The procedure for establishing the degree of loss of professional ability to work as a result of industrial accidents and occupational diseases is determined by the Government Russian Federation.
In 2005, the amount of monthly insurance payment calculated in accordance with this article cannot exceed 33 thousand rubles. The established limit applies when assigning or increasing monthly insurance payments after January 1, 2005. The amount of monthly insurance payments exceeding the amount of 33 thousand rubles as of January 1, 2005, does not change (Article 14 of the Federal Law of December 29, 2004 N 202-FZ).
The amount of the monthly insurance payment is determined as a share of the insured person’s average monthly earnings, calculated in accordance with the degree of loss of his professional ability to work.
When calculating the amount of earnings lost by the insured as a result of an insured event, all types of remuneration for his work are taken into account, both at the place of his main job and part-time, for which accrued insurance premiums for compulsory social insurance against accidents at work and occupational diseases. Amounts of remuneration under civil contracts and amounts of royalties are taken into account if they provided for the payment of insurance premiums to the insurer. During the period of temporary disability or maternity leave, benefits paid on the specified grounds are taken into account.
All types of earnings are taken into account in amounts accrued before withholding taxes, paying fees and other mandatory payments.
In areas where regional coefficients and percentage increases in wages are established, the amount of the monthly insurance payment is determined taking into account these coefficients and allowances.
When calculating the average monthly earnings of an insured person sent by the policyholder to work outside the territory of the Russian Federation, it is taken into account wage at the main place of work and wages accrued in foreign currency (if insurance premiums for compulsory social insurance against accidents at work and occupational diseases were calculated on it), which is converted into rubles at the rate of the Central Bank of the Russian Federation established on the day of appointment of the monthly insurance payments.
The average monthly earnings of the insured are calculated by dividing the total amount of his earnings (taking into account bonuses accrued in the billing period) for 12 months of work that caused damage to health, preceding the month in which he suffered an accident at work, was diagnosed with an occupational disease or (at the choice of the insured ) a loss (decrease) of his professional ability to work was established, by 12.
(as amended by Federal Law dated July 7, 2003 N 118-FZ)
If the work that caused damage to health lasted less than 12 months, the average monthly earnings of the insured are calculated by dividing the total amount of his earnings for the number of months actually worked by him preceding the month in which he suffered an accident at work, was diagnosed with an occupational disease, or (at the choice of the insured) the loss (decrease) of his professional ability to work was established for the number of these months. In cases where the period of work that caused damage to health was less than one full calendar month, the monthly insurance payment is calculated based on the conditional monthly earnings, determined as follows: the amount of earnings for the time worked is divided by the number of days worked and the resulting amount is multiplied by the number of working days in the month , calculated on average per year. When calculating average monthly earnings, months not fully worked by the insured are replaced by previous fully worked months or excluded if it is impossible to replace them.
(as amended by Federal Law dated July 7, 2003 N 118-FZ)
At the request of the insured, upon the occurrence of an insured event due to an occupational disease, the average monthly earnings can be calculated for the last 12 months of work preceding the termination of work that resulted in such an illness.
Monthly insurance payments to an insured who has not reached the age of 18 at the time of assignment of insurance coverage are calculated from his average earnings, but not less than the minimum subsistence level established in accordance with the law for the working-age population as a whole in the Russian Federation.
(Clause 4 as amended by Federal Law dated July 7, 2003 N 118-FZ)
If the insured event occurs after the expiration of the employment agreement (contract), at the request of the insured, his earnings before the expiration of the specified agreement (contract) 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 subsistence level established in accordance with the law minimum working-age population in the Russian Federation as a whole.
If the insured person’s earnings before the occurrence of the insured event have undergone sustainable changes that improve his financial situation (the salary for his position has been increased, he has been transferred to a higher position) high paying job, entered work after graduating from an educational institution as a full-time student and in other cases where the stability of the change or the possibility of changing the insured’s wages has been proven), when calculating his average monthly earnings, only the earnings that he received or should have received after the corresponding change are taken into account.
If it is impossible to obtain a document on the amount of earnings of the insured, the amount of the monthly insurance payment is calculated based on the tariff rate (official salary) established in the industry (sub-industry) for a given profession, and similar working conditions at the time of applying for insurance payments.
After submitting a document on the amount of earnings, the amount of the monthly insurance payment is recalculated from the month following the month in which the relevant documents were provided.
(as amended by Federal Law dated July 7, 2003 N 118-FZ)
Data on the size of tariff rates (official salaries) of workers are provided by the labor authorities of the constituent entities of the Russian Federation.
(paragraph entered Federal law dated 07.07.2003 N 118-FZ)
For persons entitled to receive insurance payments in the event of the death of the insured, the amount of the monthly insurance payment is calculated based on his average monthly earnings minus the shares attributable to himself and able-bodied persons who were his dependents, but not entitled to receive insurance payments. To determine the amount of monthly insurance payments to each person entitled to receive them, the total amount of these payments is divided by the number of persons entitled to receive insurance payments in the event of the death of the insured.
Setting the percentage of loss general working capacity- this is one of the types of forensic medical examination, designed to assess the damage caused to a person’s health, as a result of which he loses the ability to work, providing himself with a means of subsistence. TO this species research is used in the legal process in cases involving situations dangerous to human life and health. This examination is one of the most in demand, since its results are relied upon when sentencing the guilty party and assigning compensation and monetary payments.
