Sick leave for a domestic injury: payment, calculation, procedure for registration in 2021

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Published: March 12, 2016

Reading time: 9 min

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Payment for temporary sick leave, better known as sick leave, has undergone some changes since 2013.

If previously the employer himself handled the payment, then since 2013 the Social Insurance Fund of the Russian Federation has been paying for the citizen’s temporary disability certificate .

Will a domestic injury be paid on sick leave?
Due date
What determines the amount of payments?
Payment procedure Required documents
Where should an employee go?
What should an employer do?

When can payments be denied?

To become more familiar with this issue, we recommend that our readers pay attention to the following laws and codes:

Labor Code of the Russian Federation (Articles 124 and 183);
Tax Code of the Russian Federation (Articles 217 and 255);
Law “On the fundamentals of protecting the health of citizens in the Russian Federation” No. 323 of November 21, 2011;
Resolution “On approval of the Regulations on the specifics of the procedure for calculating benefits for temporary disability for pregnancy and childbirth, monthly child care benefits for citizens subject to compulsory social insurance in case of temporary disability and in connection with maternity” No. 375 of June 15, 2007;
Order of the Ministry of Health of the Russian Federation “On approval of the procedure for issuing certificates of incapacity for work” No. 624 dated June 29, 2011.

Changes with the payment of sick leave affected the relationship between the Social Insurance Fund of the Russian Federation (hereinafter referred to as the Social Insurance Fund of the Russian Federation) and the employer, but not much has changed for the employee.

As before, the certificate of temporary incapacity for work must be submitted directly to the accounting department at the place of work, but now it is not the employer himself who will pay for sick leave, but the Social Insurance Fund of the Russian Federation.

What is a domestic injury?

A domestic injury is an injury sustained by an employee while he is not performing his job duties. For example, during non-working hours, not on the way to work or on the way home.

An employee may receive a domestic injury under the following circumstances:

during cooking;
when cleaning the apartment;
while working in the garden;
when working in the garden.

Injuries include cuts, fractures, sprains, insect and animal bites.

Injuries received during the performance of official duties, on the way to work and on the way home are recognized as industrial injuries. If an employee receives a minor injury due to his own fault, then by agreement with the employer the injury can be registered as a domestic injury. This will allow the employer to avoid the need to conduct an investigation into the incident and a fine.

Where should an employee go?

Where should an employee go to apply for sick leave in case of a domestic injury?

In the hospital

To obtain a certificate of incapacity for work, the employee contacts his attending physician. Moreover, if a person is employed by several employers and intends to receive benefits from each of them, then this must be reported to the hospital in advance. In this case, the patient is issued several sick leaves, with a mark of the main place and part-time places, according to the number of employers.

At the enterprise

After restoration of working capacity, the employee should contact the personnel service of his enterprise. Article 12 255-FZ allows that the insured person can present documents confirming the period of illness within 6 months. But it is unlikely that the employer will wait that long for an explanation for absence from work. Such a deferment is most likely suitable for those who have already been laid off, as well as for those who fell ill on annual leave or were ill for a long time with various types of illnesses without going to work.

In any case, the person responsible for personnel records management is obliged to accept the certificate of incapacity for work without any objections. To be on the safe side, you can submit the document along with a cover letter and ask to sign the acceptance and surname or register it as incoming correspondence through the office. If a conflict does arise when accepting documents, then nothing prevents the employee from sending the original sick leave by mail with an inventory of what was included in the shipment.

The only reason for refusing to accept sick leave can be its incorrect or incomplete completion. But even then, they do not have the right to refuse to accrue benefits to the employee; they can only demand that adjustments be made to the document or a duplicate be issued. The procedure for filling out and methods for correcting errors are described in Section IX of Order No. 624n.

In a situation where the employee had a change of employer during the billing period, or perhaps there are other reasons to make additions or clarity, it is better to also contact the accounting department. Salary certificates and other documents are provided here.

Is sick leave issued for a domestic injury?

The Law on Compulsory Social Insurance No. 255-FZ dated December 29, 2006, and Order No. 925n dated September 1, 2020, provide for the circumstances under which a certificate of incapacity for work is issued. Injury is one such circumstance that entitles an employee to receive temporary disability benefits.

A sick leave certificate is issued in case of injury:

interfering with the performance of official duties;
requiring outpatient treatment due to disability;
high severity, requiring hospital treatment.

