What to do when the insurance company is not handling the long-term care claim properly: approaching the company's public enquiries officer, complaining to the Capital Market Authority, when each route is relevant and what to attach.
When a complaint is the right tool
It is important to distinguish between two different situations. The first is a dispute about the decision itself — the company examined the claim and refused it, and you disagree with the conclusion. The second is a problem with conduct — no response, prolonged delay, documents not received, or contradictory answers.
A complaint is suited mainly to the second situation. Where the problem is the conduct rather than the substance, approaching a body that supervises conduct is the effective tool.
Where the dispute is about the professional decision itself, the appropriate routes are usually an appeal, a reconsideration or seeking legal advice — not a complaint.
First stage: the company's public enquiries officer
Every insurance company has an internal officer responsible for enquiries and complaints. That is a stage worth going through before approaching an outside body, for two reasons.
The first: sometimes it simply works. An organised approach to someone whose job is to deal with problems sometimes produces a response you could not obtain through the ordinary channels.
The second: when you later approach the supervisory authority, the first question will be whether you approached the company. Documentation of an earlier approach that went unanswered strengthens the complaint.
Second stage: the Capital Market, Insurance and Savings Authority
The Capital Market Authority is the body that supervises insurance companies in Israel, and it has a unit for handling enquiries and complaints from the public.
You can file a complaint about an insurance company's conduct, including on matters of claims handling. The approach is made through the official channels published on the Authority's website.
It is important to understand what the Authority does and does not do. It supervises conduct and compliance with the rules, but it is not a court and it does not determine every factual or medical dispute.
How to write an effective complaint
A complaint that mainly describes frustration is read and closed. A complaint that describes facts with dates is dealt with.
- The insured person's details, the policy number and the claim number
- A precise timeline: what was sent, when, and what was received in response
- A clear description of the problem — what exactly was not done or was done improperly
- Supporting material: delivery confirmations, correspondence, letters received
- Documentation of the earlier approach to the company and what the answer was
- What you are asking should happen — a clear and specific request
What not to attach
There is no need to attach the entire medical file to a complaint. The body handling it examines conduct, not a medical condition.
Attach only what is relevant to the allegation itself — correspondence, delivery confirmations and decisions. Detailed medical documents are not needed in most cases, and attaching them is unnecessary from a privacy point of view.
The information here is general and does not constitute legal advice. Where there is a genuine legal dispute or an approaching deadline, you should approach an appropriate professional.
Frequently asked questions
When do you file a complaint about an insurance company?
Mainly where the problem is one of conduct — no response, prolonged delay, documents not received or contradictory answers. Where the dispute is about the professional decision itself, the appropriate routes are an appeal or legal advice.
Where do we go first?
To the public enquiries officer at the insurance company itself. Sometimes that resolves the problem, and in any event documentation of an earlier approach strengthens a later complaint to the supervisory body.
What does the Capital Market Authority do with a complaint?
It is the body that supervises insurance companies and deals with enquiries and complaints about conduct and compliance with the rules. It is not a court and it does not determine every factual or medical dispute.
What do we write in a complaint?
The insured person's and the claim's details, a precise timeline of what was sent and when, a clear description of the problem, supporting material, documentation of the earlier approach to the company, and a specific request.
Do we need to attach the medical file to a complaint?
No. The body handling it examines conduct, not a medical condition. Attach only what is relevant to the allegation — correspondence, delivery confirmations and decisions.
Official sources for further checking
This is general information and does not replace personal medical, legal or insurance advice. Eligibility is determined by the documents and rules that apply to each case.
