Partial loss of ability to work, payments from the Social Security Fund. Compensation for lost earnings due to work injury

If an employee is injured at work, he is entitled to compensation payments. However, not every injury is recognized as work-related.

Such situations require the right approach and preparation of appropriate documents. Then payments for a work injury will be justified, the employee will receive funds for treatment and rehabilitation, and the employer will avoid unpleasant consequences.

What nuances in filing industrial injuries may cause difficulties in 2019? Let's figure it out.

Concept of work injury

Situations when an employee receives a work injury are strictly and clearly described by legislation in the field of labor relations.

  • bodily injuries, including those caused by another person;
  • heatstroke; burn; frostbite; drowning; electric shock, lightning, radiation;
  • bites and other bodily injuries caused by animals and insects;
  • damage due to explosions, accidents, destruction of buildings, structures and structures, natural disasters and other emergency circumstances;
  • other health damage caused by external factors.

If they entail the need to transfer the victims to:

  • another job;
  • temporary or permanent loss of their ability to work;
  • death of the victims.

Compensation for work-related injuries directly depends on the extent of the injury. Highlight:

  1. Serious injuries that threaten the life and health of the employee.
  2. Minor health damage.

Signs by which the severity of damage in an accident can be determined are:

  • the nature of the injuries received and complications associated with them, as well as the development and aggravation of chronic diseases in connection with the injuries received;
  • the consequence of the injuries received is permanent loss of ability to work.
  • Damage to health, the acute period of which is accompanied by shock, coma, blood loss (more than 20%), embolism, acute failure of the functions of vital organs and systems;
  • Health injuries qualified during the initial examination of the victim by doctors at a hospital, trauma center or other healthcare organizations as: penetrating wounds of the skull, brain contusion, body fractures, dislocations, abdominal wounds, chest injuries, rupture of internal organs, thermal and chemical burns, etc.
  • injuries that do not directly threaten the life of the victim, but have serious consequences: loss of vision, hearing, speech, mental disorders, etc.

Occupational diseases are a chronic or acute disease of an insured employee, which is a consequence of exposure to a harmful production factor and resulted in temporary or permanent loss of professional ability or death. Harmful production factors can be considered:

  • chemical;
  • biological;
  • radiation;
  • vibration and others.
A person who does not comply with safety regulations may lose most of the entitlement payments.

Legislative regulation

In the Russian Federation, there is legislative regulation of the procedure for registering an injury, payment of compensation and the employer’s liability in case of failure to fulfill its obligations to employees.

State support for an employee in case of injury at work is regulated by the following standards:

  1. Article 184 of the Labor Code of the Russian Federation regulates the procedure for issuing monetary compensation by an employer to an employee who has received an industrial injury.
  2. Federal Law No. 255-F3 of December 29, 2006 “On compulsory social insurance in case of temporary disability and in connection with maternity” establishes the amount of monetary compensation in case of an industrial injury.
  3. Federal Law No. 125-F3 of July 24, 1998 “On compulsory social insurance against industrial accidents and occupational diseases” prescribes that the following are subject to compulsory social insurance against industrial accidents and occupational diseases: individuals performing work on the basis an employment contract concluded with the policyholder and individuals sentenced to imprisonment and recruited to work by the policyholder.

At the same time, the main law in the Russian Federation is the Constitution of the Russian Federation, which guarantees safe working conditions for every working person.

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Causes of industrial injuries


All cases of injury in the workplace are thoroughly investigated.

As a rule, the main reasons for this are:

  • negligent attitude of the employee to compliance with safety regulations;
  • performing a job function or being at the workplace in a state of alcohol (drug) intoxication;
  • unprofessional use of equipment and other equipment;
  • admission of unqualified personnel to perform complex operations;
  • lack of regular safety training.
Compliance with safety regulations at work is legally monitored by an authorized employee, but this does not relieve responsibility from the worker himself.

Objects of relationship and place of incident

It is necessary to understand that in such a complex situation there are always two objects of relations at work. This is the employee and the administration of the enterprise (employer). Each of them is required to take all necessary steps to document the fact of their work injury in accordance with the law.

Failure of the parties to fulfill their obligations may lead to irreparable consequences entailing legal liability of the parties.

Subjects of the accident

There is some confusion regarding who is paid such compensation and who can claim it.

In accordance with labor legislation, workers injured at work include:

  • an officially employed employee performing his duties under an employment contract;
  • employee and other persons receiving education in accordance with a student agreement;
  • students undergoing practical training;
  • persons suffering from mental disorders who participate in productive work at medical and industrial enterprises in the form of occupational therapy in accordance with medical recommendations;
  • members of production cooperatives and members of peasant (farm) households who take personal labor participation in their activities;
  • a citizen engaged in the production of public works under a court decision;
  • a convicted person involved in industrial work;
  • persons working on a voluntary basis.
Partners also have the right to compensation for damages on a general basis in the event of injury.

Time and place of the accident

When conducting an investigation into an industrial accident, the most important factor is establishing the location and time of injury.

There is a list of places where a person can receive an industrial injury, in which he is compensated for the costs of treatment.

