The Central District Court earlier this week partially upheld a claim and a request for approval Class action Filed in 2016 against Clal Insurance and its interest in claiming that as part of a group long-term care insurance policy it sold, Clal Insurance undertook to give insureds in the group policy who would join the private policy a discount and did not do so.
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The decision states that Clal Insurance insured the members of the Maccabi Health Services HMO with a policy Group long-term care insuranceA, offered for purchase to Maccabi members. The lawsuit concerns private long-term care insurance purchased by Maccabi members from Clal Insurance in order to supplement / expand long-term care coverage given to them under the group policy. The main claim of the plaintiff represented by attorneys Shlomi Moshkovitz, Yaniv Stis and Alina Mill David, is that as part of the group policy, Clal Insurance undertook to give Maccabi members who join the private policy a 20% discount on the premium, and that it did not.
Clal House in Tel Aviv Photo: Uriel Cohen
The decision states that in July 2008, Clal Insurance was selected by Maccabi to insure the members of the HMO in a program called “Maccabi Nursing” in a group long-term care insurance policy. The Maccabi Nursing Group policy came into effect in July 2008 and was renewed from time to time until the end of June 2017. From July 2017, Maccabi members in the group policy insure another insurance company selected as the winner of the Maccabi Nursing tender.
The plaintiff claimed that in the section of the group policy, Clal Insurance undertook to grant Maccabi members with a group policy from whom they would purchase the individual policy a discount of 20% of the insurance premiums of this policy. The group damage to the entire represented group was estimated by the plaintiff in the total amount of NIS 52 million.
On the other hand, Clal Insurance claimed that the discount promised was intended only for those who purchased the policy directly from Clal Insurance and not through insurance agents. It is further contended that the applicant has purchased his individual policies through an insurance agent and is therefore not entitled to a discount. The court did not accept this contention and Judge Ezekiel Keener ruled that there is no indication anywhere else in the policy that the discount in insurance premiums on the purchase of individual policies is limited to direct purchase only.
It was determined that “although, as Clal Insurance claimed, the policy was formulated by Maccabi, and was part of the tender documents, but since this is a significant discount granted to the insured, and as long as the discount is not economically viable for Clal Insurance, it is clear that they had different choices: To refer a question of clarification before the tender, or to draw Maccabi’s attention to it after the respondent won the tender … Clal Insurance’s choice not to act as aforesaid indicates that it agreed to the wording and its consequent obligation. ”
The court ruled that the individual policies that qualify for the discount are only policies for which the period of entitlement to compensation is for life. The plaintiff’s request to approve the claim as a class action also in respect of the entire group of insured persons who hold a private nursing policy in which the period of entitlement to compensation is not for the entire life of the insured – was denied.
Clal Insurance has not yet responded.