Sick leave with code 04, what should an employer do

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”.

Current form of sick note	Lines for entering codes by a doctor	The line where the code “04” is written
Sick leave form	Cells for codes	Code line

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:

“Cause of disability” (always indicated; when it changes, the corresponding code is written next to it in the “code change” cell).
“Family Relationship” (recorded when a ballot is issued in connection with caring for an ill family member).
“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).
“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.

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Labor law establishes the payment of compensation to workers injured at work. The employer reimburses:

unearned income of a citizen due to sick leave;

additional expenses for medical, professional or social rehabilitation.

In the event that the employer pays all insurance contributions to the Social Insurance Fund, the authorities reimburse all payments. The calculation of payments is regulated by the Federal Law “On Compulsory Social Insurance against Accidents”. Unearned income is reimbursed to the victim in the amount of the average salary for the entire period of incapacity for work.

The one-time insurance payment is calculated based on his average earnings, regional coefficients and premiums established in the given area. The maximum amount, according to Art. 11 of this law is 94,018 rubles. This amount is compensation for medical, social and professional rehabilitation.

The maximum monthly payment is calculated based on the share of average monthly earnings and the degree of disability. Average monthly earnings are calculated as follows:

ZPsr = ZPtotal / 12, where

ZPtot - the total amount of earnings for 12 months (salary itself, bonuses) before the accident occurred.

How is an injury at work paid in Russia in 2021?

After all the necessary documentation has been reviewed, the employer undertakes the obligation to determine compensation payments to the victims.

We recommend reading: Law on silence Orenburg

In the event of the death of an employee, documents are submitted for him by close relatives, who will receive money in the future.

The basis for calculating the required compensation payments is the generated Protocol. Without exception, all issues that are directly related to an industrial injury are regulated by such basic regulatory documents as: Sets out in detail the rules for calculating and processing financial compensation payments by the direct employer to employees who have received an industrial injury for various reasons; Federal Law No. 125 (in particular, Article 5) Imposes an obligation on each employee to obtain the required social insurance for the fact of a possible work-related injury

Common mistakes and questions

Is sick leave social benefit with code 04 subject to insurance contributions? Is personal income tax withheld? In accordance with Art. 422 of the Tax Code of the Russian Federation, the amounts established for the payment of compensation in the event of harm or other damage to health are not subject to an insurance premium. However, the entire amount of sick leave with this code is subject to income tax.
What is the difference between compensation for a domestic injury and a work-related injury? Domestic injuries include all those received by an employee outside of work. That is, at home or while on vacation. In such cases, an internal investigation is not carried out by the organization.
Can the amount of benefits for a work injury be reduced? If the injured employee violates the regime established by his attending physician, the amount of the benefit may be reduced to the minimum wage for a calendar month. This reduction in size is established from the day the violation is noted until the end of the sick leave.

What does this mean and in what cases is a ballot issued with this encoding?

The coding of the causes of disability is established in accordance with the order of the Ministry of Health and Social Development No. 624n . What does code “04” mean on a sick leave certificate? It means that a patient receives an injury or illness as a result of an accident that happened to him while performing his job duties or on instructions from the head of the organization. Work-related injuries also include those that occur to an employee:

while traveling to or from work (on work transport or personal transport used for production purposes under an employment contract);
on a business trip or back (by public or official transport);
during work breaks and rest between shifts when working on a rotational basis;
when performing other actions established by the employment contract.

To injuries and diseases received during work, in accordance with Art. 227 of the Labor Code of the Russian Federation, include:

injuries received as a result of an industrial emergency (building collapse, exposure to the elements, fire, explosion, etc.);
injuries caused by machinery or other workers/other persons;
heat strokes and burns;
frostbite;
injuries from electrical or radiation exposure, lightning strikes;
bites and injuries caused by fauna and flora (insect bites, poisonous effects of plants, etc.).

Possible liability and consequences for the employer

If the commission determines that the employer violated the standards established by SanPin, workers were not properly instructed on industrial safety. For violation of regulatory requirements for labor protection, the employer (Article 5.27.1 of the Code of Administrative Offenses of the Russian Federation) faces a fine (for an employer - an individual from 2 to 5 tr, for legal entities - from 50 to 80 tr).

The fine will increase with the severity of the violations committed by the employer. If the injury suffered by an employee results in serious harm to health, this will entail much more serious liability. The employer faces imprisonment for up to 1 year with or without deprivation of the right to engage in certain activities for the same period (Part 1 of Article 143 of the Criminal Code of the Russian Federation).

The reasons for incapacity for work are entered on the sick leave sheet in encrypted code form. Read our articles about how the period of incapacity for work is paid if the sick leave contains codes 01, 02, 31, 09 11, 05 and 020, 36, and 32 in the “Other” column.

An employee being injured on the job can pose serious problems for the employer. Only if the employer correctly instructs employees and provides them with safe working conditions will he not be subject to sanctions from the labor inspectorate. If an accident occurs, the employer must make every effort to thoroughly investigate the causes of the incident and organize compensation for harm caused to the employee.

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Special payment cases

Often in practice there are situations that differ from the standard ones.

