Currently, the legislation provides for various guarantees for working citizens. In particular, insured persons can rely on benefits for temporary disability, pregnancy and childbirth. Let's consider some features of these payments.
General information
The accrual of temporary disability benefits is carried out if the citizen:
- He is an insured person and is a member of labor relations.
- It performs work under a civil law agreement, and deductions to the Social Insurance Fund are made for it.
The temporary disability benefit is calculated based on the average monthly income of a person.
Subjects of law
The temporary disability benefit is paid as compensation for expenses incurred by the insured citizen during the period when he could not fulfill his duties for objective reasons. So, Federal Law No. 255 provides for payments:
- Citizens working under employment contracts.
- State and municipal civil servants.
- Subjects replacing federal, regional, municipal posts on an ongoing basis.
- Members of production cooperatives taking labor part in its work.
- To the clergy.
- Citizens sentenced to imprisonment and involved in labor.
Grounds for payment
The allowance for temporary disability is provided in cases:
- Loss of ability to perform professional duties due to trauma or occupational disease due to termination of pregnancy or IVF (in vitro fertilization).
- The need to care for a sick relative, including a disabled child.
- The quarantine of the insured person or minor (up to 7 years old) attending DOW, or another close relative who is legally incompetent.
- Prosthetics according to medical indications in a stationary medical institution.
- Aftercare in the sanatorium (in the resort).
We consider these cases separately.
Occupational disease / injury
Payment of temporary disability benefits in these cases is carried out for the entire period in which the subject could not fulfill his duties, until the date of restoration of his health or assignment of a disability group. In this case, a number of restrictions should be taken into account.
Calculation of temporary disability benefits to an entity recognized as disabled according to the established procedure is carried out no more than 4 months later. in a row or five months per calendar year. If the indicated person has been diagnosed with tuberculosis, payments are made until the date of restoration of health or the day of review of the established disability group.
Social benefits for temporary incapacity for work are provided for insured persons who have entered into fixed-term labor agreements (service contracts) for a period of up to 6 months, as well as for persons whose injury or occupational disease occurred between the date of conclusion of the agreement and its cancellation. These citizens (with the exception of those suffering from tuberculosis) can expect to be paid no more than 75 days in advance. If tuberculosis is diagnosed for these citizens, temporary disability benefits must be paid before the date of restoration of health or the establishment of disability. The subject whose injury / illness has occurred from the date of conclusion of the agreement until the moment of its cancellation, accrual is made from the date on which he was supposed to start work.
The temporary disability benefit is provided to the insured during the period of official or other professional activities, during which compulsory social insurance is provided in case of loss of ability to carry out labor activity in connection with motherhood, as well as if an injury or occupational disease occurred before the expiration of a month from the date of termination of the relevant activities.
Accrual Features
The amount of temporary disability benefits for the first 3 days is covered from the funds of the insured. From the fourth day, payment is made from the FSS. This rule applies to all insured persons, except those who voluntarily entered into legal relations for compulsory social insurance for cases of temporary disability and motherhood.
Relative care
Assignment of temporary disability benefits is allowed in the case of caring for a sick child up to 7 liters. Payments are made for the entire duration of outpatient treatment or sharing with a minor in a hospital, but not more than 60 days (calendar) a year. If a child is diagnosed with a disease that is included in the list formed by the federal executive structure that carries out legal regulation in the field of healthcare and social development, the temporary disability benefit is deducted in no more than 90 days. in a year.
If the insured entity cares for a minor of 7-15 liters, payments are made 15 days in advance (calendar) for each case of outpatient treatment or sharing with a child in a hospital. In this case, temporary disability allowance may be accrued no more than 45 days a year.
If care is taken of a minor with a disability of up to 15 years, payments are made for the entire period of outpatient treatment or staying with the child in a hospital. In this case, the accrual period is limited to 120 days per calendar year.
If the minor is HIV-infected, no payment deadlines are set. A similar rule is provided for when a sick child under 15 liters is cared for, if his illness is caused by a post-vaccination complication, malignant formation, including lymphoid, hematopoietic, or other related tissue.
In other cases, temporary disability allowance for caring for a sick relative who is on outpatient treatment is paid no more than 7 days (calendar) for each disease. Moreover, in the aggregate accrual is allowed no more than 30 days / year.
Quarantine
The temporary disability allowance is provided for the insured person who came into contact with an infectious patient or a person who was a carrier of bacteria. Accrual is made for the entire period of removal of a citizen from work.
