Cause of disability 04 on sick leave - what does it mean to pay the employer in 2022

As established, information related to the diseases of citizens is recorded in the hospital bulletin in encrypted form using special codes. Each of them has a specific purpose, which is enshrined at the legislative level, in particular, by order of the Ministry of Health and Social Development of the Russian Federation No. 624n dated June 29, 2011 (Procedure, part 6, clause 43).

The codes are written down by the doctor and the employer (each in their own sections) on certain lines. So, for example, the employer is required to indicate the appropriate code in the “Calculation Conditions” line. The remaining codes provided by the form are recorded by the doctor. These also include code “04”.

Rules for filling out the form and decoding of all used codes are available on the back of the form (Order of the Ministry of Health and Social Development No. 347n dated April 26, 2011). For your information, uniform requirements for filling out the ballot have been established for employers and doctors (clause 56 of Order of the Ministry of Health and Social Development No. 624n dated June 29, 2011).

According to the applicable legal norms, the attending physician, when filling out his section on the sick leave, must indicate the codes along the lines:

1. “Cause of disability” (always indicated; when it changes, the corresponding code is written next to it in the “code change” cell).
2. “Family Relationship” (recorded when a ballot is issued in connection with caring for an ill family member).
3. “Notes about violation of the regime” (made if available, when the doctor’s instructions were violated, for example, if the patient did not show up for an appointment on the appointed day).
4. “Other” (intended for additional information, for example, if the patient continues to be ill).

The two-digit code “04” refers to the main codes of the form. The doctor prescribes it once according to the line “Cause of disability.” The meaning of code “04,” according to the decoding indicated on the back of the form, is: “Accident at work or its consequences.” In other words, this is how a work injury is encrypted.

In what cases is a bulletin issued with code “04”

According to legislative norms, the code “04” is entered directly by the doctor if an accident occurs during work or an occupational disease worsens.

The issue related to the issuance of sick leave for work-related injuries is somewhat separate. For your information, those injuries are called industrial injuries that are classified and noted in Art. 227 and art. 230 Labor Code of the Russian Federation. Such accidents are subject to mandatory investigation and recording.

In general, this includes a significant deterioration in the employee’s well-being, noted in the process of performing his job duties as provided for in the employment agreement. For the purposes of assigning and paying social benefits (insurance compensation), the date, time, place, and cause of the incident that caused the injury are taken into account. That is, if an accident occurred during working hours on the territory of the organization, then this is an unconditional basis for registration and payment of the corresponding sick leave, as well as compensation.

Upon the fact of the incident, the employer must, as is customary, record the accident and file the appropriate materials regarding the investigation, namely:

1. Prepare a report on what happened at work (indicate the reasons, set out the circumstances of the case, the guilty violators, etc. according to the standard form N-1).

All forms of documents that are used in the process of investigating industrial accidents are presented by the Ministry of Labor of the Russian Federation in Resolution No. 73 of October 24, 2002.

1. After completion of the proceedings, give a copy of the act to the victim.
2. A copy of this act and other investigation materials shall be handed over to the executive body of the insurer.

The investigation is carried out by a specially created commission and, depending on the severity of the incident, can last from 3 to 15 days. The procedure for documenting an accident is set out in detail in Art. 230 Labor Code of the Russian Federation. As a rule, sick leave is issued on the basis of the act, and the issue of assigning compensation payments is decided.

general information

Applicant

Select who applied:

Information about the benefit recipient

Fill in the data once, the service will remember it and fill it in next time.

When filling out, pay attention to the following fields:

Information about the employer (organization)

The service will fill in the organization details. If not, fill in manually and they will be saved in the details. When filling out, pay attention to the following fields:

Benefit payment method

Payment for sick leave with code “04”: general rules

Social payments under the bulletin with code “04” are made entirely by the FSS of the Russian Federation if the insurer (organization) makes contributions for injuries.
For your information, in case of an accident at work, the following main types of payments are provided: (click to expand)

• social benefits for temporary disability;
• compensation for treatment and restoration of health (one-time);
• compensation for moral damage;
• insurance payments every month;
• financial assistance at the place of work;
• appropriate payment to relatives in the event of the death of the victim.

