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Employability qualification. Determining the degree of disability. Compensation and payments for injuries at work Types of material benefits for disability

01.03.2021

Temporary disability benefits very often allow Russian families to keep their families afloat. financial condition, especially if the situation has developed in such a way that one or more family members, due to certain circumstances, are not able to support their family. This is a very delicate issue in Russian legislation, the solution of which depends on the correct combination of many factors and nuances.

Who is eligible for disability benefits

In our country, the following categories of citizens have the right to receive financial support for temporary disability:

  • Former military personnel who left the location of the armed forces of the Russian Federation upon the onset of an incapacitated state, but on the condition that their application for benefits will be no later than 30 calendar days from the date of dismissal.
  • Russian citizens, citizens of foreign states, citizens with dual citizenship and stateless persons (stateless persons) who officially work at enterprises, organizations and commercial structures in Russia; while the form of ownership is not important, the enterprise can be both public and private.
  • Those citizens who officially have the status of unemployed and are registered with regional, federal and local employment agencies.
  • Those citizens who have received limited working capacity no later than 30 days from the date of dismissal from permanent work for good reasons.

Who regulates the rights of working citizens to benefits

In fact, all working citizens of our country are entitled to temporary disability benefits. FSS regulates this with the help of legal documents.

The structure of Russian social protection is built in such a way that benefits are the main tool for helping socially unprotected categories of citizens. The most common instrument of financial support is temporary disability benefits. The definition of this phenomenon can be found in the legislative framework.

A special place in the hierarchy of social protection of the population is occupied by benefits for temporary disability. It is worth noting that very often financial assistance from the state for disability is identified with disability benefits. This is not entirely true, since temporary disability benefits are granted only in cases where the process of health deterioration is reversible.

That is, if a citizen is seriously ill, and as a result of his illness, his ability to work has been completely or partially reduced, then he can count on financial support from the social security authorities, but on the condition that the disease can be completely cured.

Types of financial benefits for disability

Types of temporary disability benefits directly depend on the definition of insured events. To receive temporary disability benefits, the following insured events are determined at the legislative level:

1. General improvement of the body in resorts and sanatoriums.

Benefits for this insured event are allocated on the condition that the vacation is not enough to visit a sanatorium in order to improve the general state of health. Periodically, situations arise when an employee has already used vacation, but over time he needed treatment. Then the voucher indicates the period that the employee was on treatment. It is worth noting that for unused days, according to the permit, benefits are not charged.

2. Quarantine.

Temporary disability benefit for this insurance type is accrued if the health service authorities remove the employee from fulfilling his labor obligations if someone from his family is ill with an infectious disease. The incubation period and sick leave are determined by epidemiologists.

3. Diseases or injuries resulting in disability.

When calculating benefits for this type of insured event, differentiated rules are applied, which depend on the type: domestic injury, work injury, general disease or occupational disease. At the same time, in case of a work injury or an occupational disease, the benefit is accrued from the moment the disease occurs until the restoration of working activity, or the establishment of disability otherwise. The state guarantees the accrual of temporary disability benefits as soon as possible.

Such situations are allowed when disability manifests itself on vacation. In such cases, the employee must receive a sick leave, and his leave will be extended by the total number of days of incapacity for work. If a person was on vacation without pay, or he continued to get sick at the time of going to work, then the accrual and subsequent payment of disability benefits occurs from the moment he had to start implementing the terms of his employment contract.

If this case coincides with a period of production downtime, then the amount of the benefit corresponds to the full salary, so the enterprise will repay part of the benefit with its own money. If the employee's incapacity for work continues after the resumption of production activities, then he, on the basis of the general rules and principles of accrual, will receive temporary disability benefits. An example of this is manifested in occupational diseases at enterprises of an increased hazard class (chemical, radiation, etc.).

Involuntary termination of pregnancy benefits are awarded only for the first 3 days of incapacity for work, and from the 4th day of this period, financial assistance will continue to be paid only if the operation was involuntarily performed for medical reasons or as a result of spontaneous abortion. If the disability continues, then the payment of benefits resumes from the 11th day. Accounting for temporary disability benefits in this case is determined by the FSS.

For certain categories of citizens, the Russian legal framework establishes limited terms for providing disability benefits. For example, temporary and seasonal workers can receive disability benefits for a period of 75 calendar days, but provided that this period was not interrupted without good reason.

Working invalids (in particular, invalids of the Second World War and victims of the explosion at the Chernobyl nuclear power plant) have every right to receive a certain amount of benefits, but not more than for 4 consecutive months. Such restrictions are not introduced if the cause of the incapacity for work is determined to be a labor injury or an occupational disease. Previously, a similar restriction also existed for persons who do not have official work, in the amount of 30 calendar days, but as of today, this restriction has been canceled.

4. Transfer to another place of work due to an occupational disease or tuberculosis.

Legislation allows situations in which a sick worker is disabled in his professional activities, but at the same time he can perform other duties. In such cases, he can be transferred to another place of work, if the salary level is lower, then he will receive benefits. The company has a so-called additional pay sheet, according to which the salary will be paid.

The allowance is calculated on a general basis, but at the same time, its totality with the new salary should not exceed the earnings from the previous job. It is worth noting that for various occupational diseases there are different rules for calculating this allowance. You can find out more about this in the Law On Compulsory Insurance against National Accidents at Work and Occupational Diseases.

5. Financial payments for the care of a family member who, due to illness, has lost the ability to serve himself.

If an employee has a child who needs care, then one of the parents has the right to be in the hospital during the entire period of treatment. In this example, he will receive a sick leave certificate.

If other family members require care, then the following conditions must be met for the grant to be granted:

  • there are no other relatives in the family who are able to provide care;
  • lack of care poses a danger to the general health and life of the patient;
  • if the patient cannot be admitted to the hospital.

6. Prosthetics.

Temporary disability benefits for this insured event are paid only in the situation when the process of prosthetics is carried out in the conditions of inpatient treatment. This allowance is paid for the entire period of time that a person spent in a hospital.