If minors under 7 years of age attending pre-school education or other close relatives who are legally incompetent are subject to quarantine, payments are made for the entire quarantine period to the insured citizen (one of the legal representatives, parents or another family member).
Prosthetics
In the case of his appointment for medical reasons and held in a stationary specialized medical institution, a citizen can count on benefits. It is paid for the entire period of exemption from work, which includes the time of moving to the place of medical manipulations and back.
Stay in a sanatorium (in a resort)
In the case of aftercare, a citizen in sanatorium-resort institutions located in the Russian Federation, immediately after treatment in a stationary medical institution, payments are made for the entire period of stay of persons in the respective institutions. In this case, accrual is made no more than 24 days (calendar). The exception is cases of tuberculosis.
Payment Calculation Procedure
As a base for accrual acts insurance experience. Temporary disability benefits are calculated in accordance with the provisions of the Order of the Ministry of Health and Social Development No. 91 of February 6. 2007 According to this document, the insurance period includes periods of work under an employment contract, municipal and public services, other periods in which the subject was subject to compulsory social insurance.
The maximum allowance for temporary disability due to occupational disease, trauma, quarantine, prosthetics for medical reasons, and aftercare in a sanatorium (resort) immediately after being in the hospital is:
- 100% of average earnings if a citizen has insurance experience of 8 years or more;
- 80% - with the experience of 5-8 years;
- 60% - with work experience up to 5 years.
If a disease or injury occurs within a month from the date of termination of work under an employment contract, official or other activity during which compulsory social insurance was carried out, the amount of payment is 60% of the average earnings.
If the subject cares for a sick minor, the maximum temporary disability benefit is calculated as follows:
- During outpatient treatment - for the first 10 days in an amount determined on the basis of the length of the insurance period, for the next - in the amount of 50% of the average salary.
- When treating in a hospital - depending on the length of service.
The temporary disability benefit for caring for a sick relative who is on an outpatient basis (except for a child under 15 years old) is also calculated on the basis of the length of service.
Nuance
An entity with less than 6 months of experience can also count on benefits. In this case, the payment does not exceed the minimum wage for the full month (calendar). The minimum wage is established by federal law. If raising factors are applied in a particular area, they should be taken into account when calculating benefits.
The specifics of determining average earnings
The average salary is calculated for 2 years (calendar) preceding the occurrence of the insured event. This takes into account the periods of employment with another employer.
If, during the indicated 2 years preceding temporary disability, or in one of these two years, the subject is on B&R leave or caring for a minor, the corresponding years may be replaced by previous periods if this leads to an increase in the amount of the allowance. To do this, the insured citizen must write a statement.
If a citizen did not have any earnings in the billing period, or if the average salary calculated on the basis of the full calendar month is less than the minimum wage established by federal law, the average salary is taken to be equal to the minimum wage effective on the date of disability.
If a person fulfills his duties in an incomplete week (day) mode, the average salary is calculated in proportion to the length of the citizen's working time.
On Wednesday. earnings, on the basis of which the calculation of benefits is carried out, payments of all types and other benefits provided for the employee are included, on which contributions to the Social Insurance Fund, PFR and MHIF were accrued.
The average salary is taken into account for each individual calendar year in an amount not exceeding the maximum base amount established for assessing contributions to the Social Insurance Fund.
Quite often, a citizen receives benefits from various employers. In such situations, the average salary is taken into account by each employer for each year in an amount not exceeding the maximum amount of the base provided for the transfer of insurance premiums.
The average daily salary for calculating payments is determined by dividing the average salary for the estimated time (2 years) by 730. To calculate the daily allowance, the average daily salary is multiplied by the amount of the allowance, defined in%. The resulting value is multiplied with the number of calendar days in which the subject was temporarily disabled.
Payout Rules
The allowance is assigned if the subject applied for it before the expiration of six months from the date of restoration of disability or determination of a disability group, the expiration of the period of exemption from work in case of care for a sick relative, quarantine, aftercare and prosthetics.
If the specified period has been missed, the decision on the calculation of payment is made by the territorial unit of the insurer. In this case, the insured person is obliged to prove the validity of the reasons for missing the deadline. The list of circumstances that are considered a significant obstacle to a citizen's appeal in the specified period is determined by the Ministry of Health and Social Development.
The allowance is assigned and paid at the place of employment of the insured person. If the subject at the time of the onset of temporary disability fulfills the professional duties of two employers, the following rules should be followed.