The percentage of loss of general working capacity is determined in the following cases:
- To assess the consequences of road incidents and disasters, as well as other transport incidents.
- To determine the level of damage resulting from an industrial injury, as well as from man-made disasters at work.
- To establish the severity of injuries inflicted during an attack and attempted murder.
- To establish the severity of harm caused to human health due to the fault medical worker or other officials.
Damage to health is measured as a percentage of the conditional indicator of general working capacity. In general, a distinction is made between general, professional and special ability to work. General work capacity is understood as fulfilling simple operations operations that do not require special qualifications, that is, such operations, the implementation of which may be prevented by a previous injury that has consequences. Professional Performance Means Opportunity this person carry out qualified activities in some profession - for example, working as an economist. Special performance means a person’s qualifications to work in a specific specialty. For example, the profession of “economist” includes a whole set of specialties - economic analysts, banking specialists, financiers, accountants, and so on.
There is also a distinction between temporary and permanent disability. Temporary disability occurs as a result of diseases and injuries that can be cured - for example, uncomplicated fractures of the limbs, soft tissue injuries, minor injuries, and so on. Permanent disability occurs when the inflicted injuries and injuries (or their consequences) cannot be completely cured. For example, amputations of limbs or decreased intelligence and coordination problems resulting from a traumatic brain injury. The percentage of total disability is measured in relation to the lasting effects of the injuries sustained.
To calculate this indicator, forensic medical examination relies on normative document, namely, a table of percentages of permanent loss of general ability to work. This table is an appendix to the Order of the Ministry of Health and social development, which approves the criteria for establishing the extent and severity of harm caused to human health.
According to the above table, the specialist who determines the percentage of loss of general working capacity determines the harm caused to human health and identifies the corresponding percentage of loss. The table contains the most common consequences of injuries, poisoning and other external influences, for which the corresponding values of loss of ability to work, expressed as a percentage, are indicated.
Functional disorders of human organs are classified in the table according to the systemic principle. It identifies the following areas where the consequences of an incident may be observed:
- Central nervous system and peripheral nervous system.
- Digestive organs.
- Organs of vision.
- Respiratory system.
- Organs of hearing.
- The cardiovascular system.
- Genitourinary system.
- Soft fabrics.
- Musculoskeletal system.
According to the notes indicated in the table, in the event of dysfunction of two or more organs of the same system, the percentage of loss of general ability to work is determined according to one of the criteria that reflects the most pronounced damage. In case of damage to several body systems, the percentage of disability is added up, however, the total indicator should not exceed 100 percent. The table displays percentages for each case in increments of five units. The most severe (from seventy to one hundred percent) consequences of injuries, poisoning and other impacts include the following:
- Paralysis, severe dementia, epileptic seizures recurring at least once a week, aphasia, apraxia, agnosia ataxia, severe cerebellar and vestibular disorders - 100%.
- A marked decrease in strength and range of motion in the limbs, a significant impairment of the ability to coordinate, a severe decrease in intellectual abilities - 75%.
- Severe disorders of movement and sensitivity in both legs, significant dysfunction of the pelvic organs, severe bedsores and trophic ulcers - 100%.
- Trophic ulcers, lack of sensitivity and movement in the joints of the legs - 70%.
- Loss of both seeing eyes - 100%.
- Absence of a nose, resulting in a change in the victim’s face - 70%
- Congestion in the lung (or in both parts of the lung), cirrhosis of the liver, ascites, respiratory rhythm disturbances, effusion in the pericardial cavity and/or pleura - 90%.
- Obstruction of the pharynx as a result of poisoning with caustic poisons, injury or burn - 90%.
- Absolute immobility of the spine, severe deformation of the spine - 70%.
- Absence of the upper limb - 80% (for right hand) and 75% (for the left).
- Absence of a leg or stump at the level of the upper third of the thigh - 70%.
- Absence of jaw - 80%.
- Complete absence of language - 70%.
- Gastric resection to compensate for the consequences of injury - 80%.
- Absence of forearm - 70% (65% for the left hand).
The table also shows disturbances in the functioning of systems and organs of the body, as well as the consequences of injuries that cause a slight loss of the ability to carry out their activities. professional activity. The mildest functional disorders that cause a low percentage of loss of general ability to work (from five to ten percent) include:
- Cicatricial trichiasis, keratitis, conjunctivitis, entropion of one eye, which do not cause decreased vision - 5%.
- The same for two eyes - 10%.
- Removal eyeball those who did not have vision - 5%.
- A decrease in visual acuity by one tenth - 5%.
- The presence of rough scars on the tongue resulting from injury, frostbite or burns, making it difficult to eat - 5%.
- Scars on the body (including on the scalp), occupying from 2% to 4% of the body surface - 10%.
- Absence of nail phalanx - 10%.
- Absence thumb feet - 10%.
- Moderate peripheral damage to the hypoglossal, facial or trigeminal nerve, causing impairment of their function - 5%.
- Impaired reflexes and/or sensitivity as a result of damage to the lumbar and/or sacral plexus and its nerves (without movement disorder, paresis, atrophy, contractures) - 5%.
- Non-concentric narrowing of vision in one eye - 5-10%.
- Partial ptosis (drooping upper eyelid) one eye - 10%.
- Purulent inflammation of one ear - 5%. Inflammation of both ears - 10%.
Persistent loss of general ability to work is one of the criteria when determining the severity of harm caused to the victim’s health. However, permanent disability deprives the victim of the opportunity to earn money - partially or completely. As a result, determining the percentage of disability may be a reason for ordering an independent examination.
