. ¹

View plan details

Accident Insurance Outline of Coverage

Here’s how it works:
Kathy’s daughter, Molly, plays soccer. During a recent game, Molly collided with an opposing player, was knocked unconscious and taken to the local emergency room (ER) by ambulance for treatment. The ER doctor diagnosed a concussion and a broken tooth. He also ordered a CT scan. After thorough evaluation, Molly was released to her primary care physician for follow-up treatment, and her dentist repaired her broken tooth with a crown. Luckily Kathy has accident insurance!

Covered Event2	Benefit Amount3
Ambulance (ground)	$300
Emergency Care	$100
Medical Testing	$200
Concussion	$400
Physician Follow-Up ($75x 2)	$150
BrokenTooth (repaired by crown)	$200
Kathy would get a lump-sum payment totaling $1,350 with MetLife Accident Insurance High Plan.

This example is for illustrative purposes only.

Benefits paid by MetLife Accident Insurance HighPlan

Accident Insurance FAQs

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Am I eligible to enroll for this coverage?

Yes, you can enroll both yourself and eligible family members. All you need to do is enroll during your enrollment period, and be actively at work.

I have medical insurance, so why do I need accident insurance?

Accidents can happen anytime, anywhere and always when you least expect them. What’s more they can be costly.

Even the best medical plans can leave you with expenses for services that just aren’t covered. Things like plan deductibles, copays, extra costs for out-of-network care, or non-covered services. Many people aren’t prepared to handle these costs, so having this additional financial support when the time comes may mean less worry for you and your family.

Can I enroll for this insurance without having a medical exam?

Yes. Your accident coverage is guaranteed⁴, regardless of your health. You just need to be actively at work to be covered. There are no medical exams to take and no health questions to answer, so the whole process might be easier than you first thought.

Are benefits paid directly to me or to my health care provider?

Payments will be paid directly to you, not to the doctors, hospitals or any other health care providers. And to make things even easier, the check is made payable to you. There’s no need to work it around any other insurance you may have. Benefits are paid no matter what your other insurance plans may cover.

If my employment status changes, can I take my coverage with me?

Yes. This coverage is portable, meaning you can take it wherever you go. Your coverage will only end if you stop paying your premium or if your employer offers you similar coverage with a different insurance carrier. ⁵

Can I use the benefit payment on anything I need?

Yes, you can use your payment as you see fit. Use it to help cover your medical insurance deductibles, copays, household bills, and more.

Washington National Announces New Accident Insurance Product

CARMEL, Ind., June 6, 2023 /PRNewswire/ — Washington National Insurance Company, a national provider of supplemental health and life insurance products for middle-income Americans, today announced its new Accident Insurance product. Available for individual and worksite sales, Accident Insurance offers financial protection in the form of lump-sum cash benefits paid directly to the policyholders when a covered accidental injury occurs.

Accident Insurance benefits can help policyholders pay for accident-related costs that aren’t covered by a traditional health or disability insurance plan. It includes four levels of coverage, six optional benefit riders, and built-in accidental dismemberment and death benefits. The optional Return of Premium/Cash Value benefit rider is a distinctly competitive feature in the marketplace that allows customers to get back 100% of their premiums paid, minus any claims incurred, at the end of the rider period.

“With the new Washington National Accident Insurance product, customers gain the extra protection they need in an emergency,” said Kari Desai, vice president, product development, CNO Financial Group, the parent company of Washington National. “Policyholders and their families have control over how they can use their Accident Insurance benefits, so that they can focus on healing and returning to everyday activities without additional financial stress, giving them peace of mind and financial security.”

According to the U.S. Department of Health and Human Services, the average cost of a non-fatal injury treated in an emergency room is $6,620,¹ and 57% of Americans can’t afford a $1,000 emergency expense.² Washington National’s new Accident Insurance complements consumers’ existing health insurance plans by paying lump-sum cash benefits directly to consumers, not to the doctor or hospital. This gives individuals and families the flexibility to use cash benefits without restrictions, including paying for everyday bills and expenses if the policyholder is unable to work.

Accident Insurance is available in 30 states: AK, AL, AR, AZ, FL, GA, HI, IA, IL, KS, KY, LA, ME, MI, MO, MS, MT, ND, NE, NH, NV, OK, PA, SC, SD, TX, WA, WI, WV, and WY, with additional states being added later this year.

To learn more about Washington National and its suite of voluntary benefits, which include accident, cancer, critical illness, heart and stroke, life, and hospital, visit WashingtonNational.com.

