Cause of disability 04 on sick leave - what does it mean to pay the employer in 2020

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Labor law establishes the payment of compensation to workers injured at work. The employer reimburses:

1. unearned income of a citizen due to sick leave;

additional expenses for medical, professional or social rehabilitation.

Read also:  Peculiarities of dismissal of maternity leave at will

In the event that the employer pays all insurance contributions to the Social Insurance Fund, the authorities reimburse all payments. The calculation of payments is regulated by the Federal Law “On Compulsory Social Insurance against Accidents”. Unearned income is reimbursed to the victim in the amount of the average salary for the entire period of incapacity for work.

The one-time insurance payment is calculated based on his average earnings, regional coefficients and premiums established in the given area. The maximum amount, according to Art. 11 of this law is 94,018 rubles. This amount is compensation for medical, social and professional rehabilitation.

The maximum monthly payment is calculated based on the share of average monthly earnings and the degree of disability. Average monthly earnings are calculated as follows:

ZPsr = ZPtotal / 12, where

ZPtot - the total amount of earnings for 12 months (salary itself, bonuses) before the accident occurred.

Common mistakes and questions

1. Is sick leave social benefit with code 04 subject to insurance contributions? Is personal income tax withheld? In accordance with Art. 422 of the Tax Code of the Russian Federation, the amounts established for the payment of compensation in the event of harm or other damage to health are not subject to an insurance premium. However, the entire amount of sick leave with this code is subject to income tax.
2. What is the difference between compensation for a domestic injury and a work-related injury? Domestic injuries include all those received by an employee outside of work. That is, at home or while on vacation. In such cases, an internal investigation is not carried out by the organization.
3. Can the amount of benefits for a work injury be reduced? If the injured employee violates the regime established by his attending physician, the amount of the benefit may be reduced to the minimum wage for a calendar month. This reduction in size is established from the day the violation is noted until the end of the sick leave.

Possible liability and consequences for the employer

If the commission determines that the employer violated the standards established by SanPin, workers were not properly instructed on industrial safety. For violation of regulatory requirements for labor protection, the employer (Article 5.27.1 of the Code of Administrative Offenses of the Russian Federation) faces a fine (for an employer - an individual from 2 to 5 tr, for legal entities - from 50 to 80 tr).

The fine will increase with the severity of the violations committed by the employer. If the injury suffered by an employee results in serious harm to health, this will entail much more serious liability. The employer faces imprisonment for up to 1 year with or without deprivation of the right to engage in certain activities for the same period (Part 1 of Article 143 of the Criminal Code of the Russian Federation).

The reasons for incapacity for work are entered on the sick leave sheet in encrypted code form. Read our articles about how the period of incapacity for work is paid if the sick leave contains codes 01, 02, 31, 09 11, 05 and 020, 36, and 32 in the “Other” column.

An employee being injured on the job can pose serious problems for the employer. Only if the employer correctly instructs employees and provides them with safe working conditions will he not be subject to sanctions from the labor inspectorate. If an accident occurs, the employer must make every effort to thoroughly investigate the causes of the incident and organize compensation for harm caused to the employee.

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What are they needed for?

All the shortcomings have been corrected in the new form, but the important part for basic information remains the same. The procedure for completing the sheet remains the same, but some codes in the new form must be indicated by the manager .

The use of codes on sick leave is convenient for a number of reasons:

To maintain secrecy.

If a certificate of incapacity for work needs to be passed from hand to hand, then you can be calm and confident that a stranger will not find out about the illness . In the document it will be possible to distinguish only certain letters and numbers, but not the name of the disease.

This is important to know: How many days of sick leave are paid per year to an employee?

Use codes to save space in your document.

A certificate of incapacity for work usually consists of an abundance of information, because... it must be filled out by both the healthcare worker and the employer. All necessary data must be included in the document and be as useful as possible.

The doctor must indicate the specific clinic, patient information, the name of the doctor and the period of time that the employee will remain incapacitated. The employer indicates its necessary information about the employee. Thus, this amount of information takes up a lot of space, and the codes allow you to limit yourself to the size of one sick leave .