The basis for conducting an examination to establish the percentage of loss of general ability to work may also be harm to the health of the victim due to the fault of a health worker, as well as other officials responsible for the safety of the people entrusted to them.
An examination to determine the percentage of loss of general ability to work is carried out only by court determination. When carrying out expert activities, the specialist takes into account all the materials of the case. The presence of any chronic diseases is not taken into account when establishing the percentage of loss of general working capacity that occurred as a result of an incident, accident or disaster.
If the injuries were inflicted on a minor who had no income at the time of the injury, the court can recover from the culprit only compensation for the costs of caring for the victim, his treatment and prosthetics (if any), and for providing the victim with enhanced nutrition. The court may also reserve the right of the victim to compensation for losses incurred due to loss of ability to work upon reaching the age of sixteen by the plaintiff.
When establishing the percentage of loss of total working capacity for disabled people, the loss is assessed as for a practically healthy person, regardless of the disability group.
What documents should be provided to the expert to establish the percentage of loss of general ability to work?
- Identity document of the initiator of the examination.
- Court ruling.
- All available medical documents, including the certificate of examination by the Medical and Social Expert Commission.
- An industrial accident report or an accident investigation report. To determine the percentage of loss of general ability to work as a result of a traffic accident - a certificate from the traffic police.
- If necessary, the results of other examinations.
Legal framework governing the process of establishing the percentage of loss of total working capacity
- Order No. 194n of the Ministry of Health and Social Development of the Russian Federation dated April 24, 2008. “On approval of Medical criteria for establishing the severity of harm caused to human health.”
- Appendix to this order- “Table of percentages of permanent loss of general ability to work resulting from poisoning, trauma and other effects on the human body.”
Questions that a specialist answers in the process of establishing the percentage of loss of general ability to work
- What is the total percentage of loss of total working capacity?
- What percentage of loss of general ability to work corresponds to this functional disorder?
- What is the percentage of total disability caused by this particular incident?
- What is the highest percentage of disability among functional disorders organs of one body system?
- Which functional systems were disrupted?
- What disorders or injuries were taken into account when establishing the percentage of loss of general ability to work?
Cost and terms
Forensic examination
A forensic examination is carried out as determined by the court. To appoint an examination to our organization, it is necessary to submit a petition for the appointment of an examination and attach to it an information letter indicating the details of the organization, the possibility of carrying out an examination on the questions raised, the cost and duration of the study, as well as the candidacy of experts indicating their education and work experience. This letter must be certified by the seal of the organization and the signature of its head.
Our specialists prepare an information letter within one working day, after which we send a scanned copy of it by email. Also, if necessary, the original letter can be picked up at the office of our organization. As a rule, the court does not require the original information letter; it is enough to provide a copy of it.
The service for compiling an information letter is provided for free.
Extrajudicial research
Extrajudicial research is carried out on the basis of a contract with 100% prepayment. The contract can be concluded with both legal and an individual. To conclude an agreement, it is not necessary to be present at the office of our organization; in this case, the sending of all documents, including the expert opinion, will be carried out using the services of postal operators (Dimex, DHL, PonyExpress), which will take no more than 2-4 working days.
Review of expert opinion
A review is necessary in cases where it is necessary to challenge the conclusions of the examination in order to then conduct a repeat study. The conditions for concluding a contract for peer review are exactly the same as for out-of-court research.
Receiving written expert advice (certificate)
The certificate is not a conclusion, it is of an informational nature and contains answers to questions that do not require a full study, but allow one to assess the feasibility of conducting a full examination.
The conditions for concluding a contract for a certificate are exactly the same as for out-of-court research.
Obtaining preliminary expert advice
Our specialists are ready to answer any of your questions regarding the conduct of judicial and extrajudicial examinations, assess the feasibility of conducting an examination, provide assistance in formulating research questions, advise on the possibility of conducting a particular analysis, and much more.
Consultation is carried out on the basis of a written request.
To do this, you need to fill out an online application form (or send us a request by e-mail), where you should describe the circumstances of the case in as much detail as possible, formulate the goals that need to be achieved with the help of the examination, preliminary questions, and, if possible, attach all possible documents and descriptions of objects.
The more detailed you tell the circumstances of the case, the more productive the expert’s assistance will be.
Additional services
Reducing the examination period by half
30% to cost
Departure of an expert within the city of Moscow to inspect objects, select samples for research, participate in a court hearing or other events requiring the presence of an expert
Departure of an expert within the Moscow region
Departure of an expert to other regions of Russia
Transport and travel expenses
Preparation of an additional copy of the expert opinion
Legal advice on issues not related to the conduct and appointment of examinations
from 5,000 rub.
Drawing up a statement of claim
Experts
Expert psychiatrist
Graduated from Russian State Medical University with a degree in Pediatrics. Was a member of the student scientific society in psychiatry. In November 2011, she was certified by the Central Attestation Commission of the Moscow Department of Health (at the Department of Psychiatry, Narcology and Psychotherapy of the Faculty of Physical Education of the Moscow State Medical University) and was awarded the first qualification category in psychiatry. In 2012, he was awarded the second qualification category in psychiatry. In 2013, she attended advanced training courses in psychiatry at the Department of Social and Forensic Psychiatry of the First Moscow State Medical University named after. I. M. Sechenov and advanced training courses in psychotherapy at the Department of Psychiatry, Narcology and Psychotherapy FPDO MGMSU.
