Israel's National Insurance Institute Set to Stiffen Criteria for Some Disability Payments

Says changes are part of effort to update the regulations to reflect changes in medicine in the intervening decades.

A. is a 56-year-old mother of five with unregulated diabetes who also suffers from sleep apnea, high blood pressure and orthopedic problems affecting her neck, knees and feet. Under current National Insurance Institute regulations she is eligible for a monthly disability allowance of NIS 4,000 - but under proposed changes to NII regulations, a person with the same health problems may not receive any such payments.

In the course of a lengthy testing process A. proved to a medical panel that her combined disability exceeded 40 percent. But if she were tested under the new regulations, her disability rating would be between 10 percent and 20 percent - a level that would potentially not qualify for benefit payments.

The NII has said, however, the changes would not be applied retroactively to people whose disability rating has already been determined.

The institute is working to stiffen eligibility requirements for payments to people living with chronic diseases. While there have been efforts to submit the changes to the Knesset Labor, Welfare and Health Committee, only the approval of the NII council and of the Social Affairs Ministry is legally required to enact the changes.

Information obtained by Haaretz details proposed changes to regulations with regard to three chronic diseases.

The Israel Diabetes Association was recently informed of far-reaching proposed changes to criteria for determining the disability rating of people with diabetes. At present all diabetics with complications as a result of the disease automatically receive 65 percent disability. Under the new guidelines, the disability percentage would be determined by the number and severity of the complications. Diabetics with two complications, each one exceeding 20 percent, or one complication rated 30 percent or higher, would receive a 65 percent disability rating. Less severe complications, including nerve damage as a result of high blood sugar levels (diabetic neuropathy ) or retinopathy (retina damage ) without macular edema, would not qualify for a disability rating.

According to a review carried out by Hamerkaz Lemimush Zekhuyot Refuiot, a private company that represents citizens in their efforts to obtain NII disability benefits, of the cases of 30 diabetics who currently qualify for general disability, including A., 60 percent would have a lower disability rating that would potentially reduce their disability allowance if they were assessed under the new criteria. An additional 30 percent would be ineligible for any such allowance.

People with Parkinson's disease could also receive a lower disability rating in the future under the proposed changes. An NII representative reported at a meeting of patient-advocacy organizations in late July that the proposed changes would lower the disability rating of patients in such a way as to make many in their situation ineligible for disability payments.

The eligibility criteria for people with heart disease was changed recently, in cooperation with the Israel Heart Society, to include an echocardiogram and a cardiac stress test. In addition, angina pectoris was removed from the list of conditions that could be considered in determining a patient's eligibility for disability.

In the past several months changes have been made to the disability criterion in a number of medical fields. Six months ago the regulations governing eye diseases were updated, with minimal consequence to the determination of eligibility. Four months ago the guidelines for mental disorders were changed to establish percentage ratings for individual disorders, rather than assigning a rating based on each patient's overall condition.

The NII said in a response that the proposed changes are part of a comprehensive effort to update the regulations, which were written in 1956, to reflect changes in medicine in the intervening decades. "The new proposed paragraphs were written by specialist physicians belonging to a special committee and were approved by" the professional associations for endocrinologists, neurologists and cardiologists (for diabetes, Parkinson's disease and heart disease, respectively ) in Israel, the statement said. "With regard to diabetes," the statement continued, "the information [in this article] is inaccurate, in that according to the proposal two complications rated 20 percent or greater would result in the patient receiving a disability rating of 65 percent."