What is national accident insurance. How does it provide financial support for unexpected injuries. Who is eligible for accident insurance coverage. Why might you need accident insurance if you already have medical insurance. How can accident insurance benefits be used.
Understanding National Accident Insurance: An Overview
National accident insurance is a supplemental coverage designed to provide financial support when unexpected injuries occur. This type of insurance offers a lump sum payment to help cover expenses that may not be fully addressed by traditional medical insurance. Let’s delve into the key aspects of accident insurance and how it can benefit policyholders.
Key Features of National Accident Insurance
- Lump sum payment for covered accidents
- Benefits paid directly to the policyholder
- Coverage for various accident-related events
- Affordable group employee rates
- No medical exam required for enrollment
The Scope of Accident Insurance Coverage
Accident insurance provides coverage for a wide range of accident-related events. Do you know what types of incidents are typically covered? Accident insurance may cover:
- Sports injuries
- Auto accidents
- Bicycle accidents
- Broken bones
- Knee injuries
- Falls
This comprehensive coverage ensures that policyholders have financial support for various unexpected situations that can lead to injuries and associated expenses.
How Accident Insurance Works: A Real-Life Example
To better understand the practical application of accident insurance, let’s examine a hypothetical scenario involving Kathy and her daughter Molly.
Molly, a soccer player, collided with an opposing player during a game. She was knocked unconscious and taken to the emergency room by ambulance. The ER doctor diagnosed her with a concussion and a broken tooth, ordering a CT scan for further evaluation. Molly was then released to her primary care physician for follow-up treatment, and her dentist repaired the broken tooth with a crown.
In this scenario, Kathy’s accident insurance coverage would provide the following benefits:
Covered Event | Benefit Amount |
---|---|
Ambulance (ground) | $300 |
Emergency Care | $100 |
Medical Testing | $200 |
Concussion | $400 |
Physician Follow-Up ($75 x 2) | $150 |
Broken Tooth (repaired by crown) | $200 |
With the MetLife Accident Insurance High Plan, Kathy would receive a lump-sum payment totaling $1,350 to help cover these expenses.
The Importance of Accident Insurance in Addition to Medical Coverage
You might wonder why accident insurance is necessary if you already have medical insurance. While medical insurance is essential, it may not cover all expenses related to an accident. Accident insurance provides additional financial support to help with:
- Plan deductibles
- Copays
- Extra costs for out-of-network care
- Non-covered services
This supplemental coverage can offer peace of mind and help alleviate financial stress during challenging times.
Eligibility and Enrollment Process for Accident Insurance
Are you curious about who can enroll in accident insurance? The good news is that eligibility requirements are typically straightforward. Here’s what you need to know:
- You can enroll yourself and eligible family members
- Enrollment is available during your designated enrollment period
- You must be actively at work to be covered
- No medical exam is required
- Coverage is guaranteed, regardless of your health status
The simplicity of the enrollment process makes accident insurance accessible to a wide range of individuals and families.
Flexibility and Portability of Accident Insurance Coverage
One of the significant advantages of accident insurance is its flexibility and portability. Can you take your coverage with you if your employment status changes? The answer is yes. Accident insurance is portable, meaning you can maintain your coverage even if you change jobs or leave your current employer.
Your coverage will only end under two circumstances:
- If you stop paying your premium
- If your employer offers you similar coverage with a different insurance carrier
This portability feature ensures that you can maintain your financial protection regardless of changes in your employment situation.
Utilizing Accident Insurance Benefits: Freedom of Choice
When you receive a benefit payment from your accident insurance policy, you have the freedom to use it as you see fit. Are there restrictions on how you can spend the money? No, there are no limitations. You can use the payment to:
- Cover medical insurance deductibles
- Pay for copays
- Handle household bills
- Address any other financial needs
This flexibility allows you to allocate the funds where they are needed most, providing you with greater financial control during challenging times.