For example, an employee, when visiting a doctor, could miss the date of appearance for a medical examination, as a result of which the doctor will put a note on the sick leave in the appropriate field. This will have an impact on subsequent benefit calculations:

if the failure to appear at the doctor’s office was for an unexcused reason, the amount of benefits due from the date of violation of the regime is calculated based on the minimum wage;
however, if the reason was valid (for example, the employee was busy caring for a sick child), the accountant has the right to pay for such sick leave according to the general rules, without reducing the amount of benefits.

When calculating maternity sick leave, there are also some nuances:

the benefit amount is paid from the first day of maternity leave at the expense of the Social Insurance Fund;
When calculating the average daily payment, excluded periods are subtracted from the total number of calendar days for the previous two years, i.e. days of illness of the insured person.

According to clause 5 of Art. 6 Federal Law No. 255-FZ of December 29, 2006, there are restrictions on the number of paid sick days for care, which depend on the age of the child and the cause of disability. For example, an employee has already cared for a minor between seven and fifteen years of age for 40 days in the current year.

And again provides sick leave for a period of 8 days. It is legally established that an employee can use 45 days a year while on sick leave with such a child. In this case, only 5 calendar days are subject to payment, since the limit has already been exceeded.

Disease codes on sick leave certificates

A sick leave certificate is the main document indicating that an employee has suffered an illness or been injured. Based on this document, insurance payments are calculated to the employee. In order for an accountant to correctly calculate their size, it is necessary to know the sick leave codes and their interpretation. In particular, disability codes on sick leave.

The sick leave form is approved by Order of the Ministry of Health and Social Development of the Russian Federation dated April 26, 2011 No. 347n. The same document approves disease codes. The procedure for storing and providing forms is regulated by special instructions approved by Orders of the Federal Social Insurance Fund of the Russian Federation No. 18, the Ministry of Health of the Russian Federation No. 29 dated January 29, 2004.

Code "12"

Code “03” If the reasons for the violations are considered 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.

Sick leave with the code “03” is issued for the quarantine period to persons in need of temporary isolation. Today, many such leaflets are issued to persons who have arrived from abroad, or have had contact with patients with coronavirus infection, relatives living with them, etc. New rules, valid until July 1, 2020, allowed the issuance of quarantine certificates by electronic application, based on attached scans of documents confirming the need for self-isolation. For employed persons over 65 years of age, for the period from April 6 to April 19 and from April 20 to April 30, 2021, sick leave is also issued without a personal application, according to the employer’s register sent to the Social Insurance Fund.

Cause of disability codes on sick leave: decoding

The cause of disability code on the sick leave is indicated in a special field consisting of two cells. Their values range from 01 to 15. The form has three cells for specifying an additional code. It is intended to clarify the causes of injury or illness and some other details. Their values range from 017 to 021.

Let's look at the most common values, and the remaining codes for the reasons for disability on the new sick leave can be seen on the sample back of this form.

Example 1. When the injury received by an employee is not work-related

Example 2. Calculation of sick leave for a domestic injury As evidenced by the example from the FSS letter No. 14-03-18/15-12956 dated October 28, 2011, these include only individual technical shortcomings, 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.

Reason for disability “09” is entered on the sick leave if an ill relative needs care. At the same time, the “Relationship” fields are filled in, indicating who exactly is caring for the patient. The number of paid days depends on the age of the sick relative:

“Unfortunate” sick leave: we count and pay

The article from the magazine "MAIN BOOK" is current as of May 6, 2021.

Contents of magazine No. 10 for 2021 M.A. Kokurina, lawyer

How to calculate and pay sick leave for a work injury

Disability benefits due to a work injury are special. For example, it is paid in full and from the first day from the funds of the Social Insurance Fund. 1, 7 tbsp. 15 of Law No. 125-FZ of July 24, 1998 (hereinafter referred to as Law No. 125-FZ); clause 9 of the Rules, approved. Government Decree No. 184 dated March 2, 2000. Therefore, the accountant needs to carefully consider its calculation and execution. After all, an incorrect amount or undocumented payment of benefits for a work injury can lead to a dispute, for example:

<or>with the Social Insurance Fund - due to its refusal to reimburse the amount of benefits from the Fundap budget. 3 tbsp. 22 of Law No. 125-FZ; pp. 5, 10 Rules, approved. Government Decree No. 184 dated March 2, 2000;
<or>with an employee - due to underpayment of benefits for an industrial injury.

How is sick leave issued for a work injury?

Payment for sick leave in case of injury at work is carried out only with proper documentary confirmation of the fact of the accident. And this is done at the expense of insurance funds for industrial injuries, i.e. at the expense of “accident” contributions.

An employee's receipt of a work-related injury is certified by:

1. A certificate of incapacity for work, in which:

there is code 04 in the column “Cause of disability”;

For more information about the possible meanings of codes for sick leave, read the article “What do disability codes mean on sick leave?”

the date of drawing up the accident report in Form N-1 is reflected.

