Many members of the health insurance fund have the opportunity to receive significant amounts of long-term care insurance Bituah Siudithrough the health insurance fund. But it should be noted that this is not always an easy task, and there are many pitfalls that require a deep understanding of the issue and legal knowledge to overcome.
This is the Bituah Siudi collective long-term care insurance policy, which some members of the health insurance fund do not even know about, because they automatically join it and pay through membership fees to the health insurance funds. And, of course, most insured people are not familiar with the fine print of the policy in question, the full rights that it provides, the rules of insurance supervision and court decisions on this issue, and are also unaware of the changes that have taken place in recent years.
< br /> An insurance policy issued through the Health Insurance Fund provides financial rights in the amount of thousands of shekels per month for 5 years in the event that the insured suffers from illness or poor health, due to which he is effectively limited in performing at least 3 of the 6 daily activities: dressing, bathing, moving, getting out of bed and chair, controlling incontinence, eating and drinking.
Receiving these important funds for sick people depends on filing a correct and accurate legal claim with the insurance company. In this case, the health insurance fund is not involved in the process, but in fact the patient deals directly with the insurance company. It should be noted that mistakes in the process of filing a claim due to a lack of legal literacy and insufficient knowledge of this complex issue can cost the insured dearly.
And the examples below will illustrate our words well:
78-year-old Igor, a member of the Maccabi Health Insurance Fund, suffers from Parkinson's disease and kidney failure. Igor has been entitled to Bituah Leumi's care watch since December 2018 due to the fact that he needs outside help with dressing, bathing and moving around. Igor found out about the policy only about a year ago, and independently turned to the Phoenix insurance company, which insures members of the Maccabi Health Insurance Fund. After the company “Phoenix” checked Igor's documents, she rejected his claim and transferred his case to the previous Maccabi insurer; – the Klyal company. Igor was surprised, because he did not know at all that there was a replacement of the insurance company for Maccabi clients, since this step was taken without the knowledge of the insured and, of course, without their consent. Is it necessary to say that «Klyal» also refused Igor, because exactly in the month in which he was recognized by “Ciudi”, in December 2018, the insurance was changed, and Igor, as they say, “fell between the chairs.” He then approached our law office, and through a lawsuit and related legal actions, we forced the two insurance companies to sit down with us and come to an agreement whereby they would pay Igor a lump sum of NIS 180,000, each part.
In this context, it is important to note that Igor was not the only one who faced this problem, because in recent years, insurance companies have changed other health insurance funds – “Leumit”, “Meuhedet”, and there are “surprises” for insured health insurance members who did not know about the replacement and as a result did not know who to contact and how to contact.
Another example that illustrates the risk of filing an insurance claim without deep knowledge can be found in the case of the late Dina, who was 88 years old, and who suffered from many chronic diseases – heart disease, strokes, severe diabetes. She was recognized as Bituah Leumi “siudit” with the right to 26 hours of weekly care. Dina was advised by an employee of the Clalit Health Insurance Fund, of which she was a member, to send the documents to the Arel insurance company, and the same employee even helped her fill out the forms and send them to the insurance company.
However, the forms were filled out carelessly, without knowledge of long-term care insurance rules, which stipulate that the start of payment will be determined by the date when the insured became in need of assistance, and not by the date when he filed a claim. As a result of an error in filling out the claim form, Dina's claim was only recognized from the date of filing a claim for payment from the insurance company, and unfortunately Dina died a few months later, she only managed to receive about 24,000 shekels, and most of the money remained in the insurance company's pocket company.
At the intervention of our office, after an in-depth legal analysis of the case, we sued on behalf of the heir of the late Dina for the insurance company to pay money for the previous period before the claim was recognized. And even we had a hard time correcting the mistake that was in the original submissionpresented by the late Dina to an insurance company with the participation of an employee of the health insurance fund. The result of our work is that the insurance company had to pay the heir a total of about 160,000 shekels retroactively for another 3 years.
These examples, which are only a small part of the many cases that come into our office, show that behind a “harmless form” correctly completed and filed with an insurance company for a care benefit, there is in fact extensive legal knowledge, high qualifications in issues of receiving payments under “Bituach Siudi”, rules of insurance supervision, court decisions on this issue, cardinal changes that have taken place in this area in recent years. Therefore, an unprofessional attitude can be detrimental, especially when there are significant sums of money at stake that need to be collected from insurance companies.
It should be noted that our office has been working with Russian-speaking Israelis for many years and represents their interests throughout the country, and we know how to help the insured as safely, quickly, efficiently and correctly as possible. Our office is led by experienced attorney Meira Zohar. The office has been specializing exclusively in Bituah Siudi insurance for many years. for long term care. Lawyer Meira Zohar works directly with each client, there is no need for a team of “accountants”, “experts” etc. This greatly simplifies the legal process for insured sick people.
We succeeded in securing a positive decision in a very important class action lawsuit against 4 insurance companies, which relates to the private policies of Bituah Siudi. You can read about the subject of the class action and other legal successes of the firm on our website.
We achieve maximum cash payments for our clients without unreasonable costs and without any obligations.
Our main office is located in the business center of Bnei Brak. But IMPORTANT NOTE that the office staff works all over Israel, from north to south, INCLUDING EILAT, and can help you solve your problems.
Call: 03-5622772, 050-9929120 , 050-7756772 (we speak Russian).
Our fee is paid only after the successful resolution of the problem.
Our site in Russian – www.law-ru.co.il
Our site in Hebrew – www.la-w.co.il
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