These include negative events that occurred:

  • during working hours on the employer’s premises or in another place where work is performed (including during breaks, when putting production tools in order or when preparing for work);
  • when traveling to or from work (both on personal and official transport. In this case, personal transport can be used for work purposes only by agreement with the employer);
  • when traveling to and from the place of a business trip (regardless of how the employee went there - on foot, by public transport or by a company car);
  • when traveling in a vehicle as a shift worker during a rest period between shifts;
  • when working on a rotational basis during rest periods between shifts, as well as when being on the ship during free time from the watch and ship work;
  • when carrying out other actions within the framework of labor relations, including actions aimed at preventing a disaster, accident or accident.

These cases also apply to persons involved in preventing an accident or emergency and eliminating their consequences.

If it is established that the culprit of the injury is the employee himself, then this is not considered an industrial accident. However, the work of a special commission in this situation is mandatory.

Sequence of actions when identifying (receiving) an injury

Witnesses will have to testify to members of the commission investigating the industrial accident. It is recommended that you remember exactly the circumstances of the incident.

Algorithm of administration actions

When receiving messages about In any accident at work, the administration of the enterprise is obliged to:

  1. Immediately organize first aid for the victim, and, if necessary, transport him to a medical facility.
  2. Take measures to ensure the safety of other workers and to prevent the development of an emergency situation.
  3. Fence the scene of the incident to ensure its safety in the condition in which it was at the time of the incident (provided that this does not threaten the life and health of other people).
  4. Report an accident to:
    • regional branch of the FSS;
    • prosecutor's office
  5. If the injuries are severe, call the victim's relatives.
  6. If more than five people died, then the State Labor Inspectorate of the Russian Federation must be informed about such an industrial accident.
  7. Take other necessary measures to organize and ensure a proper and timely investigation of the accident.
  8. Issue an order to begin the work of the special commission. It must consist of at least three people. Namely:
    • employer representative;
    • representative of the elected body of a trade union organization;
    • specialist in the field of labor protection (except for the employee directly responsible for this area of ​​work).

The commission is headed by the employer or his representative.

If a part-time worker was injured, then his other employer must be informed.

Payment procedure


If an employee is injured at work, he or she may be entitled to the following compensation:

  1. Payment. This payment is calculated from the average monthly earnings, including bonuses. It does not depend on the insurance period.
  2. Compensation for additional treatment. The amount depends on the extent of damage.
  3. Payment for health procedures, according to the doctor’s recommendations.
  4. One-time payment from the Social Insurance Fund.
  5. Monthly benefits from the Social Insurance Fund.
  6. Compensation for moral damage is determined by agreement of the parties or in court.
  7. Payment to relatives in the event of the death of an employee.
All money comes from the Social Insurance Fund. However, the management of the organization is obliged to pay them immediately as soon as the relevant documents are received.

Mutual settlements

If the commission recognizes that the employee has suffered a work injury, then the employer is obliged to make charges for treatment (as stated above). That is, the employee receives payments from the company.

But according to current legislation, the FSS subsequently transfers these funds to the employer.

If the administration does not want to pay for sick leave or rehabilitation of the victim, citing a lack of funds, the employee has the right to appeal.

What amounts can a victim expect?


Treatment and recovery are expensive. The legislator has taken this into account.

A person injured at work has the right to receive the following amounts:

  1. Sick leave pay for the entire period of incapacity. Amount: 100% of average monthly earnings with all allowances.
  2. Compensation for additional procedures, purchase of medical supplies. Calculated on the basis of payment documents.
  3. One-time payment from the Social Insurance Fund. This amount is determined by a special formula that takes into account the maximum amount of compensation for damage of the corresponding severity level.
    Namely:
    • Sk. = MP/Day x dB, where:
      1. Sk. - amount of compensation;
      2. Mp. -maximum payment for the injury;
      3. Day - number of days of incapacity for work;
      4. db. - days of sick leave.
    • This amount cannot exceed the threshold set by the government. The amount may increase depending on the coefficient existing in the region. In 2019, the amount of payments was:
    • for a one-time payment - 94,018 rubles;
    • for monthly compensation - RUB 72,290.40.
    • Financial assistance from the enterprise, if it is stipulated by a collective agreement.
    • Compensation for moral damage. It is accrued only by court decision or by agreement of the parties.

It is necessary to collect all payment documents and receipts during treatment. They must be provided for the corresponding payments to be calculated.

However, treatment costs do not include:

  • payment for a trip to the hospital;
  • additional vacations (at your own expense);
  • funds spent on the treatment of injuries and illnesses received before or after the accident specified in the act.

Package of documents to the FSS


In order for both the employee and the company to receive all the money, it is necessary to collect all the relevant documents. They are provided as a package to the FSS.

The victim is required to:

  1. statement;
  2. a copy of the agreement with the employer;
  3. a fully completed sick leave certificate;
  4. passport or other identity document;
  5. report of an industrial accident;
  6. conclusion of the state labor inspector;
  7. work book or other document confirming the employment relationship with the employer;
  8. a court decision establishing the fact of an industrial accident;
  9. conclusion of a medical and social examination institution on the degree of loss of professional ability to work or the establishment of an occupational disease;
  10. salary certificate for the selected period;
  11. victim rehabilitation program;
  12. payment documents for medicines and medical services.