Medical expert, surgeon, lawyer (medical law)
Specialist in the field of outpatient and hospital surgery, medical and economic examination, insurance medicine and examination of the quality of medical care. Author of a number of scientific and methodological publications, including in peer-reviewed publications (list of Higher Attestation Commission). Actively involved in teaching and research activities at the Department of General Surgery. Has experience in clinical practice in hospitals and clinics. In addition to higher medical education, he has a higher education legal education. Has experience in complex expert assessment volume and quality of medical care, settlement of disputes and conflicts between patients, insurance and medical organizations. Regular participant in various conferences and seminars, both national and international level. Currently carries out expert activities in the field of healthcare on an ongoing basis
Expert obstetrician-gynecologist of the highest qualification category, candidate of medical sciences, associate professor of the department
Associate Professor at the Department of Obstetrics and Gynecology, Federal State Budgetary Educational Institution of Further Professional Education, IPK, FMBA of Russia. Specialist in the field of obstetrics and gynecology, reproductive medicine, healthcare organization. Author over 15 scientific publications. Actively engaged teaching activities. Participant of many conferences and seminars at various levels in Russia, Sweden, Germany, Romania, Turkey.
Dear Boris, Good evening! And happy holiday to you! I wish you health, you will be healthy, all problems will be solved.
Now regarding your question. I believe that the problem of establishing the degree of loss of general (professional) ability to work
(since there is no indication of this in the ITU certificate) it can only be resolved by going to court, and at the same time petitioning for the appointment of an appropriate examination. Therefore, your thoughts, it seems to me, are absolutely correct. We proceed from the following:
In accordance with paragraph 9 of the Resolution of the Plenum of the Armed Forces of the Russian Federation dated January 26, 2010. "On the application by courts of civil legislation regulating relations under obligations resulting from harm to the life or health of a citizen" - liability legal entity or a citizen, provided for in paragraph 1 of Article 1068 of the Civil Code of the Russian Federation, occurs for damage caused by his employee in the performance of his labor (official, official) duties on the basis of a concluded employment contract (service contract).
A legal entity or citizen may be obligated to compensate for damage caused by persons who performed work ON THE BASIS OF A CIVIL CONTRACT, provided that these persons acted or should have acted on the instructions of this legal entity or citizen and under his control over the safe conduct works (clause 1 of Article 1068 of the Civil Code of the Russian Federation). And in accordance with paragraph 28 of the same Resolution of the Plenum of the Armed Forces of the Russian Federation, the amount of lost earnings of the victim, in accordance with paragraph 1 of Article 1086 of the Civil Code of the Russian Federation, is determined as a percentage of his average monthly earnings at the choice of the victim - before injury or other damage to health or until he loses professional ability to work, and in the absence of professional ability to work - until loss of general ability to work. AT THIS TIME, the determination of the degree of loss of professional ability to work is carried out by institutions of the state service of medical and social examination, and the degree of loss of general ability to work is carried out by forensic medical examination in medical institutions state system healthcare.
THUS, depending on the degree of loss of which ability to work, it is necessary to establish, and you should ask the court to order an examination, entrusting it to be carried out by the SME or the ITU (or better yet, ask to appoint both)
As for paragraph 6 of the Rules, I think it applies only to those victims who independently apply to establish the degree of loss. It is no coincidence that paragraph 7 of the same Rules states that the examination of the victim in a medical and social examination institution is carried out ... by determination of the court (judge) ... when submitting a report on an industrial accident. Therefore, if the court appoints it, they will not go anywhere, they will carry it out. And in the ITU certificate, the degree of loss was not indicated IMMEDIATELY because your client was not in an employment relationship (they used their clause 6 of the Rules).
Or maybe I didn't understand your problem quite correctly? (You indicated that there is an accident report, but I can’t figure out what n-1 is, which it seems they didn’t draw up?)
The degree of loss of professional ability to work is determined by a specially authorized body - Civil service medical and social examination. ITU institutions operate within the system of organs social protection population of the Russian Federation (Article 8 of the Federal Law of November 24, 1995 No. 181-FZ “On the social protection of disabled people in the Russian Federation”).
The degree of loss of professional ability to work as a result of industrial accidents and occupational diseases is determined according to the rules approved by Decree of the Government of the Russian Federation of October 16, 2000 No. 789.
According to these rules, the victim is sent for examination to ITU institutions after the medical institution has carried out a set of therapeutic, diagnostic and rehabilitation procedures and their results allow a preliminary conclusion to be made about a permanent loss of professional ability to work. To the direction medical institution When examining a victim, ITU institutions must include information about the victim’s condition, reflecting the degree of dysfunction of organs and systems.
The ITU institution conducts an examination of the victim, taking into account the information specified in the report on Form No. N-1 or the report on the case of occupational disease, as well as in other documents provided by the employer. Specialists from the ITU institution issue an expert opinion based on the documents received and a personal examination of the victim. The degree of loss of professional ability to work is determined based on an assessment of the victim’s existing professional abilities and professionally significant qualities that allow him to perform work in his previous specialty (qualification). The rules provide for the possibility of establishing from 10 to 100% loss of professional ability to work.
The fact that loss of ability to work has been established must be confirmed by an examination of the victim. The act is signed by the head of the ITU institution, the specialists who carried out the examination, and certified by the seal of the institution.
The victim is given a certificate of the results of the examination, and the employer and executive body An extract from the inspection report is sent to the FSS of Russia.