A package of documents that confirms the onset of temporary disability and the amount of benefits

The main reason for receiving partial disability benefits is a temporary disability certificate or a similar certificate of the established form, which is issued in some cases.

A temporary disability sheet is issued to all working citizens, the unemployed who have been registered with the employment authorities, persons who have lost their ability to work within a period of not more than 30 days from the date of dismissal from their previous job for good reasons, as well as former military personnel who were dismissed in reserve within 30 calendar days from the term of dismissal.

Sheets of temporary disability are issued by doctors of medical institutions of any form of ownership, in particular state, private and municipal. However, a license is required for an expert assessment of disability. Those medical professionals who practice private practice may acquire the right to issue sick leave after advanced training.

How to get sick leave

To obtain a sick leave, you must present an identity document (passport, military ID). The attending physician for general rules may issue a sick leave certificate personally if the incapacity for work lasts up to 30 days, while he has the right to issue a sick leave certificate for no more than 10 days.

In fact, during the 1st full calendar month, the doctor will issue 3 sick leaves. If the disability lasts more than 30 days, then the issue of temporary disability is decided by an expert commission on the basis of a medical institution. The procedure for issuing sheets must comply with the canons of the legislation of the Russian Federation, and for its violation, doctors may incur both disciplinary and criminal liability. In fact, everything is decided by the law. The temporary disability benefit must have a legal basis, otherwise the doctor may lose his license.

Accrual of material assistance in the USSR

For a long time, the amount of benefits for sick leave and the procedure for issuing them were calculated on the basis of rules approved by the Council of Ministers of the USSR. In accordance with this set of rules, the amount of benefits was determined on the basis of continuous work experience. In the resolution of 04/13/1973, the Rules for accruing uninterrupted length of service for workers when assigning state insurance benefits, it is indicated that continuous work experience is the duration of the last continuous work at a particular enterprise, subject to all the conditions established by law.

Such a definition is contrary to the constitution of the Russian Federation, which gives the right to its citizens to use and use their labor force in a free manner. Therefore, the calculation of temporary disability benefits in some cases may occur without taking into account the total length of service, but in those cases that are provided by law.

The frequency of interruption of seniority in accordance with Soviet legal norms

However, the interruption of labor activity was recorded in a documented form, taking into account the frequency. To date, there are the following clear types of periods that can interrupt the overall work activity:

  • Periods of time that do not count towards seniority, however, do not violate it. An example is higher education educational institutions, postgraduate and vocational schools.
  • The period of residence of family members of military personnel who serve on a contract basis is far from the main place of work. In this case, the rules are differentiated into two parts: military service until 1992, regardless of the location, and starting from the same year, depending on the location of the military unit, provided that the family members of the serviceman did not have the opportunity to find a job in their specialty and received official status of unemployed.
  • Periods that are counted towards the total length of service (military service).
  • The period of maternity leave until the child reaches 3 years of age.
  • The period from the moment of dismissal of a woman in demolition or a woman with a young child who is under 3 years old. According to the law, they cannot be dismissed from their positions at the initiative of administrative employees. Dismissal can only occur independently or in the event of liquidation of the enterprise.
  • When terminating an employment contract by women who have children under 14 years of age.
  • Upon voluntary dismissal from their positions of pregnant women and women who have a child with a disability or an HIV-infected child under 18 years of age.

If an employee wants to change his place of work, then the generalized rule for maintaining continuous experience applies. The length of service is considered continuous if the break in work activity was no more than 30 days from the date of termination of the employment contract. However, there are some reasons why the allowable break can be up to 1 year.

At the same time, there was the following relationship between the length of service and the amount of temporary disability benefits. The allowance was assigned accordingly in the amount of the full average salary (100%), but on the condition that the total work experience was not less than 8 years. If the length of service was from 5 to 8 years, then the amount of the allowance was 80% of the average annual earnings, if less than 5 years, then 60%.

At the same time, it should be noted that some categories of citizens claimed 100% replacement of benefits in relation to wages, excluding seniority. These included citizens affected by Chernobyl disaster, workers of the Far North, disabled veterans of the Great Patriotic War who have not stopped working, citizens who live in resettlement zones, workers exempted from fulfilling labor obligations due to the need to care for children under 14, as well as members of large families.

Similar rules for calculating disability benefits were maintained until 2004, when some changes were made to the legislative system of Russia. However, this change in the principles of accrual was insignificant, all the same, most of the rules were guided precisely by the Soviet version. Since that time, every year some changes are made to the legislative base, which must be independently monitored.

So, for example, now when calculating a hospital allowance, it is not the average annual salary that is taken into account, but earnings for 2 calendar years, and only the length of service that was accompanied by mandatory insurance payments to the FSS is taken into account. But still, the main document, according to which disability benefits are now calculated, was the Order of the Ministry of Health and Social Development of the Russian Federation No. 21n of 01/24/2011. It is impractical to consider the changes for each year, especially since the main stages are a copy of the Soviet past. Therefore, we will consider how the calculation of material assistance is carried out, and what determines the amount of temporary disability benefits.

The procedure for calculating disability benefits (sick leave) in 2014

According to the current regulatory legal acts (Article 14 of the Law of the Russian Federation No. 255-F3 of December 29, 2006 and Decree of the Government of the Russian Federation No. 375 of July 15, 2007), in 2014 the hospital material allowance is calculated with some changes to the 2013 base.

Regardless of the reason for the employee's incapacity for work (occupational disease, injury, pregnancy and maternity leave, caring for a child or another family member), the same procedure for calculating benefits is applied. Our state guarantees the provision of temporary disability benefits to all those in need. In order to calculate it in accordance with the recommendations of the legislative system, it is necessary to take into account the following points:

  1. the period for which the employee will receive sick leave;
  2. income of a person for a specific period;
  3. the maximum amount of benefits established by law;
  4. the average salary of a person for a full-time job;
  5. percentage of average full-time earnings, which will be taken into account when calculating benefits;
  6. final amount of sick leave.

