Accident at work benefits. Reimbursement of expenses to an employee as a result of an accident. The formula for calculating the lump sum insurance payment

A work injury is a consequence of an accident that took place at work with an employee.

This is always unpleasant for both sides of the employment relationship. In Art. 5 federal law dated July 24, 1998 No. 125-FZ “On mandatory social insurance from accidents at work and occupational diseases" states that every employee who works under an employment contract is subject to compulsory accident insurance.

This means that in case of an industrial injury, the employer is obliged to pay compensation to the employee if the latter was injured in the course of performing his labor functions.

Recognition of work injury

In order for the injury to be recognized as a work injury, and for the employee who received it to be able to count on all due payments and benefits, several important steps must be taken. This must be done on the day of the injury:

• call a doctor, go to a first-aid post or call an ambulance to provide first aid to the victim;
• the appeal must be completed in accordance with all the rules. This needs to be followed up. If the victim himself is unable, it must be done by someone else;
• call the head of the structural unit to the place where the accident occurred. If there is such an opportunity, then you need to call the head of the enterprise himself;
• the victim must have witnesses who will confirm the fact that he received the injury in this place and in working time.

No matter how severe the injury, you first need to fix it, and only then go to the hospital. This is a big minus in recognizing a work injury. If there is no fact of proper recording of the injury received by medical personnel, or there are no witnesses to its receipt, it will be quite difficult to recognize it as a production one. But if there is at least some fixation or one witness, it is necessary to apply to the employer with a written statement recognizing the fact of injury at work. The employer is obliged to appoint an appropriate investigation in accordance with Art. 229 - 231 of the Labor Code of the Russian Federation. If he fails to do so, the victim has the right to file a complaint with labor inspection or file a lawsuit in court to recognize this fact and assign appropriate payments to him.

Payments for work-related injury are equal to the amount of payment sick leave, if the employee needed one, and compensation for his medical expenses. This is indicated in article 184 of the Labor Code of the Russian Federation.

First, the employer pays compensation to his injured employee, and then he reports to the FSS, providing sick leave and other documents. In addition to the sick leave, the rehabilitation of the injured employee takes place at the expense of the FSS. The need for rehabilitation, as well as the severity of the harm caused, is assessed by a medical and social examination, which must be passed if serious harm has been done to health, and we are talking about assigning one or another degree of disability to the victim. In order to make such payments, it must be established that the injury received is precisely an industrial injury at work.

Such an injury is recognized not only as an injury received at the workplace, but also as an injury received at the time when the employee was traveling to work or home from work in the employer's transport.

If the employee used own car, then the employment contract must stipulate that the employee has the right to use a personal car to perform his work functions or official purposes. The severity of the injury is determined by the medical institution where the victim applied for help. The duration of the investigation, which is conducted by a specially created commission, also depends on this.

If the injury is production light, then the commission can complete the investigation in 3 days, but if the injury is severe or fatal, then the investigation period is increased to 15 days. The severity of harm to health depends not only on the duration of the investigation, but also on the size compensation payments. That is, the medical and social examination establishes the severity of the harm as a percentage.
Exactly in this percentage, the employer must reimburse the employee for compensation for medicines and medical care. Sick leave, in any case, is paid in the amount of 100% of earnings.

Actions of the employer and employee in case of work injury

In order for an injury to be recognized as a work injury, the correct procedure is required, both on the part of the employee and the employer:

• you need to call a doctor or any other medical worker, which fixes the injury itself. Without this fact, no payments will be made. Therefore, even if the condition of the victim is critical, you first need to fix the fact of the injury, and only then go to the hospital;
• the employer must be present at the fact of fixing. If the employer himself cannot (especially on large enterprises where there are production and other workshops), his deputy or the head of the structural unit in which the victim works must be present;
• it is imperative to draw up an act that will be signed by the employer and witnesses of the incident;
• An investigation into the incident is immediately launched. If harm is done to health, then the investigation is carried out at the expense of his funds;
• The commission for the investigation must consist of at least 3 people. The number of committee members must be odd. It may include:
  • labor protection employee, or the person who is responsible for labor protection at the enterprise;
  • an employee who is a representative of the employer or the employer himself, if possible;
  • a representative of a trade union or other body that is representative of workers.

The obligations of an employer in the event of a work injury are as follows:

• he must provide the victim with all the necessary assistance. If hospitalization is required, the employer must ensure that “ Ambulance took the worker to the hospital. If the brigade was not called, but decided to go to the hospital on their own, then the employer must provide transport;
• conduct a thorough investigation of what happened;
• make all necessary payments to the affected employee;
• must comply with the lines of drawing up an accident report. If the injury is light, then the act is drawn up within 3 days. The degree of "lightness" or "severity" is determined on the basis of the opinion of physicians;
• even if the injury occurred through the fault of the employee, compensation is paid, but in a smaller amount.

Payment types

There are several types of payments that are assigned to the injured and injured at work:

• sick leave payments. These payments are made at the expense of the funds that the employer deducts for insurance against accidents and occupational diseases. Regardless of the length of service, sick leave is paid in the amount of 100% of the average earnings of this employee. This value is calculated based on the employee's earnings for the last year. The basis for calculating payments is a certificate of incapacity for work, duly executed in the medical institution where the victim received treatment.
• lump sum payment. Its size depends on the degree of disability suffered by the injured. It is paid in the amounts established by the FSS. In 2016, the maximum amount of such payment is 80534.8 rubles;
• monthly payment. It is paid to the employee until he fully recovers. The amount of the payment is equal to the average earnings of the affected employee for the last year. It is indexed every year. Its maximum value in 2016 is 61,920 rubles per month. This limit is set by paragraph 12 of Art. 12 of Law No. 125 - Federal Law;
• additional expenses. Such payments include compensation by the employer for expenses for:
  • provision of qualified paid medical care to the victim;
  • purchase of medicines;
  • purchase special means necessary for the careful care of the victim;
  • payment for the services of the necessary equipment or transport for its transportation.
These payments are made at the discretion of the employer and are not reimbursed from the FSS. An exception is the payment of additional leave necessary for the rehabilitation of the victim.
• compensation for moral damage. If there were not only material costs, but also moral suffering, the victim can apply to the court with a claim for compensation for moral harm.

If the commission determines that the employee suffered minor harm to health, then all compensation payments will be made not at the expense of the FSS, but at the expense of the employer.

The employee is also entitled to compensation for moral damages. Its value can be determined by agreement of both parties. If the employee is not satisfied with the amount of damages to be compensated, then he can apply to the court with a statement of claim at the location of the defendant.

In addition to mandatory payments in case of injury at work, the employer has the right to pay additional compensation. It can be issued at a time by the order of the employer, or it can be specified in the labor or collective agreement.

