Work disability insurance אובדן כושר עבודה

Loss of work ability is a serious problem and usually results in a sudden and drastic loss of income as well. All salaried employees in israel are protected against a loss of work ability situation by The national social security (Bituach Leumi). In order to receive a stipend a form needs to be filled out and submitted. The form needs to include the employee’s salary information and payroll information for the months preceeding the loss of work ability, as well as the employer’s signature confirming the salary information. Employee’s with pension plans, these usually have loss of work ability insurance built in to the policy. This will usually cover 70% of the employee’s gross pay. Bituach Leumi and pension plan for loss of work ability payments offset each other. An employee can purchase additional coverage so that it will not offset at additional cost. Speak to your pension plan company for more details.

The criteria for payment of loss of work ability insurance are the following:
1. 75% or more of loss of work ability. Approved by employment doctor for as long as this condition continues or the policy ends, which ever comes first. There usually is a waiting period when an employee joins a pension plan until they can file. If the loss of work ability occurs before then, the employee will only receive payment after the waiting period is over.
2. Complete coverage in case of acts of terror.
3. During the period of payment for loss of work ability, the employee is exempt from contributions to the pension plan.

Loss of work ability – rights and benefits

An employee who loses his ability to work due to illness or accident may find himself in a situation of loss of income and livlihood. In order to avoid this scenario all residents of Israel are insured against loss of work ability due to illness or accident by Bituach Leumi (Israel’s social security), this via their mandatory monthly contributions via their payslip. These contributions cover many different types of social security: unemployment, old age stipends, child stipends, employer bankrupcy, reserve army duty, maternity leave – just to name some of them).

In addition to Bituach leumi, many employers insure their employees in loss of work ability insurance, although it’s not mandatory. Employees can also purchase loss of work ability insurance privately. All pension plans also include loss of work ability insurance built in to the policy.

It is extremely important that you understand the implications on this subject so that if one finds themselves in this situation they know where to turn and what to do in order to minimize the beaurocracy and ensure they receive what they are eligible for.

    So, what is loss of work ability?

Loss of work ability is when an employee loses their ability to work and earn income due to injury as a result of illness or accident.

Loss of work ability can be temporary (usually up to 3 months – 90 days, after which the employee recovers and returns to work at full capacity) or permanant (non reversable and the employee will not be able to return to prior ability) and may occur in several situations:

1. Complete loss of work ability: the employee is unable to work in any type of work due the injury he/she has incurred.
2. An employee who, due to injury, his/her ability to earn income has declined and his/her pay has reduced considerably.
3. An employee who cannot continue to work in a position that fits his profession or knowledge and education due to injury.

It is important to note that insurance companies include explicit definitions for loss of work ability in the profession of the employee who is insured in the policy.

    Bituach Leumi

The coverage is dealt with by several departments, depending on the type and severity of the injury.
General disability dept

Via a monthly stipend to employees injured due to illness or accident and as a result their income earning ability has been reduced by at least 50%, or by 60% if permanent loss of work ability or 45% if temporary loss of work ability.

    Work related accidents dept

Employees who were injured during the course of work or due to a work related illness (one recognized as a profession causing illness).

    accident dept.

Employees injured in accidents that are not work related (traffic accidents that were not on the way to or from work, household accidents, etc) and as a result are unable to work. This type of injury usually will enable employee to receive monetary compensation for up to 90 days. If the damage is not remedied after 90 days, the employee will need to file for general disability stipend.

Note: The amount of compensation is not based on the employee’s actual income, but rather defined in the Bituach Leumi law and equal for all employees. Someone who had a high income may find he gets less compensation than his/her salary was, sometimes substantially. In addition, Bituach leumi usually pays stipends to those eligible between the 17th and the 20th of the month for the previous month (as opposed to salaries which are paid by the 9th of the month).

    Private insurance policies

Private insurance policies, whether via a collective policy for employees by the employer or via a personal insurance policy the employee took out privately, usually include a waiting period of 3 months prior to eligibilty for compensation. Many policies will include a clause under which the insurance company commits to a retroactive payment for the first three nmonths when the injury is prolonged. There is a provision that excludes monthly contributions in case of a claim on the policy due to loss of work ability. There usually is a separate clause committing to payments according to the policy in addition to Bituach Leumi stipends. The payment from the insurance policy is at least 75% of the average wages in the year previous to the injury (as opposed to Bituach Leumi which is different and much lower).

In short, an employee who has been injured and as a result loses work ability is eligible for money from Bituach Leumi and if insured via a loss of work policy via an insurance company, he would be eligible for money from them as well. If the injured employee is totally dependant on a family member for daily routine (dressing, bathing, eating. etc) the family member may also be entitled from Bituach Leumi and the tax authority. This applies in case of death of the employee as well.

In all cases, it is highly recommended to consult with a certified and professional insurance agent or lawyer who deals with labor laws and loss of work ability. The above advice does not replace the need for such professional advice, is not legal advice and may not be applicable to all cases. It is merely a post with basic knowledge to help employees understand the issue better.