Situations arise when a person for some reason can no longer do his job. Permanent and temporary disability are the main factors affecting the further possibility of continuing the work process.
Definition
Disability is the inability of a person to do work for one reason or another. Such causes may be related to illness, disability, accident, motherhood and other similar factors.
Disability is classified by many factors. Here are the main ones:
- If possible, restore health:
- constant;
- temporary. - By the degree of preservation of working capacity:
- complete;
- partial. - By type of activity:
- general;
- professional.
Most often in the labor relationship between the employee and the employer you can find permanent and temporary disability.
Permanent disability
Under permanent disability is understood as undermining health or any disease caused by work, disaster, professional costs, traffic accidents, violent crime, etc.
Permanent disability is divided into:
- partial: a person, due to undermining health, cannot perform work duties in accordance with national labor standards;
- complete: a person is not able to work and provide for himself due to illness or injury.
In the first case, disability varies from 10% to 90%, in the second - 100%.
Disability determination
Examination can identify the presence of permanent disability. On its implementation may ask:
- A person of working age from 16 to 55 (60) years.
- A person after retirement age or under 16 years old, if his health was undermined at the enterprise, in the performance of official duties, as a result of a disaster or violent actions.
The percentage of disability is determined for 6 months, 1, 2 or 3 years and for 5 years. The starting date for determining the period of permanent incapacity for work is the date of filing the application for examination. Upon appointment of a repeated examination, such date shall be considered the last day of the period of permanent incapacity for work, which is established by the first examination. The social insurance department conducts such examinations, involving doctors in the work.
In the application, the citizen must indicate all the data from the doctor who observes him and has all the information about the state of health necessary to determine permanent disability. Before applying, a citizen must visit a doctor for at least three months.
If an application is submitted for determination of permanent incapacity for work and an illness at the same time, one application for examination is filled out. If necessary, the citizen must submit, together with the application, a document confirming the cause of the disability:
- Act on an industrial accident;
- occupational disease act;
- medical board decision if the disease is received during the service;
- a medical document confirming the relationship between a disaster, test or accident and disability;
- certificate from the authorities about the accident;
- court ruling or certificate from investigating authorities if the injury is received as a result of violent actions.
The examination is carried out on the basis of the submitted documents and a survey of the doctor who leads the patient. As a result, the Department issues a written opinion, which is sent to the citizen and the attending physician. In case of disagreement with the decision of the Department, the person who filed the application may appeal against it in court.
Temporary disability
Temporary disability is a temporary loss by an employee of the ability to fulfill his immediate duties.
This type of disability is of a short-term nature, therefore, after a certain period, the employee can begin to assume his duties.
According to Russian law, a citizen who is temporarily unable to work is exempted from work and must receive monetary compensation from social insurance.
Depending on why disability has occurred, a number of reasons are identified. Let us consider each of them in more detail.
Causes
Temporary disability may occur for the following reasons:
- Disease. This reason is found most often and due to temporary disability the employee cannot perform the work assigned to him. Labor value can be lost in whole or in part, and after the necessary treatment can be completely restored.
- Accident. This reason, which occurred at work or at home, equally leads the employee to temporary disability. Payouts and the number of days that the patient will be treated will differ.
- Pregnancy, childbirth, abortion. Temporary disability due to maternity is issued at enterprises as maternity leave and lasts a specified number of days depending on the number of children born and the severity of childbirth and the postpartum period. In order for such a sick leave to be issued in the proper way, a woman must provide a pregnancy certificate from the medical institution, and then a sick leave, allowing to go on maternity leave. If the pregnancy was interrupted, then a sick leave certificate of a predefined pattern is also provided to the organization from the medical institution. The duration of such a sick leave will depend on the presence or absence of complications.
- Quarantine. This is a specific case of temporary disability when an employee is suspended from work if:
- a contagious disease was discovered, due to which it is strictly forbidden to communicate with other people;
- being near the carrier of the disease can be transmitted by airborne droplets and affect the general condition of the employee. In this case, disability ends as soon as the employee is cured and quarantines. - Suspension This reason can occur for a number of factors:
- lack of special rights that are needed to perform certain work;
- being in alcoholic or toxic intoxication;
- obtaining negative certification results (depending on each case, the employee can then either continue to work, or be transferred to another position, or be dismissed). - Care for a sick relative. This reason most often applies to care for persons under the age of majority. But the rule may apply to older family members if it is proven that the disease is serious. Moreover, the period of incapacity for work is limited.
- Sanatorium treatment. In connection with temporary disability, the attending physician may issue a referral for sanatorium treatment, which must be confirmed by the sick leave and the relevant prescriptions. The sick leave is issued on a general basis and presented at the place of work.
- Adoption of children. In this case, the right to sick leave appears if the child is less than three months old. The rules are the same as for decrees.
- Rehabilitation. A hospital for this reason and its duration is determined by the attending physician.
- Prosthetics. The term of the sick leave is the time necessary for a full recovery and procedures.
In almost all of these cases, the employee is supposed to calculate temporary disability benefits. The amount and conditions of payments are determined by the causes of disability.
Cash payments in the event of temporary disability occur if one of the above cases occurs:
- during work under an employment contract;
- during the performance of official or other activities on which compulsory temporary disability insurance is imposed;
- when the disease or injury occurred within a month after the termination of the specified work.
To receive benefits from the FSS, you need insurance. In this case, temporary disability for two days is paid by the employer, and then - by social insurance, if:
- trauma due to abortion surgery or in vitro fertilization;
- the injury was received on the way to work or from work not on the employer's transport.
Who is eligible for benefits?