The Direct Payment Advantage
Another benefit of accident insurance is that payments are made directly to you, not to healthcare providers. This direct payment system offers several advantages:
- Simplifies the claims process
- Allows you to manage your expenses more effectively
- Eliminates the need to coordinate with other insurance plans
- Provides quick access to funds when you need them most
Washington National’s New Accident Insurance Product
In June 2023, Washington National Insurance Company announced the launch of its new Accident Insurance product. This offering further expands the options available to consumers seeking comprehensive accident coverage. Key features of Washington National’s product include:
- Available for individual and worksite sales
- Lump-sum cash benefits paid directly to policyholders
- Four levels of coverage
- Six optional riders for customized protection
This new product demonstrates the ongoing evolution and expansion of accident insurance options in the market, providing consumers with more choices to meet their specific needs.
The Growing Importance of Supplemental Insurance
The introduction of new accident insurance products highlights the growing recognition of the importance of supplemental insurance in today’s healthcare landscape. As medical costs continue to rise and traditional health insurance plans may have gaps in coverage, supplemental policies like accident insurance play a crucial role in providing comprehensive financial protection.
Comparing Accident Insurance Plans: Factors to Consider
When evaluating accident insurance plans, it’s essential to consider several factors to ensure you choose the coverage that best meets your needs. What should you look for when comparing plans? Here are some key considerations:
- Coverage limits and benefit amounts
- Types of accidents and injuries covered
- Premium costs and payment options
- Additional riders or optional coverages
- Claims process and payout timeline
- Insurance company’s reputation and financial stability
By carefully assessing these factors, you can make an informed decision and select the accident insurance plan that provides the most appropriate coverage for your situation.
The Role of Optional Riders
Optional riders can enhance your accident insurance coverage by providing additional benefits for specific situations. Common riders may include:
- Hospital confinement benefit
- Accidental death and dismemberment (AD&D) coverage
- Wellness benefit for preventive care
- Spouse or child coverage
- Catastrophic accident benefit
Carefully consider which riders align with your needs and budget to create a comprehensive accident insurance package.
The Future of Accident Insurance: Trends and Innovations
As the insurance industry continues to evolve, accident insurance is likely to see new trends and innovations. What developments can we expect in the coming years? Some potential trends include:
- Integration with digital health platforms and wearable devices
- Customizable policies based on individual risk profiles
- Increased focus on accident prevention and risk mitigation
- Expansion of covered events to include emerging risks
- Enhanced claim processing through artificial intelligence and automation
These innovations may lead to more personalized and efficient accident insurance products, providing policyholders with even greater value and protection.
The Impact of Telemedicine on Accident Insurance
The rise of telemedicine is also likely to influence accident insurance coverage and claims processes. How might telemedicine affect accident insurance? Some potential impacts include:
- Expanded coverage for virtual consultations following accidents
- Faster claim initiation through telemedicine platforms
- Improved access to follow-up care and specialist consultations
- Potential cost savings for both insurers and policyholders
As telemedicine becomes more prevalent, accident insurance policies may evolve to better integrate with these digital healthcare solutions.
Maximizing the Value of Your Accident Insurance Policy
To get the most out of your accident insurance coverage, it’s important to understand how to maximize its value. What steps can you take to ensure you’re making the most of your policy? Consider the following strategies:
- Familiarize yourself with your policy’s coverage details and exclusions
- Keep your policy information easily accessible in case of an accident
- Promptly report accidents and injuries to initiate the claims process
- Maintain accurate records of medical treatments and related expenses
- Regularly review your coverage to ensure it still meets your needs
- Consider combining accident insurance with other supplemental policies for comprehensive protection
By implementing these strategies, you can ensure that your accident insurance provides maximum financial protection when you need it most.
The Importance of Regular Policy Reviews
Life circumstances and insurance needs can change over time. Regular reviews of your accident insurance policy can help ensure that your coverage remains appropriate for your current situation. During these reviews, consider:
- Changes in your family status (marriage, children, etc.)
- New hobbies or activities that may increase your risk of accidents
- Changes in your financial situation or insurance needs
- Updates to your primary health insurance coverage
- New product offerings or policy enhancements from your insurer
By staying proactive and regularly assessing your coverage, you can maintain optimal accident insurance protection tailored to your evolving needs.
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
Expand All
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.
2 Fortune, 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’
Call now for a consultation
Dealing with the National Insurance Institute is not as easy today as it was in the past and requires a deep understanding of the law, experience and knowledge that a bituah leumi lawyer can provide you with. Therefore, seeking legal services from an experienced lawyer in this field is a must for every citizen who wants to succeed in their claim.
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.
