Injury compensation is a payment that the national insurance pays to the insured who is injured at work as compensation for loss of wages or income (from a work accident or occupational disease), and on the condition that he is unable to work either at his job or at another suitable job as a result of the injury (all according to a medical certificate).
First step - the claims clerk at the branch checks the claim
The clerk checks the following:
If you have filled out the claim form with all the details
If you have attached all the required documents
If you answer Eligibility conditions for allowance
It is important for you to know, attaching all the required documents at the time of filing the claim shortens the time for processing the claim.
Second step - the National Insurance doctor examines the claim
The doctor checks these things:
Your statement about your medical condition
The medical documents attached to the claim. If necessary, you will be asked to submit additional documents
In the case of a mental disability - we turn to the authorities who treat you to receive medical material
If you need to be summoned to a medical committee, and if so, to which qualified doctor and medical advisors on the committee will you be summoned.
If you depend on the help of others to carry out daily activities, and if so you will be summoned to a medical committee that will check your eligibility for special services allowance.
Third step - examination by the medical committee
The doctor in the medical committee:
Look through the medical documents in your file, before entering the committee.
Hears from you about the diseases you suffer from, and performs a physical examination, as needed.
Determines your medical disability percentages.
Checks to what extent your medical deficiencies affect your ability to work and get drunk (for a housewife - on her ability to work in her household).
For your attention, the members of the medical committee may stop the discussion of your claim, and request medical tests or additional medical documents as necessary. The doctor on the committee does not have the authority to discuss the medical treatment you need, but only to determine your disability percentages.
Fourth step - making a decision on the claim
The claim returns to the claims clerk in the disability department, who performs the following actions:
Rechecks your income, according to the percentages of medical disability determined for you.
Determines to what extent your medical disability affects your ability to work and get drunk (for a housewife - her ability to function in her household), relying on the recommendation of the doctor and the rehabilitation official. In cases where a recommendation from a rehabilitation official is required, you will be invited to an interview with him.
At the end of all the tests, we will mail you a notification of the decision on your claim, together with the report of the medical committee
After the decision has been made in your claim, if you have a reservation regarding the decision made, you can appeal to her.
An injury at work, which qualifies for occupational injury pensions, is an occupational accident or occupational disease, as defined in the National Insurance Law.
An accident that happened to the insured under the following circumstances will also be considered a work accident:
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On his way from his residence (or from the place where he stayed) to work, or from work to his residence, or from one workplace to another workplace.
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During his work at the workplace (or in his closest surroundings) while he was acting to save a body or property, or to prevent damage to a body or property.
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During his work, from an injury (not due to work) caused by another person with an object located at the workplace (or in his immediate surroundings), provided that the victim had no part in causing the injury.
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For the insured employee - at the place where he or his co-workers dine during the break, which is set at the discretion of the employer and does not exceed 3 hours, as well as on his way from work, to that place, or back from that place to work.
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To the employee insured, a member of the workers' committee of his place of work, as well as to the insured, a member of the workers' committee - during the performance of this position and following the performance of the position, as well as on their way to perform the position and on their way back.
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For the salaried insured - on his way from work or residence to an examination place where he is examined according to the Apprenticeship Law or according to the Employment Service Law, or on his way back from the examination place to work or to his residence.
Assault, during and as a result of work, including sexual assault, will also be considered injury at work, if it causes physical or mental harm and requires medical treatment.
An accident that happened to the insured on his way will not be considered a work accident, if the insured interrupted his usual path with a real break or deviated from it, not for the purpose of fulfilling his obligations to his employer, and the independent insured - not for the purpose of engaging in his business. But an accident that happened to the insured on his way as stated in section 1 above will be considered a work accident, if the insured stopped his way or deviated from it to do one of the following:
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To pray morning prayer in public at the prayer house where he prays.
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To accompany his child to the gardener, to the kindergarten, to the daycare center, and also to return him from there. "Child" is a child up to the age of 10 or who, due to a mental or physical disability, requires accompaniment.
An accident that happened to the insured while he was driving negligently and did not follow a legal instruction or an instruction of his employer regarding his work will not be considered a work accident, unless as a result of that accident the insured died, or became disabled or unable to work for at least 10 days, and if he had not driven negligently, the accident would have been considered a work accident .