If the victim dies, then payments are made to his heirs (minor dependents).

They will be required to provide the following documents:

  • conclusion on the connection between the death of the insured and an industrial accident;
  • salary certificate of the deceased;
  • his death certificate;
  • confirmation of treatment costs;
  • documents on the right of inheritance (dependency);
  • documents containing information about the family composition and dependents of the deceased insured.
Important: the Social Insurance Fund compensates for expenses even if the heir changes. To do this, you must provide a supporting document to the organization.

The enterprise where the accident occurred is obliged to submit to the Social Insurance Fund:

  • a notification about an insured event is sent within 24 hours after the incident;
  • a copy of a medical report on the nature of health injuries received as a result of an industrial accident and the degree of their severity (form 315/у);
  • protocol of interviewing the victim, eyewitnesses, officials, inspection of the scene of the incident, a copy of the order to investigate the causes;
  • a copy of the employment contract or work record book of the victim;
  • copy of SNILS;
  • communication about the consequences of an accident at work and the measures taken;
  • a certificate of the final diagnosis of the victim;
  • accounting documents confirming the payment of legally required amounts;
  • an extract about the average salary of the victim;
  • a certificate confirming the transfer of a lump sum benefit to his account.
If it is determined that the injury was caused by a drunk employee, then he is paid the minimum wage for only one month. No other compensation is provided to the violator of labor discipline.

February 17, 2017, 23:40 May 16, 2019 17:14

This benefit is essentially compensation to the employee for earnings lost due to illness or some other reason. You can find out how much money you can count on and what you need to get it by reading this page.

Who is entitled to temporary disability benefits?

The insured person has the right to temporary disability benefits in the following cases:

  • loss of ability to work due to illness or injury (including abortion and IVF);
  • caring for a sick family member;
  • quarantine of the insured person, as well as quarantine of a child under seven years of age attending kindergarten, or another incapacitated family member;
  • implementation of prosthetics for medical reasons in a hospital specialized institution;
  • follow-up treatment in Russian sanatoriums immediately after inpatient treatment (Part 1, Article 5 of Federal Law No. 255-FZ of December 29, 2006; hereinafter referred to as the law on compulsory social insurance).

In what cases is temporary disability benefits paid?

The benefit is paid if the disability occurred during the period of work, as well as in cases where the illness or injury occurred within 30 calendar days from the date of termination of work or in the period from the date of conclusion of the employment contract until the day of its cancellation ().

From July 1, 2017, medical organizations have the right, at the patient’s choice and with his written consent, to issue sick leave in the form of an electronic document signed by the attending physician and medical institution using an enhanced qualified electronic signature (Federal Law dated May 1, 2017 No. 86-FZ).

It is paid according to the general rule for the entire period of temporary incapacity until the day of restoration of working capacity or determination of disability ().

To an insured person recognized as disabled (except for tuberculosis), benefits are paid for no more than four consecutive months or five months in a calendar year.

If a fixed-term employment contract was concluded for a period of up to six months, as well as if an illness or injury occurred between the date of conclusion of the employment contract and the day of its cancellation, temporary disability benefits (except for tuberculosis) are paid for no more than 75 calendar days.

In the last two cases, for patients with tuberculosis, benefits are paid until the day of restoration of working capacity (establishment of disability).

Temporary disability benefits for the need to care for a sick family member are paid for a period specified by law. More details about this are in Table 1.

Table 1. Duration of payment of temporary disability benefits when caring for a sick family member, depending on his age and illness.

Age and illness of a family member

Period for which benefits are paid

Up to 7 years

For the entire period of outpatient treatment or joint stay with a child in a hospital, but not more than 60 calendar days a year for all cases of caring for this child.

This period increases to 90 days a year if the child suffers from a disease included in the special list (). Such diseases include many types of cancer, insulin-dependent diabetes, arthritis, schizophrenia, autism, epilepsy, asthma, etc. The list also includes injuries (for example, intracranial injuries and injuries to internal organs), burns, frostbite, etc.

From 7 to 15 years

For a period of up to 15 calendar days for each case of outpatient or stationary treatment ( if the parent goes to the hospital with the child).

In this case, the maximum period should not exceed 45 calendar days per year.

Disabled child under 18 years of age

For the entire period of outpatient treatment or joint stay with a child in an inpatient treatment facility. But no more than 120 calendar days a year for all cases of caring for this child

Under 18 years of age if the child is HIV positive either suffers from a post-vaccination complication or cancer ( including malignant neoplasms of lymphoid, hematopoietic and related tissues)

For the entire period of joint stay with the child in an inpatient treatment and preventive institution no maximum term limit

In other cases of caring for a sick family member during outpatient treatment

No more than seven calendar days for each case of illness, but no more than 30 calendar days in a calendar year for all cases of care for this family member

There are two more cases of payment of temporary disability benefits. The first concerns situations where quarantine was introduced. Those who have been in contact with an infectious patient or are themselves a carrier of bacteria can count on benefits for the entire period of suspension from work due to quarantine. And if children under seven years of age attending kindergarten or incapacitated family members are quarantined, benefits will be paid to their legal representatives throughout the entire quarantine period.

