Injury Allowance from Bituach Leumi: What a Work Injury Victim Is Entitled to in the First Period

A person injured at work faces two difficulties at once: the pain and the treatments on the one hand, and the loss of income on the other. The injury allowance from Bituach Leumi (the National Insurance Institute) is intended precisely for this period, between the day of the injury and the return to work. It is a benefit that replaces part of the wages for a limited period, and it is also the gateway to everything that follows in the case: without recognition of the injury as a work injury and without a documented period of incapacity, it is much harder to move forward to a work disability claim and to the long-term rights. In this article we explain what the injury allowance is, how the payment is calculated, what the difference is between an employee and a self-employed person, which documents are required, what the deadlines are, and what to do when the injury allowance period ends and the injury still limits you.

What the injury allowance is and to whom it is paid

The injury allowance is a benefit under the National Insurance Law (Consolidated Version), 1995, paid to an insured person who suffered a work injury and is unable to work, either in his regular work or in other suitable work. A work injury for this purpose is a work accident, an occupational disease, or an injury recognized under the microtrauma track. Eligibility is subject to two cumulative conditions: recognition by the claims officer that the injury is a work injury, and a medical certificate establishing a period of incapacity.

A point worth knowing in advance: the injury allowance is paid for days on which the injured person did not work because of the injury. However, part-time work does not necessarily rule out eligibility: a person who was found partially incapacitated and returned to work for reduced hours may receive a reduced injury allowance as a supplement, in accordance with the medical certificate on the extent of the incapacity, and no more than a supplement up to 8 working hours a day. On the other hand, a person who returned to full work on those same days is, as a rule, not entitled to an injury allowance for them.

The rate of payment: 75% of wages up to a ceiling

The daily injury allowance is calculated as 75% of the insured person's income subject to insurance contributions in the 3 months preceding the 1st of the month in which work stopped because of the injury, with the amount divided by 90. The result is a daily payment reflecting approximately three quarters of the regular wages, up to a daily ceiling set by law and updated from time to time. Income tax, national insurance contributions and health insurance contributions are deducted from the payment, so the actual amount is lower than the gross calculation.

For a self-employed person, the calculation is based on the income according to which the advance payments he paid to Bituach Leumi were calculated. This is one of the reasons it is important for the self-employed to make sure the advance payments reflect their real income: a declaration that is too low will translate directly into a low benefit.

The eligibility period: up to 91 days

The injury allowance is paid for a maximum of 13 weeks, that is, up to 91 days, counted from the day after the day of the injury. This is a ceiling on eligibility and not a guarantee: payment is made only for the days covered by a valid medical certificate of incapacity. A person whose first certificate is short must continue to submit follow-up certificates, otherwise the payment will stop even if in practice he has not returned to work.

It is important to understand what the ceiling means: even if recovery continues for many months, the injury allowance ends after 91 days at most. Beyond that point, the relevant track is a claim for the determination of a work disability, which is discussed below.

Who pays for the first days: the difference between an employee and a self-employed person

This is where most of the misunderstandings lie, so we will go into detail.

• The day of the injury itself: for an employee, the employer pays the wages for that day. It is not counted among the injury allowance days.

• An employee absent for fewer than 12 days: the injury allowance is paid only from the 3rd day after the day of the injury. There is no payment from Bituach Leumi for the first 2 days, and as a rule sick days with the employer can be used for them.

• An employee absent for 12 days or more: the injury allowance is paid from the day after the day of the injury, without losing the first 2 days.

• Who ultimately bears the cost: Bituach Leumi collects the payment for the first 12 days back from the employer. The employer may not pass the cost on to the employee, either by deducting it from his wages or by charging sick days for that period.

• A self-employed person: is not entitled to an injury allowance for the first 12 days after the day of the injury, and no one makes up for them. In practice, payment begins on the 13th day, which differs substantially from the position of an employee.

It is also worth knowing that there is an arrangement for authorized employers: employers that have received approval from Bituach Leumi pay the injury allowance to their employees directly, on behalf of the Institute, and the employee receives the payment through the pay slip. In such a case as well, a claim must be filed and the injury must be recognized; the only difference is the payment channel.

