How to Prepare for the Bituach Leumi Medical Committee: A Practical Preparation Guide

The medical committee of Bituach Leumi (the National Insurance Institute) determines your degree of disability, and its decision has a direct effect on the rights and benefits you will receive. This guide explains how to prepare for the committee thoroughly, which documents to bring, what the right of appeal is, and how professional support can help you exercise your rights in full.

Introduction: why preparing for the committee is so important

For a person injured in a work accident or suffering from a medical limitation, the medical committee of the National Insurance Institute is a key juncture. It is the opportunity to present the full medical and functional picture to a professional body, and it is the committee's decision that determines the degree of disability and the scope of the rights derived from it.

Many people come to the committee insufficiently prepared. They assume that the medical documents “speak for themselves”, or that the doctors on the committee already know everything. In practice, the committee forms its impression from what is placed before it and from the way the injured person presents his condition in a relatively short session. Orderly preparation allows you to arrive with all the relevant documentation gathered, up to date and organized, and knowing what is important to emphasize.

This guide is intended to give you practical tools to prepare for the committee with confidence, with an understanding of how the process works and of the rights available to you.

What the medical committee is and what its role is

The medical committee of the National Insurance Institute is the body that examines and determines the applicant's degree of disability. It operates both in the work injury branch, where the injury has been recognized as a work accident or an occupational disease, and in the framework of general disability, where the medical impairment is not necessarily related to work.

It is important to understand the distinction between the two tracks, because they are conducted according to different rules and examine different aspects. In the work injury branch the committee examines the disability caused by the recognized injury, whereas in general disability the overall effect of the impairments on earning capacity and on functioning is examined.

In both tracks the committee is composed of doctors, and sometimes of specialists in fields relevant to the injury in question. The injured person is invited to appear before the committee, is examined as needed, and is asked to describe his complaints and the effect of the injury on his life.

Temporary disability and permanent disability: a difference worth knowing

In the work injury branch there is an important distinction between temporary disability and permanent disability. Temporary disability is determined for a defined period, when the injured person's condition is not yet stable and is expected to change with continued treatment and recovery. During this period the injured person may be entitled to payments according to the temporary disability degree that was determined.

Permanent disability is determined when the injured person's medical condition has stabilized and no substantial change is expected in it. This is the determination that sets the degree of disability for the long term, and on its basis eligibility for a pension or a grant is examined.

Understanding the stage you are at is important for your preparation. If the committee convenes to examine temporary disability, there may be further committees later on. If it is examining permanent disability, this is a decisive stage at which it is especially important to arrive prepared and with complete, up-to-date documentation.

How the degree of disability is determined in the work injury branch

In the work injury branch, the degree of disability is determined according to the list of impairments in the National Insurance Regulations (Determination of the Degree of Disability for Work Injury Victims), 1956. This is a detailed list that assigns disability percentages to each type of impairment, according to its severity and characteristics.

The committee examines the injured person's condition and matches it to the appropriate impairment items on the list. Sometimes a particular impairment corresponds exactly to an item in the regulations, and sometimes it must be matched according to the item closest to it in substance. For this reason, an accurate and complete presentation of the injury and of its functional consequences is of great importance.

The more clearly your medical documentation reflects the extent of the injury and the relevant findings, the easier it is for the committee to match your condition to the impairment items in a way that reflects reality.

Regulation 15: the possibility of increasing the degree of disability

After a permanent disability has been determined in the work injury branch, it is possible to request an increase of the degree of disability under Regulation 15. This regulation allows, when certain conditions are met, the degree of disability to be increased by up to one half of the degree that was determined.

The increase is intended for situations in which the medical disability does not reflect the full impairment of earning capacity. In principle, the increase is considered when the injured person cannot return to his previous work, and when there has been a decrease of more than twenty percent in his income as a result of the injury.

This is an important aspect that many people are not aware of. If the injury has substantially changed your ability to work in your occupation and has harmed your income, it is worth examining whether your circumstances are relevant to Regulation 15. Presenting the occupational and financial picture to the committee, alongside the medical picture, can be significant in this context.

Medical documentation: the basis for successful preparation

One of the most important principles in preparing for the committee is to arrive with orderly and up-to-date medical documentation. The committee forms its impression from the documents placed before it, so assembling the medical material properly is an essential foundation.

