Before you read on: every policy is different
The answers below describe how long-term care claims generally work in Israel. They do not describe your policy, because no two policies define the insured event in quite the same way.
So treat everything here as a map rather than a ruling. When a question turns on a number — how many daily activities, how long the waiting period, how much is paid — the answer is in your own policy document and nowhere else.
Frequently asked questions
What counts as a long-term care condition?
The precise definition is set in the policy. Usually what is examined is the ability to perform basic daily activities, or the need for supervision because of a cognitive condition.
Who can file a long-term care insurance claim?
Someone insured under a relevant policy can file a claim, and sometimes a family member or an attorney can act on their behalf, subject to the required documents.
Which documents may be required?
Usually a claim form, the policy details, an up-to-date medical summary and documentation relating to functioning. The precise list varies according to the company and the policy.
How long may the handling take?
There is no uniform length. The time depends on how complete the claim is, on requests for further documents, on assessments and on the insurance company's procedures.
What do you do when a claim is refused?
Read the reasons and the deadlines, compare them with the policy and the documents, and only then decide whether to supply further material, ask for a reconsideration or appeal.
How do you start?
Start with a short conversation and by gathering the policy details and a general description of the functional difficulty. There is no need to send sensitive medical information in the initial form.
How do we know whether a policy even exists?
Start with Har HaBituach, the official registry run by the Capital Market, Insurance and Savings Authority, and check old paperwork and standing orders on bank statements. It is common to find more than one policy.
Can we file on our own?
Yes, and in a straightforward case with a clear policy and a well-documented condition that is often the right choice. Guidance matters most when the picture is complicated or a claim has already been refused.
Do you work in English?
Yes. The process can be handled in English throughout. The forms themselves are in Hebrew and we work through them with you.
What does the first conversation cost?
Nothing. It exists to understand the situation and tell you whether there is anything to check. If we think there is no basis, or that you can handle it yourselves, we say so.
Do we need to gather documents first?
No. Bring what you know. Part of the check is working out which documents actually matter, so you do not spend time collecting things that will not be used.
Does an approval from National Insurance mean the insurer will approve too?
No. They are separate tracks assessed under different rules. The National Insurance decision is a useful supporting document but it does not bind an insurer.
Where do we get the claim form?
Always from the official source of the body that actually handles the cover. With group cover through a health fund, the form may belong to the insurer administering the scheme rather than to the fund itself.
Should we send the whole medical file?
No. Current, relevant material serves the claim better than volume. Irrelevant records can obscure the documents that matter.
What is the most common cause of delay?
A missing document, an unreadable file, an out-of-date form, or not answering a request for further information within the stated deadline.
How long does a claim take?
There is no fixed period. It depends on how complete the file is, whether further documents or an assessment are needed, and the insurer's own procedures.
Who carries out the functional assessment?
A professional on behalf of the insurer — often a nurse or occupational therapist. The arrangements are set by the insurer's procedures.
What if the assessment happened on an unusually good day?
Say so explicitly at the time and describe what other days look like, including how often. Up-to-date medical documentation can support that.
How long do we have to respond?
The deadline is normally stated in the letter itself and varies by policy, insurer and procedure. Do not leave it — even a decision not to act should be a decision, not a missed date.
Is a denial final?
Usually not. There are often further routes — completing documents, requesting a review, an internal appeal or an external approach. Which one fits depends on the ground given.
Do we need a lawyer?
Not in every case. Completing documents and making a reasoned approach do not require representation. A genuine legal dispute or a court process does.
This page is an English translation of our Hebrew content, written for English speakers living in Israel. Official Israeli terms appear with their Hebrew names so you can recognise them on forms. In any discrepancy, the Hebrew version and the official documents prevail.