Diabetes and disability percentages –
the jump from 20% to 65%

Unlike cancer, diabetes has a section of its own with a detailed table — Section 4. And that changes everything: it is a clear scale, on which you can know in advance where you stand and what moves you from one rung to the next.

Two points on that scale deserve all your attention: the 20% rung, which is exactly the threshold for a monthly allowance, and the jump to 65% the moment a significant complication appears in one of the target organs.

Section 4 — the full table

Two definitions the Regulations take the trouble to spell out

The second definition matters especially, because it makes item (ה) measurable: not “I feel my sugar dropping” but two documented events within two years, each of which required the help of an external party — a glucose injection, an infusion or hospitalisation. Without that documentation, the item is not met.

The note that changes the picture

At the end of Section 4 sits a short line that is probably the single biggest source of disappointment in this field:

Many people come to the committee assuming the percentages accumulate: 20% for the diabetes, plus more for the retinopathy, plus more for the neuropathy, plus more for the kidneys.

That is not how it works. The complications in the target organs are already built into the 65% and 100% rungs. They are what jumps you to those rungs — not an addition on top of them. Only an impairment in a target organ whose severity exceeds 50% is determined separately.

Why 20% is the critical rung

Item (ג) — diabetes treated with insulin — sets exactly 20%. And in practical terms that is not an arbitrary number:

• In work-injury disability, a rating from 9% up to below 20% entitles you to a one-off grant
• A rating of 20% or more entitles you to a monthly allowance

In other words, the move from oral treatment (10%) to insulin treatment (20%) is exactly the move from “no allowance” to “an allowance”. Which is why precise documentation of the form of treatment and the date of the change to it is critical — more so than documentation of blood sugar levels.

Source: Section 4 of the Schedule of Impairments, in the wording replaced by the 5774 amendment (in force from 1.12.2014), in the Appendix to the National Insurance Regulations (Determination of Degree of Disability for Work Injuries), 5716–1956, as it appears in the National Insurance Institute’s Disability Tests book. The full Disability Tests book (Hebrew). The quotations are reproduced for information only. The actual determination is made by the medical committee alone, and the Regulations are updated from time to time. The Regulations are enacted in Hebrew and the Hebrew text is the only binding version; the English here is our working translation, and section numbers and percentages are given exactly as they appear in the original.

What the committee checks

Unlike back pain, where range of motion is measured in the room, here almost everything rests on the file:

• The form of treatment — oral, GLP-1 analogue, insulin, the number of injections a day, a pump. This is the central measure at rungs (א)–(ד).
• Stability — whether there are documented events of severe hypoglycaemia, acidosis or hospitalisation.
• The target organs — eye examinations, kidney function and urine protein testing, neurological examination, scans or vascular testing.

What your file should contain

• Prescriptions over time — they prove the form of treatment and when it changed
• Diabetes clinic or endocrinologist summaries
• HbA1c values over a period, not a single test
• Documentation of hypoglycaemic events — ambulance report, ER summary or hospitalisation. An event that was not documented does not exist for the purposes of item (ה)
• An up-to-date eye examination with the retinopathy grade — this is often the complication that decides whether you enter the 65% rung
• Urine protein testing and kidney function tests
• A neurological examination or EMG if neuropathy is suspected
• If you use a pump — confirmation of that and the date you started using it

With diabetes, the difference between one rung and the next is almost never a question of how hard it is. It is a question of what is documented — and at what resolution.

How we help

At Yad Otefet we help you get ready for the committee: working out which sections are relevant to your condition as it is documented today, finding the gap between the symptoms and what the file actually says, and helping you prepare the documents. We do not appear before committees in your place and we do not give medical or legal advice — the determination is the committee’s alone.