Compensation for lost earnings

In Art. 184 of the Labor Code of the Russian Federation says that if an employee is injured at work, then the employer is obliged to compensate him for the earnings not received during these days. But there are several features when recovering lost earnings in favor of an employee.
It should be understood that “lost earnings due to forced absenteeism” and “lost earnings due to work injury” are different concepts. it different types compensation for harm in favor of the employee, to which different methods of calculation are applied.

Law No. 125-FZ states that an injured worker has the right to compensation for harm caused to his life and health. While he is on sick leave, he does not receive wages. Even after leaving the hospital, the injured worker cannot always work at full strength. Sometimes it takes a long time to recover.
Therefore, the earnings that he does not receive all this time are subject to compensation. First of all, it is necessary to determine from what moment it is necessary to compensate for the lost earnings.

The victim receives a sick leave benefit in the amount of 100% of his average earnings for the last year. But in Art. 1085 of the Civil Code of the Russian Federation states that he has the right to receive the entire amount of earnings lost during this period. It is collected from the employer, as from the tortfeasor. The amount of compensation is 100% of earnings for these days.

How to get paid

In order to receive all due payments, the employee must bring a sick leave and other documents that confirm his expenses for treatment. To receive disability benefits, you do not need to write additional applications. And in order to receive compensation for medicines and other expenses, it is necessary to write an application addressed to the employer with a request to pay him the indicated amounts. All necessary documents and checks are attached to the application.

Part of the payments is made at the expense of the employer, and part - at the expense of the Social Insurance Fund. For example, compensation for medicines is at the expense of the employer, and compensation for additional leave- at the expense of the fund.
Within 10 days after writing the application, it is considered by the representative of the FSS. He also decides on the payment of compensation. The decision is made after the expiration of the specified period. The lump-sum allowance is transferred to the applicant's account immediately after a positive decision is made by the fund's employee.

If the employer refuses to make payments or does not do it in full, you must contact the labor inspectorate with a complaint about the illegal actions of the employer. The complaint will be investigated.
Filing a complaint with the labor inspectorate does not deprive the injured citizen of the right to self-defense of his labor rights. That is, he can apply to the court with a claim for reimbursement of expenses incurred for his treatment.

Very often, an accident at work leads to the loss of the employee's ability to work, and even to death. Affected workers (or their families) are entitled to a range of benefits and compensation.

Payment is subject to an accident that occurred to the employee in the performance of labor duties, when going to the place of work or returning from the place of work on the transport provided by the employer (or on a personal vehicle if it is used for official purposes), when going to the place business trip and back, during business trips by public or official transport, as well as when following the order of the employer (his representative) to the place of work (assignment) and back, including on foot.

Payment types

The legislation provides for several types of payments:

1. Temporary Disability Allowance;
2. One-time and monthly insurance payments;
3. Compensation for additional expenses related to medical, social and professional rehabilitation of an employee.

The amount of the monthly insurance payment is determined as a share of his average monthly earnings, calculated in accordance with the degree of loss of his professional ability to work, as well as the fault of the injured employee. The extent of the worker's fault is determined by the accident investigation committee. The maximum amount of the monthly payment is limited and from 02/01/2016 is 69,510.00 rubles.

The maximum amount of a one-time insurance payment is also limited and from 02/01/2016 is 90,401.90 rubles * regional coefficient.

If, as a result of an accident, the death of an employee occurs, the amount of the lump sum payment for the loss of the breadwinner will be 1,000,000 rubles. If the death of an employee was the result of an accident at a hazardous production facility (or an elevator accident), the lump sum payment for the loss of a breadwinner will be 2,000,000 rubles, and the amount of insurance payment in terms of compensation for harm caused to health can reach 2,000,000 rubles.

Note: The payment of a number of compensations for causing harm as a result of an accident at a hazardous facility Insurance Company with which the owner of the HPO entered into an agreement. These include compensation for harm to the life and health of the victims, compensation associated with the loss of a breadwinner and compensation for damage caused to the property of the victims.

The following are eligible to receive these payments:

• One of the parents, spouse (wife) or other family member, regardless of his ability to work, who does not work and is busy caring for the dependent children of the deceased, his grandchildren, brothers and sisters who have not reached the age of 14 years, or older, but who are in need health care;
• Disabled persons who were dependent on him or had the right to receive maintenance from him at the time of death;
• Child of the insured, born after his death;
• Persons dependent on the insured who became disabled within five years from the date of his death.

In addition, the above categories are also eligible for monthly insurance payments.

An employee with whom an accident has occurred or a person entitled to receive insurance payments in the event of the death of an employee, or their legal or authorized representative has the right to apply to the insurer with an application for receiving insurance payments, regardless of the limitation period of the insured event.

Note: In addition to insurance payments, an employee can receive compensation for moral damage by submitting an appropriate application to the court.

The procedure for receiving payments

1. Submit a certificate of incapacity for work to the employer to receive temporary disability benefits.

This allowance is paid at the place of work of the employee on the basis of a certificate of incapacity for work.

Benefits must be assigned by the employer no later than 10 days from the date of submission of documents by the employee. Payment of benefits is made on the next day set for the payment of wages.

2. Contact the FSS with an application for receiving insurance payments.

Assignment of one-time and (or) monthly insurance payments is made on the basis of an application. An employee may apply in person or through a legal representative.

The following package of documents must be submitted along with the application:

• Certificate of average monthly earnings of an employee for the period selected for calculating monthly insurance payments.
• A document confirming the employment relationship between the employee and the employer (a copy of the work book, employment contract etc.)
• Act on an accident at work (submitted only at the initiative of the employee);
• The conclusion of the institution of medical and social expertise on the degree of loss of the employee's professional ability to work (submitted only at the initiative of the employee).

Documents can be attached in the form of originals or copies certified in the manner prescribed by legislative acts RF.

3. Get a decision from the FSS on the appointment of insurance payments.

The FSS must make a decision on the appointment of insurance payments (or refusal) no later than 10 days from the date of submission of documents.

FSS employees must notify the applicant in writing of the decision made no later than 3 days from the date of the decision.

4. Get insurance payouts.

The accrual of monthly insurance payments is carried out from the date of confirmation of the fact by the institution of medical and social examination (with the exception of periods in which the employee was paid benefits for temporary disability).

5. Apply to the Social Insurance Fund with an application for payment of additional expenses for medical, social and professional rehabilitation.

The decision to pay additional expenses is made on the basis of an application submitted by the employee or his legal representative in accordance with the rehabilitation program for the victim of an accident at work.

Documents confirming the relevant expenses are attached to the application.

There is no requirement to submit a rehabilitation program.

Note: Uncertified copies of documents are considered by FSS employees only upon presentation by the applicant of the originals of these documents.

