An example of calculating payment for sick leave with violation of the regime

What violations of the regime may be reflected in the sick leave certificate?

If we consider the provisions of Art.
8 of the Law “On Compulsory Social Insurance” dated December 29, 2006 No. 255-FZ in correspondence with the order of the Ministry of Health and Social Development of Russia dated April 26, 2011 No. 347n, then the following options for violation of the treatment regimen by an employee on sick leave can be determined: 1. Non-compliance with the treatment regimen ( This violation corresponds to code 23, recorded on the certificate of incapacity for work).

2. Failure to show up for a scheduled examination with a doctor (code 24).

3. Failure to appear for a planned medical and social examination (code 27).

4. Refusal from ITU (code 26).

5. An employee goes to work with unpaid sick leave (code 25).

In addition, sick leave may indicate illness due to intoxication (code 021).

Violations in paragraphs 1–5 are recorded in the column “Notes of violation”, code 021 - in the column “Additional notes”.

How to calculate payment to an employee for sick leave if it contains a note indicating a violation of the regime prescribed by the doctor? The answer to this question is in ConsultantPlus. Study the material by getting trial access to the K+ system for free.

All of these violation options can be combined with each other in any way. But only 1 of them is enough for the legal consequences of their commission to occur. Let's explore what they can be.

You can learn more about the codes recorded on sick leave certificates in the article “What do disability codes mean on a sick leave certificate?”

Violation codes

In accordance with Order of the Ministry of Health of Russia dated September 1, 2020 No. 925n, depending on the type of violation of the hospital regime, a two-digit code is indicated on the sick leave.

Here's a breakdown of the codes.

Entering a special mark on the sick leave sheet indicating a violation of the hospital regime entails negative consequences for the patient.

Maximum duration of sick leave

Duplicate sick leave certificate - what is it for and how to get it

The sick leave note indicates a violation of the regime: legal consequences

If 1 or more of the above codes includes sick leave, the consequences of violations of the treatment regimen that correspond to these codes will most affect the interests of the employee who committed these violations.

The fact is that his allowance for temporary working capacity in this case will be calculated at a minimum amount - based on the minimum wage. In this case, the moment of committing the action that gives rise to sanctions may be important, as well as the basis for reducing benefits based on the fact that:

1. For violations with codes 23, 24, 25, 26, 27, sick leave is calculated in the minimum amount from the date of the violation.

2. If there is code 021 on the certificate of incapacity for work, the benefit is calculated in the minimum amount for the entire period of temporary incapacity for work.

An example of calculating sick leave when an employee violates the regime from ConsultantPlus Romantsova I.M. sick leave was issued in connection with being in hospital due to illness (cause of disability code “01”). The sick leave was issued for the period from January 21 to January 25, 2022 (5 days). Due to the fact that the employee left the hospital without permission, the doctor entered the code “23” in the line “Notes on violation of the regime” and indicated the date of the violation - 01/22/2021. Explanations about the reasons for violating the regime of Romantsov I.M. didn't introduce it. Payments for the billing period for which insurance premiums for VNiM are calculated - RUB 1,204,500. The employee's insurance experience is 19 years and 5 months. The calculation of temporary disability benefits until the day of the violation is as follows... You can view the full example in K+, having received free trial access to the system.

At the same time, the employer, before reducing sick leave, must have evidence that violations under paragraph 1 were committed by the employee without a good reason.

The fact that certain codes are indicated on the sick leave is only the basis for calculating sick leave in a reduced amount, but does not give the company the right to unconditionally apply the appropriate mechanism for reducing the amount of benefits.

Let's consider how an employer can determine whether an employee's violation of a treatment regimen is due to a valid reason or not.

Is it paid if the doctor’s orders are violated for an unjustifiable reason?

If an employee violates the sick leave regime for an unexcused reason, then the amount of payments is reduced to an amount not exceeding the minimum wage. If the doctor's instructions are constantly not followed, the employee may be completely deprived of sick pay (we talked more about what consequences can be expected at work if sick leave is violated in a separate article).

Grounds for reducing the amount of compensation

Depending on the type of violation, the amount of benefit may be reduced in whole or in part from the moment of non-compliance with the regime. Decrease since violation:

• violation of medical regulations;
• being late or not showing up for a doctor's appointment.

Reduction for the entire period of sick leave: if an employee is injured or sick due to alcohol, drug, or toxic intoxication. In order to note in the BC that the employee was drunk, the doctor underlines the word “injury” in the line about the cause of incapacity and then signs “intoxicated.”