The second case is prosthetics for medical reasons in a hospital setting. The benefit must be paid for the entire period of absence from work for this reason, including travel time to and from the place of prosthetics.

When to apply for temporary disability benefits

You must apply for payment no later than six months from the date of restoration of working capacity (establishment of disability) or the end of the period of release from work in cases of caring for a sick family member, quarantine, prosthetics and after-care ().

If there are good reasons, the period may be extended. The decision on the extension must be made by the territorial body of the FSS of Russia. The list of valid reasons contains the following:

  • emergency, unavoidable circumstances (earthquake, hurricane, flood, fire, etc.);
  • long-term temporary disability due to illness or injury lasting more than six months;
  • moving to a place of residence in another locality, change of place of stay;
  • forced absenteeism due to illegal dismissal or suspension from work;
  • damage to health or death of a close relative;
  • other reasons recognized as valid in court when the insured persons apply to court ().

Benefit amount

The amount of the benefit is calculated based on average earnings for the two calendar years preceding the year of disability (). That is, if an employee was sick in 2016 (no matter in January or November), the average earnings should be calculated for 2015 and 2014.

For 2017, you can take into account earnings in an amount not exceeding 755 thousand rubles. (even if it is actually larger), and for 2016 and 2015 - in an amount not exceeding 718 thousand rubles. and 670 thousand rubles. respectively ( , ).

In this case, only those amounts for which insurance premiums were calculated will be included in the calculation of average earnings. For example, vacation pay is subject to contributions, but for payments under civil contracts, contributions to the Federal Social Insurance Fund of Russia are not accrued (clause 2, part 3, article 9 of the Federal Law of July 24, 2009 No. 212-FZ "").

As a general rule, temporary disability benefits for loss of ability to work due to illness or injury, during quarantine, prosthetics for medical reasons and after-care in sanatorium-resort institutions immediately after inpatient treatment are paid in the following amount:

  • for an insured person with eight or more years of insurance experience - 100% of average earnings;
  • for an insured person with an insurance period of five to eight years - 80% of average earnings;
  • for an insured person with up to five years of insurance experience - 60% of average earnings ().

EXAMPLE

Let's calculate the amount of temporary disability benefits for an employee who has been working for the company from 2013 to the present. His total work experience at the time of granting the benefit is seven years and two months. The employee’s salary for 2016 amounted to 780 thousand rubles, for 2015 – 612 thousand rubles.

Let’s assume that the employee was sick from April 17 to April 23 inclusive (seven calendar days), which is confirmed by sick leave.

First, let's compare the employee's annual salary with the maximum values. Remuneration for labor in 2015 did not exceed the permissible figure (670 thousand rubles), which means that its entire amount can be used - 612 thousand rubles. In contrast to earnings for 2016, which is more than the maximum (RUB 780 thousand versus RUB 718 thousand). Therefore, for the 2016 salary, the maximum value should be used.

Thus, earnings for two years will be:
612,000 rub. + 718,000 rub. = 1,330,000 rub.
Now this amount needs to be divided by 730 to determine the average daily earnings:
1,330,000: 730 = 1821.92 rubles.
The amount of temporary disability benefits will be equal to:
1821.92 x 7 x 80% = RUB 10,202.75

There are cases when the benefit is calculated based on , there are two of them: if the employee did not receive any earnings during the billing period or if his earnings turned out to be below the minimum wage in terms of days. In this case, to determine the amount of benefits, the minimum wage will be used on the day the insured event occurred, that is, on the day of illness ().

Average daily earnings are determined by the formula: minimum wage x 24/730 (7800 x 24/730 = 246.58 rubles). Then, by analogy with the calculation from the example above, you need to determine the amount of the benefit depending on the time for which the sick leave was issued and the length of service.

Who pays temporary disability benefits?

As a general rule, benefits are paid by the employer at the place of work.
If the insured person works for several employers and has worked for them over the past two calendar years, benefits are assigned and paid to him for each place of work.

If an employee works in several companies, and over the past two years he has also worked in several organizations, but in different ones, the benefit will be paid at one of the last places of work of the employee’s choice. In this case, he will need to bring certificates from other employers about the amount of their salary and that they did not provide benefits.

If a citizen works for several employers, and over the past two calendar years he worked for both them and others, the benefit will be paid either for all places of work or one at a time at the employee’s choice (,). In the latter case, you will also need certificates from employers.

For persons who have lost their ability to work within 30 days after dismissal, benefits are paid either by the employer at the last place of work or by the territorial body of the Social Insurance Fund of Russia. By the way, other insured persons can also apply to the Fund, these include the self-employed (lawyers, individual entrepreneurs, members of peasant (farm) households, individuals, private notaries, other persons engaged in private practice), as well as members of family (tribal) communities indigenous peoples of the North. But all these persons can apply for payment only if they voluntarily paid contributions to the Federal Social Insurance Fund of Russia - they have no obligation to make contributions ().

In addition, ordinary employees can apply to the Federal Social Insurance Fund of Russia for the appointment and payment of benefits if:

  • the employer has ceased its activities;
  • there is not enough money in his accounts to pay benefits;
  • it is impossible to establish the location of the employer and his property if there is a court decision that has entered into force, which confirms the fact of non-payment of benefits;
  • bankruptcy proceedings are being carried out against the employer ().