It is worth noting that, starting from 2004, the maximum limit for the amount of temporary disability benefits has been set. Federal Law No. 255 regulates this issue. Also, some other factors (hazardous production, work in the Far North, etc.) may affect the amount of the benefit.

Time period for calculating sickness benefits

When calculating the amount of benefits, the time period during which the employee could not fulfill his labor obligations for one reason or another, but provided that it relates to the loss of working condition, is taken into account. AT this case There are 2 main divisions to consider when calculating benefits.

1. You can calculate the temporary disability benefit based on the employee's average earnings for 2 working years (730 calendar days), while no time periods (sickness, extra day off, business trip, vacation, etc.) are taken into account.

2. A completely different situation becomes clear when calculating disability benefits during pregnancy, maternity leave or caring for a sick child (another family member). It also takes into account the average earnings for 730 calendar days, however, it is necessary to take into account the actual number of days in a year. So, for example, in leap year it is necessary to take into account 366 days, and not 365, as in other years. In addition, according to the explanations of the legislative framework, when determining the amount of the hospital benefit, it is necessary to exclude certain time intervals from the general calculation, in particular:

  • period of illness (if the illness is not occupational);
  • recovery of the body from the consequences of an injury (if the injury was not received in the performance of work duties);
  • additional maternity leave;
  • the period of care for a young child;
  • those periods of time during which the employee was released from her job duties, but at the same time the earnings were retained in full or in part, provided that the FSS insurance premiums were not accrued on it, in all cases the payment of temporary disability benefits will be made in in accordance with the wishes of the legal documents governing this issue.

Calculation of benefits taking into account the length of service and the causes of disability

In order to calculate the amount of the disability benefit as correctly as possible, it is necessary to take into account 2 main factors: the cause of disability and the total insurance period of the employee. In fact, the determination of the amount of benefits in 2014 is similar to the Soviet era, but with some changes.

So, for example, in the USSR they took into account the total length of service, but now they take into account the period of time that was accompanied by mandatory insurance payments to the FSS, in addition, some causes of disability have lost their original meaning. Let us consider in more detail the influence of the insurance period and the causes of disability on the total amount of benefits.

  • Any worker who becomes disabled due to illness, injury, quarantine or prosthetics (except for cases of injury or illness in connection with professional activity), but at the same time has a total insurance period exceeding 8 years, will receive a benefit at the rate of full (100%) average earnings for 730 days (Law No. 255-F3).
  • With an insurance period of 5 to 8 years, the employee is entitled to receive benefits in the amount of 80% of the average daily earnings for the past 730 working days for each day of sick leave.
  • Less than 5 years of insurance certificate will be paid at the rate of 60% of earnings for 2 full years of work, provided that the employee has not changed jobs more than 1 time. In this case, the calculation of temporary disability benefits will be carried out within 3 days.
  • If the employee has lost his labor skills due to his professional activity (injury at work, occupational disease), then the allowance will be accrued to him in the amount of 100% of the amount of the average daily earnings for 730 days for each day of sick leave. In this case, the insurance experience will not be taken into account at all.
  • If an employee resigns from his position, but within 30 days has partially lost the opportunity to realize his labor skills, then he is entitled to a benefit in the amount of 60% of the amount of his average earnings from his previous job for 2 calendar years. Insurance experience will not be considered. However, there is one exception. A person who suffered as a result of the Chernobyl accident will receive a full (100%) material benefit for temporary disability. The length of the insurance certificate will also not be taken into account.

The amount of the disability benefit due to the care of a child or other family member

When determining the amount of benefits for people who lose the opportunity to work due to caring for a sick family member, the length of service is also taken into account, and in addition, how the sick family member is being treated (inpatient or at home).

1. The amount of the allowance for caring for a child who has not reached the age of 14, provided that he is being treated at home, but under the supervision of a doctor:

  • If you have a total insurance period of more than 8 years, the amount of the benefit will correspond to 100% of the average earnings for 730 days (but only during the first 10 days, then the benefit will be accrued in half the amount (50%). At the same time, temporary disability benefits are paid in within 5 calendar days.
  • If you have at least 5 full years of service and no more than 8 years of service, supported by regular insurance payments to the Social Insurance Fund, the amount of the benefit will be 80% of the average income for 2 years in the first 10 days, starting from the 11th day, the benefit will be accrued in the amount of half the average earnings.
  • with a total insurance period of less than 5 years, the amount of the benefit will be 60% of the average two-year earnings in the first 10 days, then half (50%) of the employee's earnings for 1 working day will be accrued for each day.

2. The amount of temporary disability benefits for caring for a child under 14 years old if he is being treated in an inpatient hospital setting:

  • If the experience exceeds 8 years, then the allowance will be accrued in full of the average two-year earnings for the entire period of the child's stay in the hospital.
  • If the length of service is from 5 to 8 years, then the amount of the allowance will be 80% of the average salary for 2 years of work.
  • If the insurance period is less than 5 years, then the amount of the benefit will be equal to 60% of the employee's average income for 730 calendar days.

When caring for an adult family member, the amount of the benefit will be 100% (if the insurance period is more than 8 years), 80% (if the insurance period is from 5 to 8 years), 60% (if the insurance period is less than 5 years). This does not take into account exactly how the patient is being treated, at home under the supervision of doctors or in a hospital.

Payment for temporary disability benefits is carried out to a bank account or in person through the cash desk of the enterprise or institution in which the person works.

Labor legislation obliges the employer to provide safe working conditions. Article 212 of the Labor Code provides for the certification of workplaces, which is carried out in order to assess working conditions at workplaces and identify harmful and dangerous production factors. The results of certification provide an opportunity to develop and implement measures to bring working conditions in line with state regulatory requirements for labor protection. The procedure for attestation of workplaces is set out in the Order of the Ministry of Health and Social Development of the Russian Federation dated April 26, 2011 No. 342n “On approval of the Procedure for attestation of workplaces in terms of working conditions”.