6. Get a decision from the FSS on payment of additional expenses.

Written notification of the decision is sent to the applicant no later than 3 days from the date of the decision. Payment of additional expenses is made no later than 20 days from the moment the FSS makes a positive decision. For certain types of expenses, the transfer can be made monthly or quarterly.

The transfer of funds from the FSS is made either to the personal account indicated in the application, or using a postal order at the applicant's place of residence.

Insurance payments and benefits in case of an accident at work. Work injury.

Injury pay increased

(!) The maximum allowance for temporary disability due to an accident at work has been increased. This is due to an increase in the maximum monthly insurance payment in connection with an industrial injury to 65,330 rubles. for insured events that occurred in 2015
After all, the amount of temporary disability benefits due to an accident at work for a full calendar month should not be more than four maximum monthly insurance payments.
Consequently, the maximum amount of the work-related injury benefit paid by the employer at the expense of "injury" contributions is now 261,320 rubles. (65,330 rubles x 4).
In this regard, benefits for work-related injuries, which are transferred from 2014 to 2015, are paid based on the employee's earnings:
- until 01/01/2015 - within the maximum of 2014, that is, 247,680 rubles. per month (61,920 rubles x 4);
- from 01/01/2015 - within the maximum of 2015, that is, 261,320 rubles. per month.
We tell the employee
If in 2015 an industrial injury leads to a permanent loss of professional ability to work (in whole or in part), then the maximum amount of the FSS assigned to the injured employee:
- a one-time insurance payment will amount to 84,964.2 rubles.
When determining its size, the district coefficient and percentage allowances are taken into account
- the monthly insurance payment will be equal to 65,330 rubles.
The amount of monthly insurance payments to employees who lost their professional ability to work before 2015 will be recalculated by the FSS due to their indexation by 5.5%.

On this topic.
All policyholders are assigned, in particular, the following obligations (Article 17 of Law N 125-FZ):
- to pay insurance coverage to victims of accidents at work and occupational diseases;
- take measures to prevent occupational injuries and occupational diseases.

CONCEPT AND TYPES OF SECURITY FOR INSURANCE

Insurance coverage against industrial injuries is compensation for harm caused to the life and health of an employee
as a result of an insured event (paragraph 14, article 3 of Law N 125-FZ).
Simply put, insurance coverage is the amount of money that, in accordance with the law, is paid to an employee who has suffered as a result of an insured event. The payment of the security must compensate for the harm caused to the health of the employee as a result of such an event.

There are several types of insurance coverage (clause 1, article 8 of Law N 125-FZ):
1) allowance for temporary disability;
2) one-time or monthly insurance payments.
The size of the lump sum and monthly payments depends on the degree of loss of the insured person's professional ability to work and is limited to the maximum amount (paragraph 1 of article 11, paragraphs 1, 12 of article 12 of Law N 125-FZ).
Monthly insurance payments are subject to indexation in the manner and amount established by the Government of the Russian Federation (paragraph 2, clause 11, article 12 of Law N 125-FZ);
3) payment of additional expenses related to the medical, social and professional rehabilitation of the employee.

Note
The list of additional expenses associated with the medical, social and professional rehabilitation of an employee, which are paid by the FSS of the Russian Federation, is given in paragraphs. 3 p. 1 art. 8 of Law N 125-FZ.

Insurance coverage is paid at the expense of the FSS of the Russian Federation both by the Fund itself and by the employer. At the same time, the employer (clause 7, article 15 of Law N 125-FZ, clause 9 of the Rules for calculating, accounting and spending funds for the implementation of compulsory social insurance against industrial accidents and occupational diseases, approved by Decree of the Government of the Russian Federation of 03/02/2000 N 184 (hereinafter - the Rules for the accrual, accounting and spending of funds)):
a) pays benefits for temporary disability in connection with insured events;
b) pays for additional vacations (in excess of annual paid ones) in connection with the provision by the FSS of the Russian Federation of vouchers for sanatorium treatment to employees, including the entire period of treatment and travel to and from the place of treatment (paragraph 6, paragraph 3, paragraph 1, paragraph 1 paragraph 2 of article 8, paragraph 10 of paragraph 2 of article 17 of Law No. 125-FZ).
All other types of payments are assigned, calculated and paid directly by the FSS of the Russian Federation at the request of the employee (clauses 2 - 9 of article 15 of Law N 125-FZ).

INSURANCE CASE

The basis for the payment of insurance coverage is an insured event.
Thus, temporary disability benefits are calculated in accordance with the norms of Law N 125-FZ and (or) additional leave for treatment is paid to the employee only if an insured event has occurred with the employee.

An insured event is damage to the health of an employee as a result of an accident at work or an occupational disease, confirmed in the prescribed manner (paragraph 9, article 3 of Law 125-FZ).

As you can see, not any damage to health entitles the employee to receive insurance coverage. To do this, harm to health must be caused as a result of one of two circumstances: an accident at work or an occupational disease.

At the same time, there must be a causal relationship between an accident at work (occupational disease) and the harm caused to the health of an employee. If it is not, then you do not have to pay insurance coverage.

For example, driver organization "Alpha" V.I. Vetrov was slightly injured in an accident that occurred during a business flight. The next day, he did not show up for work due to food poisoning.
A week later, V.I. Vetrov resumed his duties. He submitted a sick leave certificate to the accounting department of the Alfa organization, stating that the cause of disability was a common illness.

The temporary disability benefit should be calculated in general order, without the features that are established by Art. 9 of Law N 125-FZ.

WORKING ACCIDENT

An accident at work is an event as a result of which an employee is injured or otherwise injured.<3>in connection with the performance of duties under an employment contract and in some other cases provided for by law (paragraph 10, article 3 of Law N 125-FZ).

An accident with an employee is an accident at work not only when harm to his health is caused at the workplace and during working hours. An accident is recognized as related to production also in some situations when it occurred outside the territory of the insured or during off-hours (for example, when going to the place of work or returning from the place of work on the transport provided by the insured) (paragraph 10, article 3 of the Law N 125-FZ). Lists of such situations are given in Part 3 of Art. 227 of the Labor Code of the Russian Federation and clause 3 of the Regulations on the peculiarities of the investigation of accidents at work in certain industries and organizations, approved by the Decree of the Ministry of Labor of Russia of October 24, 2002 N 73 (hereinafter - the Regulations on the investigation of accidents).

For example, the following circumstances do not preclude the recognition of an accident as work-related:
- the accident occurred after the end of the working day, but on the territory of the employer in connection with the fulfillment of his instructions (Resolution of the Federal Antimonopoly Service of the Moscow District dated June 24, 2013 N A40-134163 / 12-106-653);
- the employee, on the verbal order of the head, during working hours, left the territory of the employer by personal transport in order to purchase goods for production needs (Resolution of the Presidium of the Supreme Arbitration Court of the Russian Federation of December 28, 2010 N 11775/10);
- the accident happened during lunch break on the territory of the employer (Resolution of the Ninth Arbitration Court of Appeal of October 19, 2012 N 09AP-25532/2012).