About Washington National

Washington National Insurance Company, a subsidiary of CNO Financial Group, Inc., has helped Americans since 1911 to protect themselves and their families from the financial hardship that often comes with critical illnesses, accidents or loss of life. The company’s supplemental health and life insurance products are designed to help give policyholders and their loved ones’ peace of mind. Policyholders can depend on Washington National to be a strong, caring partner in helping to provide financial security for them and their families. To learn more, visit WashingtonNational.com.

¹United States Department of Health and Human Services, Average medical cost of fatal and non-fatal injuries by type in the USA, https://stacks.cdc.gov/view/cdc/90013/cdc_90013_DS1.pdf, 2021.

²Fortune, 57% of Americans can’t afford a $1,000 emergency expense, says a new report. A look at why Americans are saving less and how you can boost your emergency fund, https://fortune.com/recommends/banking/57-percent-of-americans-cant-afford-a-1000-emergency-expense/, 2023.

SOURCE Washington National Insurance Company

For further information: Contacts: Susan. J. Villalobo Manager, External Communications CNO Financial Group [email protected]

Work accident insurance

How work accident insurance is carried out in 2019. Working in any company can be dangerous. And an accident can happen to any of the workers. That is why it is extremely important to know how insurance against industrial accidents is carried out in 2019. After all, the guarantee of receiving payments for treatment and compensation from the employer depends on this procedure.

General points:
Insurance is a mandatory procedure that every employer must complete in relation to an employee.
Thus, the system of Russian legislation provides for the payment of an insurance fee for each employee. Starting from January 1, 2019, the tax service of Russia begins to deal with all such fees.
It is she who will monitor the correctness of the calculations of these contributions and their payment on time.
There are several types of insurance – compulsory, social and voluntary. In all types, the amount of payment and insured events will differ. And this should be taken into account when drawing up a document.

General aspects

Based on the fact that all cases have now been transferred to the Russian Federal Tax Service, a more thorough review of all contributions will be carried out.
And fines for violations are also quite large. All mandatory payments for accident insurance are made by production.
When calculating wages, the employer deducts a fee from the Federal Tax Service of the Russian Federation from it. If an insured event occurs, then the following is carried out:
• provision of social protection;
• compensation in full for the harm caused;
• Prevention of injury and illness in the course of work.
It should be understood that without fail the victim is paid the amount necessary for the treatment. Moreover, he receives treatment absolutely free of charge.
If the worker has other types of insurance, he can claim payment from other places of insurance.

About the parties to the agreement

There are several parties involved in this insurance process. The first is the insurer.
In the case of accidental charges, the Social Insurance Fund acts as an insurance agent.

The Social Insurance Fund carries out procedures such as:

• registration of all enterprises that insure their employees;
• accept reporting on contributions;
• control the payment of insurance premiums.
Both Russian and foreign organizations act as insurers – all those who work in Russia or employ citizens of the Russian Federation.
Individuals must also pay this insurance premium. This happens in those conditions when an individual hires those citizens who have insurance.
As for the insured persons themselves, these are exclusively natural persons. They may work on the basis of:
• an employment contract;
• civil law agreement.
In this case, in the latter case, it is necessary to place in the document a clause stating that it is the insured who pays all the contributions.

Legal framework

Federal Law No. 125-FZ “On Compulsory Social Insurance against Occupational Accidents and Occupational Diseases” provides all the conditions and provisions for the full insurance procedure for employees of enterprises.
Therefore, the employee has every right to claim insurance from his employer. The amount of the insurance payment is determined as a percentage of the amount of the insurance fee.
In this case, a special tariff scale is used. It is constantly updated and requires the payment of amounts corresponding to the costs of treatment.
This is discussed in chapter 2. All points of payments and insurance coverage are indicated here. All contributions are determined according to the risks of working in a particular area.
Decree of the Government of the Russian Federation No. 713 contains rules according to which it is necessary to determine the risks in the profession, and allow calculating the tariff fee for insurance.
But both discounts and surcharges on tariffs are approved by law. This is stated in more detail by the Decree of the Government of the Russian Federation No. 524.
How to calculate this indicator is stated in the order of the Ministry of Labor and Social Protection of the Russian Federation No. 39n.
The administration of insurance premiums has also been transferred to the Tax Service of the Russian Federation. To do this, Article 24 appeared in the Tax Code in part 2. She talks about insurance premiums and the features of working with them.

