When is an Illness or Injury Recognized as A Work Accident?

When it comes to a work accident the path to realizing one’s rights is long, difficult and complex. Attorney Gil Kraus, who has experienced this very frustrating experience in person, explains why in the struggle with major organizations you have to have a command of all the fine details

Avi Yoffe
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Attorney Gil Kraus: “Only a lawyer can represent the injured party in the medical committees” Credit: Michal Kushrov
Avi Yoffe
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Attorney Gil Kraus has fought for more than 17 years to realize the rights of injured and sick people in the National Insurance Institute ("Bituach Leumi") and other organizations. But another advantage he has over his competitors, apart from his great experience, is the fact that he himself has been on the other side and has had to contend with the bureaucratic system.

“My father was very sick at a young age and I saw his difficult struggle with the institutions,” Attorney Kraus remembers, “I also underwent a serious illness a few years ago due to which I found myself in the role of the patient, who has to contend with all kinds of struggles for rights. And that is what enables me to understand the person and the distress they are in the best way possible.”

At Eghert-Kraus & Co., of which Attorney Kraus is one of the owners, the work almost never ends, with inquiries from people who have fallen ill or been injured and want to claim their rights from large organizations. Eghert-Kraus & Co. are able to give full support for the entire process, thanks to many years of professional experience and a connection to additional fields that interface with realizing rights, such as claims according to insurance policies and claims for damages.

“The biggest problem in Israel in this subject is that there is no official entity acting on behalf of the state who sits with a person after something has happened to them and explains exactly what they are entitled to and how they can receive it,” explains Attorney Kraus. “Various centers have been established but in practice there is no instruction manual. There is nothing organized.”

Do you think there is a reason for that?
“One of the problems is often the feeling of lack of trust on the part of the system towards the injured and sick. The cheaters are a minority but sometimes it also impacts the others. In addition, there is an inherent problem in the National Insurance committees – these are discussions that take a few minutes, in which doctors sit who receive their pay from the National Insurance Institute. An attorney who accompanies these clients is the only person who can represent them in the discussion in the medical committee itself, something that the various centers for receiving rights cannot do.”

Attorney Kraus emphasizes that he and his firm “are not magicians” but their familiarity with the material and the system is deep and comprehensive, and so is their knowledge of everything concerning the benefits that can be received. “Being accompanied by a lawyer can be critical,” he emphasizes, “We know all the committees and the regulations, which clauses are relevant and which are not, what can be claimed and what cannot.”

“We know all the committees and the regulations.” Attorney Gil Kraus Credit: Yael Orbach

“There are many cases in which NII decisions also affect other procedures,” continues Attorney Kraus, “such as claims for damages or the case of a road accident that is also a work accident where in some cases the level of disability determined by the NII is also the determining disability in the procedure with the insurance company. Therefore, it is often significant not only in the NII, but beyond it. The subject of receiving rights includes topics of procedures in the framework of general disability, work injuries, medical exemption from income tax, mobility claims, claims for special services, nursing care, etc.

A kind of psychologist

Attorney Gil Kraus is a member of the National Insurance committee of the Tel Aviv District Bar Association. He accompanies patients' organizations during the process of realizing rights and is a graduate of various professional courses, including a course on medicine for lawyers. With this background, among other things, he has assisted many clients, successfully so far, to receive their lawful rights.

“For me success is measured in that a person receives what they are entitled to in full,” says Gil. “We deal with matters of life and death, with people who are in a very difficult situation where their routine has been suddenly harmed, and now they have to begin to face a new reality. This is where the need to receive all the possible rights stemming from their difficult situation comes in.”

So sometimes you are a kind of psychologist for people?
“Absolutely. Some of the consultations are not connected to law but to other subjects related to the accident or the illness. The client is in a difficult situation and sees us as a listening ear and a shoulder to cry on. And apart from complaints, they also expect us to help them as far as possible to return to their previous life or at least to receive what they are entitled to. Therefore, they expect a great deal from us.”

Has dealing with victims of accidents and sick people become a kind of agenda since you were ill?
“I think it’s very important that the client receives everything they are entitled to. For me, this is a mission. The client finds that I am very sensitive and have a suitable attitude, because I know personally how they feel and I have experienced what they are experiencing now.

What does a person need to know or prepare before they come to you?
“It’s important that a person who has been ill or has been injured in an accident keeps all the medical documents, including those that seem less relevant. Thus, a person who has a medical problem that is connected to these matters should complain about it. What is not in writing doesn’t exist as far as the NII are concerned. In the initial meeting, we examine the documents, what their rights are and what possibilities they face, every case according to its merits. Everyone can expect to receive the support package that suits their individual situation. When the chance of the process is greater, we also advise on how to act from here onwards from a medical point of view.”

And what happens at work?

The difference between a lawyer such as Gil Kraus and companies for realizing medical rights is dramatic. Unlike a lawyer, the companies cannot represent the client vis-à-vis the medical committees. “Someone who does not see the entire legal framework, is liable to give a person one right but at the expense of another right that is affected.” says Attorney Kraus.

He adds that it is important to emphasize that on the subject of work accidents, many people mistakenly think that the incident they have undergone is unrelated to their work. “It is important to examine whether it is possible to recognize such an injury as part of their work,” explains Attorney Kraus. “The extensions determined in the law include accidents on the way from home to work or from work to home, or accidents during a lunch break. There are also people who fall ill with work-related illnesses, including those with a mental state that can be proved to be connected to work.”

The importance of work-related injury can be very great, as these people have significant rights that sometimes do not contradict receiving money from other sources and continuing to work. Self-employed people can also be recognized as victims of work-related accidents or illnesses.

Credit: פרי מדיה

Attorney Kraus and his team monitor changes in the field. They take courses and keep up to date in everything necessary to represent their clients in legal proceedings.

“The fine details matter,” says Attorney Kraus. “One of the extensions in the law is that if a person is injured on the way to work after leaving home it is recognized as a work accident. But the law says that this is only if it was directly on the way to work, and there are many discussions in legal rulings about cases in which someone stopped on the way and was injured and whether they were injured in a work accident or not. One of the cases I dealt with was a woman who went to work and on the way she crossed the road to the health clinic opposite her house. After she was in the clinic for a few minutes she was injured,” says Attorney Kraus, “The NII rejected her claim and said that she did not take the most direct route and therefore it was not a work accident. I appealed to the labor court, which accepted my position that it was a work accident as she did not deviate from her route, but it was not sufficient. The NII appealed to the national labor court, which again accepted my position, according to which it was a work accident. The financial significance was very great.”

Attorney Gil Kraus
Address: 7 Masada Blvd., 4 B.S.R Tower, (23 floor) Bnei Brak
Telephone: 03-6766602
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