Medical Malpractice in Health Funds

A medical malpractice claim may be filed against a health fund when negligent care by one of its physicians or agents - for example a late diagnosis, a failure to refer for tests, or deficient follow-up - caused harm. The health fund bears responsibility for the acts of the physicians and teams operating on its behalf, which is why in most cases the claim is filed against the fund itself. Eligibility depends on the circumstances of each case.

Most of the public's encounters with the healthcare system do not take place in hospitals but in the community: at the family doctor, in specialist clinics, and in the institutes and laboratories of the health funds. Accordingly, a substantial share of diagnostic and treatment failures occurs precisely there - in routine care, gradually, and sometimes without anyone noticing in real time.

This page explains when conduct at a health fund amounts to medical malpractice, who the correct defendant is, how to obtain the medical file, and what is important to know before approaching a lawyer.

Suspect the fund was negligent in treating you or your loved ones? An initial consultation at no cost and with no obligation: 077-4075002 | also available on WhatsApp

When Is a Health Fund Liable for Medical Malpractice?

The health fund is responsible for the care provided within its framework - by its physicians, its nurses, and the institutes and laboratories acting on its behalf. The legal test is the same as in any negligence claim: did the treating party act as a reasonable practitioner would have acted, and did the deviation from the standard cause harm. What is distinctive about claims against funds is the nature of the failures - they relate less to a single dramatic event and more to a chain: a complaint that was not investigated, a test that was not ordered, a result that was never reviewed.

Typical Cases of Negligence in Community Care

• Late or incorrect diagnosis - repeated complaints that were not investigated until the disease was discovered at an advanced stage, including in the diagnosis of serious illness
• Failure to refer for tests or to a specialist - despite symptoms, risk factors, or suspicious findings
• Abnormal test results that were not acted upon - a result that was not conveyed to the patient, not documented, or not translated into further investigation
• Failures in drug treatment - an incorrect prescription, an incorrect dose, disregard of sensitivities or of dangerous combinations
• Negligence in pregnancy monitoring - which is conducted mostly in the community, in clinics and institutes on behalf of the fund
• Failures in institutes and laboratories - imaging or laboratory tests performed or interpreted deficiently

Whom Do You Sue - the Doctor or the Fund?

As a rule, the claim is filed against the health fund, which bears responsibility for care provided on its behalf - including by independent physicians contractually linked to it. The meaning for the patient is simple: there is no need to conduct a fight against the treating physician personally, and the defendant is an institutional body with the capacity to pay compensation. Identifying the precise defendant - the fund, an external institute, or several parties together - is part of the initial legal review.

How Does a Claim Against a Fund Differ From One Against a Hospital?

• The nature of the failure - in a hospital the failure is usually discrete (surgery, childbirth, hospitalisation); at a fund it is usually ongoing and cumulative, which requires reconstructing a long timeline of visits and decisions
• The documentation - the community medical file is scattered among the family doctor, specialists, institutes, and laboratories; collecting and consolidating it is a critical part of the claim
• The question of discovery - in ongoing diagnostic failures, the date the harm was discovered affects the limitation period - an issue examined case by case

How Do You Obtain the Medical File From the Fund?

Every patient has a legal right to receive a copy of their medical records, in accordance with the Patient's Rights Law, and health funds are obliged to provide them. In practice, the relevant file includes the family doctor's records, summaries of specialist visits, laboratory and imaging results, prescriptions, and referrals. As part of handling the case, our office consolidates the full documentation from all sources - so that the complete picture is placed before the medical expert.

How Is the Claim Proven?

1. Collecting the full records from the fund and from related parties
2. Building a timeline - visits, complaints, tests, and decisions, against what was accepted practice at each juncture
3. An expert opinion in the relevant field - family medicine, oncology, obstetrics and gynaecology, as applicable
4. Quantifying the harm - the deterioration caused by the delay or the failure, as distinct from the unavoidable course of the disease
5. Filing the claim and conducting it against the fund and its insurers

Will a Claim Harm the Service I Receive?

This is a common concern - and the answer is no. The right to be treated at the fund is not conditional on waiving legal rights, and the claim is conducted against the fund's legal and insurance departments, not against the treating team. There is nothing preventing you from continuing to receive the full range of services during the proceedings.

