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

What is National Accident Insurance. How does it provide financial support for unexpected injuries. Why is accident insurance important in addition to medical insurance. How can individuals and families benefit from this coverage.

Table of Contents

Understanding National Accident Insurance: An Overview

National Accident Insurance is a specialized form of 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. The primary goal is to alleviate the financial burden that often accompanies accidents and injuries, allowing individuals and families to focus on recovery rather than worrying about mounting bills.

Is accident insurance necessary if you already have medical coverage? While medical insurance is crucial, accident insurance serves as a valuable complement. It can help cover out-of-pocket expenses such as deductibles, copayments, and non-covered services that may arise from accident-related treatments. Moreover, the lump sum payment can be used flexibly to address various needs, including transportation costs, childcare expenses, or even everyday bills that might be difficult to manage during recovery.

Key Features and Benefits of National Accident Insurance

National Accident Insurance offers several distinctive features that make it an attractive option for individuals seeking additional financial protection:

Direct payment to the policyholder
Coverage regardless of other insurance plans
No medical exam required for enrollment
Portable coverage that can be maintained even with employment changes
Flexible use of benefit payments

How does the payment process work? Unlike medical insurance, where payments are often made directly to healthcare providers, accident insurance benefits are paid straight to the policyholder. This direct payment system allows for greater flexibility in how the funds are used, empowering individuals to address their most pressing financial needs following an accident.

Coverage Scenarios: When Does Accident Insurance Come into Play?

Accident insurance can provide coverage for a wide range of scenarios, including:

Sports injuries
Auto accidents
Bicycle accidents
Broken bones
Knee injuries
Falls

To illustrate the practical application of accident insurance, consider the following scenario: A child sustains injuries during a soccer game, requiring emergency room treatment, medical testing, and follow-up care. In this case, accident insurance could provide benefits for various aspects of the treatment, including ambulance transportation, emergency care, diagnostic tests, and even dental work if needed.

Sample Benefit Breakdown

Ambulance (ground): $300
Emergency Care: $100
Medical Testing: $200
Concussion: $400
Physician Follow-Up: $150
Broken Tooth (repaired by crown): $200

In this example, the total benefit payout could amount to $1,350, providing significant financial relief to the family.

Enrollment Process and Eligibility for National Accident Insurance

How can one enroll in National Accident Insurance? The enrollment process is typically straightforward and accessible. Individuals can often enroll themselves and eligible family members during designated enrollment periods. The key requirement is that the primary insured must be actively at work at the time of enrollment.

A notable aspect of accident insurance is the absence of medical underwriting. This means that coverage is guaranteed regardless of the applicant’s health status. There are no medical exams to undergo or health questionnaires to complete, making the enrollment process simple and inclusive.

The Cost-Benefit Analysis of Accident Insurance

When considering the value of accident insurance, it’s important to weigh the costs against potential benefits. Many providers offer group rates through employers, making coverage more affordable. In some cases, the cost of accident insurance can be less than the price of a daily medium cup of coffee.

How does this translate to real-world value? While the hope is always to avoid accidents, the reality is that they can happen unexpectedly. The financial impact of even a minor accident can be significant when factoring in medical costs, lost wages, and incidental expenses. Accident insurance provides a financial safety net that can help mitigate these impacts, offering peace of mind and practical support when it’s needed most.

Portability and Flexibility: Adapting Coverage to Life Changes

One of the key advantages of many accident insurance policies is their portability. What does this mean for policyholders? Essentially, if an individual’s employment status changes, they can often take their coverage with them. This feature ensures continuous protection regardless of job transitions, providing a stable financial safeguard against accidents.

How long can the coverage be maintained? Typically, the policy remains in effect as long as premiums are paid, or until the employer offers similar coverage through a different insurance carrier. This flexibility allows individuals to maintain their accident insurance even as their life circumstances evolve.

Comparing Accident Insurance to Other Financial Protection Strategies

How does accident insurance stack up against other forms of financial protection? While accident insurance serves a specific purpose, it’s important to consider it within the broader context of financial planning and risk management. Here’s a comparison with some related financial tools:

Health Insurance: Covers medical expenses but may leave gaps in coverage for accident-related costs.
Disability Insurance: Provides income replacement if unable to work but doesn’t cover immediate medical expenses.
Life Insurance: Offers financial protection for beneficiaries in case of death but doesn’t address living expenses after an accident.
Emergency Savings: Provides flexibility but may be quickly depleted by significant medical expenses.

Accident insurance complements these other financial strategies by providing targeted support for accident-related expenses. It can help bridge gaps in coverage and provide an additional layer of financial security.

Recent Developments in Accident Insurance Products

The accident insurance market continues to evolve, with providers introducing new products and features to meet changing consumer needs. For instance, Washington National Insurance Company recently announced a new Accident Insurance product designed for both individual and worksite sales.

What makes this new offering unique? The product includes four levels of coverage and six optional riders, allowing for customization based on individual needs and preferences. This flexibility enables policyholders to tailor their coverage to their specific circumstances and risk profiles.

Emerging Trends in Accident Insurance

Several trends are shaping the future of accident insurance:

Increased customization options
Integration with digital health platforms
Enhanced coverage for specific types of accidents (e.g., sports-related injuries)
Simplified claims processes leveraging technology

These developments aim to make accident insurance more accessible, relevant, and user-friendly for a broader range of consumers.