Temporary disability benefits for injuries are issued from the date of injury for the entire recovery period until recovery or disability is established. The first three days are paid at the expense of the employer, from the fourth day payment is made entirely at the expense of the Social Insurance Fund.

If a domestic injury does not prevent the employee from performing job duties, then sick leave is not issued and temporary disability benefits are not paid. The citizen continues to go to work, visiting a doctor if necessary.

How is sick leave paid after dismissal in 2021?

How is sick leave paid for a part-time worker?

Employer's procedure

Step 1. Provide assistance to the victim

The head of the enterprise or his deputy must provide first aid to the victim and organize his transportation to the hospital.

In order to later investigate the circumstances, it is necessary to maintain the situation at the scene of the emergency, if this does not endanger other employees.

The employer must notify the authorities, the trade union, and the Social Insurance Fund within 24 hours about a mass accident. Below we will tell you in more detail.

Step 2. Form a commission

The employer forms a commission that will interview the victim and/or witnesses. It should include:

occupational safety specialist;
employer representative;
representatives of a trade union or other elected body.

If several people were injured or someone died, the commission includes a GIT inspector, representatives of local governments and the territorial association of trade union organizations.

The victim himself also has the right to participate in the investigation of the accident as part of the commission (Article 229 of the Labor Code of the Russian Federation).

Step 3. Conduct an investigation and leave a report

The commission analyzes the circumstances of the incident, draws up protocols for examining the scene of the incident, interviewing the victim and witnesses, studying medical documents and drawing up an act in form N-1 (Resolution of the Ministry of Labor dated October 24, 2002 No. 73).

Three days were allotted for the investigation. If several people were injured or the victim died, the commission has 15 days to study what happened and draw up a report.

The commission members include in the act:

information about the victim;
information about the employer;
information about the circumstances of the accident (date, time, place, type of incident, extract from the medical report, etc.);
the causes of the work injury, including information about which safety instructions were violated;
the degree of guilt of the injured employee;
results of interviews with witnesses to the accident, etc.

The act is drawn up in two copies, the members of the commission sign each of them. Then information about the accident is entered into the register of industrial injuries (approved by Resolution of the Ministry of Labor dated October 24, 2002 No. 73).

Step 4: Submit Accident Reports

If as a result of an accident several people were injured or an employee died from his injuries, the employer is obliged to notify within 24 hours:

territorial branch of GIT;
the prosecutor's office;
territorial branch of the FSS;
industry department.

The notification form is approved by Resolution of the Ministry of Labor of the Russian Federation No. 73.

In order for the victim to receive compensation and benefits provided for by law, the organization sends to the Social Insurance Fund:

notification of an insured event;
a copy of the order to investigate an industrial accident (on the creation of a commission to investigate an industrial accident);
a copy of the act in form N-1 - sent within three days after approval by the employer;
a copy of the crime scene inspection report with a diagram of the crime scene;
a copy of the victim interview protocol;
a copy of the protocols of interviews with eyewitnesses of the accident (for each individual);
a copy of the minutes of interviews with officials (for each separately);
a copy of the medical report on the nature and severity of the injuries received (form 315/у);
a copy of the employment contract or copies of the sheets of the victim’s work book;
a copy of the SNILS insurance certificate;
a message about the consequences of the accident and the measures taken - drawn up upon completion of treatment of the victim and presented together with a copy of certificate 316/у;
a certificate of the final diagnosis of the victim of an accident at work (form 316/у).

The list is published on the FSS website. The department clarifies that the volume of materials may vary, it all depends on the circumstances of the accident, the severity of the injuries received and the duration of treatment.

How do you issue sick leave for a domestic injury?

Usually, for medical help in case of injury, a citizen turns to a surgeon at a clinic or a traumatologist. In case of serious injuries, an ambulance is called, which transports the victim to a hospital.

Medical organization

From the first day, the doctor issues a certificate of incapacity for work for patients. The following mandatory information must be entered on the front side of the form:

information about the medical institution:
date of sick leave;
code “02” and additional code if necessary;
place of work of the citizen;
date of commencement of disability and date of restoration;
position, full name, signature and seal of the doctor;
date of return to work;
seal of the medical institution.

Errors and inaccuracies in the sick leave certificate are unacceptable. If they are present, corrections cannot be made. The patient must be given a duplicate.