Is the regional coefficient considered?

Regional coefficient is an indicator by which the salary of a person working in regions with difficult climatic and environmental conditions is multiplied.

When a sick leave is issued without violations, the regional coefficient is not calculated, since the benefit is calculated from actual earnings, which already take into account additional allowances.

If an employee violates sick leave or receives temporary disability due to intoxication, then the amount of benefits is calculated using the formula:

Days of illness * (minimum wage * 24/730 * regional coefficient) * percentage by length of service = amount of sick leave.

The procedure and example for calculating benefits (subject to a reduction in the amount from the day of non-compliance with the doctor’s instructions)

Benefit payments, subject to a reduction in the amount from the date of violation, are calculated as follows:

1. From the date of opening of the BC until the day of the violation, sick leave is paid in the usual manner.
2. From the moment of the violation until the closure of the certificate of incapacity for work, the amount is calculated based on the minimum wage. From May 1, 2022, this amount is equal to 11,163 rubles.

Example: Sick leave opened on March 10. The employee was supposed to come for an appointment on the 15th, but for an unexcused reason he came a day later. The certificate of incapacity for work was extended and closed on the 18th.

Let's say the average salary per day is 25,000*24/730=822 rubles.

From July 10 to July 14, the employee is credited 822*5=4110 rubles.

From July 15 to 18, the minimum wage (11,163 rubles) *24/730= 367 rubles per day, which means 367*4=1468 rubles from the moment of non-compliance.

1468+4110 = 5578 rubles for the entire sick leave.

The procedure and example of calculating benefits, which requires a reduction of the entire compensation

In cases of severe violation of the disability regime, the employer has the right to reduce the entire amount of payments to the minimum wage.

Typically, the underlying cause is injury or illness sustained while intoxicated. In the BC this is marked with code 21.

Example: An employee was unable to work from July 10 to July 15. The BC has code 21. Work experience – 4 years. Regional coefficient – ​​1.3.

11163 * 24/730 = 367 rubles - the minimum wage per day.

367* (60%/100%)*1.3 = 286 – daily payment to an employee according to the minimum wage.

286 * 10 (sick days) = 2860 the entire amount of sick leave.

Calculation of minimum wage benefits if the period of illness moves to another year and the size of the minimum wage has changed

If the sick leave transfers to the next year and the minimum wage changes, or it changes several times a year, as happened in 2022, then benefit payments are calculated based on the “old” minimum wage at the time of which the BL was opened.

Example: An employee’s work experience is 20 years. He was on sick leave from April 25 to May 20, 2022. The certificate of incapacity for work indicates violations, according to which benefits are calculated according to the minimum wage. From January 1 to April 30, the minimum wage was 9,489 rubles. And from May 1, 2022, the amount increased to 11,163 rubles.

When calculating, you should take the amount current at the time of opening the sick leave, that is:

312 (average daily “old” minimum wage) * 26 (sick days) * 100% (according to length of service) = 8111 rubles - the full amount of the benefit.

The employee was very late in going to the doctor for closure (counted as absenteeism/vacation)

If an employee missed an appointment with a doctor and came back later, already healthy, then code 36 is entered in the “other” column - appeared healthy.

The doctor will not determine the moment of onset of working ability and will simply mark the day of absence as the day the sick leave ends.

Thus, the days from the missed appointment to the actual appearance are considered absenteeism and may result in a fine or dismissal from the workplace. In rare cases, the employer may treat missed days as unpaid leave.

Example: BC is open from June 1. The doctor's appointment was scheduled for June 4, but the employee only arrived on the 6th. His work experience is 8 years, the average daily salary is 822 rubles. The daily minimum wage is 367 rubles.

From 1 to 3 payments are accrued as usual: 822 * 3 * 100% = 2466 rubles.

For the 4th day, the employee will receive 367*1*100%=367 rubles.

The 5th and 6th are not subject to payment and are considered absenteeism.

It was a fact, but it was not reflected in the BL

If the employer or social insurance commission has identified violations of the employee’s hospital regime, but this is not indicated in the BC, you can submit an official request to the medical institution with documents or other evidence that confirms the fact of non-compliance with the regime.

Important: the organization does not have the right to independently make changes to the certificate of incapacity for work.

Noted in BC for care or BC

If an employee issues a BC to care for a relative, he is responsible for visiting a doctor and complying with medical instructions. In cases of non-compliance with the regime, the corresponding codes are entered on the certificate of incapacity for work. The amount of payments will be calculated in the same way as for sick leave payments due to the illness of the employee himself.