But, unfortunately, jobs do not always meet the requirements of the law. In addition, the employee may be injured as a result of subjective causes. For example, fatigue, dizziness, inattention, unstable emotional background - all these reasons can be a source of work injury.

Naturally, in the first place, the injured employee makes a claim to the employer for payment of compensation to him, since the injury was received during the performance of work duties.

Let's see what payments are due to employees in such cases and who is obliged to make them, in which cases the employer is obliged to make compensation payments to employees who were injured at work. Also, the employer should know whether these payments are subject to taxes and insurance premiums.

What regulations should the employer be guided if an accident occurs at the enterprise?

The main document regulating the actions of the employer in case of an accident at work is the Labor Code of the Russian Federation.
The procedure is defined in Article 228 of the Labor Code of the Russian Federation.

Firstly, the employer is obliged to organize the provision of first aid to the victim and his delivery to a medical facility.

Secondly, report the incident to the appropriate authorities.

Thirdly, take the necessary measures to organize and ensure a proper and timely investigation of the accident and the execution of investigation materials.

These are the main duties that an employer must perform in the event of an accident.

The next group of documents defines the procedure for assigning and paying compensation to injured workers. Such documents include the Federal Law of July 24, 1998 No. 125-FZ “On Compulsory Social Insurance against Industrial Accidents and Occupational Diseases” (hereinafter - Law 125-FZ).

In some industries, industry agreements provide for the payment of a one-time compensation in connection with the loss of working capacity.
For example, an industry agreement on the machine-building complex of the Russian Federation for 2011–2013 (approved by the Association of Machine-Building Trade Unions of Russia, the Trade Union of Automobile and Agricultural Machine-Building Workers of the Russian Federation, the Trade Union of Mechanical Engineers of the Russian Federation, the All-Russian Electroprofsoyuz Public Association, the All-Russian Industrial Association of Employers "Union of Mechanical Engineers of Russia" on 01.03 .2011) established disability compensation. Its size depends on the degree of disability and is established by local regulations.
Consequently, if the employer organization belongs to those industries in which industry agreements have been adopted, it is obliged to pay the employee the compensation due to him. Payments are made in addition to those enshrined in Law 125-FZ.

What event is considered an accident at work?

According to Law 125-FZ, insurance payments are due only to those employees who have suffered as a result of an accident. Therefore, you need to have a clear understanding of what an accident at work is.

An event is recognized as an accident at work if it entailed the need to transfer the employee to another job, led to temporary or permanent disability or death of the employee (paragraph 10, article 3 of Law 125-FZ).

The need to transfer an employee to another job must be confirmed by a medical certificate issued in accordance with the law.
Such a conclusion is the Certificate of the final diagnosis of the victim of an industrial accident (Appendix No. 2 to the Order of the Ministry of Health and Social Development of Russia dated April 15, 2005 No. 275).

At the same time, the duration of the sick leave must be at least one day (part 1 of article 230 of the Labor Code of the Russian Federation).
For example, an employee got into an accident during a work flight and received only abrasions. He did not go to a medical institution and went to work the next day.

Such a case cannot be attributed to an accident at work, since it did not cause serious damage. An injured worker is not entitled to claim social benefits.

Occupational accidents do not include cases where an employee is injured as a result of alcohol intoxication or committing criminal acts (part 6 of article 229.2 of the Labor Code of the Russian Federation). Such situations are classified as accidents not related to production. It is clear that in such situations, employees lose the right to receive social benefits.

Therefore, the task of the employer is to document the incident in a timely and correct manner, since the presence of industrial accidents inevitably leads to an increase in insurance premium rates for compulsory insurance against industrial accidents and occupational diseases (Article 22 of Law 125-FZ).

Which workers are eligible to receive compensation if they are injured while on the job?

Compensation payments are assigned only to an employee who has lost his professional ability to work. A medical and social examination has the right to make a conclusion about the loss of ability to work (clause 1, article 10 of the Law).

If the examination recognizes the employee as having not lost his professional ability to work, he is not entitled to claim compensation.

What types of payments are provided for an injury at work?

Employees who lost their ability to work as a result of an injury at work are entitled to receive two types of compensation payments - one-time and monthly.

Lump sum payments are determined in accordance with the degree of loss of the insured person's professional ability to work based on the maximum amount established by the federal law on the budget of the Social Insurance Fund of the Russian Federation for the next financial year. For 2013, 76699.8 rubles were established.

Let me remind you that the degree of disability is established by the medical and social examination in its conclusion. The procedure for conducting an examination is determined by Decree of the Government of the Russian Federation of October 16, 2000 No. 789 “On Approval of the Rules for Establishing the Degree of Loss of Professional Ability to Work as a Result of Occupational Accidents and Occupational Diseases”.

Monthly insurance payments are paid to the insured employee throughout the entire period of permanent loss of his professional ability to work from the day from which the institution of medical and social expertise established the fact of its loss, excluding the period for which the temporary disability benefit was assigned.

By virtue of paragraph 1 of Art. 12 of Law No. 125-FZ, the amount of the monthly insurance payment is determined as a share of the employee's average monthly earnings, calculated in accordance with the degree of disability.
Thus, if the employee never recovers and is unable to return to full-time employment, he will receive insurance payments for the rest of his life.
The maximum amount of insurance payment is established by the federal law on the budget of the FSS of the Russian Federation for the next financial year (clause 12, article 12 of Law No. 125-FZ).
For 2013, the specified limit is 58,970.00 rubles. (clause 2, part 1, article 6 of the Federal Law No. 219-FZ of 03.12.2012).

In addition, monthly insurance payments are subject to indexation in the manner and amount established by the Government of the Russian Federation (paragraph 2, clause 11, article 12 of Law No. 125-FZ).

Which body pays lump-sum and monthly compensation in case of disability?