Procedure for provision in Russia

In order to receive an insurance payment, you need to perform a number of simple steps:

Seek medical attention To report the injury
Notify the insurer This must be done within 30 days. The usual form of notification is a statement. It should be sent along with supporting documents to the insurer
Wait for review Usually this procedure takes from 10 to 60 days. If litigation arose during the injury, then the payment is made only after the end of this process

It is worth noting that the heir of the insured or another person specified in the contract may claim to receive payment in the event of the death of the insured.
The amount of the insurance payment can be disputed. This is done by submitting an application to the Central Bank of the Russian Federation.

Drawing up a contract

The only document that regulates the provision of insurance benefits is an insurance contract.
It must be concluded with the insurance company in paper form – only with the help of such a document can you protect your rights in court and demand a change in the amount of compensation in case of disagreement.
The insurance company draws up the contract document on its own. Since in most cases a standard form is used.
Only numbers can change in it – depending on the amount of deductions that will be made.
The contract is made in duplicate – so that one can be received by the insured, and the other is given to the insured.
In the event of an accident, this document is provided to receive payment. When concluding a transaction, you should familiarize yourself with all the clauses of this document and read it carefully in order to understand all the features of the agreement.
Since not all insured events can be taken into account in this document.
Main types
There are several types of insurance that an employee can take out in an accident plan. Thus, the legislation provides for mandatory, social and voluntary registration of insurance.
All these types are distinguished only by the fact that voluntary insurance is the type of insurance that an employee receives at his own request and in any insurance agency.
Plus, you need to understand that insurance may not cover all the costs of treatment and rehabilitation.
Therefore, you need to prepare to protect your rights in any case. This is the only way you can expect to receive the greatest compensation.

Mandatory

Compulsory social insurance is the type of payment provided by the Social Insurance Fund.
It is through this organization, at the expense of the employer’s deductions, that the state pays funds for insurance.
Payments can be made both in the form of a one-time compensation and monthly insurance payments. In some cases, you can expect to receive payments for additional expenses.
Insurance of this type includes not only payment in the course of temporary inability to work, but is also provided for a complete loss of ability to work.
Even in the event of the death of the insured, his relatives can count on receiving compensation under the insurance.
It should be taken into account that all payments will be made in accordance with the indicators for the amounts that are set on the day when the payment is calculated.
Compulsory insurance must be issued to military personnel, police and judicial officials, the Ministry of Emergency Situations and several other categories of citizens. They are the most likely to be at risk of injury at work.

Social

Social insurance is the same compulsory insurance. There are no differences between them and they are one and the same insurance option. Therefore, all functions and features are the same for them.
And in the case of registration of compulsory social insurance, the insured person receives a policy, based on which he can apply for compensation and insurance payments.

Voluntary

In the situation with voluntary insurance, the whole situation is much simpler. A person has the opportunity to independently choose an insurer company, depending on their needs and preferences.
In addition, it should be understood that this type of insurance may not be issued. This is an additional guarantee of receiving a payment. And it can concern not only an accident.
The peculiarity of this insurance is that the opening of an insurance account occurs in accordance with the application submitted by an individual or a legal entity – if it is corporate insurance.
Another aspect is the fact that the individual will pay insurance premiums on his own, and not the company will automatically collect fees from him.

Contributions for insurance against industrial accidents and occupational diseases

Industrial accident insurance rates 2019 are based on the indicator of which occupational risk class the position of the insured person belongs to.
It is in accordance with them that the amount of payment is formed, which the employer must transfer to the FSS.
There are 32 classes in total – the amounts increase by 0.1 percentage point in each class step. So, at the beginning – at the first stage, the tariff rate will be equal to 0.2%.
The increase of 0.1% will last until grade 14 and amount to 1.5%. Then the increase from 15th to 19th grade will be 0.2% each, from 20th to 23rd – 0.3%.
And further in this algorithm:

Class Tariff, %
24 4.1
25 4.5
26 5
27 5.5
28 6.1
29 6.7
30 7.4
31 8.1

But the last class – the 32nd will be 8.5%.

How the fund is formed

The Social Insurance Fund of the Russian Federation is formed at the expense of several income items:
1. Mandatory contributions from those who are insured – deductions from wages.
2. Fines and penalties resulting from late filing of fees or payment of fees.
3. Capitalization of liquidated policyholders.
This is the main block, but in some cases, the FSS may receive funds from other legal sources.
Insurance in Russia is well developed, so each employee can be protected from an accident at the place of work or a disease associated with the profession.
Therefore, the state provides compulsory insurance for all employees.

