Legal relations that are associated with the control of the accuracy of the calculation in full and at the time of payment of insurance payments for compulsory social insurance (in case of relative disability and in connection with the birth of a child) are regulated by chapter 34 of the Tax Code of the Russian Federation. They entered into force on 01.01.2017. In the Social Insurance Fund, employers must provide documents confirming payments. If the hospital regime is violated, bad consequences can occur both for the employee and the employer.
Sick leave concept
Now no one can firmly be sure that he is not threatened with temporary disability. If a person is officially employed, he provides the appropriate sheet, which he can receive at the hospital, to the employer. Such a document is drawn up only at a state institution. The main part of the sick leave is filled by the doctor, and the employer himself is the lower (front). If incorrectly formatted, it may not be accepted or paid if the information is not readable.
What is a sick leave regimen
These actions may be regarded as intentional or unintentional due to any circumstances. In the case when there are no valid reasons for this, the amount of sick leave payments will be reduced or completely canceled.
However, non-compliance with the disability regime and its indication with the appropriate code do not always entail a reduction in payment. The doctor who led the patient during the sick-time period notes only the fact of the violation, but not the reason. The organization, in turn, checks the circumstances of these actions, which entailed non-compliance with the regime.
Such powers are entrusted to a special commission at the enterprise. The employee provides an explanatory statement with good reasons. The management decision on how to pay sick leave in violation of the regime should be made out in a written act.
Reasons for violation
According to the order of the Ministry of Health and Social Development No. 74, they are as follows:
- Force majeure is natural disasters, emergencies, and accidents.
- Long-term incapacity for work - in this case, impossibility to start work of a person who has been on a sick leave for more than six months is implied.
- Change of residence, that is, moving to another city or settlement - the patient cannot come to the doctor because of the long distance from the medical institution where the document of disability is open.
- In case of injury, illness or death of close relatives - in such a situation there is a mandatory need to help relatives.
Rarely, cases of violation of the sick leave regime are brought to trial in court.
Failure to comply with the rules leads to a decrease in payments, the following situations apply to them:
- failure to see a doctor;
- violation of the treatment regimen;
- unauthorized withdrawal from the clinic;
- early work;
- refusal of medical examination.
The doctor who keeps the document of incapacity for work, notes the non-compliance with the regime in it, which is subsequently transferred to the enterprise.
Sick leave rates
At the moment, the medical certificate number is indicated in the document of incapacity for work, and most of the information is indicated by special codes, for example, the cause of the disease or the circumstances of the accrual. Their list is on the back of the sick leave.
These TIN and pension insurance certificate numbers are certified not only by the signature of the head physician, but also by the director of the enterprise.
Entries should be made only in black ink, in block letters.
According to the rules, spaces between words must be present without fail, it is impossible to go beyond the limits of the allotted field. It became possible to use various punctuation marks, for example, quotation marks in the name of the organization.
From 1.07.2017, there was an option to get the choice of the person who contacted the medical institution, an electronic document signed by the attending physician using an electronic signature.
The calculation of maternity benefits is performed on a separate sheet, which is subsequently applied to the sick leave.
If any errors are found in the document of incapacity for work in the section filled out by the doctor, it is considered invalid and a new one is issued according to the same principle.
rules
Compliance with this paragraph is mandatory for a patient who has contacted a medical institution with temporary disability.
A person should visit a doctor at the appointed time for him, follow all his instructions and do not forget to warn about any unforeseen circumstances.
Circumstances to reduce benefits
Federal Law of December 29, 2006 No. 255 regulates the provisions for changes in payments on the disability sheet, if violations of the hospital regime are recorded, they are listed in the following list:
- Failure to comply with a doctor’s prescription for no apparent good reason.
- No show at the appointed time.
- Lack of medical and social expertise.
- Premature exit to work.
- Getting injured due to the use of alcohol or drugs.
- Other non-compliance.
Payment of sick leave with impaired treatment is reduced:
- from the day when non-compliance was allowed, the size of the reduction should not exceed the minimum wage for the full 30 calendar days (taking into account the district coefficient);
- for the entire period of working capacity - in a situation when an injury was received during intoxication and the circumstances associated with it.
Non-observance of the regimen in a sick child care hospital
A reduction in the size of maternity allowance is not mentioned in any of the existing legislative documents.
However, in temporary disability due to caring for a sick family member, in this case, a child, there may be a note about a violation of the hospital regime that the pediatrician will put if they did not appear at the appointed time.
Although the reduction of benefits in this case is a difficult issue, since family members do not belong to the insured.