It becomes easier for the HR department to work thanks to the presence of codes. Everyone knows that doctors have to see hundreds of patients a day, which is why their handwriting is often difficult to read. Naturally, deciphering the code in this case is much easier than understanding the doctor’s handwriting.

Thanks to the use of codes, it becomes possible to cooperate with hospitals in other countries. The codes refer to the same diseases in all countries. For this reason, clinics abroad can easily understand the records of their foreign colleagues.

Errors are kept to a minimum.

Due to the fact that there is no longer a need to understand doctors’ handwriting, the possibility of making a mistake when reading doctor’s notes is minimized.

to contents

An employee brought in sick leave with code “4”: what should the accountant do?

Hello!

Quote (Natalia Valerievna): The employee provided sick leave with code “4”, was injured outside of working hours, In accordance with Order of the Ministry of Health and Social Development of Russia dated June 29, 2011 N 624n “On approval of the Procedure for issuing certificates of incapacity for work” 02 - injury; 04 - industrial accident or its consequences; If an employee is injured during off-duty hours, then his sick leave should have code 02. In Article 3 of the Federal Law of July 24, 1998 N 125-FZ “On compulsory social insurance against industrial accidents and occupational diseases” Quote: accident at production - an event as a result of which the insured received injury or other damage to health during the performance of his duties under an employment contract and in other cases established by this Federal Law, both on the territory of the insured and outside it, or while traveling to the place of work or returning from the place work on transport provided by the insured, and which entailed the need to transfer the insured to another job, temporary or permanent loss of professional ability to work, or his death; How does the employee explain what happened? When receiving sick leave with code 4, the employer is obliged to immediately notify the Social Insurance Fund about the occurrence of such an insured event, as well as create a commission and conduct an investigation. The FSS website can help you. During the investigation, it turns out that the injury was “domestic”, or that there was an accident at work. Depending on the results of the investigation, sick leave is paid. If it turns out that the employee was injured not at work, then benefits are calculated and paid in the usual manner. If you have questions, don't hesitate to ask. Have a nice day and successful work!

Coding of causes of disability

The codes for the reason for incapacity for work in the new sick leave are filled in by the attending physician to whom the employee addresses. The mark is made either from the patient’s own words, or on the basis of evidence, if the situation requires it.

• Digital o means disease. As a rule, this mark is placed in case of common ailments (ARVI, acute respiratory infections, hypertension, etc.).
• Code “02” is set when the patient receives a domestic injury. These could be fractures, cuts with large blood loss, dislocations, concussions, burns, etc. received by the employee at home or in other places not related to work activities.
• If the BL contains “03”, this means that the person is in quarantine, which has been officially declared by the executive authority of the place of residence (if the employee has been in contact with an infected person or has signs of a disease due to which the specified regime has been declared). Most often, quarantine is declared in preschool and educational institutions. Parents can receive a BC sheet with the specified mark if a child under 7 years of age is in quarantine.
• Code “04” requires not only the words of the employee, but also some evidence, because it is set when a person receives an injury in the following cases:

1. directly at the workplace;
2. when traveling to or from the place of work on personal or work transport;
3. during a business trip, traveling to or from its place;
4. during breaks between work;
5. during rest periods between shifts (if work is carried out on a rotational basis).

• Maternity leave is issued for 140 days. In cases where it is necessary to increase the period (up to 156 days for complications during childbirth and up to 194 for multiple pregnancies), an additional code “020” is entered. You can learn more about this here.
• When prosthetics are performed in stationary conditions, the bulletin includes o. It is determined by the doctor of the hospital where the procedure is performed.
• At the workplace, you can not only get injured, but also “earn” an occupational disease (chronic or asthmatic bronchitis when exposed to industrial aerosols, hearing loss when working in high noise conditions, etc.).
  In this case, and when the employee contacts during an exacerbation of such a disease, the attending physician puts the code “07”. As in the case of o, it requires evidence that the disease is related to work activity.
• If there is a need to continue treatment in a sanatorium (for example, during rehabilitation after a serious illness), a new sick leave sheet with code “08” is filled out.
• O means leave to care for a temporarily disabled family member or a minor child. The bulletin also contains information about the sick family member and indicates the relationship code, because There is a difference in the payment of care benefits for adults and their child depending on the age of the child.
• Code "10" means a different condition. This means poisoning or carrying out procedures, examinations and other manipulations to identify a particular disease.
• O means that a person has a socially significant disease (malignant tumor, hepatitis, tuberculosis, etc.), and code “12” means a similar disease in a child under 7 years of age.
• To care for a disabled child, a BC with code “13” is issued.
• If an employee has complications after vaccination (allergic reaction, anaphylactic shock, etc.) or if a malignant tumor is detected in his child, code “14” is set. In order to register it on the sheet, the consent of the person is required.
• Care for HIV-infected children is carried out with care, which also requires the consent of the person for whom the certificate is issued.

