Class Action: Insurers, HMOs Refuse Coverage for Disabled

Plaintiffs charge that Clal, Dikla, Maccabi, Clalit and Leumit, refused them nursing insurance due to their disabilities.

Insurance companies are refusing to sell nursing care insurance to people with disabilities, a class-action suit charges.

The NIS 660 million suit was filed on Tuesday by six disabled people. It accuses two insurance companies, Clal and Dikla, and three health maintenance organizations, Maccabi, Clalit and Leumit, of either refusing to provide them with nursing insurance due to their disabilities, without any effort to examine their individual situations, or of canceling existing policies for the same reason.

The suit also asks the Jerusalem District Court to declare the case a class action covering 329,960 people. While Israel has some 1.5 million disabled people altogether, including about 700,000 with severe disabilities, the suit would apply only to those who were either denied nursing insurance or had existing policies canceled.

The suit relates to group insurance policies that all members of a given HMO are theoretically entitled to purchase. The policies used to be administered by the HMOs, and at that time, they did cover disabled people. But five years ago, a new law was passed forbidding the HMOs to provide nursing insurance, so the policies were collectively transferred to insurance companies.

For most people, the change made no difference. But in some cases, the insurance companies informed the policy holder that due to some medical problem or disability, the insurance was being canceled. In other cases, people who sought to purchase nursing insurance were denied.

"Being disabled in this country means getting up each morning to a new battle," said attorney Yotam Tolub of Bizchut, an advocacy organization for the disabled that helped file the suit. "A person wants to go abroad, and they refuse to insure him. A person wants to buy an apartment, and they refuse to give him a mortgage. A person wants to take care of his future, and they refuse to give him nursing insurance. The problem is not the disability, but the society."

One of the plaintiffs, Yisrael Even-Zahav, is a 65-year-old polio victim who has been recognized by the National Insurance Institute as being 80 percent disabled. Nevertheless, he can function on his own, and works as a consultant on accessibility for the Israel Standards Institute and various Knesset committees. He has also won three medals in the Paralympics.

Despite this, both the Clalit HMO (before the new law was passed ) and the Dikla insurance firm (afterward ) decided that he was already in need of nursing care, and therefore refused to sell him insurance.

"It's an abnormal absurdity, because I live a full life," he said. "There were times when I worked 18 hours a day as a construction engineer. I ran construction companies. But I'm defined as needing nursing care. No one asked me any questions about how I function. They hear 'polio' and '80 percent disability' and it's automatic - no. Granted, I can't run, but that's a long way from needing nursing care."

The suit noted that "by law, insurance companies must examine the specific medical situation of the person applying for insurance and base their refusal on his personal medical data." But in Even-Zahav's case, it said, the companies "ignored his specific situation. Granted, another person with an 80 percent mobility disability might be considered in need of nursing care, but that isn't the plaintiff's situation."

A., 44, has been diagnosed with schizophrenia and is also recognized as disabled by the NII. He was particularly stunned to be refused nursing insurance because he had been paying premiums on such a policy for the last 12 years, ever since joining Clalit's nursing insurance program in 1998.

When the policy was transferred to Dikla, initially, nothing happened. But in June 2010, the company informed him that it wouldn't cover him due to his preexisting condition.

When A.'s mother sought clarification from Dikla, it asked her to supply additional medical data, which she did. But in November 2010, she got two contradictory letters from the firm on the same day: one that requested additional documents, and another saying that due to his medical condition, A. was ineligible for nursing insurance.

After receiving a complaint from Bizchut, Dikla agreed to refund the 12 years of premium payments. But it continued to refuse to insure A.

"This is an unacceptable practice, whereby insurance companies do everything possible to thwart implementation of the equality law, which states that they must enable every person to obtain insurance," said Asaf Pink, one of the plaintiffs' attorneys. Despite the rule that companies may deny insurance only on the basis of the applicant's individual medical data, "it turns out the companies have no such data; they reject the disabled on the basis of a telephone conversation."

Dikla said it hadn't yet seen the suit and therefore couldn't respond, but insisted that it acts in strict accordance with the law. Clal and Maccabi both said they hadn't yet seen the suit and thus couldn't respond.

Leumit said it would give its response in court, while Clalit referred questions to Dikla.

Yisrael Even-Zahav was rejected for insurance.
Tomer Appelbaum