The medical and social examination institution established that employee I.I. Ivanov lost his professional ability to work by 30%.
Therefore, the size of the lump sum insurance payment will be:
30,000 rub. x 30% = 9000 rub.
A one-time insurance payment is made to the victim no later than one calendar month from the date of its appointment. In the event of the death of the insured, payment is made to his dependents within two days from the date the employer provides the executive body of the FSS of Russia with all the documents necessary to assign such a payment.
Monthly insurance payments. The amount of the monthly payment is determined based on the average monthly earnings of the victim. Average earnings are calculated for the previous 12 months of work that resulted in damage to health, up to the month in which the accident occurred or the diagnosis of an occupational disease was made. At the choice of the victim, earnings can be taken into account for the last 12 months of work that caused damage to health, up to the month in which the ITU institution established the degree of loss of professional ability to work.
As you can see, the main difference between the calculation period for determining the monthly insurance payment and the similar period for calculating temporary disability benefits is that in the first case only months of work that caused damage to health are taken into account.
Average monthly earnings are determined as follows: all payments received by the employee in the billing period are summed up, and the result is divided by 12.
What if the work that caused health damage lasted less than 12 months? In this case, you need to divide all actual earnings for the months of work that resulted in damage to health by the number of these months. If some months are not fully worked, they are replaced by the previous fully worked months or excluded from the calculation if replacement is impossible.
How to determine whether such a replacement is possible in the billing period or not? Let's look at this with specific examples.
Employee I.I. Ivanov was diagnosed with an occupational disease on June 10, 2004. The calculation period for determining average monthly earnings is the period from June 1, 2003 to May 31, 2004.
The work that caused damage to health lasted from September 15, 2003 to May 31, 2004 inclusive (8 months 16 days). Until September 15, 2003, the work was not related to the employee’s occupational illness. Therefore, the period from June 1 to September 14, 2003 is excluded from the calculation.
The incompletely worked September 2003 (from the 14th to the 30th) is also not taken into account, since it is impossible to replace it with previous fully worked months.
Thus, the average monthly earnings are determined for the period from October 1, 2003 to May 31, 2004.
Let's change the conditions of the previous example. Let's say the work that resulted in an occupational disease lasted from March 15, 2003 to May 31, 2004 inclusive (14 months 17 days).
The estimated period is from June 1, 2003 to May 31, 2004. The employee only worked there for half of June 2003 - from the 1st to the 15th. In this case, the unprocessed part of June can be replaced with the fully processed May 2003.
Thus, the average monthly earnings are taken into account in total for May 2003 and for the period from July 1, 2003 to May 31, 2004.
note
Earnings for calculating the monthly insurance payment include all amounts received by the employee for performing work on employment contract, on which insurance premiums for compulsory social insurance against industrial accidents and occupational diseases were calculated.
To determine the size of the monthly insurance payment, you need to multiply your average monthly earnings by the percentage of loss of professional ability.
The assigned monthly insurance payments are not subsequently recalculated. There are three exceptions to this rule:
· change in the degree of loss of professional ability to work;
· changing the circle of persons entitled to receive payments;
· indexation of payments taking into account the level of inflation 5 .
The maximum monthly payment currently cannot exceed RUB 30,000. for a full calendar month. This is established by Article 16 of Federal Law No. 17-FZ of February 11, 2002 “On the budget of the Social Insurance Fund of the Russian Federation for 2002” 6 (hereinafter referred to as Law No. 17-FZ).
The ITU establishment established that employee I.I. Ivanov lost 60% of his professional ability due to an industrial accident.
Average monthly earnings of I.I. Ivanova - 60,000 rubles.
The monthly insurance payment will be:
60,000 rub. x 60% = 36,000 rub.
Since the payment amount is limited by the maximum limit, I.I. Ivanov will receive 30,000 rubles monthly.
The victim receives monthly payments for the entire period for which the loss of professional ability to work is established. Only the period of temporary disability due to an accident at work or occupational disease is excluded from it, since during this time the victim receives an appropriate benefit.
On March 30, 2004, employee I.I. Ivanov was injured as a result of an industrial accident. On May 31, 2004, specialists from the ITU institution who examined I.I. Ivanov, established the degree of loss of professional ability to work at 50% for a period of 6 months. The sick leave was closed on June 30, 2004.
Thus, I.I. Ivanov must receive temporary disability benefits for the period from March 30 to June 30, 2004. He will begin receiving monthly insurance payments on July 1, 2004.
Insurance benefits for dependents. In the event of the death of the insured person, insurance payments are received by his dependents (Article 7 of Law No. 125-FZ). First of all, these are disabled persons who were dependent on the deceased or who had the right to receive maintenance from him on the day the insured event occurred. Disabled dependents usually include minors, as well as persons who have reached the age for old-age pension. Disabled people are also disabled dependents.
If the insured's child was born after his death, he is also entitled to receive insurance benefits.
Dependents are considered family members of the deceased who were not working at the time of his death in connection with the care of his children, grandchildren, brothers or sisters under the age of 14 or who have reached this age, but are recognized as needing outside care. In this case, the ability to work of family members providing care does not matter.
And finally, dependents of the deceased have the right to receive insurance payments if they become disabled within five years from the date of his death.
note
Not only relatives can be dependents. They may be persons who were not related to the deceased, but lived with him. The main thing is to confirm in court the fact of being a dependent. The dependency of the children of the deceased is assumed by force of law, so there is no need to confirm it.