When registering sick leave for pregnancy and childbirth, the legislation of the Russian Federation does not provide codes for violation of the regime. Problems with receiving payments can only arise if there are errors or inaccuracies when filling out the document.

Payments for temporary disability are due to all officially employed citizens. If you strictly follow the medical requirements and visit the doctor in a timely manner, there will be no problems with the calculation of benefits. In cases where a violation of the regime occurred for a good reason, try to prepare documents confirming this and provide them, along with an explanatory note at the place of work, so that this has less impact on the payment of sick leave.

How to pay for sick leave, taking into account the need to justify the amount of benefits

The best option is if the decision on whether or not the employee’s violation of the treatment regimen is due to valid reasons is made collectively in the company. For these purposes, the organization can establish a special commission on social insurance issues - permanent or temporary (convened from time to time).

This commission may decide to recognize the reasons for the violation as valid:

1. Based on the content of the explanatory note requested from the employee. At the same time, since the formation of this note is not regulated by the Labor Code of the Russian Federation, the employee may refuse to provide it.

2. Based on information provided in writing by other employees (including if the employee refuses to provide an explanatory note).

3. Based on the actual circumstances of the violation established by the commission.

4. Taking into account the proportionality of the actual violation (taking into account the identified circumstances of its commission) and the employee’s possible material losses (which may be much greater than the employer’s losses - due to the fact that the main part of the sick leave is paid by the Social Insurance Fund).

We remind you that starting from 2022, the employer will accrue and pay benefits only for the first 3 days of sick leave due to illness or domestic injury. The rest of the benefit amount is calculated and paid to the Social Insurance Fund employee, and some benefits are paid by the fund 100%. For more information, see our guide to direct benefit payments.

At the same time, even if the decision is made in favor of the employee, the Social Insurance Fund, nevertheless, based on the fact that the sick leave contains violation codes, may refuse full payment of disability benefits if it recognizes the commission’s conclusions as unfounded.

This decision of the commission, one way or another, is important to document. Alternatively, in a special act. Let's study its features.

What does a sample act of violation of hospital regulations look like?

The act of violation of sick leave, which must necessarily contain one of the above codes, may reflect, in particular:

1. Information about the circumstances of the employee’s violation of the treatment regimen, which are known to the commission (taking into account the codes entered by the doctor on the certificate of incapacity for work - there should be no obvious discrepancies between these circumstances and the decoding of the code).

2. The substantive content and details of the employee’s explanatory note, as well as the fact that it is attached to the act.

3. Information about the composition of the commission.

4. Information about employees from whom the commission received useful information about the circumstances of the employee’s violation of the treatment regimen.

5. Information about the sources of data on the circumstances of the violation that were at the disposal of the commission.

4. Formulations reflecting the decision of the commission - to recognize or not to recognize as valid the reasons for the employee’s violation of the treatment regimen (as a consequence - the presence of legal grounds for the employer to reduce temporary disability benefits).

You can report a violation of sick leave by an employee on our website - click on the link below.

What is considered a violation

After conducting the necessary diagnostic tests, the doctor prescribes treatment to the patient on an outpatient or inpatient basis. From the date a citizen applies for medical care, a sick leave certificate is opened for payment of temporary disability benefits for the period of treatment.

One of the conditions for paying sick leave is the patient’s compliance with the hospital regime, that is, rules and regulations, the implementation of which is necessary for recovery.

In practice, the following violations of the hospital regime are common:

• going to work without being discharged or ending sick leave;
• non-compliance with doctor's recommendations regarding treatment;
• unauthorized departure from the hospital;
• failure to show up for a doctor's appointment;
• failure to complete prescribed rehabilitation.

The presence of one of the listed circumstances may affect the quality and duration of treatment. If the doctor determines a violation of the hospital regime, he is obliged to make a note on the sick leave sheet, indicating the code of the violation.

Results

If one or another code is entered on the sick leave certificate, reflecting the fact that the employee has violated the treatment regimen, then the employer can pay him disability benefits in a reduced amount. However, before making a decision to reduce payments, the employer is obliged to establish the fact that there are no valid reasons for the employee committing a particular violation of the treatment regimen.

You can learn more about issuing sick leave within various legal relationships in other articles in our special section.

You can find more complete information on the topic in ConsultantPlus. Free trial access to the system for 2 days.