The document has been sent for payment to the Social Insurance Fund: when will the money arrive?

For several years now, the Russian Social Insurance Fund has been actively developing the Direct Payments program. Under the terms of this program, employees can receive benefits directly from the Social Insurance Fund. From now on, any insured employee can check the status of the paid benefit in his personal account lk.fss.ru or through the Social Navigator application.

However, when tracking such statuses, users often have questions regarding some of the designations. For example, people are often interested in what exactly the status “Document sent for payment” means and how long it will take for the money to arrive in the applicant’s account. In this article we will examine this issue.

Status in the Social Insurance Fund: document sent for payment

What has changed in sick pay since 2021?

The main change in the procedure for paying sick leave for employees is that now benefits will be paid not only by the employer, but also by the regional branch of the Social Insurance Fund, in which the employer is registered as an insurer. In fact, the benefit will be divided into 2 parts, which can be paid in different ways and at different times.

The first part of the benefit consists of payments for the first 3 days of temporary disability (staying on sick leave). The employer is responsible for these payments, who makes them at his own expense without the possibility of subsequent reimbursement from the Social Insurance Fund (Part 2, Article 3 of Federal Law No. 255-FZ of December 29, 2006). The benefit for the entire subsequent period of temporary disability, starting from the 4th day of illness, will be transferred directly to the employee by the Social Insurance Fund.

At the same time, for the entire 2021 and subsequent periods, the application procedure for receiving temporary disability benefits will remain. To receive sick leave benefits, the employee must still contact his employer, provide a sick leave certificate and write a corresponding application.

Sickness benefits in 2021 will be calculated according to new rules. So, if the benefit for a full month turns out to be below the minimum wage, then it will still be calculated based on the minimum wage. To do this, the current minimum wage is divided by the number of calendar days of the month (28,29,30 or 31) and multiplied by the number of calendar days during illness (Federal Law No. 478-FZ of December 29, 2020).

The procedure for obtaining sick leave has also undergone a number of changes in 2021.

Cheat sheet on the article from the editors of BUKH.1S for those who do not have time

1. From 2021, the first 3 days of sick leave are paid by the employer, and the subsequent days by the Social Insurance Fund.

2. If the benefit for a full month is below the minimum wage, then it will still be calculated based on the minimum wage.

3. To receive sick leave benefits, an employee must contact his employer, provide a sick leave certificate and write an application.

4. In some cases, an employee may apply for sick leave benefits directly to the Social Insurance Fund.

5. Employees can now control the payment of sick leave benefits in the personal account of the insured person on the Social Insurance Fund website or through a special mobile application “Social Navigator”.

The procedure for calculating average earnings to pay for sick time

In order for the employee to receive the compensation due to him, the accountant must correctly calculate the payment for temporary disability. The basic rules for calculating and paying sick leave in 2021 are as follows.

Step 1. The accountant calculates the average earnings for the billing period, then calculates the average daily earnings and the amount of the disability benefit itself. It is necessary to calculate the average salary in accordance with Government Decree No. 922 of December 24, 2007.

Step 2. Average earnings are calculated as follows: wages are determined for the two-year period preceding the accrual. When calculating average earnings, all income that the employee received from official employers and from which insurance premiums were paid is taken into account. The resulting amount is divided by 730.

Accountable income includes (Article 421 of the Tax Code of the Russian Federation):

• income that an employee receives by agreement with the employer - wages, rewards and fees, allowances, bonuses, compensation and incentive payments;
• long service payments;
• payment for an academic degree, badge and certificate of honor;
• for working night shifts, weekends and holidays;
• payment for expanding service areas, for combining job responsibilities;
• remuneration for piece work according to orders;
• salary in kind;
• payments to state and municipal employees;
• allowances to tariff rates and established salaries;
• regional coefficients and northern allowances;
• additional payments for work in difficult climatic conditions, in hazardous industries, etc.;
• allowances for working with documents and information containing state secrets.

Step 3. The formula for calculating average earnings for sick leave is as follows:

SZ = income for the previous 2 years / 730 days.

If one of the calculation years is a leap year, then the total income for 2 years is divided by 731 days. To calculate maternity leave, we take 731 days.