If the employee has a conclusion of a medical and social examination on disability, then in this case he has the right to receive a one-time compensation. But the obligation to pay it does not lie with the employer, but with the territorial body of the FSS at the place of registration of the employer, since he is an insurer. According to paragraph 7 of Art. 15 of the Law, it is the insurer, and not the employer, that is obliged to pay insurance payments.

The employer, being the insurer, is only obliged to pay the employee temporary disability benefits on the basis of the sick leave provided (clause 1 clause 1 article 8, clause 7 article 15 of Law No. 125-FZ).

The amount of temporary disability benefit due to an accident at work

The temporary disability benefit due to an accident at work and an occupational disease is paid in the amount of 100% of the employee's average earnings and does not depend on the employee's length of service (Article 9 of Law No. 125-FZ, clause 2 of Article 1, Article 14 of Law No. 255-FZ).

At the same time, Federal Law No. 36-FZ dated April 5, 2013 establishes the maximum amount of insurance payment, which cannot exceed four times the maximum monthly insurance payment.

The maximum amount of insurance payment is established by the federal law on the budget of the FSS of the Russian Federation for the next financial year (clause 12, article 12 of Law No. 125-FZ).

In 2013, this limit is 58,970.00 rubles. (clause 2, part 1, article 6 of the Federal Law No. 219-FZ of 03.12.2012). Consequently, the maximum amount of disability benefits due to an occupational injury or illness per full calendar month will be 235,880.00 rubles. (Article 1 of Law No. 36-FZ, paragraph 12 of Article 12 of Law No. 125-FZ, paragraph 2 of Part 1 of Article 6 of Law No. 219-FZ).

What documents do I need to submit to receive a lump sum payment?

If the conclusion of the medical and social examination indicates that the employee has lost his ability to work as a result of an accident, then he has the right to apply to the FSS for a lump-sum allowance. The benefit is assigned based on the application of the insured person. Since the insured person is an employee, the application must be submitted on his behalf.

Moreover, the application must be submitted to the territorial body of the FSS at the place of registration of the insured, that is, the employer.

Documents are attached to the application in accordance with the list established by the FSS for each specific case (clause 4, article 15 of the Law).

These documents include:

  • an act on an accident at work or an act on an occupational disease;
  • certificate of the average monthly earnings of the insured for the period chosen by him for the calculation of monthly insurance payments in accordance with this Law;
  • the conclusion of the institution of medical and social expertise on the degree of loss of professional capacity for work of the insured;
  • the conclusion of the institution of medical and social expertise on the necessary types of social, medical and professional rehabilitation of the insured;
  • copy work book or other document confirming that the victim is in an employment relationship with the insured;
  • notification of a medical institution about the establishment of the final diagnosis of an acute or chronic occupational disease;
  • the conclusion of the center of occupational pathology on the presence of an occupational disease;
  • documents confirming the expenses for the implementation, according to the conclusion of the institution of medical and social expertise, of the social, medical and vocational rehabilitation of the insured, provided for in sub. 3 p. 1 art. 8 of this Federal Law;
  • victim rehabilitation program.

The list of documents may differ, since the FSS authorities request the relevant documents for each specific case.

It should be noted that the insured employee, who is entitled to receive insurance payments, has the right to apply to the insurer, that is, to the FSS, with an application for receiving insurance coverage, regardless of the limitation period of the insured event.

When applying for an appointment for the payment of monthly insurance coverage, after three years from the moment the right to receive it arises, payments are made for the past time for no more than three years preceding the application.

The term for consideration of the application of the injured employee in the territorial body of the FSS

The decision to assign a payment or refuse is made by the FSS of the Russian Federation within 10 days from the date of submission of the application and relevant documents. Payments to the insured employee are made by the FSS of the Russian Federation within one month from the moment a positive decision is made (clauses 4, 7, article 15 of the Law).

Can an employer apply for their employee?

Getting injured is always stressful for anyone. And even after treatment, he is not always able to independently collect all the documents and submit them to the territorial body of the FSS. Usually, employees have a very superficial understanding of the social insurance system and the rights that they have, since these issues are usually decided for them by the employer.

And in this situation, first of all, the employer must explain to the employee what payments he is entitled to receive from the FSS, and provide him with all the necessary documents in a timely manner.

In addition, the organization can help the employee by independently filling out the documents indicated in the list and submitting them to the bodies of the FSS of the Russian Federation. Law 125-FZ allows the possibility of filing an application through a proxy, therefore, the organization has the right to submit documents for the employee (paragraph 1, clause 4, article 15 of Law 125-FZ).

Can an employer provide financial assistance to an injured worker?

From the analysis of the Law, it is clear that the employer organization is obliged to pay an employee who has received an industrial injury only temporary disability benefits. One-time and monthly social payments are made by the Social Insurance Fund.

But the employer may, on its own initiative or on the basis of the employee's application, pay the employee financial assistance in order to compensate for the costs of treatment and rehabilitation, and the amount of this assistance is not limited by the legislation of the Russian Federation.

At the same time, it must be remembered that material assistance in the amount of 4 thousand rubles is not subject to insurance premiums (clause 11, part 1, article 9, part 1, article 10, part 2, article 12, part 2, article 62 of the Law No. 212-FZ, paragraph 12, paragraph 1, article 20.2 of Law No. 125-FZ, Letters of the Ministry of Health and Social Development of May 17, 2010 No. 1212-19, of March 1, 2010 No. 426-19). Personal income tax is also not withheld from this amount (Article 216, paragraph 4, paragraph 28, Article 217 of the Tax Code of the Russian Federation).

In addition, the employer has the right to pay his employee the cost of treatment and medical care from the funds remaining after paying income tax. In this case, the income received by the employee is not subject to personal income tax (clause 10, article 217 of the Tax Code of the Russian Federation).

Thus, if an accident occurs in your organization and the injured employee applies to you for compensation payments, you must remember that the employer is obliged to pay his employee only temporary disability benefits. At the same time, it must be remembered that an accident that is not related to production (for example, due to alcohol intoxication), but received at the workplace, is paid at the rate of the minimum wage (clause 2, article 8 of the Federal Law of December 29, 2006 No. 255-ФЗ “On compulsory social insurance in case of temporary disability and in connection with motherhood”).