Employer

The second part of the form is filled out by the employer’s HR department after the sick leave is closed and presented to the employer.

The HR department provides the following information:

name of company;
type of employment (main or part-time);
subordination code in the FSS system;
accrual conditions;
information about the employee;
SNILS;
insurance experience;
period of incapacity;
average earnings and average daily earnings;
benefit amount;
position and full name of the manager and chief accountant;
employer's stamp.

Before sending the certificate of incapacity for work to the Social Insurance Fund, you should check it for errors. If malfunctions made by the employer are detected, they can be corrected.

The completed document is submitted to the Social Insurance Fund for payment of temporary disability benefits.

With the consent of the citizen, the certificate of incapacity for work is issued electronically through the FSS online service. The first part is filled out by the doctor and provides the sick leave number to the patient. The second part is filled out by the employer through his personal account. Next, the certificate of incapacity for work is sent to the Social Insurance Fund.

Is it possible to obtain recognition of a work injury after the fact?

There are often cases when the victim, in order not to embarrass the employer, initially agrees to admit a domestic injury, although he was injured at work.

For example, an employee slipped and fell on the sales floor. He developed pain in his ankle and consulted a doctor. The doctor fixes the sprain. The employee agrees to the code “domestic injury” on the sick leave certificate, since he considers the leg injury to be insignificant. But over time, the condition of the ankle worsens and systematic treatment is required.

What should an employee do in this case? Solution: look for witnesses to his fall at the workplace, write a statement to the director of the enterprise to review the type of injury, appoint an investigation and a commission. The employee's goal is to receive 100% of the benefit payment and payment for additional treatment.

Calculation and payment procedure

The calculation of temporary disability benefits for a domestic injury is carried out according to the general rules:

The accountant determines the average earnings for the last two years preceding the occurrence of the insured event. To do this, all data on the employee’s income is raised. If necessary, a certificate from the previous place of employment is issued.
Next, the employee’s average daily earnings are calculated by dividing the average earnings by 730.
The amount of daily earnings is calculated taking into account the amount of insurance coverage. With an experience of 8 years or more, the amount of daily earnings is 100% of the average daily earnings, from 5 to 8 years - 80%, from six months to 5 years - 60%.
The amount of daily earnings is multiplied by the number of days of temporary disability.

An example of calculating benefits for a domestic injury. Yurchenko N.T. was on sick leave due to a fractured collarbone from February 1 to March 1, 2021 (29 days). The code “02” was indicated on the certificate of incapacity for work, which means that the incapacity for work was caused by a domestic injury. The employee's insurance experience is 6 years, average earnings for 2019 and 2021 are 670,000 rubles. and 850,000 rub.

The calculation will be as follows:

The average earnings for two years are determined to be 670,000 + 850,000 = 1,520,000 rubles.

The amount received is below the insurance base subject to insurance premiums, which in 2021 is RUB 1,777,000. (865,000 rubles, in 2021 – 912,000 rubles).

The average daily earnings are determined to be 1,520,000 / 730 = 2,082.19 rubles.
Daily earnings are determined taking into account the employee’s insurance experience: 2,082.19 * 80% = 1,665.75 rubles.
The amount of benefit paid by the employer is determined as 1,665.75 * 3 days = 4,997.25 rubles.
The amount of benefits paid from the Social Insurance Fund is determined as 1,665.75*26 days = 43,309.50 rubles.

Before paying the benefit, the employer and the Social Insurance Fund will withhold 13% from the personal income tax benefit. The total payment amount will be (4,997.25 – 13%) + (43,309.50 – 13%) = 42,026.86 rubles.

Results

When an employee receives a work-related injury, benefits are paid by the Social Insurance Fund from the 1st day of sick leave.
The calculation of the amount paid is made based on the average earnings of the employee for whom “unfortunate” insurance premiums are calculated in accordance with Law No. 125-FZ. A reduction factor taking into account length of service is not applied. However, restrictions in the form of a legally established amount of the maximum possible payment must be taken into account. You can find more complete information on the topic in ConsultantPlus. Free trial access to the system for 2 days.

In what cases is the benefit reduced?

The law provides for circumstances under which the amount of temporary disability benefits may be reduced.