Citizens of the Russian Federation, non-residents who have temporary or permanent residence in the Russian Federation, as well as stateless persons are entitled to receive benefits in case of temporary disability. And in this regard, the following categories of such persons are distinguished:
- citizens carrying out activities under an employment contract, admitted in fact to work in accordance with labor legislation;
- citizens performing state and municipal services;
- citizens who are lawyers, individual entrepreneurs, farmers;
- individuals who are not private entrepreneurs, members of tribal communities of small northern peoples who voluntarily took out insurance against temporary incapacity for work and who make contributions to the Social Insurance Fund for themselves on the basis of Federal Law No. 190 of December 31, 02;
- other categories of citizens subject to compulsory social insurance in case of temporary inability to perform work, subject to the payment of contributions to the Social Insurance Fund.
To whom and how much they pay
Calculation of temporary disability occurs from the first day that the employee loses the opportunity to work. The amount of payment is considered as follows: 80% of the average income - in the first six days of sick leave, 100% - for the following days.
Who is entitled to temporary disability benefits in the amount of 100% from the first day of disability:
- war invalids and other categories of invalids equal to this privilege;
- participants in the liquidation of the Chernobyl accident;
- internationalist warriors if temporary disability is the result of injuries or illnesses received in the performance of an international duty;
- citizens who have dependent three or more children under 16 years of age;
- the wives of contract officers and military personnel;
- donors within a year after the last blood donation (at the same time over the past year, a male donor donated blood at least five times, a female donor at least three times);
- organ or tissue donors;
- orphans up to 21 years old;
- citizens during temporary disability and in connection with motherhood, when caring for a sick child under 14 years old, when caring for a disabled person under 18 years old, when caring for a child under three years old in case of ailment of the mother; with spa treatment;
- citizens injured in work due to an accident or occupational disease;
- citizens who were in the performance of state duties.
Insured persons receive benefits from social insurance from the first day if:
- there is a need to care for a sick family member;
- the person is in quarantine;
- a person is caring for a child under 7 years old or an unemployed member of a quarantined family;
- performed prosthetics according to medical indications in a hospital;
- aftercare is carried out in a sanatorium on the territory of the Russian Federation after inpatient treatment.
Calculation of temporary disability occurs at 50% in the following cases:
- when the inability to start work has occurred due to injuries resulting from alcohol, toxic or drug intoxication;
- when a citizen violated the regimen established by a doctor, or did not appear at the appointed physical examination;
- when the inability to start work occurred during absenteeism.
Documents for calculating benefits
Temporary disability is a kind of sick leave. Therefore, to receive cash payments, you must submit the following documents:
- Disability certificate of a temporary nature (sick leave).
- Help on the form 095 or 095.
- Extract from the medical history, if the allowance is issued by the student for academic leave, in the form of 027 or 027.
- A certificate in any form, certified by the seal of a state medical institution or attending physician.
Particular attention should be paid to sick leave. Only those persons who hold a medical position on the basis of a special license have the right to extradite him.
Functional signs of the sick leave:
- The presence of legal force. On its basis, the employer releases the employee from the performance of labor duties.
- Availability of accounting function. The bulletin is attached to the rest of the documents in personnel, accounting, insurance paperwork.
- Creation of medical statistics. On the basis of the hospital bulletin, various medical reports are created and analytical studies are carried out on the spread of a disease.
- The presence of a financial aspect. Upon presentation, temporary disability is paid. The calculation takes place according to the reasons for the absence and the number of days of absence from the workplace.
Deprivation of benefits
The allowance for temporary disability is called cash payments due to social insurance, which compensate for the employee’s salary lost due to temporary inability to attend work due to illness or other factors established by law.
You can withdraw such benefits for the following reasons:
- deliberate infliction of harm to one’s own health in order to evade the performance of work duties or to simulate a disease (in these cases, cash payments that were made before the violation was discovered are recovered from the employee in court);
- abuse of alcohol, drugs or the commission of actions based on the effects of these substances;
- commission of criminally punishable actions by an employee;
- violation by the employee of the regimen prescribed by the attending physician without good reason: failure to appear at the doctor on time without a good reason, failure to appear in the medical and social commission (the allowance ceases to be paid from the moment these reasons are discovered);
- committing absenteeism before the onset of temporary disability (here the employee loses the allowance for the entire period of disability).
A special case
It is worth considering insurance risks and cases under Federal Law No. 213 dated 07.24.09 in more detail. this includes temporary disability and motherhood, as well as expenses for family members due to the occurrence of an insured event. These include:
- Disease or injury of the insured person.
- Pregnancy and childbirth.
- Birth of a child or children.
- Caring for a child up to one and a half years.
- Death of an insured person or minor family member.
We found out what the insurance is based on. Temporary disability and motherhood are paid on the basis of the following types of insurance coverage:
- Cash payments for temporary disability.
- Maternity cash payments.
- A one-time cash payment for those women who are registered in the early stages.
- One-time cash payment at birth.
- Monthly payment up to one and a half years.
- Payment for burial.
The conditions, the amount of benefits and the payment procedure are defined in Federal Law No. 81 of 05/19/95 and in Federal Law No. 8 of 12/01/96.
The insured persons have the right to:
- receive security on time with the occurrence of insured events;
- receive information on the assessment of contributions to the FSS and monitor the transfer of funds in social networks;
- seek advice on insurance issues and free assistance required to receive benefits (preparation of applications, petitions and other legal documents);
- apply to the FSS to verify the correctness of accrual of benefits;
- protect your rights and interests in court.
Insured persons are required to:
- submit reliable documents on the basis of which payments will be made and legal issues resolved;
- inform the FSS or the employer of circumstances that may affect the conditions and amount of benefits received;
- comply with the regimen prescribed by the doctor, determined for the period of disability or motherhood;
- comply with other requirements established by Russian law.