Social benefits are assigned in accordance with Art. 184 Labor Code of the Russian Federation. The payment amount is 100% of average earnings. Experience does not affect this amount, and it is actually calculated on the basis of average daily earnings.

When calculating social benefits (taking into account current limits), the standard formula is used: SDZ * number of days of illness. If the victim had no earnings during the billing period or was paid less than 24 minimum wages, then the calculation is made based on the minimum wage. Grounds for payment: sick leave with code “04”, act in form N-1.

Memo to the policyholder when applying for sick leave

The section “TO BE COMPLETED BY THE EMPLOYER” of the certificate of incapacity for work is drawn up by the employer of the insured person.
Entries on the certificate of incapacity for work are made in Russian in printed capital letters in black ink or using printing devices. You can use a gel, capillary or fountain pen. The use of a ballpoint pen is not permitted. Entries on the certificate of incapacity for work should not go beyond the boundaries of the cells provided for making the corresponding entries, and also should not come into contact with the boundaries of the cells. All entries in specially designated cells are entered starting from the first cell.

The employer's seal may extend beyond the specially designated space, but should not fall into the cells of the information field of the certificate of incapacity form. To correct errors made when filling out this section, the erroneous entry is carefully crossed out, the correct entry in place of the erroneous one is entered on the back of the certificate of incapacity for work, confirmed by the entry “corrected believe”, the signature and seal of the employer (for an employer - an individual, a seal is affixed if available) . Errors may not be corrected by correction or other similar means.

When filling out the “TO BE COMPLETED BY EMPLOYER” section:

If the policyholder, an individual, does not have the specified positions, the surname and initials of the policyholder himself are indicated in this line, and his signature is affixed in the “Signature” field.

The calculation of benefits for temporary disability and pregnancy and childbirth is made by the policyholder on a separate sheet and attached to the certificate of incapacity for work.

Source

If the completed ballot contains errors in the codes

The presence of incorrect codes in the bulletin is a significant error. It cannot be ignored, since the FSS accepts for consideration only ballots with minor errors.

As evidenced by the example from the FSS letter No. 14-03-18/15-12956 dated October 28, 2011, these include only isolated technical flaws, such as spaces when writing the doctor’s initials. The key point, the FSS draws attention to, is the readability of the text and the absence of distortions in content.

A. P. Kaminsky.

If the code “04” or any other code indicated by the doctor is incorrect, then the sick leave form is considered damaged and must be replaced. Only the employer has the right to make corrections in the bulletin, but only in his own section and no more than 2 times.

Important! If, during an inspection, the FSS of the Russian Federation reveals serious errors that distort the meaning, or 3 or more corrections to the text made by the employer, it will recognize such a ballot as invalid.

Accordingly, the FSS will refuse to assign and pay social benefits for the above reasons. A justified written refusal, sick leave with errors in this situation is sent to the employer.

If the amount of social benefits was paid on an illegally issued ballot, then it must be returned. The onset of liability for the above violations is stated in paragraph 4 of paragraph 1 of Art. 4. 2 Federal Law of the Russian Federation No. 255 of December 29, 2006, as well as clause 18 of Resolution No. 101 of February 12, 1994.

Features of code 09

Speaking about what the codes on the sick leave mean, it is worth considering absence due to caring for a sick family member. Code 09 implies additional columns in the “Care” section. In this place, the doctor must indicate the details of the people in need of care and who they are to the employee. In this case, the benefit is also paid in full. However, if caring for a sick relative was carried out at the time of vacation, then payments are not accrued.

It is worth considering that this type of code must correlate with the exact reason for absence from work. For example, when caring for a small child, an additional code is indicated.

Common mistakes when issuing a ballot with code “04”

Error 1. The following statement is correct. Generally obligatory insurance contributions are not deducted from the amount of social benefits for sick leave with code “04”.

Error 2. A bulletin issued for a domestic injury is paid differently than sick leave issued in connection with an industrial accident.

In addition, an investigation in case of domestic injury is not carried out by the employer and a report in Form N-1 is not drawn up. The amount of payment is affected by the number of days of illness, the length of service of the victim and his SZ.