It should be borne in mind that an event is recognized as an accident at work only if it entailed the need to transfer the insured to another job, temporary or permanent loss of professional ability to work, or his death (paragraph 10, article 3 of Law N 125-FZ).
At the same time, the need for transfer to another job must be confirmed medical opinion issued in the prescribed manner (part 1 of article 230 of the Labor Code of the Russian Federation). Such a conclusion is the Certificate of the final diagnosis of the victim of an accident at work (Appendix N 2 to the Order of the Ministry of Health and Social Development of Russia dated April 15, 2005 N 275).
And disability must have a duration of at least one day (part 1 of article 230 of the Labor Code of the Russian Federation).

For example, with one of the cars of the organization "Alpha" an accident occurred during a working flight from a warehouse to a store. As a result, the driver O.Yew., who was in the car, Semenov ended up in the hospital with a head injury, and forwarder T.S. Somova did not receive serious injuries (only bruises and abrasions).
The freight forwarder was able to go to work the next day, and the driver lost his ability to work for 30 days.
In the situation under consideration, an accident at work occurred only for O.Y. Semenova.

And most importantly: in order for the case that happened to the employee to be recognized as insurance, it must be investigated and recognized as an accident at work in the manner prescribed by labor law(subclause 5, clause 2, article 17 of Law N 125-FZ, articles 227 - 231 of the Labor Code of the Russian Federation).

INVESTIGATION OF ACCIDENT AT WORK

To do this, the employer must special commission, which includes at least three people, including: a labor protection specialist ( responsible person for labor protection), a representative of the employer and a representative of the trade union (or other body authorized by employees for labor protection). At the same time, persons who are obliged to monitor labor protection at the facility where the accident occurred are not included in the commission.
In general, the composition of the commission is determined by the employer. But if a severe case or a fatal case occurs, then the state labor inspector, representatives of regional or local authorities, trade unions and the FSS of the Russian Federation (Article 229 of the Labor Code of the Russian Federation) are included in the commission.
If the worker(s) suffered minor injuries as a result of the accident, the investigation must be completed within three calendar days. If the damage is severe or the accident was fatal - within 15 calendar days. If for objective reasons this time is not enough, the chairman of the commission may extend the investigation for another 15 days (parts 1, 3 of article 229.1 of the Labor Code of the Russian Federation, clause 19 of the Regulation on the investigation of accidents).

During the work of the commission, the employer is obliged to create the necessary conditions to establish all the circumstances of the accident. For example, to provide the commission with transport, photo and video shooting, etc. (part 2 of article 229.2 of the Labor Code of the Russian Federation).
In the course of its work, the commission forms the materials of the investigation. They include (part 3 of article 229.2 of the Labor Code of the Russian Federation, clause 22 of the Regulations on the investigation of accidents):
- an order (instruction) on the establishment of a commission to investigate the accident;
- plans, sketches, diagrams, protocol of inspection of the scene, and if necessary - photo and video materials;
- documents characterizing the state of the workplace, the presence of dangerous and harmful production factors;
- a medical report on the nature and severity of the injury caused to the health of the victim (account form N 315 / y (Appendix N 1 to the Order of the Ministry of Health and Social Development of Russia dated 15.04.2005 N 275)), etc.

Note that this list is indicative. The final package of documents is formed by decision of the chairman of the commission, taking into account all the circumstances of the incident (part 4 of article 229.2 of the Labor Code of the Russian Federation).

For example, additional documents will be needed if the commission is investigating the circumstances of a traffic accident involving an employee who uses production purposes personal transport. So, you need documents confirming the use of personal transport in work. For example, an agreement between an employee and an employer, an order or other order of an organization (see Letter of the FSS of the Russian Federation of March 26, 2009 N 02-15 / 06-646l).

The final results of the investigation are reflected in the report on the accident at work in the form N-1 or N-1 (PS) (Article 230 of the Labor Code of the Russian Federation, clause 26 of the Regulations on the Investigation of Accidents). The forms of the act (depending on the category of the victim) are given in Appendix N 1 to the Decree of the Ministry of Labor of Russia of October 24, 2002 N 73.
OCCUPATIONAL ILLNESS
An occupational disease is a chronic or acute illness of the insured as a result of exposure to harmful production factors that caused him to temporarily or permanently lose his professional ability to work (paragraph 11, article 3 of Law N 125-FZ).
At the same time, chronic is understood as a disease that has arisen as a result of prolonged exposure of an employee to a harmful production factor (paragraph 2, clause 4 of the Regulation on the investigation and registration of occupational diseases, approved by Decree of the Government of the Russian Federation of December 15, 2000 N 967 (hereinafter - the Regulation on the investigation of occupational diseases )).

For example, the cause of chronic occupational diseases of the respiratory organs of welders can be welding aerosols entering the respiratory zone, which contain iron, silicon, nickel, titanium, copper, aluminum and other metals (clause 1.2.4 Intersectoral rules on labor protection during gas-plasma processing of materials approved by the Decree of the Ministry of Labor of Russia dated August 14, 2002 N 55).

An acute disease is understood to be the result of a single (during no more than one working day, one work shift) the impact on the employee of a harmful production factor (paragraph 1, clause 4 of the Regulations on the Investigation of Occupational Diseases).
In order for an occupational disease to be recognized as an insured event, two conditions must be met (clause 5, clause 2, article 17 of Law N 125-FZ, Regulations on the Investigation of Occupational Diseases):
- an occupational disease of the employee must be established medical organization in due course;
- the circumstances and causes of the occupational disease should be investigated by the employer.

TEMPORARY DISABILITY BENEFIT

If, as a result of an accident at work or an occupational disease, an employee temporarily lost his ability to work (fell ill, injured, etc.) and did not go to work, he must be paid temporary disability benefits from the funds of compulsory social insurance against industrial injuries (clause 1 item 1 of article 8, item 7 of article 15 of the Law N 125-FZ, item 1 of item 9 of the Rules for the accrual, accounting and spending of funds).

Note!
The employee has the right to receive benefits upon the onset of temporary disability in any case (Article 5 of the Federal Law of December 29, 2006 N 255-FZ "On the provision of benefits for temporary disability, pregnancy and childbirth of citizens subject to compulsory social insurance" (hereinafter - the Law N 255-FZ)).
However, for injuries (illnesses) that are not related to accidents and occupational diseases, the usual allowance is paid. Without taking into account the features established by Law N 125-FZ.

The part-time worker is also obliged to pay temporary disability benefits in full.
Moreover, regardless of where the insured event occurred - at the main place of work or with another employer (clause 1, article 15 of Law N 125-FZ, clause 1 of article 13 of Law 255-FZ, Letter of the Ministry of Health and Social Development of Russia dated 04.24.2007 N 3311-LG).