The size of the one-time insurance payment due to dependents is 30,000 rubles. This amount is divided between the deceased's spouse (whether or not she was a dependent) and any other dependents.
The amount of the monthly payment is determined based on the average monthly earnings of the deceased. Pensions and benefits that he received during his lifetime are also taken into account. From the amount received, the shares attributable to the injured person and able-bodied persons who were dependent on him, but who are not entitled to receive insurance payments, are excluded. The remaining amount is divided equally among the dependents of the victim who are entitled to insurance benefits.
note
The total amount of monthly insurance payments to all dependents cannot exceed RUB 30,000. (Clause 12, Article 12 of Law No. 125-FZ and Article 16 of Law No. 17-FZ).
The average income of the deceased was 25,000 rubles. He was dependent on: an able-bodied wife, a mother aged 70, and two children aged 15 and 16 years. Three dependents - mother and children - are entitled to monthly insurance payments; wife, mother and children are entitled to a lump sum insurance payment.
Let's calculate the share of the lump sum insurance payment due to each dependent. Shares are determined based on the total amount of 30,000 rubles. The amount of the one-time insurance payment will be:
30,000 rub. : 4 people = 7500 rub.
Now let's calculate the amount of the monthly insurance payment.
First, we determine the share due to each recipient:
25,000 rub. : 5 people = 5000 rub.
25,000 rub. – (5000 rub. x 2 people) = 15,000 rub.
Thus, 15,000 rubles. - the total amount of monthly insurance payment that will be received by three dependents - the mother and two children of the deceased.
The periods during which dependents have the right to receive insurance payments are established by paragraph 3 of Article 7 of Law No. 125-FZ.
Minor children receive monthly insurance payments until they are 18 years old, and if they are full-time students, then until they graduate, but not more than 23 years old.
Old-age pensioners (women from 55 years of age, men from 60) will receive monthly insurance payments for life, and disabled people - during the period of disability. At the same time, insurance payments do not affect the size of the pension (for old age or disability) that these persons receive.
Persons who are not working in connection with the care of children, grandchildren, brothers or sisters of the deceased who are under 14 years of age receive insurance payments until the specified dependents turn 14 years of age. If dependents are over 14 years of age but need care, their caregivers receive insurance benefits until the dependents' condition changes.
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If you are injured at work or have an occupational disease, you have the right to benefits or compensation. Who will receive how much or not at all will be decided by the institution of a medical and social examination according to the new rules, which were recently signed by Prime Minister Mikhail Kasyanov.
Who is better to be - sick or healthy?
Conditions are getting tougher
A friend of mine once decided to jump from a parachute. As a result, he landed unsuccessfully and broke both legs. When the private company where he worked learned about what had happened, they decided to pay for the operation free of charge. A few months later, he left the hospital and sued the management of the unfortunate company to receive compensation for an injury at work. The parachutist lost the case and was also fired from his job. The story is instructive, but that’s not the point. Those rules that existed before pitted the employee and the employer head-on. The first one always tried to attribute any bruise to work injury, and the latter refused to recognize people without an arm or leg as disabled. And all because the employer had to pay for treatment and compensation. Now this function is taken over by the Social Insurance Fund.
Another key point: the new rules more clearly spell out in which cases disability is established and in which it is not. “It used to be like this,” says Elena Andreeva, deputy head of the department labor relations Ministry of Labor, - a person, having graduated from a technical school, received, for example, a diploma as a plumber. But for the last 10 years he worked in the company, sitting on home phone. And then he breaks his leg and demands compensation, because he is a mechanic by profession and cannot work. But this has nothing to do with his current occupation: he is quite capable of performing his duties while sitting at home." So now compensation will be paid in relation to the job in which the victim is currently located.
In ordinary cases (fracture, sprain, etc.) this is 15% of the salary. If a person cannot work at all, he will receive 100%. If the injury is so serious that the employee will now have to limit his activities, it is realistic to receive from 40% to 90%. How much exactly will be determined by a medical and social examination.
Appeal if possible
According to the new rules, it turns out that people who become disabled in the workplace will receive less. Previously, the victim was paid a salary, a pension and compensation for the amount of damage. Now it will only be a pension and, if necessary, payment for treatment.
Depending on how badly you were injured, the Ministry of Labor, the Ministry of Health and the Social Insurance Fund will decide whether you need treatment in a sanatorium, surgery, retraining in a new specialty or not. If it decides that it is necessary, the Social Insurance Fund will pay.
In addition, another significant change was made to the rules: now the victim and the insurer will have equal conditions to appeal their position. That is, previously an employee could demand compensation, but the one who had to pay it to him could not. Now they can sue each other. By the way, in addition to the court, you will also be heard at the Main Bureau of Medical and Social Expertise and the local department of social protection. The Bureau even set a strict deadline for making a decision - a month from the date of receipt of the application.
And the last thing many of us will now have to put up with. As you know, some people are not enough to earn one salary and have to work part-time in several places. So, if a person is injured, then he applies for compensation for all, say, three jobs. On one it turns out to be 60%, on the other - 40%, on the third another 40%. As a result, it turns out that, having become disabled, he receives more than when he was healthy. Now officials have introduced a restriction: no matter how many jobs the victim has, he should receive no more than 100% compensation in total.
The latest rules on this subject were issued in 1994. How long the new document will last is unknown. Wait and see.