It is advisable to gather the following documents, insofar as they are relevant to your condition:

Hospitalization summaries and emergency room documents related to the injury. Discharge letters and documentation of treatments you have received. Results of imaging tests, such as X-rays, ultrasound, CT or MRI, together with their reports. Documents from specialist doctors who examined and treated you. Documentation of complementary treatments, such as physiotherapy or occupational therapy. Prescriptions attesting to ongoing drug treatment.

It is important that the documents be up to date and reflect your current condition. Old documentation alone may fail to reflect a deterioration or change that has occurred in your condition. If you recently had a relevant test or visit, make sure you have the documentation and that it is gathered together with the rest of the material.

It is advisable to arrange the documents chronologically or by subject, so that they are easy to present and to refer to. An orderly file conveys seriousness and makes it easier for the committee to find its way through the material.

Appearing before the committee: what you should know

Beyond the documentation, the way you present your condition at the committee session is also important. Here are some guiding principles:

Describe your condition honestly and accurately. Present your complaints, pains and limitations as they manifest in daily life. Avoid exaggeration, but also do not play down your difficulties out of a wish to appear to be “managing”. A balanced and accurate description serves you.

Focus on the functional impact. It is important for the committee to understand how the injury affects your ability to function, to work and to perform daily activities. Explain concretely which activities have become difficult or impossible for you.

Prepare in advance what you want to say. The committee session may be short and stressful. A short list of the main points you want to convey will help you not to forget important details.

Be patient and respectful. Even if you feel the process is unpleasant, keeping a matter-of-fact and respectful tone serves you.

The right to be represented and accompanied

You should know that the injured person may appear accompanied and be represented by a lawyer at the committee. There is no obligation to appear alone. A person coping with a physical injury, and sometimes also with emotional stress, is not always in a state in which it is easy to present his condition in the best way.

Professional support can help in preparing the medical file, in identifying the essential points to emphasize, and in presenting the medical and functional picture in an orderly way. A lawyer specializing in the field knows how the committee operates and the relevant legal principles, and can help you prepare and appear with confidence.

The choice of whether to use professional support is yours, and depends on the complexity of the case and its circumstances. It is important that you know the right exists, and that you do not have to deal with the process on your own.

The right to appeal the committee's decision

Not every decision of the medical committee is final. There is a right of appeal against the medical committee's decision, filed with a medical appeals committee. It is important to know about this right, because it can be exercised only within a fixed period of time.

The practical meaning is that if you have received a decision which in your view does not reflect your condition, you must not delay. The decision should be examined quickly, and filing an appeal within the prescribed deadline should be considered. Missing the deadline may harm the ability to appeal.

The appeals committee examines the matter anew, and is a further opportunity to present the full picture. At this stage too you have the right to be accompanied and represented, and here too orderly preparation of the medical material is important.

Practical examples

First example: a worker who injured his back. A worker in a physical job injured his back in the course of his work, and the injury was recognized as a work accident. At first, a temporary disability was determined for him for the recovery period. As the date of the committee for determining permanent disability approached, he gathered all the medical documentation, including the up-to-date imaging tests and the documentation of the treatments he had undergone. In addition, since he could not return to his physical work and there had been a significant decrease in his income, he also presented the occupational picture to the committee, and examined the relevance of Regulation 15 to his case. The orderly preparation allowed him to present a complete picture, both medical and functional.

Second example: a person who received a decision that does not reflect his condition. A person appeared before the medical committee, but felt in hindsight that he had not managed to present the full difficulties he experiences in daily life, and that some of the up-to-date medical documents had not been in his possession at the committee session. After receiving the decision, he acted quickly, gathered the missing documentation, and examined the possibility of filing an appeal with the medical appeals committee within the fixed period of time. The example illustrates how important it is to come to the committee prepared, and to know about the right to appeal within the deadline.

Summary and next steps

Understanding your rights in this area is the first step toward exercising them properly. Each case is examined according to its circumstances, so it is important to prepare accordingly, keep orderly documentation and act on time.

If you are dealing with an issue in this area, or wish to examine your rights, you are welcome to contact Yaniv Gavish Law Office to review your individual circumstances. The office practices tort law and the exercise of rights before the National Insurance Institute, and represents injured persons in these proceedings.

Yaniv Gavish Law Office, 4 Berkowitz Street, Tel Aviv. Telephone: 076-5385862. Website: gavishlaw.co.il.