For example, V.S. Petrov works simultaneously in the Alpha organization and the Beta organization. An insured event happened to him in the Alpha organization.
Both the Alpha organization and the Beta organization are obliged to pay V.S. Petrov temporary disability allowance in the amount of 100% of his average earnings.

We add that the benefit in connection with an occupational injury (disease) is fully paid at the expense of the FSS of the Russian Federation for compulsory social insurance against industrial injuries. Your expenses for the payment of such benefits will be offset by the FSS of the Russian Federation against the payment of insurance premiums (clause 7, article 15 of Law N 125-FZ, clause 10 of the Rules for calculating, accounting and spending funds).

BASIS FOR PAYMENT OF BENEFITS

The basis for the appointment and payment of benefits is a certificate of incapacity for work, issued and filled out in strict accordance with the requirements of regulatory legal acts (clause 5 of article 13 of Law N 255-FZ, Order of the Ministry of Health and Social Development of Russia dated 04.26.2011 N 347n, Procedure for issuing certificates of incapacity for work, approved by the Order of the Ministry of Health and Social Development of Russia dated June 29, 2011 N 624n).
The sick leave must contain a note on the cause of disability: an accident at work or an occupational disease.

BENEFITS AMOUNT

Benefit for temporary disability in connection with an accident at work and occupational disease paid in the amount of 100% of the employee's average earnings. It is calculated, assigned and paid in the same manner as in common cases when temporary disability is not associated with an occupational injury or illness (Article 9 of Law N 125-FZ, clause 2 of Article 1, Article 14 of Law N 255-FZ).
At the same time, the amount of the benefit paid in connection with an occupational injury or illness does not depend on insurance experience worker
(Article 9 of Law N 125-FZ).

To determine the amount of the benefit paid in connection with an occupational injury and illness, it is necessary (Article 9 of Law N 125-FZ, part 2 of Article 1, Article 14 of Law N 255-FZ):
1) calculate the amount of benefits for a calendar month based on the average earnings of an employee;
2) compare the calculated amount of the monthly allowance with the maximum allowance for the calendar month.
If the allowance for the month does not exceed the established limit, then it is paid based on the calculated average daily earnings and the actual number of sick days.
If the allowance for the month exceeds the established limit, then the average daily earnings are determined as follows. The maximum allowance for a calendar month must be divided by the number of days in the month. This daily wage is multiplied by the number of sick days in a month.
Since the limit on the amount of benefits is set in the calculation for the calendar month, it is necessary to carry out appropriate calculations for each month, taking into account the different number of days in the calendar month. At the same time, the average daily earnings for calculating benefits do not change (part 1 of article 14 of Law N 255-FZ).

ASSIGNMENT AND PAYMENT OF BENEFITS

The temporary disability benefit in case of an industrial injury is assigned and paid in the same manner as when paying benefits in cases not related to an occupational injury (disease) (clause 1, article 15 of Law N 125-FZ, clause 2, article 1 , articles 12, 13, 15 of Law N 255-FZ).

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An accident at work is an event as a result of which an employee was injured or otherwise damaged to health: in the performance of duties under an employment contract or in the performance of any work on behalf of the employer (his representative), as well as in the performance of other lawful actions due to labor relations with the employer or committed in his interests both on the territory of the employer and outside it; or while traveling to or returning from the place of work in transport provided by the employer (or in a personal vehicle...

An accident at work is an event as a result of which an employee was injured or otherwise injured:

• when performing duties under an employment contract or performing any work on behalf of the employer (his representative), as well as when performing other lawful actions due to labor relations with the employer or performed in his interests both on the territory of the employer and abroad,
• or while traveling to the place of work or returning from the place of work on the transport provided by the employer (or on a personal vehicle if it is used for production (official) purposes by order of the employer (his representative) or by agreement of the parties to the employment contract), and which entailed the need to transfer the employee to another job, temporary or permanent loss of his professional ability to work or his death (Article 3 of the Law of July 24, 1998 No. 125-FZ; Article 227 of the Labor Code of the Russian Federation; Clause 9 of the Resolution of the Plenum of the Supreme Court of the Russian Federation of March 10, 2011 No. 2).

Occupational accidents also include an event as a result of which an employee was injured or otherwise injured while traveling to the place of a business trip and back, during business trips by public or official transport, as well as when following the order of the employer (his representative) to place of work (assignment) and back, including on foot (clause 9 of the Decree of the Plenum of the Supreme Court of the Russian Federation dated March 10, 2011 No. 2).

PAYMENTS TO AN EMPLOYEE IN THE OCCURENCE OF ACCIDENT AT THE PRODUCTION

In the event of an accident at work, the employee is paid:

• temporary disability allowance (clause 1, clause 1, article 8 of the Law of July 24, 1998 No. 125-FZ);
• lump-sum and monthly insurance payments (clause 2 clause 1 article 8 of the Law of July 24, 1998 No. 125-FZ);
• additional costs associated with the medical, social and professional rehabilitation of an employee (clause 3 clause 1 article 8 of the Law of July 24, 1998 No. 125-FZ).

To receive payments to an employee in case of an accident at work, it is recommended to adhere to the following algorithm.

Step 1: Apply to an employer with a disability certificate for temporary disability benefits

The temporary disability benefit due to an accident at work is assigned and paid by the employer at the employee's place of work (clause 7, article 15 of the Law of July 24, 1998 No. 125-FZ; part 1 of article 13 of the Law of December 29, 2006 No. 255- FZ). The basis for the payment of benefits is a certificate of incapacity for work issued by a medical organization in the prescribed form and in the prescribed manner (part 5 of article 13 of the Law of December 29, 2006 No. 255-FZ).

The employer assigns temporary disability benefits within 10 calendar days from the date of submission of the certificate of incapacity for work and pays it on the next day after the grant of benefits, established for the payment of wages (part 1 of article 15 of the Law of December 29, 2006 No. 255-FZ).

Step 2. Apply to the territorial body of the FSS of the Russian Federation or the MFC at the place of residence with an application for a one-time and (or) monthly insurance payments and the necessary documents

One-time and (or) monthly insurance payments are assigned on the basis of an application from the employee with whom the accident occurred, his authorized representative or a person entitled to receive insurance payments, to receive insurance coverage. The application is submitted on paper or in the form electronic document signed by enhanced qualified electronic signature(Clause 4, Article 15 of the Law of July 24, 1998 No. 125-FZ).

The application can be submitted by the applicant or his representative (clause 56 of the Order of the Ministry of Labor of Russia dated October 25, 2013 No. 577n):

• personally;
• through postal service;
• in the form of an electronic document, including through the Unified Portal of State and Municipal Services (functions), by filling out a special interactive form that provides identification of the applicant;
• through the MFC (if an agreement on cooperation has been concluded between the MFC and the territorial body of the FSS of the Russian Federation (clause 14 of the Order of the Ministry of Labor of Russia dated October 25, 2013 No. 577n)).