This benefit is assigned and paid only on the basis of a certificate of incapacity for work (sick leave) ().

1. A temporary disability benefit in case of loss of ability to work due to illness or injury is paid to the insured person for the entire period of temporary disability until the day of restoration of working capacity (establishment of disability), except for the cases specified in parts 3 and this article.

2. When the insured person undergoes further treatment in a sanatorium-resort organization located on the territory of the Russian Federation, immediately after the provision of medical care in a hospital setting, temporary disability benefits are paid for the period of stay in the sanatorium-resort organization, but not more than 24 calendar days (for excluding tuberculosis).

(see text in the previous edition)

3. An insured person recognized as a disabled person in accordance with the established procedure is paid a temporary disability benefit (except for tuberculosis) for no more than four months in a row or five months in a calendar year. If these persons fall ill with tuberculosis, temporary disability benefits are paid until the day of restoration of working capacity or until the day the disability group is revised due to tuberculosis.

(see text in the previous edition)

4. An insured person who has entered into a fixed-term employment contract (fixed-term service contract) for a period of up to six months, as well as an insured person whose illness or injury occurred during the period from the date of conclusion of the employment contract until the day of its cancellation, temporary disability benefits (with the exception of tuberculosis) is paid for no more than 75 calendar days under this agreement. In case of tuberculosis, temporary disability benefits are paid until the day the ability to work is restored (disability is established). In this case, an insured person whose illness or injury occurred during the period from the date of conclusion of the employment contract until the day of its cancellation is paid temporary disability benefits from the day on which the employee was supposed to start work.

(see text in the previous edition)

5. Temporary disability benefits, if it is necessary to care for a sick family member, are paid to the insured person:

1) in the case of caring for a sick child under 7 years of age - for the entire period of treatment of the child on an outpatient basis or joint stay with the child in a medical organization when providing medical care to him in an inpatient setting, but not more than 60 calendar days in a calendar year for all cases of caring for this child, and in the case of a child’s illness included in the list of diseases determined by the federal executive body exercising the functions of developing and implementing state policy and legal regulation in the field of healthcare, no more than 90 calendar days in advance calendar year for all cases of care for this child in connection with the specified disease;

(see text in the previous edition)

2) in the case of caring for a sick child aged 7 to 15 years - for a period of up to 15 calendar days for each case of treatment of the child on an outpatient basis or joint stay with the child in a medical organization when providing medical care to him in an inpatient setting, but no more than 45 calendar days in a calendar year for all cases of care for this child;

(see text in the previous edition)

3) in the case of caring for a sick disabled child under the age of 18 years - for the entire period of treatment of the child in an outpatient setting or a joint stay with the child in a medical organization when providing medical care to him in an inpatient setting, but not more than 120 calendar days in calendar year for all cases of care for this child;

(see text in the previous edition)

4) in the case of caring for a sick child under the age of 18 who is HIV-infected - for the entire period of joint stay with the child in a medical organization when providing medical care to him in an inpatient setting;

(see text in the previous edition)

5) in the case of caring for a sick child under the age of 18 with his illness associated with a post-vaccination complication, with malignant neoplasms, including malignant neoplasms of lymphoid, hematopoietic and related tissues - for the entire period of treatment of the child in an outpatient setting or joint stay with a child in a medical organization when providing medical care in an inpatient setting;

(see text in the previous edition)

6) in other cases of caring for a sick family member during outpatient treatment - no more than 7 calendar days for each case of illness, but no more than 30 calendar days in a calendar year for all cases of caring for this family member.

Compensation for lost earnings to an employee as a result of general compensation for harm caused to health during the performance of such employee’s job duties has its own characteristics that must be taken into account when recovering lost earnings in favor of the employee.

In accordance with Art. 184 of the Labor Code of the Russian Federation in case of damage to health or in the event of death of an employee due to an accident at work or an occupational disease for the employee (his family) his lost earnings (income) are reimbursed, as well as additional costs associated with health damage for medical, social and professional rehabilitation or corresponding costs in connection with the death of the employee. The types, volumes and conditions for providing guarantees and compensation to employees in these cases are determined by federal laws.

It is necessary to decide what should be understood by the concept of lost earnings in a specific legal relationship. After all, lost earnings during forced absence and lost earnings due to an industrial injury are completely different types of compensation for harm caused to an employee, and completely different methods for calculating lost earnings are applied to them.

In accordance with the preamble of the Federal Law of the Russian Federation dated July 24, 1998 N125-FZ “On compulsory social insurance against accidents, industrial accidents and occupational diseases”, this Federal Law determines the procedure for compensation for harm caused to the life and health of an employee during the performance of his duties under an employment contract and in other cases established by this Federal Law.

As a result of the injury, the employee does not work and, accordingly, does not receive wages. Consequently, lost earnings for the entire time the employee was on sick leave (certificate of incapacity for work) are subject to compensation.