But in any case, the employer must find out the reasons for non-compliance, and the citizen should be given an explanatory account of violations of the hospital regime.
The procedure for payments for caring for a sick child is established:
- when he is on outpatient treatment - for 10 days in the amount determined by the insurance experience of the employee, and for the next days - 50% of the average earnings;
- in stationary conditions - the value will also depend on the length of service of the insured person.
Codes
Doctors use special signs to record non-compliance with a disability document. Codes of violation of the regime on the sick leave and are such. Here are some of them:
- "24" - an appointment with the doctor, but not at the appointed time. The treatment process is always accompanied by regular and periodic examinations for monitoring and monitoring. Obstacle to such actions will lead to inappropriate recovery ahead of time, and therefore absenteeism.
- "25" - exit to work ahead of time, without discharge. This is a case in which it is assumed that disability benefits and salaries are accrued at the same time, which is unacceptable.
- "26" - refusal of social medical examination. The sick leave is closed in this case by the date of disagreement with her.
- "27" - the patient skips the medical and social examination, scheduled for a certain time. Payout also changes downwards.
- "28" - other violations. The doctor marks this code when non-compliance does not fit under any of the list.
The presence of such a designation is mandatory in the document on temporary disability.
How sick leave is calculated with some violations
Human life is considered so unforeseen that non-compliance with the rules of disability documents is a common case.
Calculation of sick leave with a violation of the regime is determined by its period.
The first step is to justify the reasons for non-compliance.
If the circumstances are valid, the payment procedure will be as follows. First, the calculation period is calculated: the wages for the last 2 years (732 days) are taken into account. Then the average earnings are calculated: this is the aggregate of all contributions to the Social Insurance Fund.
The calculation formula looks like this:
average daily earnings = payroll for 24 months / 730 days
An important role here is played by the insurance experience (up to 5 years, it makes up the rate of 60%, from 5 to 8 - 80%, and more than 8 years - 100%).
Formula:
allowance = average daily earnings x length of service x sick days.
Here is an example of a sick leave with a violation of the regime.
Marketer Ivanov D.A. I filled out a document on temporary disability for a period of 2 weeks due to poor health. He has 4 years of insurance experience.
After treatment, he brought a document of disability, in which the attending physician noted code number 24.
When clarifying the circumstances, it turned out that the reason is valid, that is, when calculating the sick leave, violations of the regime in it (child care) will not be taken into account:
- In total, the salary for 2016 and 2017 is 810 thousand rubles.
- Average daily earnings = (810,000 / 730 days) = 1,109.6 rubles.
- The seniority compensates for 60% of the salary: the amount of the benefit = 1109.6 rubles. x 60% = 665.7 rubles.
- According to the document of incapacity for work, the amount is: 665.7 rubles. x 14 = 9,320.6 rubles.
A sick-list with a mark of violation of the regime for an excusable reason is calculated using this formula:
Max. payout amount = (average monthly earnings for 12 months (n-2) + average monthly earnings for 12 months (n-1) / number of calendar days
Compensation in any case should be close to the minimum wage.
Consequences of Violations
Failure to comply with the rules of temporary disability threatens to reduce the payment for the relevant document from the date of its commission. The average earnings in the formula will be replaced by the minimum wage (multiplied by the coefficient of experience). It turns out the due payment. A period that is not in violation of the hospital regime and the consequences at work does not entail is paid in the appropriate manner.
Absenteeism in this case is the failure to appear on the planned day and time, which cannot be paid.
Is it possible to fire an employee who is on sick leave
Such actions of the head are unacceptable. Only if the employee leaves on his own initiative. These conditions are governed by the last paragraph of Article 81: "the dismissal of an employee on the initiative of the employer (...) during his temporary disability and during his vacation is not lawful."
There is an exception, he called the liquidation of the organization. In the case when an employee submits an application for termination of his own free will and suddenly becomes ill when he leaves for sick leave, termination of the contract during his or her temporary incapacity for work is possible. But there are some nuances.
Such sick leave is paid under general conditions in that situation if he was still employed by a working employee.
Conclusion
The unified rules and norms for the control of recovery of employees of various enterprises were created for timely payments and to help employers in respecting the honesty of their employees. Some directives are purely medical - this is the passage of treatment and related procedures, taking medications, and dieting. Other rules and regulations are needed to determine the exact and correct calculation of benefits.
Payment of sick leave with violations of the regime is regulated by the relevant standards and legislative acts. The causes of violations are divided into valid and non-relevant.
The consequence of the latter is a reduction in payments, the period under such circumstances is divided into the interval before and after non-compliance, which then add up. For good reason, an employee needs to provide a rationale.