Cause of disability, code 02: decoding. How is sick leave paid

Have you ever been given a sick leave certificate at a medical facility? If not, then you are probably a lucky person. If yes, then you most likely noticed that instead of a text description, all sorts of uniform codes were used. For example, very often this document indicates code 02 as the cause of disability, the decoding of which remains a mystery to many ordinary people. Let's try to figure out what information may be hidden behind the numbers. Moreover, it is not at all difficult. We will also find out how sick leave is issued (cause of incapacity for work - code 02).

What is written on a sick leave sheet

The following data is entered into a document such as a certificate of incapacity for work:

Full name of the sick patient (the basis is an identity card, namely a passport).
The date, month and year of his birth.
Floor.
Name of the organization (factory) where the patient works (based on the patient’s words). If the patient works for an individual entrepreneur or is one himself, then the full name of the employer is indicated in this column.
Information about where the sick leave was issued: at the place of work or residence.
Patient Taxpayer Identification Number.
Reason for disability.
Date of opening and filling out sick leave.
The period during which a person was unable to work.
All kinds of violations of the regime.
Other information.
Conditions for calculating cash benefits.

All codes in the document, starting from the first to the penultimate one, are entered by the doctor who opens the sick leave. But the conditions for calculating disability benefits (in coded form) are entered by the employer, namely the employee dealing with these issues.

What to do if there is an error in the instructions

The rules for filling out sick leave require the use of only generally accepted codes; a list of them must be kept by the doctor or at the reception desk. The certificate of incapacity for work has three parts - the front side, the back side, and the tear-off form. The first part is completed by the attending physician and contains medical information intended for the employer. The second part is filled out by the HR department or manager - it contains information for payments. The third part, with detailed medical information, remains at the hospital and is filled out by health workers for their own reports.

Important! What does it mean if the reason for disability is 02? This is an injury that occurred anywhere other than work. Injury and illness are the most common reasons for taking sick leave.

If an error is made on the certificate of incapacity for work, correction occurs in different ways. Errors on the front side of the form are unacceptable; in such a case, the doctor or registrar must take another form and fill it out again without errors. Mistakes made by the personnel officer or manager are corrected in the document. To do this, you need to cross out the entry, write the correct value, and put o. Errors in tear-off coupons are corrected in the same way.

Why do you need to encode information?

What is the purpose of coding? And it is as follows:

fully preserve confidential information about the patient’s illness;
minimize the likelihood of any counterfeit;
desire to use medical forms economically and compactly;
have the opportunity to cooperate with various medical institutions abroad;
significantly simplify (sometimes a doctor’s handwriting is very difficult to read) and optimize the activities of HR workers.

On a note! Not only the personnel officer, but also the patient himself can familiarize himself with the decoding of these codes: it is presented on the back of the sick leave. Just turn it over and read it.

Who needs these codes

The most important part of the certificate of incapacity for work is the columns in which codes are entered indicating certain reasons why patients cannot be at work and carry out their professional activities as usual. Several cells are allocated for this encoded information:

the first two are the main code (numbers from 01 to 15);
the next three are an additional code (numbers from 017 to 021);
the final two are a clarifying code (fixed if the diagnosis has been clarified).

Why do you need to use so many codes? Who needs them? And they are needed both by medical workers and by management (that is, the employer).

What certificates of incapacity are there?

There are a number of circumstances, citing which a person cannot fulfill his work obligations. Each reason on the sick leave has its own codes. We present them not in ascending numbering order, but in random order.

Disease (LN 01)

An employee may apply for sick leave if his condition may affect the quality of work. Unfortunately, not all diseases give the right to register and receive medical insurance. In severe forms of the disease, as well as in cases of exacerbation of chronic diseases, the cause of disability 01 is indicated on the sick leave certificate.

