New Ruling on Compensation for Road Accident Victims — The Fibromyalgia Dimension

By: Adv. Moshe Taieb

New Ruling on Compensation for Road Accident Victims, with a Focus on Fibromyalgia

The Rishon LeZion Magistrate Court recently issued a significant ruling on the calculation of compensation for road accident victims suffering from various disabilities, including fibromyalgia. Judge Dov Gutleib set out in this ruling clear principles guiding compensation awards in complex cases. At our firm, we see this decision as a meaningful milestone in the field of personal injury, clarifying important principles that frequently arise in complex cases.

The case involved a 44-year-old plaintiff who was injured in a road accident in November 2019 when a third-party vehicle struck him from behind. The National Insurance Institute recognized the accident as a work accident and determined that the plaintiff suffers from permanent disabilities: limitations in cervical spine movement, vertigo, and fibromyalgia.

The Factual Background of the Case

We are dealing with a case that has complex medical dimensions. The plaintiff, who was employed in industry at the time of the accident, suffered severe rear-impact trauma that caused significant damage. Generally, we see such accidents characterized by chronic pain and functional disabilities that do not resolve in the short term.

The National Insurance Institute determined a general disability rate of 20 percent: five percent for mild limitation of cervical spine movement, five additional percent for mild limitation of the lower cervical spine, and ten percent for vertigo. However, the rheumatology expert appointed by the court reached more complex conclusions regarding fibromyalgia.

According to her findings, the plaintiff suffers from fibromyalgia at a rate of ten percent disability. Of those, only five percent were directly caused by the accident. This question posed a legal challenge before the court: how should compensation be calculated when a disability existed in part even before the accident? In an era when conditions such as fibromyalgia are becoming more prevalent, this question is highly relevant.

The Legal Questions at Issue

The court faced a two-dimensional issue. First, how to calculate functional disability when multiple disabilities coexist — and in particular, what to do when part of the disability predated the accident. Second, whether a person is required first to exhaust all remedies against the National Insurance Institute before suing a third party.

The first issue touches on the basic principle of tort law — the causal link. The plaintiff must prove that the damage results from the accident and not from prior conditions or other illnesses. In this case, the picture was complex because fibromyalgia existed before the accident but was aggravated as a result.

The second question relates to the relationship between the National Insurance Institute and third-party liability insurance. The insurer argued that the plaintiff was obligated first to use his rights against the National Insurance Institute and only then to sue the third party. Had this position been accepted, it would have significantly harmed the rights of road accident victims and materially prolonged the litigation process.

The Rulings Made in the Judgment

The court gave a clear and significant answer to both questions. On functional disability, Judge Gutleib ruled that all the evidence and circumstances must be considered, with the medical disability serving merely as a starting point and not as a final determination. In his reasoning, the court held that functional disability stands at 22.84 percent, in accordance with the overall medical disability.

The approach underlying this decision represents a balance between two directions. On one hand, the court acknowledged all the disabilities that occurred, including those aggravated by the accident. On the other hand, it did not expand the disability beyond the concrete medical findings. This approach is correct because it provides fair compensation without exaggerating the assessment of damage.

Regarding the exhaustion of National Insurance remedies, the court rejected the insurer’s argument clearly. The judge ruled that the injured party has the right to sue the third party for all damages without any obligation to wait for proceedings with the National Insurance Institute to conclude. This ruling in practice preserves the rights of the injured, as it allows faster compensation without dependence on heavy bureaucratic processes.

Legal Analysis of the Right to Subrogation and Prevention of Double Recovery

One of the most complex issues in this ruling is the right to subrogation of the National Insurance Institute. In our work, we regularly deal with the confusion that arises among our clients regarding the relationship between National Insurance compensation and third-party insurance compensation. The court added an important clarification: the right of subrogation exists in order to prevent an injured party from receiving double compensation for the same damage.

In practice, the significance is that the injured party has the option: to file a suit against the third-party insurer first and receive full compensation, or to receive benefits from the National Insurance Institute first and then sue the third party for the difference. In this case, the plaintiff received from the National Insurance Institute the sum of 163,129 shekels, and the court placed upon the insurance company the obligation to pay the remainder.

The total compensation awarded was 754,944 shekels. After deducting what the plaintiff had already received from the National Insurance Institute, he is entitled to receive from the insurance company the sum of 591,815 shekels. This amount reflects fair compensation for a disability of 22.84 percent for a person at his working age, taking into account the impact of the disabilities on his quality of life and his future earning capacity.