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When submitting an application, a document proving the identity of the applicant (his representative) is personally presented. If the application is made by a representative, then a document certifying the authority of the representative is also presented. When submitting an application in the form of an electronic document signed with an enhanced qualified electronic signature, the submission of an identity document of the applicant (representative) is not required (clause 20 of the Order of the Ministry of Labor of Russia dated October 25, 2013 No. 577n).

Application must be attached the following documents(Clause 4, Article 15 of the Law of July 24, 1998 No. 125-FZ):

• act on an accident at work in case of its registration before 01.02.2002. After 02/01/2002, such an act is submitted at the initiative of the applicant (clause 21, clause "a", clause 24, clause 25 of the Order of the Ministry of Labor of Russia dated October 25, 2013 No. 577n; article 230 of the Labor Code of the Russian Federation);
• the conclusion of the institution of medical and social expertise on the degree of loss of professional capacity for work of the employee in case of its registration before 08.11.2000. After 11/08/2000, such a conclusion is submitted at the initiative of the applicant (clause 21, clause "c", clause 24, clause 25 of the Order of the Ministry of Labor of Russia dated 10/25/2013 No. 577n);
• a civil law contract providing for the payment of insurance premiums in favor of the employee, and (or) a copy of the work book or other document confirming the employee's employment relationship with the employer;
• a certificate of the employee's average monthly earnings for the period selected for calculating monthly insurance payments in accordance with the Law of July 24, 1998 No. 125-FZ (clause 21 of the Order of the Ministry of Labor of Russia of October 25, 2013 No. 577n).

Note. If it is impossible for you to receive a certificate of average monthly earnings, the appointment of a monthly insurance payment is carried out without presenting it. At the same time, the FSS of the Russian Federation, at your request, sends a request to the territorial body of the PFR to provide information about your salary, other payments and remuneration from the relevant employer for the calendar year preceding the year in which you had an accident at work. If the specified information is available, the monthly insurance payment is calculated based on this information (clause 7, article 12 of the Law of July 24, 1998 No. 125-FZ).

The documents attached to the application must be submitted in originals or copies certified in accordance with the procedure established by the legislation of the Russian Federation. If these documents have been submitted to electronic form(including through the Unified Portal of State and Municipal Services (Functions)), they must be signed with a qualified electronic signature. If these documents are sent to the territorial body of the FSS of the Russian Federation, copies of documents are sent by mail, the correctness of which is certified in the manner prescribed by law, the originals of the documents are not sent (paragraphs 23, 57 of the Order of the Ministry of Labor of Russia dated October 25, 2013 No. 577n).

Step 3. Get a decision of the territorial body of the FSS of the Russian Federation on the appointment or a notice of refusal to assign insurance payments

The decision on the appointment or refusal to assign insurance payments is made by the territorial body of the FSS of the Russian Federation no later than 10 days from the date of receipt of the application and all required documents(their certified copies) according to the list determined by him (clause 4, article 15 of the Law of July 24, 1998 No. 125-FZ). The order of the territorial body of the FSS of the Russian Federation on the appointment of insurance payments or a written notice of refusal to assign insurance payments is sent (issued) to the applicant within three days from the date of appointment (refusal to assign) insurance payments (clause 82 of the Order of the Ministry of Labor of Russia dated 10.25.2013 No. 577n ).

Step 4: Get Your Insurance Benefits

One-time insurance payments are made by the territorial body of the FSS of the Russian Federation before the expiration of a calendar month from the date of their appointment. The territorial body of the FSS of the Russian Federation makes monthly insurance payments no later than the expiration of a calendar month from the date of their accrual (clause 2, article 10, clause 7, article 15 of the Law of July 24, 1998 No. 125-FZ).

Note. Monthly insurance payments are assigned and paid to the employee for the entire period of loss of his professional ability to work from the day on which the institution of medical and social examination established the fact that the employee lost his professional ability to work, excluding the period for which the insured person was assigned temporary disability benefits (paragraph 3 of Art. 15 of the Law of July 24, 1998 No. 125-FZ).

Step 5. Apply to the territorial body of the FSS of the Russian Federation at the place of residence with an application for payment of additional expenses for medical, social and professional rehabilitation

The decision to pay additional expenses for the medical, social and professional rehabilitation of an employee is made on the basis of an application from the employee (his authorized representative) and in accordance with the rehabilitation program for the victim of an industrial accident. The application is submitted on paper or in the form of an electronic document signed with an enhanced qualified electronic signature (clause 4, article 15 of the Law of July 24, 1998 No. 125-FZ; clause 5 of the Regulation, approved by Decree of the Government of the Russian Federation of May 15, 2006 No. 286; paragraph 22 of the Order of the Ministry of Labor of Russia dated December 12, 2013 No. 736n).

The procedure for filing an application is similar to filing an application for a lump sum and (or) monthly insurance payments.

Documents must be attached to the application confirming the expenses for the implementation, according to the conclusion of the institution, of the medical and social examination of social, medical and vocational rehabilitation (clause 4, article 15 of the Law of July 24, 1998 No. 125-FZ; clause 23 of the Order of the Ministry of Labor of Russia dated 12.12. 2013 No. 736n).

It is not necessary to present the rehabilitation program itself. Failure to submit it is not a reason for refusing to pay additional expenses (clause 26 of the Order of the Ministry of Labor of Russia dated December 12, 2013 No. 736n).

Documents (their copies) attached to the application, the applicant (his representative) can submit in person or send by mail. Copies of documents not certified in accordance with the procedure established by the legislation of the Russian Federation, received by mail or in the form of an electronic document, are considered upon submission by the applicant (his representative) to the territorial body of the FSS of the Russian Federation of the originals of these documents (clause 25 of the Order of the Ministry of Labor of Russia dated 12.12.2013 No. 736n).

Step 6. Obtain a decision of the territorial body of the FSS of the Russian Federation on payment of additional expenses for medical, social and professional rehabilitation or on refusal to pay these expenses

Within three days from the date of the decision to pay additional expenses for medical, social and professional rehabilitation or to refuse to pay the specified expenses, the territorial body of the FSS of the Russian Federation informs the victim (his authorized representative) in writing of the appropriate decision. At the same time, in the event of a refusal to pay these expenses, the FSS of the Russian Federation explains the reasons for the refusal (clause 7 of the Regulation, approved by Decree of the Government of the Russian Federation of May 15, 2006 No. 286).