Citizens’ rights at the National Insurance Institute under the National Insurance Law [consolidated version] of 1995:
According to the law, various benefits are provided to eligible persons from birth to old age. The most common benefits that people apply for are:
- Old-age and survivor’s pension
- Unemployment benefit
- Pregnancy Support
- Lump sum for the birth of a child
- Work injury allowance
- General disability allowance
- Care allowance
- Special Services Allowance
Call now for a consultation
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. .
In addition, thousands of applications are submitted to the National Insurance Institute each year, which puts a significant strain on the system, so filing an application in the wrong form and/or in the wrong way without proper documentation to support the claim will almost certainly result in the application being rejected.
Therefore, it is recommended that you consult a lawyer specialized in this field in order to avoid unnecessary procedures and rejection of the application by the Office.
Important basic concepts and terms:
- Disability benefit – paid to insured persons who are unable to work due to a physical, mental or mental disease, congenital or due to injury, from the age of 18 until retirement age.
- Housewife Disability Allowance – Allowance is given to insured women whose ability to perform housework is impaired by at least 50% due to health reasons, from the age of 18 until retirement age.
- Benefit for care for child – disabled – paid to a parent who has taken on the difficult responsibility of caring for a child with a medical disability up to the age of 18 .
- Benefit for persons with limited mobility (mobility allowance) retirement age, if the medical commission of the Ministry of Health has established the percentage of mobility restriction due to damage/defect of the lower extremities of the insured person.
Important ! Before applying for a mobility allowance, you must first apply to the Ministry of Health with a request for an examination by a commission of the Ministry of Health.
- 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.
- Vocational rehabilitation rehabilitation is an insured person who, due to a medical disability, cannot return to his/her job or work in another suitable job, and is eligible for vocational rehabilitation according to the parameters.
- Insurance victims accidents accidents – paid to insured persons aged 18 to retirement age who are injured in an accident (not a traffic accident or industrial accident) in Israel or abroad, and as a result lost his ability to work due to an accident. The maximum billing period is 90 days.
Important ! The term “accident” refers to an incident in which the insured person was injured by some external factor and underwent a medical examination within 72 hours after the accident.
The most common benefits:
- General disability allowance – general disability allowance is paid to those who, due to disability, have limited or reduced their ability to work by at least 50%, and they have been diagnosed with a medical disability of at least 60% or at least 40% if one of the defects/violations is 25% of the disability.
The following is the amount of the monthly disability allowance depending on the degree of disability:
- Degree of disability 60% – the amount of the partial benefit is 2135 shekels per month, as of 2022.
- Degree of incapacity for work 65% – the amount of the partial allowance is 2273 NIS per month, as of 2022.
- Disability rate 74% – Partial benefit amount is NIS 2522 per month, as of 2022.
- Disability rate of 75% or more – the maximum benefit amount is NIS 3,700 per month as of 2022.
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.
For detailed information about the rights of insured persons who have suffered an accident at work, go to the category “Work accidents”.
- Occupational disease — a disease that the insured person contracted as a result of his/her work, and this disease appears in the second supplement to the National Insurance Ordinances (Insurance against industrial accident) dated 1954 g. If a certain disease does not appear in the list of diseases in the second appendix, it is not recognized as an occupational disease.
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.
Medical Board:
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.
Procedure for conducting a medical commission:
First stage – before the insured person is invited to the office of the commission meeting, the doctor reviews the documents of the insured person’s case and only after that the insured person is invited to the room and asked to identify himself with an identity card .
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.
Third stage — after the insured person leaves the office, the commission doctor sums up the results of the discussion and determines the degree of disability and disability of the insured person in percentage terms.
Preparation for the National Insurance Institute medical examination:
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.
Do you need a Russian speaking lawyer in Haifa? Civil Lawyer, Bituach Leumi Lawyer? Call now!
Also, our law office can help you get pitzuim in case of an industrial injury – teunat avodah bituach leumi, or if you have a reason for receiving benefits from bituach leumi, or clarify the laws of bituach leumi – contact us!
Why our office?
Our office has extensive and proven experience of more than 10 years in this field. We accompany our clients through the bureaucratic labyrinth of the National Insurance Institute, when filing applications, claims and represent our clients at medical boards and in regional labor courts throughout the country.