According to the last paragraph of Art. 12 Resolution of the Plenum of the Supreme Court of the Russian Federation dated March 10, 2011 No. 2 Moscow “On the application by courts of legislation on compulsory social insurance against industrial accidents and occupational diseases”

The main document confirming the fact of damage to health and temporary loss of professional ability to work is a certificate of incapacity for work issued by a medical organization in the form and in the manner prescribed by the Ministry of Health and Social Development of the Russian Federation.

However, even after the closure of the certificate of incapacity for work, the employee cannot always fully restore his ability to work.

Ability to work refers to a person’s ability to work.

An employee’s ability to work is of two types: general and professional. General working capacity is characteristic of every worker, since it simply implies a person’s ability to perform any work, while professional working capacity implies a person’s ability to perform work in the profession in which he worked before injury.

Consequently, lost earnings are subject to compensation for the entire time the employee is on sick leave, as well as in the event of partial or complete loss of ability to work. It is necessary to find out how, in what order and from what time the compensation for lost earnings occurs, and also whether lost earnings are subject to compensation in the event of partial or complete loss of ability to work in any case, or only in the case of loss of a certain type of ability to work.

Harm caused to the health or life of an employee during the performance of work duties is compensated by providing compulsory social insurance against accidents and occupational diseases.

According to Part 1 of Art. 8 of the Federal Law “On compulsory social insurance against accidents at work and occupational diseases” for the entire time an employee is on sick leave due to an industrial injury he is paid temporary disability benefits.

In accordance with Art. 9 of the Federal Law “On Compulsory Social Insurance against Industrial Accidents and Occupational Diseases”, temporary disability benefits in connection with an industrial accident or occupational disease are paid for the entire period of temporary disability of the insured until his recovery or permanent loss of professional working capacity is established in the amount 100 percent of his average earnings, calculated in accordance with the legislation of the Russian Federation on temporary disability benefits.

Temporary disability benefits in accordance with Art. 14 of this Law, is calculated based on the average earnings of the insured person, calculated for two calendar years preceding the year of temporary disability.

Harm caused to the health or life of an employee during the performance of work duties is subject to compensation not only through the provision of compulsory social insurance against accidents and occupational diseases, which is paid from the Social Insurance Fund in the form of temporary disability benefits.

In other words, in addition to receiving temporary disability benefits, the injured employee has the right to receive lost earnings in full. For clarification on this issue, I am grateful to our colleague, lawyer Stanislav Vsevolodovich Izosimov, and taking into account his comments, I am amending the article.

In accordance with Art. 1085 Civil Code of the Russian Federation If a citizen is injured or otherwise damaged his health, the victim’s lost earnings (income) that he had or could definitely have are subject to compensation. When determining lost earnings (income), the disability pension assigned to the victim in connection with injury or other damage to health, as well as other pensions, benefits and other similar payments assigned both before and after the injury to health, are not taken into account and are not entail a reduction in the amount of compensation for harm (they are not counted towards compensation for harm). Earnings (income) received by the victim after damage to health are also not included in compensation for harm.
Higher courts in their decisions indicated that compensation for harm is aimed at protecting the property interests of victims; the law does not allow its size to be reduced at the expense of the pension assigned to the victim (including for disability), benefits and other similar payments that were assigned as before, and after causing harm, as a result of which lost earnings are subject to compensation by the causer of harm, regardless of the amount of disability benefits paid.

Lost wages are the wages the injured worker would have had if he had not been injured.

Lost earnings are subject to recovery in full - 100%, despite the fact that the employee was paid temporary disability benefits.

Lost earnings are subject to recovery from the tortfeasor, i.e., from the employer.

Lost earnings are calculated as follows:

The average monthly earnings (income) of the victim is calculated in the manner established by paragraphs 3 and 4 of Article 1086 of the Civil Code of the Russian Federation
The average monthly earnings (income) of the victim is calculated by dividing the total amount of his earnings (income) for the twelve months of work preceding the injury by twelve. In the case where the victim had been working for less than twelve months at the time of the injury, the average monthly earnings (income) is calculated by dividing the total amount of earnings (income) for the number of months actually worked prior to the injury by the number of these months.

Months not fully worked by the victim are, at his request, replaced by previous fully worked months or excluded from the calculation if it is impossible to replace them.
In the case where the victim was not working at the time of the injury, at his request, his earnings before dismissal or the usual amount of remuneration for an employee of his qualifications in the given area are taken into account, but not less than the minimum subsistence level established in accordance with the law for the working population as a whole in the Russian Federation.
Lost earnings while the employee is on sick leave are calculated as follows. Let's take for example an employee who has worked for more than one year. Then, on the basis of Part 3 of Art. 1086 of the Civil Code of the Russian Federation, we sum up his income for the last 12 months and then find either the average daily earnings or the average hourly wage rate. After which we multiply the number of working days or the number of working hours calculated during the period of temporary disability of the employee by the average daily earnings or average hourly rate obtained during the calculation earlier. The amount received will be the employee’s lost earnings during the period of his temporary disability.

If an employee loses partial or complete disability, the employee also has the right to compensation for lost earnings. Calculating lost earnings in the event of total disability does not cause any particular difficulties, since in this case lost earnings are subject to compensation in the amount of average earnings of 100%.

