Spoiler: the judge didn't like the insurance company's exercise and she also had a convincing reason.
Last year, two years after he was seriously injured in a car accident and his benefits were stopped due to a loss of working capacity, he was surprised to receive a message from the Manora insurance company: the company is stopping paying him benefits, and this is because medical experts on its behalf have determined that his condition has improved, and that he can return Engage in any reasonable occupation, even in his previous occupation, full-time.
In his frustration, S turned to attorney Rafael Almog from the Almog-Shapira law firm, who filed a lawsuit on his behalf with the Tel Aviv Magistrate's Court against the Manora company
. As this term is defined in the policy.
Subsequently, the insurance company submitted a request to the court to amend the statement of defense, for the purpose of adding a new claim, according to which S. has no cause of action at all, since the accident in which he was involved was caused, directly or indirectly, by the fact that he was under the influence of cannabis and alcohol.
According to 'Manora' this information was revealed to her, only after reviewing the opinion of a medical expert in the mental field, appointed by the court in the parallel lawsuit that the plaintiff is conducting against the compulsory insurer in order to receive compensation for his damages as a result of the accident.
Attorney Almog opposed the request of 'Manora', Arguing that the requested amendment amounts to what is known in the legal language as 'expansion of an illegal and prohibited front', and is an attempt to assign improvements, based on a false and dishonest claim.
However, Tel Aviv Magistrate's Court Judge Yuval Gazit accepted the request of the Menora company, and authorized it to submit an amended statement of defense.
Judge Gazit stated in his decision, that the insurance company discovered the significant detail, regarding drunkenness or drug use, only upon receiving the medical opinion, and after submitting its defense statement.
According to the judge, he finds it appropriate to grant the request, given the date of discovery and since it is a substantial defense claim.
Against this decision, Attorney Rafael Almog submitted a request for permission to appeal to the District Court in Tel Aviv. This is on the grounds that it is an issue that is not relevant at all, and which was raised by the insurance company unnecessarily, while cynically exploiting the legal proceedings. All this, according to him, in order to exhaust the the plaintiff while spoiling the valuable time of the court.
According to Attorney Almog, the incorrect and denied information regarding the presence of THC in the plaintiff's urine near the time of the accident was in the hands of the insurance company as early as 2020, as can be seen in the summary of the hospitalization from the 'Soruka' hospital, which was forwarded to it more than two years ago.
Despite this, the insurance company approved the claim and paid him benefits for about two years.
Therefore, there is no connection between the denied and incorrect findings and the occurrence of the insurance case and the fact that the applicant has lost his ability to work.
The insurance company took advantage of S's appeal against the cessation of payments to assert a claim it did not make two years ago/ShutterStock
Attorney Rafael Almog/Golan Kerio
Judge Hadva Weinbaum Weltsky of the District Court in Tel Aviv, who heard the appeal, stated in her decision that when an insurance company rejects a plaintiff's claim, it must list all the reasons for the rejection at the first opportunity it has.
If she did not do so, the judge ruled, she cannot do so at a later date.
The judge qualified her words and stated that the insurance company may raise additional reasons only when it is about facts or circumstances that arose after that date, or if it was unable to know about them.
According to Judge Weinbaum Walecki, in this case, the insurance company did not claim that the plaintiff hid information from her, or prevented her from receiving it.
Judge Weinbaum Valtsky also stated that she does not accept the insurance company's claim, according to which she learned about the new defense claim only after the medical expert's opinion was presented for review.
According to her, with reasonable diligence, the insurance company could have collected all the medical documentation in the plaintiff's case, through the use of a confidentiality waiver, which he signed before the start of the legal process, and certainly after it as well, and before submitting its statement of defense.
In light of all this, the Honorable Judge Weinbaum Weltzky ruled that she does not allow the insurance company to add to the reasons for the rejection.
The judge also criticized the decision of the Magistrate's Court, stating that it has the potential to cause a miscarriage of justice for the plaintiff.
The lawsuit will now continue to be conducted in the Magistrate's Court in Tel Aviv.
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