Compensation and Limitation Periods

Compensation derives from the harm actually caused and may include medical expenses, loss of earnings, assistance and nursing care, and pain and suffering. As a rule, a claim becomes time-barred after seven years; however, in ongoing diagnostic failures the date the harm was discovered is decisive in the calculation, and for injured minors the period generally begins at age 18. Do not rely on your own calculation - contact us to have the deadlines in your case checked.

The Experience of Ron-Festinger Law Office in Claims Against Health Funds

Ron-Festinger has represented patients in medical malpractice claims for more than 44 years, including in claims against all of Israel's health funds - in diagnostic failures, in pregnancy monitoring, and in community care. The initial review is free of charge, and fees are collected only if the claim succeeds.

Examples of Malpractice Claims Against Health Funds Handled by Our Office

A man approached a family doctor complaining of chest pain. The doctor discharged him home with a prescription for paracetamol and without an ECG, after mistakenly diagnosing the pain as chest-wall muscular pain. Within two days the man suffered a severe heart attack that caused him irreversible brain damage, leaving him in a vegetative state. Relying on a medical expert opinion we attached to the claim, the court held that the doctor had a duty to perform an ECG, and that failing to do so - a test that would have revealed the onset of a heart attack - was negligent and caused the harm. The District Court held the health fund liable for only half of the damages, finding that the patient too had been negligent because, despite the worsening pain after his discharge, he did not go to the emergency room. We appealed that finding to the Supreme Court, which reversed the District Court's decision and held that the fund must bear the full harm. A person who consults a doctor and hears their diagnosis is entitled to rely on it and need not suspect that the doctor was negligent. The compensation awarded to the patient and his family amounts, in today's values, to millions of shekels.

A further example: a pregnant woman approached a family doctor complaining of a swelling/lump in her breast. The doctor dismissed the complaint, saying it was a thickening of the milk ducts related to the pregnancy. Only after she gave birth and the swelling did not subside was it discovered that this was a cancerous tumour, found at a fairly advanced stage, from which, sadly, the woman died. Adopting the opinions of a family physician and an oncologist that we presented, the court held that the family doctor had been negligent in failing to refer the woman to a surgeon or oncologist, who would have diagnosed the cancerous tumour and treated her immediately, thereby preventing her death. The widower and his children received compensation of millions of shekels.

To arrange an initial consultation at no cost and with no obligation: 077-4075002 | also available on WhatsApp

Frequently Asked Questions

Can you sue a health fund for medical malpractice?

Yes. The health fund is responsible for care provided by the physicians, nurses, institutes, and laboratories acting on its behalf. Where negligent care within its framework caused harm - a late diagnosis, a failure to refer for tests, deficient follow-up - a compensation claim may be filed against it, subject to the circumstances of the case.

The doctor who treated me is independent - whom do I sue?

In most cases the fund can be sued even where the care was provided by an independent physician to whom it refers patients and who is contractually linked to it, and sometimes several parties are sued together. Identifying the correct defendant is part of the legal review - and should not trouble you at the stage of getting in touch.

How do I obtain the medical file from the fund?

Every patient has a legal right to receive a copy of their records, and the fund is obliged to provide them. You may apply through the fund's website or a branch, and as part of handling the case we consolidate the full documentation - including from institutes and laboratories - on your behalf.

Will the claim harm the service I receive at the fund?

No. The claim is conducted against the fund's legal and insurance departments and not against the treating team, and your right to the full range of services is not conditional on waiving legal rights. You may continue to be treated at the fund as usual during the proceedings.

How long do I have to file a claim against a health fund?

As a rule seven years, but in ongoing diagnostic failures the date the harm was discovered affects when the period begins, and for minors it generally begins at age 18. Because calculating deadlines in ongoing failures is complex, it is advisable to seek a legal review as soon as possible.

What is the difference between a complaint to the Ombudsman and a claim?

A complaint to the Ministry of Health's Ombudsman is a public investigative process that does not award monetary compensation. A negligence claim is a legal proceeding intended to compensate for the harm. The two tracks are not mutually exclusive, and choosing the right one is part of the initial consultation.

Get in Touch

If you suspect that a late diagnosis or deficient treatment at your fund caused you harm - do not live with the doubt. Contact us for an initial consultation at no cost: 077-4075002 | WhatsApp | or leave your details on the form | Offices in Jerusalem and Tel Aviv. No Win No Fee.

The content of this page is general information only, does not constitute legal advice, and is not a substitute for individual legal advice. Each case is examined on its own circumstances. For a professional assessment of your case, contact us for an initial consultation at no cost and with no obligation.