When calculating average earnings, payments that are not subject to FSS insurance contributions are not taken into account. Chapter 34 of the Tax Code of the Russian Federation states that when calculating average earnings, the following amounts are not taken into account (Article 422 of the Tax Code of the Russian Federation):

1. Maternity leave.
2. A benefit paid during parental leave.
3. For other sick leave.
4. Travel allowances (daily allowances) paid for business trips both within the Russian Federation and abroad.
5. Vacation pay during business trips.
6. Financial assistance in the amount of up to 4000 rubles. per employee for a certain billing period.
7. One-time financial assistance that is paid in connection with natural disasters or emergency situations, the death of employee family members, the birth of a child, or the establishment of guardianship.
8. Year-end bonuses. The final bonus for the year is included in the calculation of average earnings in direct proportion to the number of months worked.
9. Compensation payments upon dismissal of an employee. The exception is compensation for unused vacation, amounts of payments in the form of severance pay and average monthly earnings for the period of employment.
10. Compensation for costs of professional retraining.
11. Payment for employee training for basic and additional professional programs.
12. Payments to individuals under GPC agreements.
13. Public utilities.
14. Compensations related to the employment of laid-off employees and the employee’s relocation to another area. The exception is benefits paid in connection with difficult, harmful working conditions.

Step 4. If the average earnings for each previous period exceed the limit (815,000 rubles in 2021 and 865,000 rubles in 2021), then the limit value is taken for calculation. For 2021, the maximum value of the insurance base for calculating benefits for temporary disability and maternity will be 912,000 rubles. The updated limit value of the base for calculating insurance contributions for compulsory pension insurance from 01/01/2020 is RUB 1,292,000.

There are no excluded periods for calculating average earnings for temporary disability certificates.

Step 5. The resulting calculated result of average earnings is compared with the current minimum wage at the time the minimum wage is calculated. From 01/01/2020, the official minimum wage will be 12,130 rubles. (until the end of 2021 - 11,163 rubles).

How to get sick leave in 2021

The new procedure for issuing temporary disability certificates is regulated by Order of the Ministry of Health dated September 1, 2020 No. 925n. Now the employee has the right to independently choose what kind of sick leave he needs - electronic or traditional, on paper. In this case, electronic sick leave is issued only with the written consent of the patient.

Sick leave for up to 15 calendar days inclusive is issued by the doctor independently, and for periods of temporary disability exceeding 15 calendar days, sick leave is issued and extended by decision of the medical commission. Sick leave is issued for the entire period of incapacity, including non-working holidays and weekends.

Paper sick leave is issued upon presentation of a passport or other identification document. Electronic sick leave is issued upon presentation of a passport (another identification document), as well as a SNILS number.

If a citizen at the time of the onset of temporary disability is employed by several employers and was employed by the same employers in the 2 calendar years preceding the year of issue of the certificate of incapacity for work, then he is issued several paper certificates of incapacity for work for each place of work.

Having received a sick leave certificate, the employee can apply for the appointment and payment of sick leave benefits.

Issuing a certificate of incapacity for work retroactively

There are often cases when an employee tries to get sick leave retroactively. This usually occurs if an employee has missed several working days for any reason other than illness. But according to the legislation of the Russian Federation, it is impossible to officially issue such a sick leave. This is clearly and clearly indicated in the Order of the Ministry of Health and Social Development of Russia No. 624n dated 06/29/11 and in the Decision of the Supreme Court of the Russian Federation No. AKPI14-105 dated 04/25/14.

That is, according to the law, if an employee decides to obtain a sick leave certificate retroactively in some way, not only he will be responsible for this, but also the one (medical employee or special organization) who issued him the document.

Due to the fact that previously employees could calmly bring a certificate of incapacity to work retroactively, while they themselves were healthy and simply did not come to work, in 2011 the certificate form adopted a new form that is still used today. It describes all the data in more detail, which complicates the task of applying for sick leave retroactively, which means employees bear a huge risk when trying to hide behind such a document.

By the way! If an employee came to work, worked for some time, but then fell ill, then sick leave can only be opened from the next day, since the organization cannot compensate for the day on which the employee was present at work through insurance.

Applying for assignment and payment of sick leave benefits

The application for the assignment of benefits is submitted by the employee in the form given in Appendix 1 to the order of the Federal Social Insurance Fund of the Russian Federation dated November 24, 2017 No. 578. The application must indicate the specific method of transferring the sick leave benefit - to a Mir bank card, to a bank account or by postal transfer. Please note that the application form will be changed in the very near future.

As a rule, the application is completed by the employer using accounting programs. The employee is only required to provide all the necessary information - sick leave data, as well as details of the bank account to which the benefit will be transferred.