RULES FOR ESTABLISHING THE DEGREE OF LOSS OF PROFESSIONAL WORK CAPACITY AS A RESULT OF WORK ACCIDENTS AND OCCUPATIONAL DISEASES
I. General provisions
1. These Rules determine the procedure for establishing by medical and social examination institutions the degree of loss of professional ability for persons who have suffered health damage as a result of industrial accidents and occupational diseases (hereinafter referred to as victims).
2. The degree of loss of professional ability to work is established as a percentage 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 to work, approved by the Ministry of Labor and Social Development of the Russian Federation according to in agreement with the Ministry of Health of the Russian Federation and the Social Insurance Fund of the Russian Federation.
3. Simultaneously with establishing the degree of loss of professional ability to work, the institution of a medical and social examination, if there are grounds, determines the need of the victim for medical, social and professional rehabilitation, and also recognizes the victim as disabled.
4. The examination of the victim is carried out in a medical and social examination institution at the place of his residence or at the place of attachment to a state or municipal medical and preventive health care institution (hereinafter referred to as a health care institution).
If, in accordance with the conclusion of a health care institution, the victim cannot come to the medical and social examination institution for health reasons, the examination can be carried out at home or in a hospital where the victim is being treated.
5. The medical and social examination institution is obliged to familiarize the victim in a form accessible to him with these Rules.
6. For citizens who were injured while not performing their work duties, the degree of loss of professional ability to work is established by forensic medical examination institutions.
II. Examination of victims
7. An examination of the victim in a medical and social examination institution is carried out on the basis of a request from the employer (insurer), insurer, by a ruling of the court (judge) or on an independent request of the victim or his representative when submitting a report on an industrial accident or a report on an occupational disease.
8. The employer (insurer) submits to the medical and social examination institution the conclusion of the state examination body of working conditions on the nature and working conditions of the victims that preceded the industrial accident and occupational disease.
9. The health care institution carries out the necessary diagnostic, therapeutic and rehabilitation measures and, based on their results, issues a referral to the victim to a medical and social examination institution for examination to determine the degree of loss of professional ability. The referral contains data on the victim’s health status, reflecting the degree of dysfunction of organs and systems, the state of the compensatory capabilities of his body and the results of the treatment and rehabilitation measures taken.
In some cases, before identifying signs of permanent loss of professional ability in a victim, a health care institution may refer him to a medical and social examination institution to determine his need for certain types rehabilitation.
10. If it is necessary to conduct an examination using special techniques or equipment, to obtain additional data, the medical and social examination institution sends the victim for additional examination to a medical, rehabilitation or other institution, requests the necessary information, carries out an examination of the victim’s working conditions, his social and living conditions and accepts other measures.
11. If the victim refuses additional examination, an expert decision on the degree of loss of professional ability to work is made on the basis of available data, about which a corresponding entry is made in the examination report of the victim.
12. Based on the received documents and information, personal examination of the victim, the degree of loss of his professional ability to work is determined, based on an assessment of the victim’s professional abilities, psychophysiological capabilities and professionally significant qualities that allow him to continue to perform professional activities preceding the industrial accident and occupational disease, the same content and in the same volume, or taking into account the reduction of qualifications, the reduction in the volume of work performed and the severity of labor in ordinary or specially created production conditions.
Specially created production conditions mean the organization of work in which the victim is given a shortened working day, individual production standards, additional breaks in work, and appropriate sanitary and hygienic conditions are created, workplace is equipped with special technical means, systematic medical supervision and other measures are carried out.
13. An expert decision on the degree of loss of professional ability to work is made in the presence of the victim by a simple majority vote of the specialists who conducted the examination.
14. If the victim has a complete loss of professional ability to work due to a pronounced impairment of body functions in the presence of absolute contraindications for performing any type of professional activity, even in specially created conditions, the degree of loss of professional ability to work is established at 100 percent.
15. If the victim, due to a pronounced impairment of body functions, can perform work only in specially created conditions, the degree of loss of professional ability to work is established from 70 to 90 percent.
16. If a victim as a result of an accident at work and an occupational disease can, under normal production conditions, continue his professional activities with a pronounced decrease in qualifications or with a decrease in the volume of work performed, or if he has lost the ability to continue professional activities due to a moderate impairment of body functions, but can in normal in production conditions to perform professional activities of lower qualifications, the degree of loss of professional ability to work is established from 40 to 60 percent.
17. If the victim can continue his professional activity with a moderate or slight reduction in qualifications, or with a decrease in the volume of work performed, or with changes in working conditions that entail a decrease in earnings, or if the performance of his professional activity requires more stress than before, the degree of loss is established professional work capacity from 10 to 30 percent.
18. The degree of loss of professional ability to work in case of repeated industrial accidents and occupational diseases is determined at the time of examination for each of them separately, regardless of whether they occurred during the period of work for one employer or different employers, taking into account the professional knowledge and skills of the victim and generally cannot exceed 100 percent.
19. When re-examining the victim after rehabilitation measures, specialists from the medical and social examination institution, when establishing the degree of loss of professional ability to work, take into account damage to health due to an industrial accident and occupational disease, the ability to perform work in the profession acquired as a result of training or retraining, the ability of the victim to perform professional activity preceding an industrial accident and occupational disease, taking into account his existing professional knowledge and skills.
In case of evasion (refusal) of the victim from carrying out recommended rehabilitation measures, the question of the degree of loss of professional ability to work is considered taking into account the ability to perform any work activity.
20. When establishing the degree of loss of professional ability of the victim, the need of the victim for medical, social and professional rehabilitation is determined.