Payment of additional expenses for medical, social and professional rehabilitation of the insured person by paying money to the victim is carried out by postal order at the place of residence of the insured person or by transferring them to the personal account of the victim in the credit institution indicated in his application. Payment is made no later than 20 days from the date of adoption by the territorial body of the FSS of the Russian Federation of the relevant decision, and for certain expenses - monthly (expenses for outside care) or quarterly ( Maintenance vehicle) (clause 50 of the Regulation, approved by Decree of the Government of the Russian Federation of May 15, 2006 No. 286; clauses 17, 19, 20 of the Order of the Ministry of Labor of Russia of December 12, 2013 No. 736n).

In a relationship certain types expenses (for example, expenses for the medical rehabilitation of the insured person in organizations providing sanatorium and resort services), additional expenses for the medical, social and professional rehabilitation of the victim are paid by issuing appropriate vouchers (referrals).

Note! The employee also has the right to demand compensation for harm (including moral) from the employer in the framework of civil proceedings.

Document provided

The labor law obliges the employer to provide safe conditions labor. Article 212 of the Labor Code provides for the certification of workplaces, which is carried out in order to assess working conditions at workplaces and identify harmful and dangerous production factors. The results of certification provide an opportunity to develop and implement measures to bring working conditions in line with state regulatory requirements for labor protection. The procedure for attestation of workplaces is set out in the Order of the Ministry of Health and Social Development of the Russian Federation dated April 26, 2011 No. 342n “On approval of the Procedure for attestation of workplaces in terms of working conditions”.

But, unfortunately, jobs do not always meet the requirements of the law. In addition, the employee may be injured as a result of subjective causes. For example, fatigue, dizziness, inattention, unstable emotional background - all these reasons can be a source of work injury.

Naturally, in the first place, the injured employee makes a claim to the employer for payment of compensation to him, since the injury was received during the performance of work duties.

Let's see what payments are due to employees in such cases and who is obliged to make them, in which cases the employer is obliged to make compensation payments to employees who were injured at work. Also, the employer should know whether these payments are subject to taxes and insurance premiums.

What regulations should the employer be guided if an accident occurs at the enterprise?

The main document regulating the actions of the employer in case of an accident at work is Labor Code RF.
The procedure is defined in Article 228 of the Labor Code of the Russian Federation.

Firstly, the employer is obliged to organize the provision of first aid to the victim and his delivery to a medical facility.

Secondly, report the incident to the appropriate authorities.

Thirdly, take the necessary measures to organize and ensure a proper and timely investigation of the accident and the execution of investigation materials.

These are the main duties that an employer must perform in the event of an accident.

The next group of documents defines the procedure for assigning and paying compensation to injured workers. Such documents include the Federal Law of July 24, 1998 No. 125-FZ “On Compulsory Social Insurance against Industrial Accidents and Occupational Diseases” (hereinafter - Law 125-FZ).

In some industries, industry agreements provide for the payment of a one-time compensation in connection with the loss of working capacity.
For example, an industry agreement on machine-building complex of the Russian Federation for 2011-2013 (approved by the Association of Machine-Building Trade Unions of Russia, the Trade Union of Automobile and Agricultural Engineering Workers of the Russian Federation, the Trade Union of Mechanical Engineers of the Russian Federation, public association"All-Russian Electroprofsoyuz", the All-Russian industrial association of employers "Union of machine builders of Russia" on 03/01/2011) established compensation for disability. Its size depends on the degree of disability and is established by local regulations.
Consequently, if the employer organization belongs to those industries in which industry agreements have been adopted, it is obliged to pay the employee the compensation due to him. Payments are made in addition to those enshrined in Law 125-FZ.

What event is considered an accident at work?

According to Law 125-FZ, insurance payments are due only to those employees who have suffered as a result of an accident. Therefore, you need to have a clear understanding of what an accident at work is.

An event is recognized as an accident at work if it entailed the need to transfer the employee to another job, led to temporary or permanent disability or death of the employee (paragraph 10, article 3 of Law 125-FZ).

The need to transfer an employee to another job must be confirmed by a medical certificate issued in accordance with the law.
Such a conclusion is the Certificate of the final diagnosis of the victim of an industrial accident (Appendix No. 2 to the Order of the Ministry of Health and Social Development of Russia dated April 15, 2005 No. 275).

At the same time, the duration of the sick leave must be at least one day (part 1 of article 230 of the Labor Code of the Russian Federation).
For example, an employee got into an accident during a work flight and received only abrasions. He did not go to a medical institution and went to work the next day.

Such a case cannot be attributed to an accident at work, since it did not cause serious damage. An injured worker is not entitled to claim social benefits.

Accidents at work also do not include those cases when an employee was injured due to alcohol intoxication or the commission of criminal acts (part 6 of article 229.2 of the Labor Code of the Russian Federation). Such situations are classified as accidents not related to production. It is clear that in such situations, employees lose the right to receive social benefits.

Therefore, the task of the employer is to document the incident in a timely and correct manner, since the presence of industrial accidents inevitably leads to an increase in insurance premium rates for compulsory insurance against industrial accidents and occupational diseases (Article 22 of Law 125-FZ).

Which workers are eligible to receive compensation if they are injured while on the job?

Compensation payments are assigned only to an employee who has lost his professional ability to work. A medical and social examination has the right to make a conclusion about the loss of ability to work (clause 1, article 10 of the Law).

If the examination recognizes the employee as having not lost his professional ability to work, he is not entitled to claim compensation.

What types of payments are provided for an injury at work?

Employees who lost their ability to work as a result of an injury at work are entitled to receive two types of compensation payments - one-time and monthly.

Lump sum payments are determined in accordance with the degree of loss of the insured's professional ability to work based on maximum amount established by the federal law on the budget of the Social Insurance Fund of the Russian Federation for the next fiscal year. For 2013, 76699.8 rubles were established.

Let me remind you that the degree of disability is established by the medical and social examination in its conclusion. The procedure for conducting an examination is determined by Decree of the Government of the Russian Federation of October 16, 2000 No. 789 “On Approval of the Rules for Establishing the Degree of Loss of Professional Ability to Work as a Result of Occupational Accidents and Occupational Diseases”.

Monthly insurance payments are paid to the insured employee throughout the entire period of permanent loss of his professional ability to work from the day from which the institution of medical and social expertise established the fact of its loss, excluding the period for which the temporary disability benefit was assigned.

By virtue of paragraph 1 of Art. 12 of Law No. 125-FZ, the amount of the monthly insurance payment is determined as a share of the employee's average monthly earnings, calculated in accordance with the degree of disability.
Thus, if the worker never recovers and is unable to return to a full labor activity, he will receive insurance payments for the rest of his life.
The maximum amount of insurance payment is established by the federal law on the budget of the FSS of the Russian Federation for the next financial year (clause 12, article 12 of Law No. 125-FZ).
For 2013, the specified limit is 58,970.00 rubles. (clause 2, part 1, article 6 of the Federal Law No. 219-FZ of 03.12.2012).