Actually, social benefits for a domestic injury are paid by the employer for the first 2 days, and starting from the third day, all subsequent days are paid by the Social Insurance Fund of the Russian Federation (reference to Article 8 of the Federal Law of the Russian Federation No. 202 of December 29, 2004).

FSS of the Russian Federation (Letter No. 02-18/07-1243 dated February 15, 2005).

Error 3. An injury that an employee received while on duty while on a business trip is considered industrial. The fact that the accident occurred outside the organization is not taken into account. Justification: the incident was related to the performance of official duties.

Typical mistakes when creating a register for sick pay

Author: Egorova A. O. , expert of the information and reference system “Ayudar Info”

The material describes the most common mistakes made by policyholders when creating registers of information sent for the assignment and payment of social insurance benefits. FSS inspectors recommend accountants to be more careful when filling out registers.

Order of the Federal Social Insurance Fund of the Russian Federation dated 02/04/2021 No. 26 (valid from 05/02/2021) approved the forms of documents used for the appointment and payment in 2021 by the territorial bodies of the Social Insurance Fund to insured persons of insurance coverage for compulsory social insurance in case of temporary disability and in connection with maternity and for compulsory social insurance against industrial accidents and occupational diseases, including a register of information necessary for the appointment and payment of benefits for temporary disability, pregnancy and childbirth, a one-time benefit for women registered with medical organizations in the early stages of pregnancy (hereinafter – register, register of information), and the procedure for filling out the register.

Let us list the mistakes that policyholders usually make when filling out this register.

Error 1: providing incorrect information about the organization.

Error 2: indicating incorrect personal data of employees (columns 2 – 15 of the register).

Error 3 : Indicating the wrong payment period.

When creating a register of information for payment of benefits for temporary disability due to illness (cause of incapacity code - 01) or injury (cause of incapacity code - 02), the fields “Period of release from work” (column 22 of the register) must correspond to the data contained in the certificate of incapacity for work .

One of the common mistakes is to indicate the incorrect period for which benefits are paid, for example: from 05/04/2021 to 05/12/2020.

In addition, you need to remember that in the field “Benefit due for the period” (columns 35, 36 of the register) you should indicate the period minus the first three days of temporary disability. For example, in the column “Period of release from work” you need to indicate - from 05/04/2021 to 05/12/2021, and in the column “Benefits due for the period” - from 05/07/2021 to 05/12/2021 (that is, minus the period for which sick leave paid by the employer).

Temporary disability benefits due to the need to care for a sick family member, including a child, are paid entirely from the Social Insurance Fund, and in this case the content of the column “Benefit due for the period” coincides with the content of the column “Period of release from work.”

Error 4: indicating the wrong length of service on a rolling certificate of incapacity for work.

Column 29 “Duration of insurance period / total” of the register is filled out taking into account clause 8 of the Rules for determining the insurance period, approved by Order of the Ministry of Labor of the Russian Federation dated 09.09.2020 No. 585n. In particular, the length of service is determined on the day of the occurrence of the corresponding insured event (temporary disability, maternity leave). Please note that one insured event of temporary disability should be considered a case of illness completed by one completed period of incapacity, certified by a certificate of incapacity for work, taking into account all certificates of incapacity for work issued in continuation of the primary one. That is, changing the insurance period in different certificates of incapacity for work in one insured event is not allowed.

Error 5: specifying the wrong billing period.

Common mistakes are:

incorrect indication of the order of years in the billing period, for example: 2022, 2022, instead of 2022, 2020;

indication of an incorrect calculation period for a rolling certificate of incapacity for work.

The fact is that the average earnings of the insured person (columns 39, 40 of the register), as well as his insurance period, are determined at the time of the onset of temporary disability. That is, certificates of incapacity for work issued as a continuation of the initial certificate of incapacity for work must indicate the same billing period. For example, for a work disability that began in 2022 and continues in 2022, the calculation periods will be 2022 and 2019.

Error 6: indicating incorrect average earnings.

