Rights8/8/2026

Long-Term Care Insurance in Israel: When an Insurer’s Rejection of a Claim Can Be Challenged

An insurer’s rejection of a claim for long-term care insurance benefits does not always mean the permanent loss of entitlement to the money. Eligibility for payments is generally assessed according to the ability to perform activities of daily living or the presence of cognitive impairment requiring constant supervision.

Key facts

•Publication date: July 22, 2026
•Activities of daily living threshold: at least three of six tasks
•Period for older policies: three years
•For policies from November 2022: five years
•Legal basis: Insurance Contract Law

When Eligibility for Payments Arises

Insurance policies generally provide two grounds for recognizing a person as requiring long-term care. The first concerns an inability to independently perform at least three of six activities of daily living: getting up and lying down, mobility, eating and drinking, bathing, dressing, and controlling bodily functions. The second is a cognitive condition, such as Alzheimer’s disease, dementia, or another impairment requiring constant supervision.

Why Insurers Reject Claims

The insurer may argue that the insured is able, even partially, to perform basic activities and therefore does not meet the policy’s conditions. To assess the insured’s condition, it is entitled to send a physician on its behalf and, in some cases, use materials gathered through covert surveillance. The insurer’s physician’s opinion is not final: it can be requested, a reassessment can be demanded, and an independent medical opinion can be submitted.

Payments for a Previous Period

In appropriate cases, a claim may also be filed for a period during which the person was already in a condition entitling them to benefits under the policy but did not receive payments. For this purpose, both the date of the insured event and the limitation period are important. According to the source, the period is three years for older policies and five years for policies purchased from November 2022 onward, pursuant to an amendment to the Insurance Contract Law.

Documents and the Date of the Insured Event

The outcome of the claim review depends largely on the medical documents and an accurate description of the daily limitations. The source notes that the conditions for recognizing eligibility for payments have recently changed, and the applicable rules must therefore be determined according to the date of the specific insured event. Missing documents or imprecise wording may make it more difficult to obtain payments, even when the medical condition is serious.

What this means for you

A person whose claim has been rejected should examine not only the insurer’s decision itself, but also the medical opinion, the policy terms, the date the condition began, and the limitation period. In some cases, the claim can be reconsidered and payments obtained for a previous period. The specific outcome depends on the wording of the policy and the evidence concerning the insured’s condition.

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