One-time and monthly insurance payments are assigned and paid to the employee by the territorial bodies of the FSS on the basis of the employee's application, so the employer can only help his employee in preparing a package of documents for submission to the FSS.

In addition, the employer can provide material assistance to the injured employee or pay for his treatment and purchase of medicines.

You need to pass the ITU (medical social expertise) to determine the presence or absence of disability and the degree of disability. Compensation for the difference in disability is possible if the employer is at fault for the injury. To do this, an accident report is drawn up in the form of H 1, as well as an accident investigation report, the investigation is carried out in accordance with the Labor Code of the Russian Federation:

Article 229.2. Procedure for conducting an accident investigation

(Introduced by Federal Law No. 90-FZ of June 30, 2006)

When investigating each accident, the commission (in the cases provided for by this Code, the state labor inspector who independently conducts an investigation of the accident) identifies and interrogates eyewitnesses of the accident, persons who committed violations of labor protection requirements, receives the necessary information from the employer (his representative) and, if possible, explanations from the victim.

At the request of the commission, in cases necessary for the investigation, the employer, at his own expense, provides:

performance of technical calculations, laboratory research, testing, other expert work and the involvement of experts for this purpose;

photographing and (or) video filming of the scene and damaged objects, drawing up plans, sketches, diagrams;

provision of transport, office space, means of communication, special clothing, special footwear and other personal protective equipment.

Accident investigation materials include:

an order (instruction) on the establishment of a commission to investigate the accident;

plans, sketches, diagrams, protocol of inspection of the scene, and if necessary - photo and video materials;

documents characterizing the state of the workplace, the presence of dangerous and harmful production factors;

extracts from the logs of registration of briefings on labor protection and protocols for checking the knowledge of the victims of labor protection requirements;

records of interviews of eyewitnesses of the accident and officials, explanations of the victims;

expert opinions of specialists, results of technical calculations, laboratory studies and tests;

a medical opinion on the nature and severity of the damage caused to the health of the victim, or the cause of his death, the presence of the victim at the time of the accident in a state of alcoholic, narcotic or other toxic intoxication;

copies of documents confirming the issuance of special clothing, special footwear and other personal protective equipment to the victim in accordance with applicable standards;

extracts from the instructions of state labor inspectors and officials of the territorial body of the corresponding federal body previously issued to the employer and relating to the subject of the investigation executive power exercising the functions of state supervision in the established field of activity (if the accident occurred in an organization or at a facility controlled by this body), as well as extracts from the submissions of trade union labor inspectors on the elimination of identified violations of labor protection requirements;

(as amended by Federal Law No. 242-FZ of July 18, 2011)

other documents at the discretion of the commission.

The specific list of investigation materials is determined by the chairman of the commission, depending on the nature and circumstances of the accident.

On the basis of the collected materials of the investigation, the commission (in the cases provided for by this Code, the state labor inspector who independently conducts an investigation of the accident) establishes the circumstances and causes of the accident, as well as persons who committed violations of labor protection requirements, develops proposals to eliminate the identified violations, causes of the accident and prevention of similar accidents, determines whether the actions (inaction) of the victim at the time of the accident were due to labor relations with the employer or participation in his production activities, if necessary, decides which employer records the accident, qualifies the accident as an accident an accident at work or as an accident not related to work.

Investigated in the prescribed manner and by decision of the commission (in the cases provided for by this Code of the state labor inspector who independently conducted the investigation of the accident), depending on the specific circumstances, they can be qualified as accidents not related to production:

death due to a general illness or suicide, confirmed in the prescribed manner, respectively, by a medical organization, investigating authorities or a court;

death or damage to health, the sole cause of which, according to the conclusion of a medical organization, was alcohol, drug or other toxic intoxication (poisoning) of the victim, not related to violations of the technological process in which technical alcohols, aromatic, narcotic and other toxic substances are used;

ConsultantPlus: note.

The normative provisions of part six of this article are partially reproduced from the normative provisions of part twelve of article 230 of this Code, which were the subject of consideration by the Constitutional Court of the Russian Federation and recognized as corresponding to the Constitution of the Russian Federation by the Resolution of the Constitutional Court of the Russian Federation dated May 24, 2007 N 7-P, which at the same time revealed their constitutional legal meaning.

an accident that occurred when the victim committed actions (inaction) qualified by law enforcement agencies as a criminally punishable act.

An accident at work is an insured event if it occurred with an insured person or another person subject to compulsory social insurance against accidents at work and occupational diseases.

If, during the investigation of an accident with the insured, it is established that the gross negligence of the insured contributed to the occurrence or increase of harm caused to his health, then, taking into account the conclusion of the elected body of the primary trade union organization or other body authorized by employees, the commission (in the cases provided for by this Code, the state labor inspector, independently conducting investigation of an accident) establishes the degree of fault of the insured in percentage terms.

Part nine is no longer valid. - Federal Law of July 17, 2009 N 167-FZ.

(see text in previous edition)

The regulation on the specifics of the investigation of accidents at work in certain industries and organizations and the forms of documents required for the investigation of accidents are approved in the manner established by the authorized Government Russian Federation federal agency executive power.

In addition, according to the Labor Code of the Russian Federation:

Article 184

In case of damage to health or in case of death of an employee due to an accident at work or an occupational disease, the employee (his family) shall be compensated for his lost earnings (income), as well as additional expenses related to damage to health for medical, social and professional rehabilitation or appropriate expenses in connection with the death of an employee.

The types, volumes and conditions for granting guarantees and compensations to employees in these cases are determined by federal laws.

(As amended by Federal Law No. 90-FZ dated June 30, 2006)

You also have the right to recover compensation for non-pecuniary damage from the employer for physical harm caused in judicial order.