“Unfortunate” sick leave: we count and pay

The article from the magazine “MAIN BOOK” is current as of May 6, 2020.

Contents of magazine No. 10 for 2020 M.A. Kokurina, lawyer

How to calculate and pay sick leave for a work injury

Disability benefits due to a work injury are special. For example, it is paid in full and from the first day from the funds of the Social Insurance Fund. 1, 7 tbsp. 15 of Law No. 125-FZ of July 24, 1998 (hereinafter referred to as Law No. 125-FZ); clause 9 of the Rules, approved. Government Decree No. 184 dated March 2, 2000. Therefore, the accountant needs to carefully consider its calculation and execution. After all, an incorrect amount or undocumented payment of benefits for a work injury can lead to a dispute, for example:

• <or>with the Social Insurance Fund - due to its refusal to reimburse the amount of benefits from the Fundap budget. 3 tbsp. 22 of Law No. 125-FZ; pp. 5, 10 Rules, approved. Government Decree No. 184 dated March 2, 2000;
• <or>with an employee - due to underpayment of benefits for an industrial injury.

We accept sick leave from an employee

To ensure you pay benefits reasonably, carefully look at:

• what date is indicated in the line of the certificate of incapacity for work “Get to work” h. 1 tbsp. 6 of Law No. 255-FZ of December 29, 2006 (hereinafter referred to as Law No. 255-FZ). For example, if the code is “32,” then this is the day the disability was established. In this case, it happens that an employee who has become disabled brings sick leave later than 6 months from the date of its end. 1 tbsp. 12 of Law No. 255-FZ. In such a situation, you do not have to pay benefits; the Social Insurance Fund will do this at the request of a late employee. 3 tbsp. 12 of Law No. 255-FZ;
• whether the cause of disability is correctly indicated. For sick leave benefits, the code must be “04”. It happens that an employee seeks medical help on his own, informs the doctor simply about the injury, and he puts the code “02” on the sick leave - a domestic injury. If you have already recorded an emergency at work, and they brought you sick leave with the wrong code, ask the employee to contact a medical organization. Let him show there a copy of the report on the industrial accident (form N-1) so that the doctor can complete the sick leave. He will write down the required code “04” in the “measuring code” cell of the sheet.

If you did not find any design errors on the sick leave, then in the line “Act of form N-1” indicate the day, month and year of drawing up the act based on the results of your investigation of the production ChPabz. 19 clause 66 of the Procedure, approved. By Order of the Ministry of Health and Social Development dated June 29, 2011 No. 624n.

Having taken sick leave, you must:

• calculate and accrue benefits no later than 10 calendar days from the date the employee contacts you with a certificate of incapacity for work. 5 tbsp. 13, part 1 art. 15 of Law No. 255-FZ;
• pay the benefit on the next day after the payment is issued. 1 tbsp. 15 of Law No. 255-FZ.

ADVICE

If you find any errors in the certificate of incapacity for work, then it is better to justify why you refused to accept sick leave from an employee injured at work.

You can compose, for example:

• <or>a statement that, due to errors in the sick leave, you returned it to the employee to receive a duplicate. Let two witnesses and the employee himself sign the act;
• <or>written notification to the employee of the need to obtain a duplicate certificate of incapacity for work.