Let us name the grounds for reducing benefits (Article 8 of the Law on Compulsory Social Insurance):

violation of the treatment regimen (for example, non-compliance with bed rest, unauthorized leaving the hospital);
failure to show up for an appointment with a surgeon or traumatologist at the appointed time;
injury while under the influence of alcohol or drugs.

If there are one or more grounds, the amount of temporary disability benefits is calculated based on the minimum wage. The payment is reduced from the date of the violation. If the injury was sustained while under the influence of alcohol or drugs, the benefits will be reduced for the entire period of sick leave.

What determines the amount of payments?

Article 7 255-FZ tells in detail how sick leave is calculated for a domestic injury and what amount of benefits the victim will ultimately receive.

The amount of benefits for a domestic injury mainly depends on the number of years of insurance coverage of the injured person:

an employee who recently got a job, but has worked for less than six months recently, cannot expect to be paid more than the minimum wage prevailing in his region on the date of injury;
a person who has worked for more than 6 months, but less than 5 years, will be paid only 60% of the average earnings for the previous two years;
those who have worked for more than 5 years, but less than 8, will receive 80% of the average salary;
100% will be received by persons officially employed for more than 8 years.

Unfortunately, length of service will not matter if the former employee suffered a domestic injury after being fired. No matter how long he works throughout his life, the benefit amount will be only 60% of the average salary. But if he was injured while still employed, and provided a document about this 6 months later, then the payment will be calculated in full, the amount will depend on the length of service and the amount of income.

What can reduce sick leave payments?

In addition to length of service, the final amount of benefits may also be affected by the circumstances that arise during a domestic injury, and the presence of notes about violation of the regime or state of intoxication while on sick leave. Article 8 255-FZ tells how sick leave is paid for a domestic injury, which has special doctor’s notes on the front side of the disability document.

So, if an employee, while in a hospital or on outpatient treatment, neglected the regime or did not show up for an appointment prescribed by the attending doctor, then the employer is obliged to significantly reduce the amount of benefits to the amount of the minimum wage from the date the violation began. But if the cause of a domestic injury was intoxication, no matter what type, then the payment will not exceed the minimum wage from the first day. The presence of special doctor’s notes on sick leave will force the employer to demand from the victim a written explanation of his behavior, to assess the degree of validity of the reasons and events that led to the violation of the regime. It is safer to record a decision to reduce the amount of benefits in an order, having familiarized the employee with its contents.

The employer's right to a reduction arises already when the certificate of incapacity for work is marked with the code of a domestic injury (02), and in the period about the facts of violation of the regime, code 24 is indicated or in the “Other” field there is 34. If there is a conclusion that the employee was injured in a state of alcoholic or toxic intoxication (domestic injury code - 021), then you need to prove a direct connection between these events. This will require an explanatory statement from the victim; without it, the employee will be able to challenge the accrual amount in court and accuse management of non-payment of wages.

A situation may arise where the injury was not the result of drunkenness, it was simply an accompanying circumstance. Alternatively, the person received a traumatic brain injury from a heavy object falling on his head from the roof of a building, past which he was returning home, being slightly drunk. Since the illness would have occurred regardless of the fact of drinking alcohol, the benefit must be accrued in full. But if he drunkenly climbed onto this roof and fell, then the connection will be direct, and the negligent employee simply has no reason to assume that he will be paid sick leave according to the average salary.

How to calculate reduced benefits?

The calculation of the reduced benefit is made in proportion to the number of days of sick leave, based on the fact that the minimum wage is calculated for the entire month. This means that the accrued amount for each full month of illness, from the first to the last day, will be equal to the minimum wage plus the regional coefficient. If the injury was not severe and the employee was ill for only a few days, then the minimum wage on the day the injury occurred at home must be multiplied by 24 months and divided by 730/731 calendar days, and then multiplied by the number of calendar days of illness or period of violation. However, the benefit calculated in proportion to the minimum wage may be greater than that calculated on the basis of data on average earnings and length of service, in which case the latter amount will be payable.

In what cases are benefits not paid?

Based on Article 9 of the Law on Compulsory Social Insurance, an employee may be denied payment of temporary disability benefits in whole or in part.

Benefits are not paid for the following periods:

the injury was sustained during unpaid leave, maternity leave, or parental leave;
temporary disability arose during the period of suspension from work without pay;
during the period of sick leave, the citizen is taken into custody or under administrative arrest;
the citizen undergoes a forensic medical examination;
the injury occurred during a period of inactivity;
the injury was received as a result of intentional harm to one’s health;
a citizen was injured while committing an intentional crime.