Maternity leave (LN 05)

One of the types of benefits is payments for pregnancy, childbirth and child care up to 3 years old. A company employee can receive sick leave before and after childbirth. The period of incapacity for work is set by the doctor based on the patient’s condition.

Sick leave for caring for a minor child (LN 12)

If a child gets sick, the mother can also count on receiving sick leave. LN is issued for the purpose of caring for a sick child. Both mom and dad, as well as grandparents, can count on getting the document. Parents can apply for sick leave in parts, alternately.

Accident at work or injury received at home (LN 02)

An injury that occurs as a result of an accident at work or at home is a particular prerequisite for obtaining personal injury. A case of confirmed injury while performing functional duties at the workplace may affect the amount of benefits. The victim can expect to receive compensation. It is worth considering that this situation may also be accompanied by fines for the employer.

Quarantine (LN 03)

A quarantine may be declared at the enterprise, place where you work, or the educational institution your children attend. If one of the employees or students is a carrier of an infectious disease, a quarantine is declared, the period of which depends on the specifics of the infection and the time of its treatment.

At the same time, a number of regime anti-epidemic measures are carried out at the enterprise or in the office, the purpose of which is to completely isolate the bacteriological focus of the lesion on the territory. The decision on quarantine is made exclusively by the governing body. Detection of a disease does not guarantee a quarantine; if this is an isolated case, then the person goes on sick leave until complete recovery.

Caring for a sick relative (LN 09)

A company employee can exercise his right to issue a temporary disability certificate, even if it is not he himself who is sick, but one of his family members.

Obtaining sick leave applies to the following cases:

One of the family members is seriously ill and requires constant care
Deterioration in the health of one of the relatives who is disabled

It is important to note that care cannot be prescribed for people who are permanently competent. In situations with disability, only options in which a sharp deterioration in health occurs are considered.

Sanatorium-resort treatment or rehabilitation (LN 08)

In the absence of an employee due to sanatorium treatment, he is issued a personal statement similar to a traditional sick leave. The code corresponding to the reason is only entered on the document form.

Only those employees who were sent to a sanatorium for medical reasons, and not on their own initiative, have the right to be excused from work.

A recovery period is necessary after any surgical intervention. The rehabilitation period is determined by the attending doctor depending on the patient’s condition.

Prosthetics (LN 06)

Prosthetics is considered as a private type of surgical intervention. The employee receives the right to issue a sick leave, the terms of which are approved by the doctor.

Basic codes

So, let's take a look at the list of basic codes that the doctor writes in the first two cells of the medical document:

01 – the presence of any disease that does not require the patient to be at work.
02 is a sick leave code indicating a person’s incapacity for work as a result of being injured.
03 – quarantine is declared, preventing a person from being at work.
04 – the patient received an injury (or consequences after it) directly at the workplace.
05 – leave was granted for the period of pregnancy and childbirth.
06 – the need for prosthetics in a medical hospital.
07 – exacerbation of a previously identified disease or detection of an illness associated with professional activity.
08 – rehabilitation period in a sanatorium after an illness.
09 – exemption from work, which is issued in case of caring for a sick close relative.
10 – other circumstances entailing the release of a person from the need to be at the workplace.
11 – a disease specified in a special list (for example, mental disorder, hepatitis, diabetes mellitus or other similar ones) approved by the government.
12 – the need to care for a child (under 7 years of age) who has one of the ailments listed in the list of diseases approved by the Ministry of Health and Social Development.
13 – presence of disability in a child who needs care.
14 – a case when a child is diagnosed with a malignant disease or certain complications arise after vaccination.
15 – caring for a child with HIV infection.

Line “Other” (code 31, 36)

It contains additional information in encrypted form. Here are some of them.

Code 31 means that a person needs long-term treatment, and although he was given a certificate of incapacity for work, he continues to be ill. In this case, he submits the primary sheet to the accounting department and receives benefits for the first part of the illness. In this document, the “Get Started” field is not filled in. And in the “Other” field there is code 31, which stands for “continues to hurt.”