Conditions for calculation on sick leave

The list of such diseases is approved by the Government of the Russian Federation (Resolution of the Government of the Russian Federation dated December 1, 2004 N 715) 12 This code is indicated if sick leave is issued in connection with the illness of a child under 7 years of age and his illness is included in a special list (Order of the Ministry of Health and Social Development of the Russian Federation dated February 20, 2008 N 84n) 13 This code is reflected in the sick leave if it is issued in connection with the care of a disabled child 14 This code is indicated on the certificate of incapacity for work if it is issued to care for a child whose illness is associated with a post-vaccination complication, or for malignant neoplasms 15 Code “15” means that temporary disability is caused by the need to care for an HIV-infected child. If, for example, the cause of disability has changed, then one of these codes will be indicated in the “change code” cells of the sick leave sheet. Those.

Calculating injury benefits

STEP 1. Determine the billing period.

These are 2 calendar years preceding the year in which the person was on sick leave. 1 tbsp. 14 Law No. 255-FZ; Art. 3 of Law No. 125-FZ:

• <if>an employee received an injury and sick leave for it in 2016, then you take payments for 2014 and 2020;
• <if>an employee was injured in 2020, and brought you sick leave in 2020, then you take his earnings for 2013-2014. By the way, these same years must be taken for calculation if the employee went on sick leave in 2020, and the report in form N-1 was drawn up in 2020. This is possible, for example, when the employer learns about the work-related nature of the injury only on the day the recovered employee leaves to work with sick leave, which indicates the code “04”, and the investigation of the industrial accident is carried out later than it happened.

At the request of an employee who was on parental leave or maternity leave during the pay period, you can replace one or both years of the pay period with the year(s) immediately preceding such leave. 1 tbsp. 14 Law No. 255-FZ; Letters of the Ministry of Labor dated December 9, 2015 No. 17-1/OOG-1755; FSS dated November 30, 2015 No. 02-09-11/15-23247.

STEP 2. Determine the employee’s earnings for the billing period.

SITUATION 1. The employee worked for 2 calendar years preceding the year the insured event occurred, and his earnings are known. Then take all amounts paid to the employee for the specified period, from which insurance premiums for “accident” insurance were paid. This may include payments from your company, as well as payments from previous employers.

Let us remind you that earnings for calculating benefits for a work injury are not limited to a maximum amount. That is, when calculating, you need to take the entire amount of payments to the employee (unlike calculating benefits for ordinary illness, where payments cannot exceed 624,000 rubles for 2014, and 670,000 rubles for 2020. Part 4, Article 8 Law of July 24, 2009 No. 212-FZ; Government Decrees of November 30, 2013 No. 1101, of December 4, 2014 No. 1316).

By the way, look at what amounts of earnings are indicated in paragraph 3 of the salary certificate at the previous place of work for the 2 previous calendar years, Appendix 1 to Order of the Ministry of Labor dated April 30, 2013 No. 182n; Part 5 Art. 13 of Law No. 255-FZ from an employee who came to you recently. If there are maximum amounts for the base for insurance premiums (for 2014 - 624,000 rubles, for 2020 - 670,000 rubles), then this may mean that his salary was higher. Therefore, ask the employee to submit an application to the former employer with a request to issue a salary certificate indicating: “The certificate is required to calculate temporary disability benefits due to an industrial accident.”

SITUATION 2. The employee did not work for 2 calendar years preceding the year the insured event occurred. Then, to calculate the benefit, earnings are taken in the amount of the minimum wage established on the day of the onset of temporary disability for 24 months. 1.1 art. 14 Law No. 255-FZ; clause 11(1) of the Regulations, approved. Government Decree No. 375 dated June 15, 2007.

SITUATION 3. The employee earned an amount less than 24 times the minimum wage or his earnings are not known for all 2 calendar years. Then, to calculate, you need to take the amount that is greater. Letter from the Social Insurance Fund dated March 11, 2011 No. 14-03-18/05-2129:

• <or>the employee’s earnings known to you. 2.1 Art. 15, part 1.1 art. 14 Law No. 255-FZ;
• <or>24 minimum wage.

If the employee subsequently brings a salary certificate from his previous place of work for the previous 2 calendar years. 3 hours 2 tbsp. 4.1, part 5 art. 13 of Law No. 255-FZ; Appendix 1 to Order of the Ministry of Labor dated April 30, 2013 No. 182n, then the amount of the benefit will have to be recalculated based on the earnings that have become known.

STEP 4. Determine the amount of daily allowance.