Certain difficulties are presented by the procedure for determining the type, calculation and receipt of lost earnings in the event of a partial loss of the employee’s ability to work.

Lost earnings are subject to compensation, both for loss of professional ability to work and for loss of general ability to work, as mentioned in Part 1 of Art. 1086 of the Civil Code of the Russian Federation.
The amount of earnings (income) lost by the victim to be compensated is determined as a percentage of his average monthly earnings (income) before injury or other damage to health or until he lost his ability to work, corresponding to the degree loss of the victim's professional ability to work, and in the absence of professional ability to work - degree of loss of general ability to work.
Based on the meaning of this article, it follows that the initial criterion for assigning compensation for lost earnings is first the loss of professional ability to work, and in its absence, the loss of the employee’s general ability to work is taken as a basis.

With the entry into force of the Order of the Ministry of Labor and Social Protection of the Russian Federation dated October 11, 2012 N 310n, Moscow “On approval of the Procedure for the organization and activities of federal state institutions of medical and social examination”, the functions of determining loss of professional and permanent disability were assigned to federal state institutions of medical and social expertise, which include the Federal Bureau of Medical and Social Expertise.

Previously, in accordance with paragraph. 2 p. 28 Resolution of the Plenum of the Supreme Court of the Russian Federation dated January 26, 2010 No. 1 Moscow “On the application by courts of civil legislation governing relations under obligations resulting from harm to the life or health of a citizen”
Determination of the degree of loss of professional ability is carried out by institutions of the state medical and social examination service (Decree of the Government of the Russian Federation of December 16, 2004 N 805 “On the procedure for organizing and operating federal state institutions of medical and social examination”), and the degree of loss of general ability to work - by forensic medical examination in medical institutions of the state health care system (Article 52 of the Fundamentals of Legislation of the Russian Federation on the protection of the health of citizens, approved by Resolution of the Supreme Council of the Russian Federation of July 22, 1993 N 5487-1).
In accordance with Part 3 of Art. 11 of the Law “On compulsory social insurance against accidents at work and occupational diseases”

The degree of loss of professional ability of the insured is established on the basis of the conclusion of a medical and social examination institution.
The procedure for determining the degree of loss of professional ability to work as a result of industrial accidents and occupational diseases is determined by the Government of the Russian Federation.

In this case, the concept of loss of professional ability to work should be understood as the loss by an employee of the ability to perform high-quality, to the same extent, labor functions in the profession or specialty that he directly performed before he was injured.

The degree of professional disability is established on the basis of the Rules for determining the degree of loss of professional disability as a result of industrial accidents and occupational diseases (approved by Decree of the Government of the Russian Federation of October 16, 2000 N 789).

According to Art. 2 Rules above
The degree of loss of professional ability to work is established in percentages at the time of examination of the victim, based on the assessment of the loss of ability to carry out professional activities due to an industrial accident and occupational disease, in accordance with the criteria for determining the degree of loss of professional ability, approved by the Ministry of Labor and Social Protection of the Russian Federation in agreement with the Ministry of Health of the Russian Federation.
In pursuance of the Decree of the Government of the Russian Federation of October 16, 2000 No. 789, the Decree of the Ministry of Labor of Russia of July 18, 2001 56 introduced “Temporary criteria for determining the degree of loss of professional ability to work as a result of industrial accidents and occupational diseases”, which are still in effect today.

In accordance with Part 1 of the Temporary Criteria the degree of loss of professional ability to work is expressed as a percentage and is set in the range from 10 to 100 percent.

In addition to examining the victim himself, during the MSE, the commission examines the documents received from the employer related to the accident. The main document that needs to be taken into account, first of all, by the victim himself, is a Medical Report on the severity of the injury.

The medical report is filled out in accordance with the Scheme for determining the severity of health damage in industrial accidents, approved by order of the Ministry of Health and Social Development of the Russian Federation dated February 24, 2005 N 160. In accordance with part 1 of this order

Accidents at work are divided into 2 categories according to the severity of damage to health: heavy and light.

The employer is obliged to make a request within 24 hours to the medical institution where the victim first sought medical help (ambulance and emergency medical doctors do not fill out a medical report) to obtain an opinion on the nature of the injuries received, and the medical organization is obliged to immediately issue a medical report at the employer’s request.

Employers do their best to avoid writing in the Industrial Accident Report that the severity of the injury to health is severe, since accordingly more serious consequences occur for it, and therefore they do not hesitate to enter deliberately false information, as in the Accident Report case at work, and in the Medical report.

The severity of harm to an employee’s health directly affects the amount of subsequent amounts paid to such an employee as compensation for harm to health, therefore it is in the interests of the employee himself to initially monitor this moment.

In accordance with Part 1 and Part 3 of Art. 10 of the Law “On compulsory social insurance against accidents at work and occupational diseases”

Monthly insurance payments are assigned and paid:
to the insured - if, according to the conclusion of a medical and social examination institution, the result of the occurrence of an insured event was the loss of professional ability to work.

Monthly insurance payments are paid to the insured during the entire period of permanent loss professional ability to work.