Code 36 indicates the following situation. The employee, while on sick leave, missed his next doctor's appointment. And when he showed up (later than the appointed date), he was recognized as able to work. The ballot fields are filled in as follows:

“Notes on violation of the regime” - worth 24 and the date of the missed appointment;
“Exemption from work” - the period from the onset of illness to the date of the missed appointment is indicated;
“Other” - costs 36;
“Get Started” remains blank.

ATTENTION. The benefit for the ballot, in which code 36 is indicated in the “Other” field, is calculated as follows. From the onset of illness to the date preceding the absence - based on actual average earnings. For a day of failure to appear - in an amount not exceeding for a full calendar month the minimum wage established for the current year and multiplied by the regional coefficient (if any). From the date following the day of failure to appear, benefits are not accrued at all (letter from the Moscow branch of the FSS dated September 01, 2020 No. 14-15/7710-2216l; see “The capital FSS clarified how to calculate benefits if there is a note on the sick leave for violation of the regime ").

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Additional codes

Now let’s find out what additional codes are put down in the next three cells of the disability sheet:

017 – the need for treatment in a special-purpose medical institution.
018 – staying in a sanatorium (or resort) after undergoing treatment for an injury received as a result of an accident at work.
019 – therapeutic activities carried out in rehabilitation clinics.
020 – maternity leave provided in addition to the main one.
021 – release due to illness or injury resulting from intoxication (drugs, alcohol or toxic).

Important! If the reason for the employee’s absence from his place is fully reflected in the first two cells of the sick leave sheet, then the next three do not need to be filled out. But if such a need exists, then the medical worker enters both the main code and the additional one.

Decoding numbers: what does it mean?

An entry with code “02” means that the insured person received a domestic injury not related to work. That is, the damage to the body occurred during non-working hours and not at the workplace.

The cause of disability is indicated by two main codes and five explanatory codes: addition code “3” and change code “2”. Diseases are indicated by codes from “01” to “15” (read more about what it means and how to decipher an entry on a sick leave certificate with code 01 here).

The amount of the benefit mostly depends on the code written on the sick leave certificate . If disability is assigned, then the reason due to which the health of the insured person was impaired is indicated.

Payment of sick leave for a domestic injury

What is sick leave? This is a medical document that indicates the reasons for a person’s temporary disability and on the basis of which he can receive (for the entire period of absence from work) a certain amount of money.

How is sick leave paid? That is, what factors are fundamental in determining the amount intended to be paid to the employee?

The insurance record of the person presenting sick leave for payment. Moreover, if this length of service is up to 5 years, then the amount of the benefit will be equal to 60% of the average salary; if from 5 to 8 years, then the employee receives 80% of the PPP; and if more than 8 years, then he has a chance to get 100%.
Average annual earnings.

Important! Keep in mind that there are significant limitations in determining average earnings per year. So, in 2016, its largest amount was 670,000 rubles. That is, even if, during the actual calculation, your average annual income significantly exceeds this figure, the value that is officially determined to be the highest will be taken into account in the calculation of hospital compensation.

Average daily earnings.
The number of days during which the employee may be absent from work.

Important! If the reason for the employee’s absence is illness (for example, the flu) or a domestic injury, then payment for the first three days is the responsibility of the employer directly, and the subsequent days are paid exclusively from the Social Insurance Fund (SIF) - see Law No. 255-FZ (clause 1, part 2, article 3).

Payment of personal income to the employee after termination of the contract

In addition to full-time employees, the employer is obliged to pay labor compensation to a dismissed employee. The benefit is paid in the event of injury within 30 days from the date of dismissal. The ballot must be presented for payment within six months. After the deadline, benefits will be denied. In addition to paying benefits, the employer does not have other obligations to the former employee in the form of deductions of contributions or reinstatement in the lists. The amount of benefits for illness or domestic injury is paid at the rate of 60% of average earnings.