You must apply for sick leave benefits no later than 6 months from the date of restoration of your ability to work or determination of disability. If the benefit is assigned in connection with caring for a sick family member, quarantine, prosthetics or after-care, it must also be applied for no later than 6 months from the end of the corresponding period of release from work (Article 12 of the Federal Law of December 29, 2006 No. 255-FZ ). In other words, sick leave must be provided to the employer no later than six months from the date of its registration. Otherwise, the provision of benefits will be denied (clause 17 of the Decree of the Government of the Russian Federation dated December 30, 2020 No. 2375).

Having accepted the documents from the employee, the employer sends them to the Social Insurance Fund office for payment of benefits. The employer is given 5 days for this. This period is counted from the moment all necessary documents are received by the accounting department of the enterprise.

From January 1, 2022, applications for sick leave will be abolished. To pay benefits, it will be enough to present only an electronic certificate of temporary disability (Bill No. 1062568-7 p approved by the State Duma).

The employer will pay the first part of the benefit (for the first three days of sick leave) to the employee’s card when paying the next salary. The second part of the benefit will be received by the employee within 10 days from the moment the documents are received by the fund department (clause 11 of the Decree of the Government of the Russian Federation of December 30, 2020 No. 2375).

Right to postpone settlement periods for payment

If an employee does not have an income base, he has the right to write an application for calculating average earnings, taking into account the financial data of those time periods when his income was recorded (clause 1 of Article 14 255-FZ). The transfer can be made by persons who were on maternity leave or parental leave during the billing period.

A period transfer is made when such a replacement is beneficial to the employee due to the fact that his income in the billing period is lower than in the previous ones. For example, if an employee did not work for several years and got a job in an organization. Here is how sick leave is calculated at a new place of work with a postponement of the period:

1. Replace either one accounting year of your choice or both periods.
2. To carry out the transfer, you must submit a corresponding application to the accounting department.
3. The application is drawn up in free form. Indicate the basis for the transfer, refer to the legislative norm - clause 1 of Art. 14 255-ФЗ - and indicate the periods to be replaced.

For example, Viktorova V.V. in 2021 and 2021 I was on maternity leave, and after that I couldn’t find a job. Thus, she has no income for these periods. In October 2021, she got a job. In January 2021, I provided my employer with sick leave. The duration of incapacity for work is 10 days. The employee has 15 years of experience, sick leave is paid in full.

The minimum wage for January 2021 is 12,130 rubles.

Minimum average daily earnings: 12,130 × 24 / 730 = 398.79 rubles. Sick leave based on the minimum wage is paid as follows: 398.79 × 10 = 3987.90 rubles.

The accountant raised the documents and saw that the total income of Viktorova V.V. for 2015 and 2021 equal to RUB 550,000.00.

If you calculate compensation based on income for the previous period, then the payment for a certificate of incapacity for work is as follows:

• 550,000 / 730 = 753.42 rubles;
• 753.42 × 10 = 7534.20 rub.

Accruals for the previous period from Viktorova V.V. much higher than current ones. The employee must fill out an application to postpone the pay periods.

Independent receipt of sick leave benefits from the Social Insurance Fund

As a general rule, sick leave benefits in 2021 are processed through employers. They are the ones who receive temporary disability certificates and applications from employees, create a package of documents for assigning benefits and transfer it to the Social Insurance Fund.

However, the new rules still stipulate a number of cases when employees have the right to independently apply to the Social Insurance Fund for the appointment and payment of sick leave benefits. This is possible, in particular, in the following cases (clause 7 of the Decree of the Government of the Russian Federation of December 30, 2020 No. 2375):

• termination by the employer of its activities on the day of application for appointment and payment of benefits;
• impossibility of establishing the actual location of the employer on the day of application for appointment and payment of benefits.

In order to receive benefits on their own, the employee must submit to the Social Insurance Fund an application, a sick leave certificate confirming the fact of temporary disability, a work record book, as well as a certificate of the amount of earnings from which the benefit should be calculated (Part 5 of Article 13 of the Federal Law of December 29, 2006 No. 255-FZ). This set of documents must be sent to the territorial office of the Social Insurance Fund at the place of registration of the employer. Having received all the above documents, the Social Insurance Fund will pay the employee benefits using the details he specified.

An example of calculating maternity benefits

Alexandrova A.A. provided sick leave for pregnancy and childbirth. She is going on maternity leave on 02/05/2019. In Alexandrova A.A. singleton pregnancy, the leave for which is 140 days.