When creating a register of information, it is necessary to indicate the employee’s real earnings for the 2 calendar years preceding the year the insured event occurred (columns 39 – 40 of the register). If the insured person worked for less than 2 years (for example, several months) before the occurrence of the insured event, the accrued wages for these months should be indicated, without bringing the average earnings to the minimum wage. This is most relevant for employers whose employees are employed on a part-time basis. In the information provided, bringing the insured's earnings up to the average earnings calculated from the minimum wage is regarded as real earnings, which can lead to an unreasonable overestimation of benefits accrued to part-time workers.

Error 7: Specifying an incorrect downtime period.

According to Part 7 of Art. 7 of Federal Law No. 255-FZ of December 29, 2006, in the event of temporary disability that began before the downtime period and continues during the downtime period, temporary disability benefits for the downtime period are paid in the same amount as wages are maintained during this time, but not higher than the amount of temporary disability benefits that the insured person would receive according to the general rules. If the illness began during a period of downtime, benefits are not assigned at all (clause 5, part 1, article 9 of Federal Law No. 255-FZ).

Thus, incorrect reflection of periods of inactivity affects the amount, and sometimes even the possibility of receiving benefits.

Error 8 : incorrect indication of information about the date of conclusion of the employment contract.

Column 31 “Validity of the employment contract is less than 6 months” of the register is filled in only if an employment contract is concluded for a period of up to 6 months. It contains the date, month and year of the beginning and end of the fixed-term employment contract (fixed-term service contract) (clause 3.16 of the Procedure for filling out the register).

If an open-ended employment contract or a fixed-term employment contract for a period of more than 6 months is concluded, this column is not filled in. It must also be left free in the event of an employee contracting tuberculosis, regardless of the type of employment contract concluded and its duration.

Error 9: sending for payment of sick leave to care for a child while another person is on leave to care for this child.

The basis for the appointment and payment of both monthly child care benefits and temporary disability benefits in connection with caring for a sick child is the actual provision of child care. In this regard, temporary disability benefits for caring for a sick child cannot be assigned if the actual care of the child is provided by another person who is on leave to care for him. If the actual care of a sick child during his illness is carried out by the insured person who applied for temporary disability benefits, another insured person who is on parental leave is obliged to interrupt this leave for this period, since the grounds for paying the monthly benefit child care in this case will be lost.

Error 10: Specifying incorrect bank details.

When filling out the section “Details for transferring benefits to the insured person to a bank account,” false information is indicated, namely: details of a card that does not belong to the benefit recipient (columns 44 – 47 of the register).

The “Date of Birth” field (column 5 of the register) is also filled in incorrectly. In this regard, the information from the register does not coincide with the issuing bank’s data on the cardholder’s date of birth. For this reason, the issuing bank may refuse to fulfill a request to top up a payment card.

The issuing bank's refusal to fulfill a request to top up a payment card may also be due to the expiration of the payment card or blocking of the card.

Error 11: indicating the wrong delivery address for the postal order to the insured person, in particular, failure to indicate the postal code of the benefit recipient.

Error 12: failure to mark a violation of the regime.

A common mistake is failure to indicate in the registry information about codes indicating the presence of a note about violation of the regime in the electronic certificate of incapacity for work. Also, often these codes are erroneously not entered on certificates of incapacity for work issued as a continuation of the first certificate of incapacity for work in case of a long-term insured event.

Error 13: indication (failure to indicate) codes for the conditions for calculating benefits.

In accordance with clause 3.17 of the Procedure for filling out the register, in column 32 “Conditions for calculating benefits”, if necessary, a code (or several codes) is entered that affects the procedure for calculating benefits and its amount. The procedure for filling out the register provides the following codes:

43 – if the recipient of the benefit is entitled to benefits as a participant in the liquidation of an accident related to nuclear energy;

44 – if the recipient of the benefit started working in the Far North before 2007 and continues to work in these areas;

45 – if at the time of the onset of temporary disability the benefit recipient has a disability group;

47 – if the beneficiary’s illness or injury occurred within 30 calendar days after termination of work under an employment contract, during which he is subject to compulsory social insurance;

48 – for a valid reason for violating the regime (if the corresponding code is entered in the line of the certificate of incapacity (field of the electronic certificate of incapacity for work) “Notes on violation of the regime);

49, 50 - if the duration of the disease (except for tuberculosis) or injury exceeds 4 months in a row (5 months in a calendar year, respectively) - for benefit recipients who are disabled on the day of the insured event. This code is not entered if code 11 is indicated in the line “Cause of incapacity for work” on the certificate of incapacity for work (field of the electronic certificate of incapacity for work);

51 – if the benefit recipient is working part-time at the time of the insured event. If there are no grounds for reflecting the named codes in the specified column, a dash is entered in the column.