An example of compliance with deadlines for presenting compensation for injury. Employee K. left the company on June 6. On July 5, K. was injured and opened the LN on July 8. When contacting his former employer with an application for payment of disability, K. was refused due to exceeding the permissible insurance period.

Example of calculating hospital compensation

Theoretically, of course, everything is extremely clear. Let's see how in practice you can independently determine the amount due to you.

Let's say citizen Ivan Ivanovich Ivanov was absent from work due to a domestic injury (or due to the flu) for 10 days (note, calendar days). Ivan Ivanovich’s average daily earnings is 1,600 rubles, and his insurance experience is 7 years. The benefit amount will be 12,800 rubles (1,600 x 10 x 80%). Of these, 3840 rubles (1600 x 3 x 80%) will be paid by the employer, and the remaining amount will be 8960 rubles from the Social Insurance Fund.

Violation codes

The line “Record of violation of the regime” is filled in only if a violation is detected. Codes apply:

23 – in case of non-compliance with the prescribed regimen, unauthorized departure from the hospital;
24 – when you miss an appointment with a doctor;
25 – when reporting to work without an extract;
26 – upon refusal to be referred to an ITU institution;
27 – in case of untimely attendance at the ITU institution;
28 – for other violations.

If the reasons for the violation are found to be unjustified, the benefit is reduced from the date of the violation. Together with these codes, code “36” can be used in the “Other” line, indicating that the employee was able to work at the last doctor’s appointment.

Deadlines for submitting sick leave to guarantee receipt of benefits

A sick leave certificate issued due to illness, disability - code 02 (deciphering is presented above) - or for other circumstances, the employee must present before six months (or rather, 6 months) have passed from the date indicated in the medical document (and exactly in the column “by what date”).

Remember! In case of delay, sick leave benefits are not paid. For example, if the last day on sick leave is May 15, then the latest date for presenting the document is November 15. If you do this even a day later, you will not receive benefits.

Number of days for which benefits will be paid

There are certain deadlines for assigning and paying sick leave:

The period for consideration and assignment of benefits is 10 calendar days. The countdown begins from the day the sick leave is presented. This is stated in Law No. 255-FZ (Part 5, Article 13, Part 1, Article 15).
Payment of benefits is made at the earliest (after it is assigned) date of payment of the next salary in accordance with the same Law (Part 8, Article 13, Part 1, Article 15).

On a note! For each day of delay, you have the right to demand compensation in accordance with the Labor Code of the Russian Federation (Article 236).

Number of paid days on sick leave

If an employee is sick or absent from work due to disability - code 02 (explained above), then the benefit must be guaranteed to be paid for the entire period of exemption from performing his professional activities (or more precisely, for all calendar days indicated in the medical document) . This is clearly stated in Law No. 255-FZ (Part 1, Article 9). Moreover, there are no restrictions on the maximum duration of the paid period. The only exceptions are sick leave benefits for employees hired for temporary work or with disabilities.

Important! If an employee falls ill or is absent from the workplace due to incapacity for work - code 02 (explained above) during the next paid leave, then benefits are paid for the entire period of incapacity for work. The vacation (by agreement) is either extended or postponed to another convenient time. This seems very fair.

Circumstances excluding payment if there is such a reason for disability

In some cases, an injured person is denied sick pay. The list of reasons for refusal is listed in Art. 9 Federal Law dated December 29, 2006 No. 255-FZ.

Here are some of them:

The injury was caused intentionally to oneself or as a result of illegal actions. This must be determined by a court decision.
The injury occurred during the employee’s release from work with full or partial pay or without pay, with the exception of annual paid leave. This includes suspension from work.
The employee was injured while the company's operations were suspended. Downtime of the enterprise must be documented by an official order. If the injury occurs before the downtime, the entire period is paid.
In the event that an employee was injured, but was under investigation or administrative arrest.