What This Means for Road Accident Victims

This ruling carries far-reaching implications for every victim and their family members. First, it clearly establishes that there is no obligation to coordinate with the National Insurance Institute before approaching third-party insurance. This is especially important in situations where the injured party requires urgent medical treatment or is under financial pressure.

Second, the ruling highlights the importance of fundamental medical examination by experts. In this case, the rheumatology expert was key to determining the disability for fibromyalgia. At our firm, we always recommend obtaining opinions from additional specialists whenever there is any suspicion of a complex or chronic medical condition.

Third, the ruling addresses the issue of prior disability. It clarifies that even if part of the disability predated the accident, a person can still receive compensation for the part that was caused or aggravated by it. This principle is vital in an era when conditions such as fibromyalgia, depression, and anxiety are becoming more prevalent in the population.

Finally, the ruling highlights the value of professional legal representation. The complexity of disability calculations, the handling of the National Insurance Institute, and the need for medical opinions of significant weight require deep legal expertise. As can be seen from the guides we publish in the guides category, the field of personal injury is laden with technical details that demand extensive practical knowledge.

Frequently Asked Questions

Am I required to exhaust proceedings with the National Insurance Institute before suing a third-party insurer?

No, this is the clear ruling of the court. An injured party may demand full compensation from a third party without needing to exhaust proceedings against the National Insurance Institute first. You are free to choose which path to take. At our firm, we examine with each client all available options and propose the most suitable path for their personal situation, taking into account timing, the complexity of the case, and financial pressures that may arise.

What happens when a disability existed in part before the accident?

When a pre-existing disability was aggravated following the accident, you are entitled to compensation — but only for the part caused by the accident. In our example, out of ten percent fibromyalgia, only five percent were attributed to the accident. It is therefore vital to obtain detailed medical expertise that precisely distinguishes between the condition before and after. At our firm, we work in collaboration with expert physicians who have extensive experience in complex conditions such as these.

What is the difference between medical disability and functional disability?

Medical disability examines the degree of biological or psychological injury based on objective medical tests. Functional disability, by contrast, assesses how the disability affects the person’s day-to-day functioning and work. Sometimes functional disability can be higher than medical disability, especially when the impairment concerns professions requiring special physical capabilities. In our case, both rates were identical — 22.84 percent.

How long does a personal injury lawsuit typically take?

The duration depends mainly on the complexity of the case and the willingness of both parties to cooperate. Simple cases can conclude within six months to a year, but complex cases may extend to a year and a half or more. In this case, the accident occurred in November 2019 and proceedings only began in 2021. Prompt medical treatment and thorough documentation of all records accelerate the proceedings. At our firm, we place emphasis on shortening timelines while doing everything possible to protect the client’s rights in the best way.

How is compensation calculated in personal injury suits?

Compensation is determined through multi-step calculations: disability percentage, plaintiff’s age, income, circumstances of the accident, and more. Standard tables exist for calculating compensation by disability percentage and age. In our example, for a 44-year-old with 22.84 percent disability, the total compensation reached 754,944 shekels. The calculation includes compensation for past and future pain and suffering, impact on earning capacity, and decline in quality of life. At our firm, we use advanced calculation tools and make sure the client receives the full compensation amount due under the law.

Summary

This ruling from the Rishon LeZion Magistrate Court is significant and innovative in the field of personal injury. It clarifies fundamental principles in compensation calculations and the handling of complex cases. The determinations in the ruling — including the injured party’s right to choose their path, the advanced approach to disability calculation in complex conditions, and the explanation of the right to subrogation — all contribute to protecting the rights of road accident victims.

At our firm, we see in this ruling an endorsement of our professional approach to handling personal injury cases. The emphasis on the importance of expert medical opinion, precise causal link analysis, and the principle that the injured party has rights that must be defended proactively — all these have long guided the way we operate.

If you were injured in a road accident and need professional legal advice, it is advisable to contact a law firm specializing in personal injury. Your rights are important, and proper legal representation can significantly change the outcome of your case.

For a free consultation, contact us now — our experts will examine your case and provide personalized advice tailored to your unique circumstances.

The information above does not constitute legal advice. For advice suited to your situation, please contact our firm.