A person's ability to work is his ability to perform his professional activity qualitatively and in full. People devote most of their lives to their work. It begins with the choice of a profession, its study and development. For 30 - 40 years, a person develops his own and sells them in exchange for wages. This is considered work

Types of labor

Employment qualification implies the presence of several types:

Regardless of which one a person chooses, he has legal protection if there is a partial or complete disability.

Reasons for disability

Deprivation of the opportunity to fully perform work can occur with an occupational disease or a general one. Common illnesses are health problems that are not related to working conditions or the complexity of the profession. Most often this general working capacity a person when he does not require a long-term development of a specialty or any specific skills. The resulting diseases are non-professional in nature, but, nevertheless, the temporary loss of the opportunity to work is paid by the state or the employer in accordance with labor legislation.

The loss of professional working capacity of people is directly related to the risks of their specialty or diseases acquired due to unfavorable working conditions. In this case, not only the Labor Law comes into force, but also the rules for life insurance against accidents at work.

Partial disability

Everyone has the right to quality medical care in case of partial or complete disability. The degree of disability and, accordingly, monetary compensation is determined by the attending physician or the commission. The amount of payments depends either on the insured event, or is appointed by law. Partial is the temporary inability of a person to perform their professional duties. In this regard, the percentage of the degree of loss of working capacity is established, which is determined by the medical commission. It can be 10 - 30% of the previous level of efficiency, when the employee needs other working conditions or a smaller amount of output. Level 40 - 60% is defined when a person can only continue with a strong decrease in the amount of work or a decrease in skill level. When an employee can perform work only with a complete change in conditions and not in full, the examination of working capacity sets the level of disability at 70 - 90%.

Payment for partial loss of working capacity

If the employee's illness is of a general, and not professional nature, then he is issued and paid a sick leave for the entire period of treatment.

Sick leave is paid in accordance with labor legislation.

In case of temporary incapacity for work, the state or the employer partially or fully compensates the employee for the earnings lost due to illness.

  • So, if the employee's work experience is less than 5 years, then he receives 60% of the salary.
  • With an experience of 5 to 8 years - 80%.
  • When the employee's length of service is 10 years or more, the compensation will be 100% of the average wage.

Special list

According to the legislation, partial disability by persons included in a special list is paid at a rate of 100%, regardless of their length of service. These include:

  • war veterans and combatants;
  • employees who support 3 or more minor children;
  • wives or husbands of military personnel (this does not apply to conscripts);
  • women who are granted maternity leave;
  • former orphans and children deprived of parental care.

Partial disability implies a temporary absence from work due to a general illness.

Complete disability

If an employee has clearly expressed disturbances in the functioning of the body, directly related to his professional activities, and he cannot continue to work under any circumstances, he is set to 100% disability.

When such a person is injured at work or becomes disabled due to his professional activities, he is entitled to monetary compensation. The work capacity qualification of an employee is determined in accordance with an insured event or a special commission.

Complete disability includes not only injuries and injuries resulting from an accident, but also occupational diseases that prevent the employee from continuing to carry out their activities.

Occupational diseases

Diseases that a person has received in connection with his professional activities are divided into two types:

  • The former have partial or complete reversibility. They are treatable, and such loss of professional ability to work is most often associated with allergic manifestations or the initial stages of bronchitis and intoxication. Sometimes it is enough to change working conditions and undergo a course of treatment in order to fully recover. For the first group of people, there are preventive and medical institutions where they can get qualified help.

  • The second group is not amenable to complete cure. These include occupational diseases such as pneumoconiosis, hearing loss, severe forms of intoxication. The medical commission determines the degree of damage to the human body and decides on the establishment of a disability group. Often such diseases are "overgrown" with side diseases that develop against the background of chronic manifestations. In this case, the disability group may change.

    • Employees of the second group should be provided with a referral for treatment in specialized clinics.

    Registration of disability

    The issue of assignment is considered only when a full examination of the employee's ability to work has been carried out. The facts of getting the disease in connection with professional activities or at the workplace are also checked. considers the issue of disability on the basis of the conclusion of the medical commission and the current list of occupational diseases. According to existing guidelines, in which the qualification of the working capacity of employees, expressed as a percentage, is considered, the degree of its loss is established.

    The first and second groups of disability are awarded in case of intoxication or damage in an accident. Also, this group may include workers whose occupational diseases have entered the phase of irreversible or intractable diseases.

    In the event that a person has other diseases along with industrial ones, then their exacerbation due to the impact of a “working” illness on them also falls into the category of professional and can be considered as a basis for obtaining a disability.

    In order to accurately determine the degree of working capacity of workers, the expert must be a highly qualified specialist.

    Compensation for health damage

    In accordance with the physical or mental damage that the employee received during his labor activity, he is assigned financial compensation in the amount provided for by labor legislation.

    Currently, it is customary for employees to conclude life insurance contracts in case of disability. If an employee is partially incapacitated, then he is paid a salary, compensation for medications and maintenance in the hospital, a one-time payment from the Social Insurance Fund.

    If a certain work capacity qualification is established as a result of severe injuries, the employee is paid monthly benefits, appropriate medical care is provided and the opportunity to recover in a sanatorium is provided.

    disability

    In the event that an employee has received a disability due to an occupational disease or in connection with and has lost the ability to work in full, he is transferred to light work or a shorter day with wage compensation. This applies to those with 1 and 2 disability groups.

    The third group is awarded in case of complete disability, when the employee can no longer perform his duties or retrain due to an industrial illness or injury.

    The transition from one disability group to another is carried out on the basis of a medical examination.

    The decision on the amount of payments for sickness, reimbursement for medicines and hospital treatment is made by the Social Insurance Fund, based on the data provided by the forensic medical expert. According to the examination and determination of the degree of physical and moral damage to the victim, in the absence of his fault, the amount of compensation is assigned, as well as possible solutions for the rehabilitation of the patient. This applies to such measures as determining the victim in a specialized clinic, issuing a voucher to a sanatorium, paying for consultations with a psychologist.