One of the features of the work injury benefit is that its amount is not affected by the length of the victim’s work experience. That is, sick leave for an injury is paid in the amount of 100% of the average earnings of the injured employee, even if his work experience is less than 6 months. 1 tbsp. 9 of Law No. 125-FZ. That's why:

STEP 5. We compare the amount of the employee’s daily allowance with the amount of the maximum allowable daily allowance.

That is, the maximum allowable daily allowance since February 2016:

The employee's average daily earnings for a particular month cannot exceed the maximum allowable daily benefit.

STEP 6. Determine the amount of the benefit.

We calculate the amount of benefits that an employee is entitled to during illness. 5 tbsp. 14 of Law No. 255-FZ:

• <if the average daily allowance of an employee in any month does not exceed the maximum allowable, then according to the formula:

• <if>the average daily allowance of an employee is greater than the maximum allowable amount in at least one of the months, then according to the formulas:

If the employee’s average daily earnings are greater than the maximum allowable amount in all months of illness, then also calculate the benefit for each month of incapacity for work depending on the number of days of sick leave in a particular month, and then sum up the resulting values.

For example, a deputy director with an average daily salary above the maximum allowable amount was injured at work. You were on sick leave from February 25 to March 15, 2020. You must:

What exist and their decoding

On the certificate of incapacity for work, the disease codes mean the following:

01 This code means a disease.

02 This code indicates that an injury is occurring. What kind of injury can be indicated in the comment.

03 The third code is quarantine.

04 Accident at the enterprise. Or this code may mean the consequences of an accident.

05 This code means an employee’s vacation due to pregnancy and childbirth.

06 Prostheses that are installed in a medical institution.

07 A disease that is associated with the profession. This disease is determined by a medical commission.

08 This code means that the employee needed to undergo further treatment in a sanatorium. The referral is issued by the doctor, and it is attached to the sick leave certificate.

09 An employee is caring for a sick loved one.

10 Serious poisoning and undergoing special treatment and procedures in connection with this.

11 Serious illnesses of particular importance to society. The list is given in Government Decree No. 715.

12 Caring for a child who is not yet seven years old but suffers from a serious illness.

13 Caring for a child with a disability.

14 Malaise due to vaccinations, or a malignant neoplasm in a disabled minor. In this case, the code can only be entered if the child’s parents agree. They must express their consent in writing.

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15 Caring for a child with HIV. Parental permission in writing is also required to enter this code on the sick leave sheet.

These codes have the same meaning for all clinics.

Just illness means code 01 . If a worker with a general illness seeks medical advice, then code 01 is entered on the certificate of incapacity for work and this means that he needs full payments for this reason. Thanks to the code, employees in the accounting department understand what payment is due to a sick employee.

Read our article on how sick leave is calculated.

Absolutely all codes are recorded by medical workers . You need to know that the number 01 can also be written in the code change window. For this reason, the accountant needs to be careful when reviewing all records.

This is important to know: Is sick leave paid under GPC?

There is no need to decipher code 01 on the certificate of incapacity for work. Therefore, it may not be recorded, because it is common to many diseases.

The accountant must know what payments to make if code 09

, because care accruals have their limitations, and then the employee is absent from the workplace at his own expense.

If an employee went on sick leave due to an injury, then you need to clarify its type. If the code is 02, then you need to know that there was a domestic injury. If the code is 04, then in this case the employee was injured at work.

Certain diseases fall under several codes at once.

Taking into account the allowance

By the amount of benefits paid to the injured employee in connection with an industrial emergency, you reduce contributions to the Social Insurance Fund “for injuries.” If this amount exceeds the contributions, then contact the Social Insurance Fund for reimbursement of the difference. 7 tbsp. 15 of Law No. 125-FZ.

Injury benefits paid to the victim cannot be taken into account as expenses for income tax purposes. 252, sub. 48.1 clause 1 art. 264 Tax Code of the Russian Federation. And the money reimbursed from the Social Insurance Fund for the payment of benefits does not need to be taken into account in income. 250 Tax Code of the Russian Federation.

***

If you learned about an industrial accident only when the employee brought in his sick leave with code “04,” it means that the company has not yet conducted an investigation, there is no investigation report or materials confirming the industrial nature of the injury.