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

Determining whether accident insurance is a good fit for your financial protection strategy requires careful consideration of your individual circumstances. Here are some factors to consider:

Your current health insurance coverage and potential out-of-pocket expenses
Your lifestyle and risk of accidents (e.g., participation in sports or high-risk activities)
Your financial situation and ability to handle unexpected medical expenses
Your family situation and potential need for additional support in case of an accident

How can you evaluate your need for accident insurance? Start by reviewing your existing insurance coverage and identifying potential gaps. Consider your budget and how an unexpected accident could impact your finances. Consult with a financial advisor or insurance professional to get personalized advice based on your specific situation.

Questions to Ask When Considering Accident Insurance

What types of accidents and injuries are covered under the policy?
How do the benefit amounts compare to potential out-of-pocket costs for medical treatment?
Are there any exclusions or limitations that could affect your coverage?
How does the claims process work, and what documentation is required?
Can the policy be customized with additional riders or coverage options?

By thoroughly researching and asking these questions, you can make an informed decision about whether accident insurance is a valuable addition to your financial protection strategy.

Maximizing the Value of Your Accident Insurance Policy

Once you’ve decided to invest in accident insurance, it’s important to understand how to maximize its value. Here are some strategies to ensure you’re getting the most out of your coverage:

Familiarize yourself with the policy details and covered events
Keep your policy information easily accessible in case of an accident
Maintain accurate records of any accidents or injuries
Submit claims promptly and provide all required documentation
Consider combining accident insurance with other supplemental policies for comprehensive coverage

How can you stay informed about your coverage? Regularly review your policy documents and stay in touch with your insurance provider regarding any updates or changes to your coverage. Many insurers now offer online portals or mobile apps that allow you to easily access your policy information and submit claims.

Leveraging Technology for Better Accident Insurance Management

Advancements in technology are making it easier for policyholders to manage their accident insurance:

Mobile apps for quick claim submissions
Online portals for policy management and benefit tracking
Integration with wearable devices for accident prevention and health monitoring
AI-powered chatbots for instant customer support and policy inquiries

By taking advantage of these technological tools, you can streamline your interaction with your insurance provider and ensure you’re making the most of your accident insurance coverage.

The Future of Accident Insurance: Trends and Predictions

As the insurance industry continues to evolve, accident insurance is likely to see significant changes in the coming years. What can we expect from future accident insurance products? Here are some potential trends:

Increased personalization based on individual risk profiles
Integration with broader health and wellness programs
Expansion of covered events to include emerging risks
Enhanced use of data analytics for more accurate pricing and risk assessment
Greater emphasis on preventive measures and accident avoidance

How might these trends impact consumers? As accident insurance becomes more sophisticated and tailored to individual needs, policyholders may benefit from more comprehensive coverage and potentially lower premiums for those who maintain healthy lifestyles and take steps to reduce their risk of accidents.

The Role of Accident Insurance in a Changing Healthcare Landscape

As healthcare costs continue to rise and the insurance landscape evolves, accident insurance is likely to play an increasingly important role in comprehensive financial protection strategies. It may become a more integral part of employee benefits packages and individual financial planning.

Will accident insurance become more mainstream? As awareness of the potential financial impacts of accidents grows, and as insurance products become more flexible and accessible, it’s possible that accident insurance will become a more common component of personal financial protection plans.

Case Studies: Real-World Applications of Accident Insurance

To further illustrate the practical value of accident insurance, let’s examine a few hypothetical case studies:

Case Study 1: The Amateur Athlete

John, a 35-year-old amateur soccer player, suffers a severe knee injury during a weekend game. His accident insurance policy provides benefits for emergency room treatment, diagnostic tests, surgery, and physical therapy. The lump sum payment helps cover his health insurance deductible and copayments, as well as lost wages during his recovery period.

Case Study 2: The Busy Parent

Sarah, a mother of two young children, slips on ice outside her home and breaks her arm. Her accident insurance policy provides benefits for emergency treatment, X-rays, casting, and follow-up care. The payment also helps cover childcare expenses while she’s unable to care for her children independently during her recovery.

Case Study 3: The Adventure Enthusiast

Mike, an avid mountain biker, sustains multiple injuries in a biking accident. His accident insurance policy provides benefits for ambulance transportation, emergency room treatment, surgery, and an extended hospital stay. The lump sum payment helps offset the significant out-of-pocket costs not covered by his high-deductible health plan.

These case studies demonstrate how accident insurance can provide valuable financial support in a variety of real-world scenarios, helping individuals and families navigate the financial challenges that often accompany unexpected injuries.

Navigating the Claims Process: Tips for a Smooth Experience

Understanding how to navigate the claims process is crucial for maximizing the benefits of your accident insurance policy. Here are some tips to ensure a smooth claims experience:

Report the accident promptly: Notify your insurance provider as soon as possible after the accident occurs.
Gather necessary documentation: Collect all relevant medical records, bills, and incident reports.
Follow the claims procedure carefully: Adhere to your insurer’s specific guidelines for submitting claims.
Provide detailed information: Be thorough and accurate in describing the accident and resulting injuries.
Keep copies of all submitted documents: Maintain a personal record of all communications and paperwork related to your claim.
Follow up regularly: Stay in touch with your insurance provider to track the progress of your claim.

What can you do if your claim is denied? If your claim is initially denied, don’t lose hope. Review the reason for denial carefully and consider the following steps:

Request a detailed explanation of the denial
Review your policy to ensure the claim should be covered
Provide any additional information or documentation that might support your claim
Consider appealing the decision if you believe it was made in error

By being proactive and thorough in the claims process, you can increase the likelihood of a successful outcome and ensure you receive the full benefits to which you’re entitled under your accident insurance policy.

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.