    Payment through court

    If an employee has received a disability in connection with his work at work, he is entitled to monetary compensation for health and compensation for moral damage.

    The issue of the amount of compensation is decided according to the conclusion given by the forensic medical expert. He checks the degree of mental disorder of the victim in connection with the incident and assesses the moral damage caused to him. You can also contact him if the employee does not agree with the disability group assigned to him by the VTEK.

    In this case, the employee files a claim against the employer or the insurance company. It can be won only upon receipt of expert conclusions about the discrepancy between the assigned disability group or the amount of compensation for the mental and physical state in which the injured party is located.

    Re-examination of an employee who has lost his ability to work

    There are terms for re-examination of the health status of workers who have lost their ability to work. This is done because the disease can progress and the deterioration of the physical health of the victim requires a different level of disability or compensation payments.

    Re-examination takes place 6 months, a year or two after the first diagnosis. This procedure usually takes place once a year. This does not apply to those workers whose illness is recognized as irreversible or whose injuries prevent them from continuing to work. Such people are assigned disability with lifelong pension payments.

    It is possible to undergo an early re-examination if the patient's condition has deteriorated sharply, which is confirmed by the medical commission. In this case, the Bureau of Medical and Social Expertise conducts an inspection and makes a decision based on the new results.

    Also, the employee has the right to apply for an early check of his condition. In addition to an employee for re-examination can apply Insurance Company or the employer if inconsistencies in documents or their forgery were found.

An accident at work or an acquired disease is fraught with negative consequences for human well-being. In particular, the result may be a loss of ability to work and the inability in the future to perform work duties in part or in full. The type and degree of damage received are determined in accordance with established standards during the passage of a specialized examination.

The essence of the concept of "employment"

Employability of a citizen in professionally implies the ability of a person to perform the duties established by the instructions for a particular position held by him. A separate role is played by the quality and timeliness of the work done.

In situations where there is a violation of the functions of the body, resulting from an accident or a disease acquired in the course of activity, they speak of disability. This means that the citizen is no longer able to carry out the actions and duties assigned to him.

Types of disability

Disability is classified according to various parameters. The main criteria are:

  • degree of probability of restoration of health indicators and return to work in the future;
  • the level of preservation of the ability to work;
  • professional area.

According to these parameters, the loss of the opportunity to apply one's professional skills and, in general, to carry out any useful actions can be of several types.

The types of disability can be:

  1. Temporary loss of ability to work. In this case, it is understood that the ability to use labor skills is lost until the moment when health is restored. This type is fixed without establishing a disability.
  2. Permanent or permanent disability. In other words, a person can no longer work due to the lack of chances for a complete cure, for example, with amputation of limbs. In this case, any . However, this can also be removed if there is an improvement in physical performance.
  3. Partial degree of preservation of the opportunity to engage in professional activities. This refers to the restrictions imposed on a person and not allowing to perform the work to the fullest extent or allowing easier working conditions.
  4. Complete loss of ability to work. When such a status is fixed, a person can no longer and should not work, since from now on he should live according to the regime corresponding to his state of health.
  5. Restriction to work in a certain professional field. In other words, a citizen is forbidden to engage in activities in any area due to inconsistencies in health indicators, for example, a ban on working in a hot shop has been imposed.
  6. General disability precludes engaging in any type of work, both because of the unsatisfactory condition of the citizen, and in connection with the risk of illness of other people. For example, if we are talking about a viral infection.

As already mentioned, the loss of the ability to work can be recorded as a result of an illness or injury at work, as well as in case of illness, the need to care for a bedridden patient, and for other reasons.

How is disability determined?

The degree of loss of ability to work is determined by specialized commissions, most often by the ITU State Service (medical and social expertise) or employees of the medico-judicial direction.

The latter case is due to the fact that going to court allows you to more accurately identify the type of restriction in the use of professional skills by a citizen. This is especially true if the disability is persistent, that is, a person can no longer work and provide for himself.

A forensic medical examination is required in case of an industrial injury, a serious accident at the workplace, when it is necessary to assess the damage to human health. On the basis of which the amount of compensation for damage will be calculated in the future and the amount of additional payments will be determined.

The commission includes:

  • therapist;
  • ophthalmologist;
  • surgeon;
  • neuropathologist;
  • traumatologist and others.

If we are talking about (medical labor commission), social security workers are included in the group of specialists. Members of the commission carefully and comprehensively study how the functions of the body are impaired, assess the real possibilities of a person to perform this or that work.

The final identification of the degree of loss occurs by calculating the damage caused to health as a percentage of the conditional criterion of the general ability to work. In order to obtain the most accurate result, tables with fixed values ​​\u200b\u200bare used.

Percentages

According to the Decree of the Ministry of Labor, under No. 56, it is customary to use the following indicators to determine the degree of disability:

  • with a complete loss of the ability to work in any professional areas, even in the presence of specially created conditions, 100% loss of the ability to work is established;
  • the ability to work in specialized conditions - 70-90%;
  • the ability to engage in professional activities under normal conditions, but either with a decrease in qualifications, or with a decrease in the amount of work - 40-60%.

There is another, the easiest indicator of the degree of disability, ranging from 10 to 30 percent. In this case, a person can engage in the following activities:

  • work in constant production conditions with a slight decrease in qualifications;
  • activities under the condition of a lighter workload;
  • performance of duties when working conditions change, but at the same time with a decrease in wages.

In any case, each situation submitted for consideration by the commission is studied on an individual basis. Therefore, these values ​​\u200b\u200bshould be taken conditionally, for review. The final and exact decision one way or another remains with the experts.

Loss of ability to work due to injury, occupational disease in without fail requires an appropriate examination in order to identify the degree of loss of the opportunity to work. Depending on the indicator obtained, the type of disability is determined and cash payments are assigned.

In addition to state benefits, if a disability category has been assigned, a citizen can count on compensation for harm in court. The latter case concerns situations where an injury was received at work, and its consequences really caused serious damage to human health.

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