Fibromyalgia and National Insurance: Item 92, Disability Percentages and the Route to a Pension
Since March 2022 fibromyalgia has had an impairment item of its own in the National Insurance list, item 92, with five grades up to 40%. That recognition solved an old problem, but not the hardest one: 40% alone does not qualify for a pension. The route to a pension runs through functional documentation and weighting with other impairments.
“In fibromyalgia the question is not whether the illness exists. The question is whether the file shows what it does to function, because that is what item 92 measures.”
Adv. Yissachar Leibowitz · Head of the Social Security Department
What fibromyalgia is, and why it is hard to prove
Fibromyalgia is a syndrome of chronic widespread pain, usually accompanied by fatigue, sleep disturbance, difficulties with concentration and memory, and sometimes digestive symptoms. It is more common in women and is usually diagnosed during working age.
The evidentiary difficulty lies in the nature of the illness: there is no blood test, imaging or laboratory finding that confirms it. The diagnosis rests on complaints, on the exclusion of other illnesses and on clinical assessment tools. The National Insurance Institute itself notes in its medical bureau circular that the diagnosis is “made primarily on the basis of subjective complaints”.
This is where the difference between a rejected file and an accepted one comes from. Both contain the same diagnosis. Only one of them contains documentation of what the illness does to daily life and to work.
Item 92: the 2022 recognition and what it says
Until 2022 fibromyalgia did not appear in the list of impairments, and committees had to use approximate items. The medical bureau circular of 22 February 2022, in force from 1 March 2022, added item 92 to the list, dedicated to fibromyalgia alone.
The item grades the illness by severity, from remission with no functional impairment to severe clinical signs requiring ongoing medical treatment, in grades reaching up to 40% medical disability. The circular sets three criteria for determining severity: the severity and duration of the clinical signs, the degree of impairment in occupational and social function, and the ongoing medical treatment and its effectiveness.
The circular also refers to accepted assessment tools, including the WPI and SSS questionnaires for diagnosis and the FIQR for severity, and names the relevant professionals: pain clinics, rheumatology, family medicine and, where appropriate, psychiatry and neurology.
A further important rule in the circular: no separate impairment items are to be set for each of the accompanying symptoms of the fibromyalgia itself. Accompanying symptoms that worsen the picture justify a higher grade under item 92, not an additional item.
Why 40% is not enough, and what is
Here lies the gap most patients discover late. Item 92 reaches at most 40%, whereas a general disability pension requires a weighted medical disability of at least 60%, or 40% where there are several impairments and one of them is at least 25%, and in addition a degree of incapacity to earn of 50% or more.
The meaning: someone suffering from fibromyalgia alone, at the highest grade, does not cross the pension threshold on item 92 by itself. The route to a pension runs through weighting with other impairments diagnosed separately: a mental health condition diagnosed by a psychiatrist, a bowel disease, an orthopaedic impairment, a documented sleep disorder, and others. Each is examined under its own item, and the weighting is what decides.
Even someone who does not reach the pension threshold does not leave with nothing: a permanent medical disability of at least 20% opens entitlement to vocational rehabilitation, and the disability percentage may serve in other proceedings.
Building the file: what the committee needs to see
Because item 92 measures function, the file is built around function. Four components recur in files that receive the grade the condition justifies.
- A grounded diagnosis by a rheumatologist or pain clinic, dated, with other illnesses excluded, and preferably with the results of the assessment questionnaires the circular refers to.
- A treatment sequence: medications given and the response to them, physical therapies, regular follow-up. Severe grade under the circular involves ongoing medical treatment, so treatment that was not documented is a grade that will not be recognised.
- Functional documentation: absences from work, reduced hours, occupational physician certificates, and a description of the daily activities affected.
- Accompanying impairments diagnosed separately, each with the documentation of its own field, so that weighting can take place.
A document missing from the file is not completed by the committee. It is simply not counted.
At the committee: what is examined and what is recorded
The general disability medical committee consists of a specialist physician in the field of the impairment and a session secretary, and in fibromyalgia there may be several committees, one for each impairment in its field. Complaints are recorded in the protocol and the claimant signs them. The claimant has the right to an accompanying person and the right to be represented by a lawyer.