Due date

After receiving the original certificate of incapacity for work or its established copy, in the event of injury to a part-time worker, the employer must calculate and issue financial benefits within the time limits specified by law. According to Article 15 255-FZ, the employer’s HR and accounting department has a 10-day period to fill out the back side of the received document and calculate benefits. The enterprise is obliged to pay all funds due to the sick employee on the next date of payment of wages at the enterprise. In practice, the maximum period will not exceed 26 calendar days, since, according to Article 136 of the Labor Code of the Russian Federation, the payment of wages due to employees must be carried out at least once every half a month, in other words, the break cannot exceed 16 days.

“Direct payments” from the Social Insurance Fund from 2021

From January 1, 2021, all subjects of Russia switched to the no longer pilot project of the Social Insurance Fund of direct payments of sick leave and maternity benefits - their provision immediately at the expense of the Social Insurance Fund (Law dated December 29, 2020 No. 478-FZ).

For more information about this, see “What happened to the FSS pilot project “Direct Payments” in 2021: regions.”

This law establishes that from 2021, sick leave benefits, maternity benefits, and a one-time benefit for women registered in the early stages of pregnancy are assigned and paid by the Social Insurance Fund - according to information provided by the employer.

If for some reason the employer did not provide information (for example, it managed to be liquidated), the Social Insurance Fund received the right to request data for calculating benefits from government agencies - the Pension Fund of the Russian Federation, the Federal Tax Service.

OPINION
This, on the one hand, is very convenient for employers, since there is no longer any need to divert their own funds from circulation to pay these benefits and compensate them by offsetting them with the Social Insurance Fund. On the other hand, employers remained responsible for transmitting data for calculating sick leave and for its accuracy.

If, due to the inaccuracy of the information that the employer submitted to the Social Insurance Fund, an error was made and the Fund subsequently incurred expenses associated with its correction, all such expenses are claimed from the employer as compensation.

There are many examples of calculating sick leave according to the new rules in Consultant Plus.

Full and free access to the system for 2 days.

Sick leave

The duration of hospital stay is determined depending on the doctor’s conclusion, which directly depends on the severity of the injury. Typically, a therapist issues sick leave for a work injury for fifteen days , which can be extended in the future.

In the most serious case, sick leave can be issued for 12 months, but a special medical commission is convened to issue it. If experts believe that there is a possibility of complete loss of ability to work, then an examination may be appointed to recognize the person as disabled.

The most common accidents are dislocations and fractures. Different sectors, however, have their own specificities and injuries that are characteristic of them. For an energy company, for example, the likelihood of an employee receiving an electric shock is much higher than for a process engineer.

Let's look at some types of injuries and possible periods of sick leave:

fracture of the arm/leg - for a mild fracture, the period is most often less than a month, for a complex fracture - 3 or more months;
spinal fracture is a very serious injury, sick leave is issued for several months, loss of ability to work and disability cannot be ruled out;
fracture of the coccyx - usually 2-3 months, in complex cases - from three;
concussion - from one to four months;
burns - can have varying severity, from mild with a period of a couple of weeks to complete loss of ability to work;
cut - mild severity, most often sick leave is not required;
electric shock - if the shock was weak and there were no complications, then - from several days to a week;
insect bite - if an infection develops, the period of sick leave will be longer.

general information

An injury is a physical injury to an employee that significantly affects his or her ability to work. An industrial injury is more of a colloquial expression, because such a term does not exist in the Labor Code.

Article 227 of the Labor Code defines this kind of incident as an “accident”, which is subject to recording and investigation.

If an employee performing work duties is injured, then such an incident must be documented, recorded and processed. If an employee was injured while performing an assignment for the employer that is not a daily duty, then, despite this fact, the incident must be taken into account and investigated.

The concept covers a fairly broad category of persons, which includes not only full-time employees signed up under a standard employment contract, but also includes:

trainees - citizens undergoing internship at an enterprise;
employees who are present at the enterprise as part of a professional development program;
persons engaged in community service;
citizens deprived of their liberty.

The Labor Code describes in detail which injuries are subject to investigation. These include damage resulting from:

burns/exposure to high temperatures;
exposure to radiation, current;
bites/damage caused by animals;
accidents/explosions;
emergency circumstances.