For example, a common mistake is to indicate in column 41 “Information on part-time working time (rate rate)” the size of the part-time working time rate, and in line 32 of the register to fail to indicate code 51 or vice versa.

Error 14: providing incomplete information about a sick family member.

In accordance with clause 3.7 of the Procedure for filling out the register, in column 20 “Care for a sick family member, age, kinship (family) connection” the surname and initials of the sick family member being cared for, his age, kinship (family) ties are indicated, in in accordance with the certificate of incapacity for work (electronic certificate of incapacity for work). When caring for a sick disabled child under the age of 18, the group of his disability is also indicated.

A common mistake is not to indicate the initials of the sick family member being cared for, as well as the family connection.

Source

Example 2. Calculation of sick leave for a domestic injury

While doing repair work at home, an employee of Sluchai LLC injured his hand. He was given a ballot for 13 days. The victim’s work experience is 6 years, which means that he is entitled to a payment in the amount of 80% of the SDZ. SDZ size for the last 2 years: RUB 2,000.

This injury is a domestic injury. Accordingly, the first 2 days are paid by the employer, and the rest - by the Social Insurance Fund. The actual calculation of social benefits is made according to the formula: SDZ * 80% * number of days of illness (2,000 rubles * 80% * 13 = 20,800 rubles).

Codes of reasons for incapacity for work on sick leave: decoding of other designations

The payment of the insurance premium depends on the code, so sometimes more detailed information is required about the reasons why the employee could not go to work. For example, there is a column “Other”. It may contain significant information about the citizen’s health status. For example, here the doctor can indicate code 31, which means that the treatment has not yet been completed and a new sick leave has been issued to the employee.

If additional information indicates that a person was injured due to intoxication at work, then the employer has the right to reduce compensation payments, since the consumption of alcohol is prohibited while performing work.

Among other designations, there may be any clarifying information. It can be neutral or negative and contain employee data.

All about certificates of incapacity for work

Law of the Russian Federation of February 12, 1993 No. 4468-1 “On pension provision for persons who served in military service, service in internal affairs bodies, the State Fire Service, authorities for control of the circulation of narcotic drugs and psychotropic substances, institutions and bodies of the criminal executive systems, and their families" from January 1, 2007; - in the line "Benefits due for the period" in the cells "from □□-□□-□□□□" "to □□-□□-□□□□" it is indicated the period for which the employee should be assigned and paid temporary disability benefits, maternity benefits; - in the line “Average earnings for calculating benefits □□□□□□р □□к” the amount of average earnings from which should be benefits for temporary disability, pregnancy and childbirth, determined in accordance with the Federal Law of December 29, 2006, prosthetics carried out in a medical institution on an inpatient basis - 06;

• diagnosing an occupational disease, as well as the consequences associated with it - 07;
• completion of treatment in a sanatorium - 08;
• code 09 on the sick leave certificate is indicated for providing care in the event of illness of a family member;
• other condition in which the patient is – 10;
• tuberculosis - 11;
• treatment of a child under the age of seven years, in the case of a disease included in the list of the Ministry of Health, in accordance with the law under number 255-FZ of December 29, 2006 - 12;
• the child is disabled - 13;
• if the disease occurred after vaccination, as well as if cancer was detected in a child - 14;
• a child has AIDS - 15.

It should be noted that diagnosis codes on the sick leave numbered fourteen and fifteen are placed with the consent of the employee for whom the sick leave is issued.

Features of using additional codes

In the line intended to indicate the cause of disability, an additional code is written (in the next three cells):

If the reason for leave from work is fully reflected in the first code cells, then subsequent cells remain empty. If necessary, the doctor enters both the main code and the additional code into the form.

How to decipher the first numeric code

The first two cells contain codes that reflect:

Important! The doctor can enter codes 14 and 15 only after receiving the “okay” of the insured employee.