If you have applied for a benefit from the National Insurance Institute due to your disability, you will be invited to appear before a medical board to determine your degree of disability and whether it is permanent or temporary.

How the medical board operates

The medical board assesses your level of medical disability to determine your disability percentage and whether this percentage is permanent or temporary.

The board is comprised of a doctor specializing in the relevant field (in the case of stroke, a neurologist), who is responsible for determining the degree of disability, and a secretary whose responsibilities include ensuring the claimant’s rights are respected and recording the statements of the claimant and the protocol of the board.

The board’s doctor reviews the medical tests already performed by your doctors, conducts an additional physical examination, and translates your illnesses and medical impairments into a medical disability percentage determined by the severity level of these impairments. Your disability percentage is actually the weighted sum of all your illnesses and impairments, calculated according to the National Insurance Institute’s official “list of impairments”. The board’s doctor is entitled to refer you to additional medical testing before making a decision.

If you wish, you may bring a chaperone (family member or friend), interpreter, or lawyer to represent you with you to the board. In cases of severe disability, it may be possible to determine medical disability without physically appearing before the board.

After the board’s evaluation, your claim is sent to the claims officer to establish your degree of incapacity (loss of earning capacity), which is an assessment of whether your disability partially or fully impairs your earning capacity if you are of working age and meet one of the following conditions:

• You have been granted at least 60% medical disability.
• You have been granted at least 40% medical disability, where at least one impairment accounts for 25%.
• You are a housewife who has been granted at least 50% medical disability.

If it is established that your degree of incapacity is over 50%, you are entitled to a monthly disability pension, detailed on the General Disability and Work Disability Pension page:

Stages of the medical board evaluation process

1. Before the board convenes, the doctor will examine the medical documents in your file (sent ahead of time).
2. The secretary will invite you into the room and introduce themselves and the doctor by name. If you are personally or professionally acquainted with the doctor, the evaluation cannot take place and a new board will be scheduled with a different doctor.
3. You will be asked to detail your illnesses and medical impairments and describe how they affect your lifestyle and daily function.
   It is recommended to prepare a document in advance detailing your impairments and challenges and request to have it included in your file and in the board’s protocol.
4. At the stage of evaluating your medical condition (in order to determine your degree of disability and not for the purposes of medical treatment), you can and should submit additional medical documents if the board requests them or if they are missing from your file.
   *A physical examination is not always necessary. Sometimes your medical documents are sufficient.
5. If the board decides there is a need for additional medical tests or documents, it will not establish your degree of disability at this stage, and you will be asked to supply additional test results. In this case, you will receive a written letter detailing the board’s requests.
6. If there is no need for additional medical testing, once you have left the room the doctor will establish your degree of medical disability, based on your medical examination and the documents reviewed by the board and in keeping with the NII’s list of impairments, which includes a predetermined medical disability percentage for each impairment. Moreover, the doctor will determine the effective date of your medical disability percentage and whether it is temporary or permanent.
7. You will then be sent a notification of the decision regarding your claim and a copy of the protocol. Make sure to save this copy, as it can later be used for purposes such as applying for an income tax exemption.

Important tips

• If appearing before the board or undergoing additional medical tests required by the board involved special financial costs such as lodging or transportation (if you cannot use public transportation due to your disability), you can submit a request for reimbursement of these costs.
• It is important to arrive at the scheduled time of your board evaluation, even though this is only an estimate and you may be required to wait for your turn. Moreover, the order in which claimants appear before the board is not always determined by the order in which they arrived.
• You will not be allowed to appear before the board without photo identification.

How to prepare for the medical board

1. Bring your medical documents, as detailed in the General Disability and Disability Pension section.
2. You should see at least one doctor specializing in the relevant field before your board evaluation (this can be done through your HMO) and bring the doctor’s summary and recommendations with you to the evaluation.
3. Save all medical documents, including bills, receipts, and travel and equipment expenses, along with your pay slips from before the stroke (and after it). If you are self-employed, it is recommended to save all income tax reports submitted both before and after the stroke.
4. It is important to prepare a file, arranged either by impairment or in chronological order. Submit this to the board and save a copy for yourself. The more detailed, up-to-date, legible and clear your medical information is, the better the board’s ability to make the right decision about your case will be.
5. It is very important to describe all your existing impairments, even minor ones, including those unrelated to the stroke. If possible, indicate citations in the medical documents.
6. Prepare your comments in advance in a written document, as the time allotted for the medical board’s evaluation is short. It is recommended to submit this document for inclusion in the protocol.

Establishing disability without the claimant’s presence: As a rule, the degree of disability cannot be determined without the claimant’s presence at the board evaluation. Only in certain cases where the claimant has agreed to such in advance is the doctor permitted to establish the percentage of medical disability on the basis of medical documents alone.

Failing to show up for your medical board evaluation or for a medical examination requested by the board without advance notice can result in sanctions and revoking your entitlement to a rescheduled board appointment.

How to appeal the decision of a medical board

If the board grants less than 80% medical disability or determines your degree of incapacity to be less than 74%, you may appeal the decision. 

You must submit the appeal in person to the National Insurance Institute branch near your residence within 60 days of the date of the first medical board that established your disability percentage. You can find a list of branches here.

Download the appeal form from the National Insurance Institute website here.

A medical appeals board will then reevaluate your case in light of the claims included in your appeal.

The most common reasons for appealing a decision are an incorrect assessment of the severity of the medical condition or the omission of an important detail regarding the claim. It is possible that the appeals board will grant a lower disability percentage or degree of incapacity than the first medical board, in which case your monthly pension will be reduced.

Additional appeal in a labor court: If you do not agree with the decision of the medical appeals board, you are permitted to submit a claim before a labor court within 60 days of receiving notice of the appeals board’s decision. If there is a mistake in the documents held by the National Insurance Institute, you are entitled to request to have it corrected within one year from the day of the board evaluation.

If there is a change in your personal or marital status, a decline or improvement in your medical condition, the birth of a child, etc., you should immediately notify the National Insurance Institute branch in your area.

Time for submitting the appeal: The appeal must be submitted within 30 days from the day the claimant was notified of the board’s decision; if the National Insurance Institute agrees, this period may be extended by 30 additional days.

The appeal must be submitted in writing and detail the reasons for appealing the decision. As a rule, it is best to submit the appeal directly to the NII in person or by registered mail with delivery confirmation. While you are detailing the reasons for your appeal, it is best to have the board protocol and the information upon which the decision was based in front of you.

Representation in the medical appeals board:  You are entitled to be represented before the medical appeals board by your doctor or a specialist.

Review of the appeal: The review must be conducted in the presence of the individual who submitted the appeal or, if the individual agrees to such, the board may review the appeal on the basis of medical documents alone, without physically examining the person who submitted it.