The total income for 2021 amounted to RUB 650,000.00, for 2021 - RUB 730,000.00. The employee did not take sick leave during this period. Alexandrova’s income does not exceed the maximum base.

Let's calculate the maternity benefit: (650,000.00 + 730,000.00) / 730 = 1890.41 rubles.

The benefit will be: 1,890.41 × 140 = 264,657.53 rubles.

Procedure and terms for payment of sick leave benefits in 2021

The procedure for paying sick leave benefits for the first three days of illness is similar to the procedure for paying an employee his salary. The benefit will be paid to the employee on the next day after his appointment, established for the payment of wages in the organization (Federal Law of December 29, 2006 No. 255-FZ).

That is, for the first 3 days of sick leave, the employee will receive money either on the day he receives his salary or on the day the advance is paid, whichever comes first. The benefit for the first 3 days of illness will be transferred to the employee’s salary card.

In turn, the Social Insurance Fund will transfer sick leave benefits for the entire remaining period of temporary disability, starting from day 4, in one of the following ways specified by the employee in the application:

• to a Mir bank card;
• to a bank account;
• through the federal postal service (Russian Post).

The payment period for this part of the sick leave benefit is no later than 10 days from the date of receipt of the required set of documents by the Social Insurance Fund (clause 11 of the Decree of the Government of the Russian Federation of December 30, 2020 No. 2375).

Where is sick leave paid in 2021 - to the MIR card or any other card?

Extension of the program to the regions

At the moment, it depends on the region who pays sick leave - the Social Insurance Fund or the employer, since regions are connecting to the payment system through the Fund gradually.

Since July 1, 77 regions have already been involved in the program; since July 1, the project has expanded to another 8 regions:

• republics: Bashkortostan, Dagestan;
• Stavropol and Krasnoyarsk territories;
• regions: Volgograd, Leningrad, Yaroslavl, Tyumen.

Lastly, the following constituent entities of the Russian Federation will join the direct payment system:

• regions: Krasnodar, Perm;
• regions: Moscow, Chelyabinsk, Sverdlovsk;
• Khanty-Mansiysk Autonomous Okrug;
• and capitals: Moscow and St. Petersburg.

This should happen from January 1, 2021.

Responsibility of the employer for untimely transfer of sick leave to the Social Insurance Fund

The absence of the need to reimburse benefits paid to employees may lead to employers delaying the 5-day deadline for submitting documents/registers to the Social Insurance Fund. For these purposes, the legislation provides for administrative liability for failure to submit and untimely submission to the Social Insurance Fund of documents and information necessary for the assignment and payment of hospital benefits.

Employers are responsible for such an offense under Part 4 of Art. 15.33 of the Code of Administrative Offenses of the Russian Federation (violation of the procedure and deadlines for submitting documents to the territorial bodies of the FSS).

In accordance with this article, failure to comply with the 5-day deadline for submitting the necessary documents to the Social Insurance Fund will entail the imposition of a fine on the head and chief accountant of the employing organization in the amount of 300 to 500 rubles.
Payment of sick leave by the employer in 2021: new responsibilities for organizations

An example of calculating payment for caring for a sick child

Ezhova E.E. provided sick leave to care for a sick child from January 13 to January 20, 2021. The child’s age is 7 years. According to the new rules, such sick leave is paid in full for the entire duration of the child’s illness. The employee's experience is 15 years.

Income for 2021—RUB 500,000.00.

Income for 2021—RUB 600,000.00.

SDZ = (500,000.00 + 600,000.00) / 730 = 1506.85.

The compensation will be: 1506.85 × 7 = 10,547.95 rubles.

How can an employee control the payment of sick leave benefits?

An important change in sick pay for workers from 2021 is that they can now control the payment of sick leave benefits, in what is called real time.

To do this, the FSS has implemented several free services at once that allow you to find out at what specific stage a particular payment is at and how soon the money will arrive in the employee’s account.

In particular, an employee can now track the status of documents sent for payment of benefits in the Personal Account of the insured person on the official website of the Social Insurance Fund. The login and password in your personal account are the same as in the citizen’s personal account on the State Services website.

Here you can check whether documents have been received by the Social Insurance Fund office, and also track the stages of their passage in the form of certain statuses (document uploaded, document calculated, document paid).

Please note that this opportunity is provided only if the employee has issued an electronic sick leave certificate.

You can also check the payment status through a special mobile application “Social Navigator”. Here you can also get a free consultation from a FSS specialist regarding the procedure for receiving benefits.

