HMO ordered to compensate patient after refusing to fund treatments

The Haifa Labor Court has ordered the Clalit HMO to pay NIS 30,000 in compensation to a cancer patient whose additional treatments it refused to cover.

The legal battle began three years ago, when 55-year-old Ehud Hoch asked the HMO to finance treatments he was required to undergo as a result of complications from his leukemia.

The treatment, which had Hoch placed inside a pressure chamber to reduce the buildup of fluid in his brain that came as a result of radiation treatments, is not generally covered by insurance.

As such, Clalit, refused to compensate him. Hoch subsequently lodged a complaint with the Health Ministry's public commissioner.

In September 2006, the commissioner decided that Hoch was indeed entitled to HMO coverage for the treatment and that he should be compensated for funds he had paid thus far. Clalit rejected the commissioner's decision and took Hoch and the Health Ministry to court.

Initially, Hoch was wary of the legal proceedings and volunteered to remove himself case in exchange for naming the Health Ministry as the main defendant. He eventually decided return as a defendant with the goal of setting a legal precedent on behalf of other patients in need of the same treatment and coverage.

Labor Court Justice Michal Freeman ruled that pressure chamber treatment against brain damage is subject to HMO coverage by the HMO and demanded that Clalit pay Hoch a sum of NIS 30,000 in compensation.

"This was an important victory," Hoch told Haaretz. "I was forced to defend myself in court while simultaneously fighting this disease. I needed to attend meetings, to consult with my lawyer, and testify on four occasions. I decided in the end to continue with the legal proceedings in order to obtain a positive ruling for patients who may come after me."