The distinction between an employee and a self-employed person also matters at the recognition stage: the presumption that an accident which occurred in the course of work also occurred as a result of work applies only to an employee, and a self-employed person is required to prove the connection to his work in full. The self-employed have another weak point: a person who is not registered as self-employed with Bituach Leumi on the date of the injury may find himself with no coverage at all, so arranging the registration and paying the advance payments are a precondition for any right.

The first medical certificate for a work injury victim

The first medical certificate for a work injury victim is the core document of the claim. It is issued by a physician, as a rule at the health fund or in the emergency room, and it includes the diagnosis and the period of incapacity that was determined. A few practical working rules:

• Seek medical treatment as close as possible to the injury, and tell the doctor precisely how it occurred during work. The first medical record is key evidence, and contradictions between it and a later version make recognition harder.

• Make sure the document you received is a first medical certificate for a work injury victim, and not an ordinary sick note. A sick note does not entitle you to an injury allowance.

• If the incapacity continues beyond the period determined, you must obtain an additional medical certificate for a work injury victim for the continuation.

To receive medical treatment, an employee receives Form BL/250 from the employer, which serves as a referral for medical treatment for a work injury victim, and a self-employed person uses Form BL/283. Medical treatment for a recognized work injury is provided free of charge.

Notifying the employer and filing the claim

An employee should notify the employer of the injury as soon as possible, preferably on the same day and in writing, and make sure the event is recorded by the employer. Immediate notice helps later on, since a first report close to the event strengthens the injured person's version.

The claim for an injury allowance is filed with Bituach Leumi on Form BL/211, together with the first medical certificate and the follow-up certificates. The form requires a description of the circumstances of the injury, and you should make sure it is accurate and consistent with the medical record. An employee's claim also requires the employer's confirmation of the wage details and of the employee's absence.

The deadline for filing the claim is 12 months from the day of the injury. Late filing may harm eligibility, in whole or in part, so there is no reason to wait: the claim can be filed even while medical treatment is still ongoing.

An illustrative scenario

A salaried warehouse worker slips off a ladder and injures his ankle. The employer pays the wages for the day of the injury and gives him Form BL/250. In the emergency room a period of incapacity of 21 days is determined, extended by follow-up certificates to 60 days. The worker files Form BL/211 within a few weeks, the claims officer recognizes the accident, and the injury allowance is paid from the day after the injury, since the absence exceeded 12 days. As a limitation in the ankle remains even after the return to work, he proceeds to a work disability claim. Had he been self-employed in the same circumstances, the first 12 days would have been deducted from the payment, and the calculation would have been based on the income according to which the advance payments he paid were calculated.

And after the injury allowance: a work disability claim

The injury allowance covers 91 days at most, but many injuries leave a limitation even after that. In such a situation a claim is filed for the determination of a work disability degree, and the injured person is summoned to a medical committee that determines whether a disability remains, temporary or permanent, and at what rate. The principles of the outcome, in brief: a permanent disability of 9% to less than 20% entitles you to a one-time grant, a disability of 20% or more entitles you to a monthly pension, and a permanent disability of less than 9% does not entitle you to a work disability benefit. The injury allowance in the first period does not depend on the disability rate. In appropriate cases you can also request the application of Regulation 15, which allows the disability degree that was determined to be increased by up to one half of it, taking into account the occupation, the age and the loss of income.

Preparing for the medical committee is a stage that justifies professional support: the committee relies on the medical documentation accumulated since the injury, so continuous follow-up and treatment throughout the injury allowance period also serve the injured person at this stage.

Summary

The injury allowance is the immediate safety net of a work injury victim: 75% of wages up to a ceiling, for a period of up to 91 days, subject to recognition of the injury and documentation of the incapacity. Eligibility depends on small details: the correct medical certificate, the appropriate form, a consistent description of the circumstances and meeting the 12-month deadline. No less important, this is the stage that lays the groundwork for the disability claim that follows. Yaniv Gavish Law Office represents work injury victims before the National Insurance Institute, from the filing of the claim through the medical committees and the courts. You can contact us at 4 Berkowitz Street, Tel Aviv, telephone 076-5385862.