However, you are required to pay the victim temporary disability benefits. First, you will have to pay and spend sick leave as for a domestic injury, taking into account the length of service of the victim. And when, based on the results of an internal investigation, a report on an industrial accident is drawn up, then it is necessary to accrue and pay additional benefits based on 100% of the employee’s average earnings.

After this, you can submit an updated calculation for the period in which you suffered a domestic injury.

Other articles from the magazine “MAIN BOOK” on the topic “Benefits / sick leave”:

2020

1. Children's benefits: indexation-2020, No. 4
2. The 50-ruble compensation was canceled, No. 1

Social insurance called problem-free mistakes

After the current form of temporary disability certificate was introduced, companies began to send workers to re-issue the certificate to medical organizations at the slightest doubt about the correctness of its execution. As a result, the percentage of damaged forms has increased significantly. In this regard, the Federal Social Insurance Fund of Russia, in a letter dated September 30, 2011 No. 14-03-11/15-11575, indicated that if a company has doubts about the correctness of issuing a certificate of incapacity for work, it should contact the regional branches of the fund. In addition, it was clarified that the presence of technical deficiencies in the form filled out in handwriting is not grounds for re-issuing the certificate of incapacity for work and refusal to assign and pay benefits, if all entries in the certificate of incapacity for work are read. The FSS of Russia includes the following shortcomings:

— filling out the form fields in capital letters;

— letters hitting the cell boundaries;

— stamps entering the information field;

— indication of the words “doctor” or “attending physician”;

— putting spaces between the doctor’s initials;

- other similar shortcomings (letter dated October 28, 2011 No. 14-03-18/15-12956).

The FSS of Russia also clarified that the combined filling out of a certificate of incapacity for work (handwritten and using a printing device) should not be considered as a violation of the procedure for drawing up a certificate, entailing a refusal to pay benefits and the insurer’s non-acceptance of funds for the payment of temporary disability benefits made by the insured (letter from October 23, 2014 No. 17-03-09/06-3841P).

How is sick leave issued for a work injury?

Payment for sick leave in case of injury at work is carried out only with proper documentary confirmation of the fact of the accident. And this is done at the expense of insurance funds for industrial injuries, i.e. at the expense of “accident” contributions.

An employee's receipt of a work-related injury is certified by:

1. A certificate of incapacity for work, in which:

• there is code 04 in the column “Cause of disability”;

For more information about the possible meanings of codes for sick leave, read the article “What do disability codes mean on sick leave?”

• the date of drawing up the accident report in Form N-1 is reflected.

2. Act N-1, the form of which was approved by Decree of the Ministry of Labor of Russia dated October 24, 2002 No. 73.

The entire amount of payments made by the employer is compensated by the Social Insurance Fund (Clause 7, Article 15 of the Law “On Compulsory Accident Insurance” dated July 24, 1998 No. 125-FZ). This is the difference between the procedure for paying benefits for an industrial injury and sick leave for a common illness (when the Social Insurance Fund reimburses the employer’s expenses only from the 4th day of the employee’s incapacity for work).

Accrual condition line on sick leave

In the same order (including personal income tax) indicators are reflected in the lines “Amount of benefit: at the expense of the employer” and “at the expense of the Social Insurance Fund of the Russian Federation”. An example of filling out a sick leave certificate when assigning sick leave benefits.

The benefit is calculated based on actual earnings for the pay period. Employee experience for more than eight years Cashier A.V. Dezhneva was sick from August 3 to August 11, 2020.

The employee’s insurance experience is more than eight years, so she has the right to sick pay in the amount of 100 percent of her earnings. The billing period is from January 1, 2013 to December 31, 2014 inclusive. Dezhneva’s earnings for the billing period were:

The period of incapacity for work is nine calendar days. The total amount of accrued sick leave benefits was: 430.14 rubles/day.

× 9 days = 3871.26 rub.

The total amount of benefits payable to Dezhneva: RUB 3,871.26. – (3871.26 rubles × 13%) = 3368.26 rubles. Based on these data, the accountant filled out the relevant part of the sick leave certificate.

For the first three days of incapacity, the benefit is paid by the organization. The benefit amount is: 430.14 rubles/day. × 3 days = 1290.42 rub. The remaining sick days are paid for by the Russian Social Insurance Fund.