If during the previous 2 calendar years a citizen carried out professional activities with the same employers, benefits are calculated and paid at each place of work based on average earnings.
If the subject worked for different persons, accrual and payment are made at one of the last places of labor activity at the choice of the insured citizen.
If a citizen worked for the same employer and other employers during the settlement years, payment is made either at all places of work, or at the last place of choice.
An entity that has lost its ability to work due to an injury or occupational disease before the expiration of 30 days from the date of termination of activity under the contract shall be accrued and paid at the last place of work or the territorial unit of the insurer upon liquidation of the enterprise.
Documents
The insured citizen must submit an application for temporary disability benefits. Attached to it:
- Sick leave. It is issued by the medical organization in which the citizen was treated.
- A certificate of the amount of earnings, based on which the calculation of benefits is made, if the subject works with another employer.
- A certificate from another place of work stating that accrual and payment of benefits were not carried out if a citizen works for several people and receives compensation for disability of his choice from one of them.
The employer must assign the benefit within 10 days from the date of receipt of the application for the payment of temporary disability benefits with the above documents. Direct payment is made on the day closest to the date of appointment according to the rules established for the payment of salaries.
Application for accrual of temporary disability benefits
The form is approved by the Order of the FSS No. 335 of September 17. 2012. You can fill out the application by hand or in a typewritten way (on a computer). In the first case, use a pen with black ink. The document does not allow corrections (including the use of corrective putty), strikethrough, blots, etc.
Sick pay can be made at the post office or by transfer to a personal account. The temporary disability allowance is provided only if the original leaflet issued by the medical institution is available.
Depending on the method of receiving compensation, a citizen fills out either a block in which he indicates the bank details of his account, or section 6, where he puts down the address of the post office.
Reasons to reduce benefits
The legislation defines cases when the amount of compensation can be reduced. This is allowed if the insured citizen:
- violated the regimen prescribed by a doctor without a good reason;
- He failed to appear for a visit to a doctor or medical and social examination at the appointed time without a good reason;
- received an injury or illness due to toxic, alcoholic, drug intoxication or actions related to it.
If one or more of these reasons is identified, the citizen will receive a benefit the amount of which does not exceed the minimum wage for the full month (taking into account the increasing coefficients in the areas where they are used) from the moment the violation was committed or for the entire period of incapacity for work.
Exceptional Cases
The allowance is not assigned to a citizen for periods:
- Exemption from work with partial / full preservation of earnings or without payment, in accordance with the provisions of the law. An exception is when a staff member is injured or ill during paid annual leave.
- Suspensions from work on the grounds provided by law, if during this time no salary is accrued.
- Detention or administrative punishment of a person in the form of arrest.
- Forensic medical examination.
- Idle, except as provided by law.
Refusal to pay benefits
The legislation provides grounds for refusing to satisfy a citizen's application for compensation for temporary disability. The insured person cannot rely on benefits if an injury or occupational disease occurred as a result of intentionally causing harm to his health or attempted suicide, as well as the commission of a deliberate crime.
additional information
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Calculation Examples
1 2018 . 9489 . , :
9489 24 / 730 . = 311,97 .
. 2016 . 718 . ., 2017 – 755 . . ( 1 473 000 .). – 2017,81 . ((718 . . + 755 . .) / 730).
Let's look at a few examples.
2018 . , 7 , . , 9 . 2016 . – 400 . ., 2017 – 480 . . / 2 – 880 . . , , .
:
(400 . . + 480 . .) / 730 80 % = 964,38 .
, 80 %, . . 5, 8 .
9 :
964,38 9 = 8679,42 .
, , . ? 2 – 1 473 000 . Consider an example.
2018 . 11- . , , 10 . 2016 . 820 . ., 2017 . – 880 . . 1 700 000 . . 1 473 000 .
2017,81 . , :
2017,81 10 . = 20 178,1 .
. , , :
- / .
- .
- / .
- 6 .
, . , 2016-2017 . . . , 5 .
:
9489 . 24 . / 730 . = 311,97 .
4 . 3 ., , 60 % :
311,97 5 60 % = 936,91 .
Now we will analyze the calculation in the case when the experience does not reach six months. To determine the amount of compensation, you should compare the daily allowance (it is calculated based on the employee’s earnings) and the maximum daily payment for a certain month (calculated according to the minimum wage).
Take February and March 2018. The first month is 28, and the second - 31 days. The maximum daily allowance in February will be equal to:
9489/28 days = 338, 89 rubles.
Maximum compensation in March:
9489/31 = 306.1 rubles