In addition, the FSS now operates a hotline. For example, Muscovites can find out when they will be paid sick leave by phone.

Where to go if sick leave is not paid

The FSS explains on the official website how to find out when the money for sick leave will arrive - contact the territorial department in person or call the hotline. Regional Social Insurance hotlines have been opened for each constituent entity of the Russian Federation.

In Moscow:

Here's where to call about sick leave in St. Petersburg:

Find out by calling the territorial departments how long sick leave must be paid for, giving the number of the certificate of incapacity for work. If the sick leave is filled out correctly and the policyholder has submitted all the required documents, the benefit will be transferred within 10 days.

What affects the duration?

Factors influencing the duration of sick leave after myocardial infarction and the resulting surgical treatment are:

• type of heart attack;
• the presence or absence of complications of the disease;
• data from clinical and laboratory studies obtained over time;
• duration of prescribed bed rest;
• the presence or absence of severe rhythm and conduction disturbances;
• the presence or absence of severe chronic coronary insufficiency;
• the nature of the patient’s work activity.

The basis for extending sick leave is the need for long-term rehabilitation , which requires rest, as well as the serious condition of the patient after a heart attack or related invasive procedures, due to which he cannot perform his work duties. According to the Federal Law “On the Fundamentals of Protecting the Health of Citizens in the Russian Federation” dated November 21, 2011 No. 323-FZ, with an obvious unfavorable prognosis, the patient is sent to undergo an examination and receive disability.

If a person refuses to undergo an examination, the certificate of incapacity for work is closed. If the work and clinical prognosis is favorable, no later than 10 months after the injury, the patient must be discharged to work or referred to medical examination (Part 4 of Article 59 of the Law).

How many days does a paid ballot last?

Let's consider how long they keep on a certificate of incapacity for work in case of myocardial infarction. The approximate periods of temporary disability for this disease are established in the Recommendations of the Ministry of Health of Russia No. 2510/9362-34 of August 20, 2000 (hereinafter referred to as the Recommendations) and are:

1. 70-90 calendars. days – in case of acute transmural infarction of the anterior or lower myocardial wall, as well as other specified localizations without significant complications with mild anginal syndrome and 90-130 calendar days. days if complications of the acute period occur.
2. 60-70 calendars. days – in acute subendocardial (non-transmural) myocardial infarction without complications and longer periods in cases of heart failure, depending on its degree:
   I FC, i.e. not causing discomfort during physical activity (60-80 calendar days);
3. FC II, when physical activity causes moderate, minor discomfort (80-110 calendar days);
4. III-IV FC, in which poor health can manifest itself even at rest (90-120 calendar days).
5. 90-120 calendars. days – repeated myocardial infarction.

Important! It should be noted that for all types of heart attack, accompanied by complications in the acute period, as well as for repeated heart attack, in accordance with the Recommendations, it is possible to be referred for a medical and social examination to obtain disability.

How long does the period of disability last after cardiac stenting and bypass surgery?

The need for surgical intervention for myocardial infarction occurs quite often. There are two types of operations that radically solve the problem of acute coronary circulatory disorders:

• bypass surgery is a cavity operation to install a shunt, the purpose of which is to create an artificial path for blood movement;
• Stenting is an endovascular intervention in which an implant is inserted through a puncture in the artery through a catheter, expanding the vessel in the place where it is needed.

The duration of sick leave directly depends on which of these operations the doctor will resort to.

Bypass surgery is a full-fledged surgery and is performed on a stopped heart during artificial ventilation with the patient being placed under anesthesia.

Accordingly, the recovery period after such an operation will last as long as the doctor decides , guided by Part 4 of Art. 59 of the Federal Law “On the Fundamentals of Protecting the Health of Citizens in the Russian Federation”, according to which, if the prognosis is favorable, after 10 months from the date of opening the sick leave, the patient must either be discharged to work or referred to the ITU to resolve the issue of assigning disability.

The average period of sick leave after coronary artery bypass surgery is 90 calendar days. As a result of stenting, which does not require putting the patient under anesthesia and is not associated with a chest incision, the recovery period will be shorter, however, in this case, the doctor will focus on the general condition of the patient and many other factors.

Regarding the duration of sick leave, the medical worker, as in the case discussed above, will be limited to a ten-month period.

Attention! On average, after stenting, the need for which arose as a result of myocardial infarction, the patient is on sick leave for about 60 calendar days.

The further duration of sick leave depends on the characteristics of the postoperative period.