21. The conclusion of a medical and social examination institution on the need for medical, social and professional rehabilitation is drawn up taking into account the potential capabilities and abilities of the victim to carry out professional, household and social activities and is formalized in the form of a rehabilitation program for victims of an industrial accident or occupational disease.
The rehabilitation program for the victim determines the specific types, forms, volumes of necessary rehabilitation measures and the timing of their implementation.
The rehabilitation program for the victim is drawn up within one month after the expert decision is made in a form approved by the Ministry of Labor and Social Development of the Russian Federation in agreement with the Ministry of Health of the Russian Federation and the Social Insurance Fund of the Russian Federation.
22. The data from the examination of the victim and the expert decision are entered into the minutes of the meeting and the certificate of examination of the victim, which are signed by the head of the medical and social examination institution, the specialists who conducted the examination, certified by the seal of this institution and, along with all medical documents, are stored for 10 years in the specified institution.
23. The results of the examination are announced to the victim in a form accessible to him by the head of the medical and social examination institution in the presence of specialists who made the expert decision. The specialists who made the expert decision provide explanations to the victim or his representative.
24. A certificate from the medical and social examination institution on the results of establishing the degree of loss of professional ability to work, and, if necessary, a rehabilitation program, is issued to the victim against signature.
25. An extract from the examination report indicating the results of establishing the degree of loss of professional ability and the rehabilitation program for the victim are sent to the employer (insurer) or insurer within 3 days after their execution, and are also issued to the victim if the examination was carried out at his request.
III. Re-examination of victims
26. Re-examination of the victim is carried out in the manner established to determine the degree of loss of professional ability to work as a result of industrial accidents and occupational diseases.
27. The period for re-examination of the victim when determining the degree of loss of professional ability to work is established after six months, one year or two years based on an assessment of the victim’s health status and the forecast for the development of his compensatory and adaptive capabilities.
The degree of loss of professional ability of the victim is established indefinitely in the event of irreversible consequences of health damage due to an industrial accident and occupational disease with a persistent impairment of professional abilities and the ability to perform production activities.
28. If the victim misses the deadline for the next re-examination, the degree of loss of professional ability for the missed period is established if there is a referral from the employer (policyholder), insurer or a court (judge) order.
29. Re-examination of the victim earlier than the deadlines specified in paragraph 27 of these Rules is carried out in the event of: a change in the health status of the victim in the presence of a referral from a health care institution or a personal appeal of the victim or his representative to a medical and social examination institution and medical documents confirming this change; identifying facts of an unreasonably made decision (including based on forged documents) or an appeal by the victim, employer (insurer), or insurer of the decision of the institution of a medical and social examination in the prescribed manner.
30. The medical and social examination institution conducts an examination in order to dynamically monitor the implementation of rehabilitation measures to assess their effectiveness within the time frame established by the victim’s rehabilitation program.
IV. Appealing the decision of the medical and social examination institution
31. The victim, his representative, employer (insurer) or insurer, in case of disagreement with the decision of the medical and social examination institution, may appeal it by submitting a written statement to the institution that examined the victim, or to the main bureau of medical and social examination, or to the social authority protection of the population of a constituent entity of the Russian Federation.
The Bureau of Medical and Social Expertise, which examined the victim, sends this application with all documents to the main Bureau of Medical and Social Expertise within 3 days from the date of receipt of the application.
32. The Main Bureau of Medical and Social Expertise, within a month from the date of receipt of the application, conducts a re-examination of the victim and makes a decision based on the results obtained.
The decision of the main bureau of medical and social examination can be appealed within a month to the social protection body of the population of the constituent entity of the Russian Federation, which can entrust the re-examination of the victim to another group of specialists of the required profile of the specified institution.
33. The decision of the institution of medical and social examination may be appealed to the court in the manner established by the legislation of the Russian Federation.
DECREE OF THE GOVERNMENT OF THE RUSSIAN FEDERATION of October 16, 2000 N 789 ON THE APPROVAL OF RULES FOR ESTABLISHING THE DEGREE OF LOSS OF PROFESSIONAL CAPACITY AS A RESULT OF WORK ACCIDENTS AND OCCUPATIONAL DISEASES
In accordance with the Federal Law “On Compulsory Social Insurance against Industrial Accidents and Occupational Diseases” (Collected Legislation of the Russian Federation, 1998, No. 31, Art. 3803), the Government of the Russian Federation decides:
1. Approve the attached Rules for determining the degree of loss of professional ability to work as a result of industrial accidents and occupational diseases.
2. The Ministry of Labor and Social Development of the Russian Federation, in agreement with the Ministry of Health of the Russian Federation and the Social Insurance Fund of the Russian Federation, approve:
criteria for determining the degree of loss of professional ability to work as a result of industrial accidents and occupational diseases;
form of a rehabilitation program for a victim as a result of an accident at work and an occupational disease.
3. The Ministry of Labor and Social Development of the Russian Federation and the Ministry of Health of the Russian Federation provide the necessary clarifications on issues related to the application of the Rules approved by this resolution.
4. Decree of the Government of the Russian Federation dated April 23, 1994 N 392 “On approval of the Regulations on the procedure for establishing by medical-labor expert commissions the degree of loss of professional ability in percentage to workers who have received injury, occupational disease or other health damage associated with the performance of their labor duties" (Collected Legislation of the Russian Federation, 1994, No. 2, Art. 101).
Chairman of the Government of the Russian Federation M. KASYANOV