In fibromyalgia the protocol carries particular weight, because there is no objective finding to correct it later. A complaint of fatigue not recorded, a description of a working day cut short not stated, a treatment not mentioned: all of these disappear from the file at the objection stage.
Anyone assessed below 80% medical disability may object to a medical appeals committee within 60 days, and on a degree of incapacity not exceeding 74% within 60 days. An objection built from the protocol, according to the criteria of the circular, is an objection that can stand.
The degree of incapacity: the stage that sets the pension
Even once the weighting crosses the 60% threshold, the pension is set by the degree of incapacity to earn, determined by the claims officer in consultation with an authorised physician and a rehabilitation officer. The degrees are 60%, 65%, 74% or 100%, and the full pension stands at ILS 4,711 a month (as of 1 January 2026), compared with ILS 2,718 at the 60% degree.
In fibromyalgia this stage is especially decisive, because the impairment is in persistence: good days and bad days, working hours cut short, concentration affected. Someone who continues to work part time does not lose entitlement; income from work must be below ILS 8,261 a month, and total income from work and pension is always higher than the pension alone.
When to approach, and why not to wait
The pension is paid retroactively for no more than 12 months from the date the claim is filed. Someone who has lived with fibromyalgia for several years before filing loses a month of pension for every further month of waiting, even if the claim is accepted in full.
The right time to approach is before filing, at the stage when the file can still be completed: asking the treating physician for the assessment questionnaires, documenting the treatment, and gathering the occupational documents. A rejected claim is examined next time according to what has changed, so the first filing is the best opportunity.
In summary
In summary, fibromyalgia has been recognised since 1 March 2022 under item 92 of the list of impairments, in grades up to 40%, according to the severity of signs, the degree of functional impairment and ongoing treatment. A general disability pension requires 60% weighted and a degree of incapacity of 50% or more, so the route to a pension runs through functional documentation and weighting with separately diagnosed impairments. The pension is retroactive for up to 12 months, and an objection is filed within 60 days.
The complexity is that the illness itself is subjective, while the committee measures things that were recorded: questionnaires, treatment, absences, accompanying diagnoses. A lawyer who knows the circular and the list of impairments knows which documents turn a complaint into a measure, and which accompanying impairments need a separate diagnosis to enter the weighting.
If you have been diagnosed with fibromyalgia and are considering a claim, or the committee has set a percentage that does not reflect your condition, contact us with the medical documents and we will tell you frankly what is missing from the file and what the chances are of crossing the threshold.
What comes up most about fibromyalgia
Is fibromyalgia recognised by National Insurance?
Yes. Since 1 March 2022 it has had its own impairment item, item 92, under the medical bureau circular. The item grades the illness by severity and function, in grades reaching up to 40% medical disability.
How many disability percentages does fibromyalgia receive?
Item 92 ranges from remission with no functional impairment to 40% for severe clinical signs with ongoing medical treatment. The grade is set according to the severity of the signs, the degree of occupational and social impairment, and ongoing treatment.
Can I receive a pension for fibromyalgia alone?
Item 92 reaches at most 40%, whereas the pension requires 60% weighted (or 40% with an impairment of 25%) and a degree of incapacity of 50% or more. In practice, therefore, the pension rests on weighting with additional separately diagnosed impairments, and on functional documentation.
Which physician needs to make the diagnosis?
The circular refers to pain clinics, rheumatology and family medicine and, where appropriate, psychiatry and neurology. The WPI, SSS and FIQR questionnaires are used for diagnosis and severity assessment, and it is worth asking for them to be documented in the file.
I work part time. Does that disqualify me?
No. The income condition is income from work below ILS 8,261 a month (as of 1 January 2026). A pension recipient may continue to work, and total income from work and pension is always higher than the pension alone.
The committee set only 10%. What now?
Object to a medical appeals committee within 60 days, on the basis of the protocol and the criteria of the circular: what was not recorded, which treatment was not considered, and which functional documentation was not placed before it. An objection that attaches assessment questionnaires and occupational documentation is an objection that can stand.
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Send us the diagnosis and the medical documents. We will check the file against the criteria of item 92, tell you what is missing, and what the chances are of crossing the pension threshold.