National insurance – איתן זבולון ושות’

Indeed, the National Insurance Institute is responsible for the provision of services and social assistance to citizens, but the bureaucratic labyrinths and confusion that a citizen has to face require skills, knowledge and extensive experience in this area, especially when the relevant laws and issued on their basis The regulations are numerous and very cumbersome and are updated every year. There are many cases where people do not get all they are entitled to and in full, if at all, from the National Insurance Institute, and the main reason for this is that people go to this huge and bureaucratic institution alone, without any – any experience and without a lawyer who specializes in this area, which leads to the rejection of his claims by the institution or does not achieve a fair and appropriate result in the circumstances of the case.

The law states that in order to receive a benefit or payment for the rights listed in the law, it is necessary to apply in advance to the National Insurance Institute. Some of the procedures are simple and can be done by filling out a special form such as an application for unemployment benefits and a lump sum for the birth of a child, and some are complex and require prior knowledge and understanding of what is being done from both a legal and practical point of view. .

Special services allowance – paid to an insured person aged 18 to retirement age who is heavily dependent on the help of others in daily household chores (eating, personal hygiene, moving around the house, bathing and dressing ), or the insured person needs supervision in order to prevent danger to himself or others. The benefit is also paid to patients undergoing chemotherapy, dialysis, ventilators and transplant patients.

It is important to note that the term “medical disability” refers only to the degree of medical disability to be determined by the results of examinations and tests, as defined in the National Insurance Regulations (Determination of the degree of disability in victims of industrial accidents) of 1956 ., and only after determining the degree of disability in %, if the degree of medical disability entitling to the allowance is established, the doctor of the Commission of the Office determines the degree of disability. The amount of the monthly allowance is calculated based on the percentage of disability, but if the insured person is able to return to full or part-time employment, according to the opinion of the commission doctor, the insured person will be invited to a meeting with a rehabilitation specialist so that he can give his opinion on this issue.

Insurance from accidents accidents at production – designed to compensate for loss of income to the insured to a person injured in an accident at work and to provide assistance for recovery and return to work . The purpose of the law is to provide lifelong free medical care and treatment in everything related to an accident at work, as well as vocational rehabilitation, financial compensation for loss of income, which is determined based on the income of the insured person at the time of the accident. If the victim becomes disabled as a result of an accident, a lump-sum payment or a lifetime allowance is paid. In the event of the death of the victim, the heirs are entitled to a lifetime benefit.

Accident at work/workplace – This definition refers to a wide variety of incidents and cases in which a person is suddenly and unexpectedly injured, and the injury occurs during (during work, at the place of work and in the process of work) of his work and as a consequence (because of the risks of the work, as a result of the performance of work) of his work for or on behalf of his employer. In fact, the law states that work-related activities such as: eating at work, taking breaks, using devices and amenities that the employer has provided to the employee, an accident on the way to and from work, corporate days, training days, at courses and parties will be considered an accident at work, for which you can file a claim for compensation with the National Insurance Institute.

Important! On a health condition violation in connection with work (accident at work or occupational disease), as a result of which a person died, or his condition requires medical assistance, or he lost his ability to work for at least 3 days, the insured person or his heirs must notify the National Insurance Institute as soon as possible. In addition, the information provided by the injured person in the emergency department is critical to the continuation of the process with the National Insurance Institute.

The National Insurance Institute Medical Board consists of a medical specialist and a secretary of the board meeting, whose responsibility is to keep records and ensure that rules and procedures are followed. The Medical Commission is relevant for any insured person who wants to fully exercise their rights in the National Insurance Institute. A medical examination by a doctor of the medical commission is carried out in order to study the complaints of the insured person and to establish defects, injuries and restrictions from which the insured person suffers.

Second stage — In the second stage, the commission doctor will conduct an examination of the health status of the insured person. The examination is intended to determine the degree of disability of the insured person in percentage terms. At this stage, the commission doctor must be presented with additional documents that were not presented in the case, if any, and the insured person, before the examination, must describe in detail to the commission doctor the diseases and / or disorders that he suffers from and how they affect his life expectancy and normal daily activities.

As part of your case with the National Insurance Institute, our office prepares the client for the medical examination, clearly and clearly explaining the violations, defects and limitations that the commission doctor will check, and the examination procedure. Our work does not end there, unlike various firms that send their clients alone to the medical commission, our bureau and lawyers specializing in this field accompany the client to the commission for as long as necessary in connection with the case.