In addition, monthly insurance payments are subject to indexation in the manner and amount established by the Government of the Russian Federation (paragraph 2, clause 11, article 12 of Law No. 125-FZ).

Which body pays lump-sum and monthly compensation in case of disability?

If the employee has a conclusion of a medical and social examination on disability, then in this case he has the right to receive a one-time compensation. But the obligation to pay it does not lie with the employer, but with the territorial body of the FSS at the place of registration of the employer, since he is an insurer. According to paragraph 7 of Art. 15 of the Law, it is the insurer, and not the employer, that is obliged to pay insurance payments.

The employer, being the insured, is only obliged to pay the employee temporary disability benefits on the basis of the sick leave provided (clause 1, clause 1, article 8, clause 7, article 15 of Law No. 125-FZ).

The amount of temporary disability benefit due to an accident at work

The temporary disability benefit due to an accident at work and an occupational disease is paid in the amount of 100% of the employee's average earnings and does not depend on the employee's length of service (Article 9 of Law No. 125-FZ, clause 2 of Article 1, Article 14 of Law No. 255-FZ).

At the same time, Federal Law No. 36-FZ dated April 5, 2013 establishes the maximum amount of insurance payment, which cannot exceed four times the maximum monthly insurance payment.

The maximum amount of insurance payment is established by the federal law on the budget of the FSS of the Russian Federation for the next financial year (clause 12, article 12 of Law No. 125-FZ).

In 2013, this limit is 58,970.00 rubles. (clause 2, part 1, article 6 of the Federal Law No. 219-FZ of 03.12.2012). Consequently, the maximum amount of disability benefits due to an occupational injury or illness per full calendar month will be 235,880.00 rubles. (Article 1 of Law No. 36-FZ, paragraph 12 of Article 12 of Law No. 125-FZ, paragraph 2 of Part 1 of Article 6 of Law No. 219-FZ).

What documents do I need to submit to receive a lump sum payment?

If the conclusion of the medical and social examination indicates that the employee has lost his ability to work as a result of an accident, then he has the right to apply to the FSS for a lump-sum allowance. The benefit is assigned based on the application of the insured person. Since the insured person is an employee, the application must be submitted on his behalf.

Moreover, the application must be submitted to the territorial body of the FSS at the place of registration of the insured, that is, the employer.

Documents are attached to the application in accordance with the list established by the FSS for each specific case (clause 4, article 15 of the Law).

These documents include:

• an act on an accident at work or an act on an occupational disease;
• certificate of the average monthly earnings of the insured for the period chosen by him for the calculation of monthly insurance payments in accordance with this Law;
• the conclusion of the institution of medical and social expertise on the degree of loss of professional capacity for work of the insured;
• the conclusion of the institution of medical and social expertise on the necessary types of social, medical and professional rehabilitation of the insured;
• a copy of the work book or other document confirming the location of the victim in labor relations with the insured
• notification of a medical institution about the establishment of the final diagnosis of an acute or chronic occupational disease;
• the conclusion of the center of occupational pathology on the presence of an occupational disease;
• documents confirming the costs of implementing, according to the conclusion of the institution of medical and social expertise, the social, medical and vocational rehabilitation of the insured, provided for in sub. 3 p. 1 art. 8 of this Federal Law;
• victim rehabilitation program.

The list of documents may differ, since the FSS authorities request the relevant documents for each specific case.

It should be noted that the insured employee, who is entitled to receive insurance payments, has the right to apply to the insurer, that is, to the FSS, with an application for receiving insurance coverage, regardless of the limitation period of the insured event.

When applying for an appointment for the payment of monthly insurance coverage, after three years from the moment the right to receive it arises, payments are made for the past time for no more than three years preceding the application.

The term for consideration of the application of the injured employee in the territorial body of the FSS

The decision to assign a payment or refuse is made by the FSS of the Russian Federation within 10 days from the date of submission of the application and relevant documents. Payments to the insured employee are made by the FSS of the Russian Federation within one month from the moment a positive decision is made (clauses 4, 7, article 15 of the Law).

Can an employer apply for their employee?

Getting injured is always stressful for anyone. And even after treatment, he is not always able to independently collect all the documents and submit them to the territorial body of the FSS. Usually, employees have a very superficial understanding of the social insurance system and the rights that they have, since these issues are usually decided for them by the employer.

And in this situation, first of all, the employer must explain to the employee what payments he is entitled to receive from the FSS, and provide him with all the necessary documents in a timely manner.

In addition, the organization can help the employee by independently filling out the documents indicated in the list and submitting them to the bodies of the FSS of the Russian Federation. Law 125-FZ allows the possibility of filing an application through a proxy, therefore, the organization has the right to submit documents for the employee (paragraph 1, clause 4, article 15 of Law 125-FZ).

Can an employer provide financial assistance to an injured worker?

From the analysis of the Law, it is clear that the employer organization is obliged to pay an employee who has received an industrial injury only temporary disability benefits. One-time and monthly social payments are made by the Social Insurance Fund.

But the employer may, on its own initiative or on the basis of the employee's application, pay the employee financial assistance in order to compensate for the costs of treatment and rehabilitation, and the amount of this assistance is not limited by the legislation of the Russian Federation.

At the same time, it must be remembered that material assistance in the amount of 4 thousand rubles is not subject to insurance premiums (clause 11, part 1, article 9, part 1, article 10, part 2, article 12, part 2, article 62 of the Law No. 212-FZ, paragraph 12, paragraph 1, article 20.2 of Law No. 125-FZ, Letters of the Ministry of Health and Social Development of May 17, 2010 No. 1212-19, of March 1, 2010 No. 426-19). Personal income tax is also not withheld from this amount (Article 216, paragraph 4, paragraph 28, Article 217 of the Tax Code of the Russian Federation).

In addition, the employer has the right to pay his employee the cost of treatment and medical care from the funds remaining after paying income tax. In this case, the income received by the employee is not subject to personal income tax (clause 10, article 217 of the Tax Code of the Russian Federation).

Thus, if an accident occurs in your organization and the injured employee applies to you for compensation payments, you must remember that the employer is obliged to pay his employee only temporary disability benefits. At the same time, it must be remembered that an accident that is not related to production (for example, due to alcohol intoxication), but received at the workplace, is paid at the rate of the minimum wage (clause 2, article 8 of the Federal Law of December 29, 2006 No. 255-ФЗ “On compulsory social insurance in case of temporary disability and in connection with motherhood”).

One-time and monthly insurance payments are assigned and paid to the employee by the territorial bodies of the FSS on the basis of the employee's application, so the employer can only help his employee in preparing a package of documents for submission to the FSS.

In addition, the employer can provide material assistance to the injured employee or pay for his treatment and purchase of medicines.