The Plenum of the Supreme Court of the Russian Federation, referring in its Resolution of January 26, 2010 No. 1 Moscow “On the application by courts of civil legislation governing relations under obligations resulting from harm to the life or health of a citizen” on Art. 52 of the Fundamentals of the legislation of the Russian Federation on the protection of the health of citizens, approved by Resolution of the Supreme Council of the Russian Federation of July 22, 1993 N 5487-1, however, did not disclose either the concept of loss of general ability to work, or the procedure for compensation for harm lost as a result of loss of general ability to work .

General ability to work is a person’s ability to perform unskilled labor.

As a result of loss of ability to work, the employee develops a disability, which can be either permanent (i.e. permanent) or temporary (i.e. such that after a certain period of time the victim’s health and ability to work are restored).

Compensation for lost earnings for the period of temporary disability of an employee who suffered a work injury was discussed above, so all that remains is to consider the issue of compensation for lost earnings for an employee in the event of a permanent loss of his general ability to work.

The degree of loss of general ability to work is established by a forensic medical examination carried out in medical institutions of the state health care system.

Previously, the definition of permanent loss of general ability to work was determined on the basis of a table of percentages of loss of ability to work as a result of various injuries provided for by the terms of personal insurance, set out in Instruction of the Ministry of Finance of the USSR dated May 12, 1974 No. 110 “On the procedure for organizing and conducting a medical insurance examination”).

Since 2008, the definition of permanent loss of general working capacity is determined on the basis of the “Table of percentages of persistent loss of general working capacity as a result of various injuries, poisonings and other consequences of external causes,” which is an appendix to the Order of the Ministry of Health and Social Development of the Russian Federation dated April 24, 2008 N 194n “On approval of Medical criteria for determining the severity of harm caused to human health.”

If there are several Medical criteria, the severity of the harm caused to human health is determined by the criterion that corresponds to the greater severity of the harm. If multiple injuries mutually aggravate each other, the determination of the severity of the harm caused to human health is made based on their totality.

At the same time, I would like to draw attention to an important point that remains unresolved in the new order of the Ministry of Health.

In accordance with the new rules, when determining the degree of loss of general ability to work in the aggregate of a multiplicity of injuries to various organs, they are summed up, but at the same time, the rules do not indicate the limit of such summation, while in the previous rules the total degree of loss of general ability to work when summed up could not exceed 100%.

Therefore, how the general degree of disability will be specifically decided in accordance with the new legislation can only be guessed at, probably again at the discretion of the court.

You need to undergo an MSE (medical and social examination) 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 Form N 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 accident investigations

(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 the investigation of the accident) identifies and interviews eyewitnesses of the incident, 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 conducting an investigation, the employer, at its own expense, provides:

performing technical calculations, conducting laboratory research, testing, other expert work and engaging expert specialists for these purposes;

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

provision of transport, office space, communications equipment, special clothing, special shoes and other personal protective equipment.

Accident investigation materials include:

order (instruction) to create a commission to investigate the accident;

plans, sketches, diagrams, protocol for examining the scene of the incident, and, if necessary, photo and video materials;

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

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

protocols of interviews with eyewitnesses of the accident and officials, explanations of the victims;

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

a medical report on the nature and severity of the damage caused to the victim’s health, or the cause of his death, whether the victim was in a state of alcohol, narcotic or other toxic intoxication at the time of the accident;

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

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

(as amended by Federal Law dated July 18, 2011 N 242-FZ)

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.

Based on the collected investigation materials, the commission (in the cases provided for by this Code, a 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 for eliminating the identified violations, the 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, resolves the issue of which employer records the accident, qualifies the accident as an accident accident at work or as an accident not related to production.

They are investigated in the prescribed manner and, by decision of the commission (in the cases provided for by this Code, a state labor inspector who independently conducted an investigation of the accident), depending on the specific circumstances, may be classified as accidents not related to production:

death due to a general illness or suicide, confirmed in the prescribed manner by a medical organization, investigative bodies or court;

death or injury to health, the only cause of which, according to the conclusion of a medical organization, was alcohol, narcotic or other toxic intoxication (poisoning) of the victim, not associated with violations of the technological process in which industrial 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 were recognized as consistent with the Constitution of the Russian Federation by Resolution of the Constitutional Court of the Russian Federation dated May 24, 2007 N 7-P, which simultaneously revealed their constitutional- legal meaning.

an accident that occurred when the victim committed actions (inactions) qualified by law enforcement agencies as a criminal offense.

An accident at work is an insured event if it occurs with the insured 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 another body authorized by the employees, the commission (in the cases provided for by this Code, a state labor inspector who independently conducts accident investigation) establishes the degree of fault of the insured as a percentage.

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

(see text in the previous edition)

The regulations on the specifics of the investigation of industrial accidents in certain industries and organizations and the forms of documents required for the investigation of accidents are approved in the manner established by the federal executive body authorized by the Government of the Russian Federation.

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

Article 184. Guarantees and compensation in case of accident at work and occupational disease

In case of damage to health or in the event of death of an employee as a result of an accident at work or an occupational disease, the employee (his family) is compensated for his lost earnings (income), as well as additional expenses associated with damage to health for medical, social and professional rehabilitation or corresponding expenses in connection with death of an employee.

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

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

You also have the right to recover compensation for moral damage from your employer for physical harm caused in court.