2. Act N-1, the form of which was approved by Decree of the Ministry of Labor of Russia dated October 24, 2002 No. 73.

The entire amount of payments made by the employer is compensated by the Social Insurance Fund (Clause 7, Article 15 of the Law “On Compulsory Accident Insurance” dated July 24, 1998 No. 125-FZ). This is the difference between the procedure for paying benefits for an industrial injury and sick leave for a common illness (when the Social Insurance Fund reimburses the employer’s expenses only from the 4th day of the employee’s incapacity for work).

We accept sick leave from an employee

To ensure you pay benefits reasonably, carefully look at:

what date is indicated in the line of the certificate of incapacity for work “Get to work” h. 1 tbsp. 6 of Law No. 255-FZ of December 29, 2006 (hereinafter referred to as Law No. 255-FZ). For example, if the code is “32,” then this is the day the disability was established. In this case, it happens that an employee who has become disabled brings sick leave later than 6 months from the date of its end. 1 tbsp. 12 of Law No. 255-FZ. In such a situation, you do not have to pay benefits; the Social Insurance Fund will do this at the request of a late employee. 3 tbsp. 12 of Law No. 255-FZ;
whether the cause of disability is correctly indicated. For sick leave benefits, the code must be “04”. It happens that an employee seeks medical help on his own, informs the doctor simply about the injury, and he puts the code “02” on the sick leave - a domestic injury. If you have already recorded an emergency at work, and they brought you sick leave with the wrong code, ask the employee to contact a medical organization. Let him show there a copy of the report on the industrial accident (form N-1) so that the doctor can complete the sick leave. He will write down the required code “04” in the “measuring code” cell of the sheet.

If you did not find any design errors on the sick leave, then in the line “Act of form N-1” indicate the day, month and year of drawing up the act based on the results of your investigation of the production ChPabz. 19 clause 66 of the Procedure, approved. By Order of the Ministry of Health and Social Development dated June 29, 2011 No. 624n.

Having taken sick leave, you must:

calculate and accrue benefits no later than 10 calendar days from the date the employee contacts you with a certificate of incapacity for work. 5 tbsp. 13, part 1 art. 15 of Law No. 255-FZ;
pay the benefit on the next day after the payment is issued. 1 tbsp. 15 of Law No. 255-FZ.

ADVICE

If you find any errors in the certificate of incapacity for work, then it is better to justify why you refused to accept sick leave from an employee injured at work.

You can compose, for example:

<or>a statement that, due to errors in the sick leave, you returned it to the employee to receive a duplicate. Let two witnesses and the employee himself sign the act;
<or>written notification to the employee of the need to obtain a duplicate certificate of incapacity for work.

General information and procedure for registration according to the Labor Code of the Russian Federation

The issuance of sick leave is regulated by Order of the Ministry of Health and Social Development of the Russian Federation No. 624n dated June 29, 2011. The day you apply for medical care will be the date the sick leave is issued.

After examining the patient and determining the diagnosis, the doctor sets the period for which the employee is released from work. Currently, during outpatient treatment, according to clause 11 of Order No. 624n, the doctor can decide and issue sick leave for 15 calendar days.

If it is necessary to release the patient from work beyond the established restrictions, the chairman of the medical commission signs the certificate of incapacity for work.

It is worth noting the categories of persons for whom a certificate of incapacity for work is not issued. Such exceptions include:

women caring for young children under 3 years of age;
employees working under a GPC agreement;
employees on leave without pay;
women on maternity leave.

A sick leave certificate is drawn up on a universal form, which is filled out by the medical institution, as well as by the employer. When issuing a sick leave certificate, the health worker does not indicate the diagnosis, but enters a numeric code on the form in the appropriate cell in the line “Cause of disability.”

Calculating injury benefits

STEP 1. Determine the billing period.

These are 2 calendar years preceding the year in which the person was on sick leave. 1 tbsp. 14 Law No. 255-FZ; Art. 3 of Law No. 125-FZ:

<if>an employee received an injury and sick leave for it in 2016, then you take payments for 2014 and 2015;
<if>an employee was injured in 2015, and brought you sick leave in 2021, then you take his earnings for 2013-2014. By the way, these same years must be taken for calculation if the employee went on sick leave in 2015, and the report in form N-1 was drawn up in 2021. This is possible, for example, when the employer learns about the work-related nature of the injury only on the day the recovered employee leaves to work with sick leave, which indicates the code “04”, and the investigation of the industrial accident is carried out later than it happened.

At the request of an employee who was on parental leave or maternity leave during the pay period, you can replace one or both years of the pay period with the year(s) immediately preceding such leave. 1 tbsp. 14 Law No. 255-FZ; Letters of the Ministry of Labor dated December 9, 2015 No. 17-1/OOG-1755; FSS dated November 30, 2015 No. 02-09-11/15-23247.

STEP 2. Determine the employee’s earnings for the billing period.

SITUATION 1. The employee worked for 2 calendar years preceding the year the insured event occurred, and his earnings are known. Then take all amounts paid to the employee for the specified period, from which insurance premiums for “accident” insurance were paid. This may include payments from your company, as well as payments from previous employers.

Let us remind you that earnings for calculating benefits for a work injury are not limited to a maximum amount. That is, when calculating, you need to take the entire amount of payments to the employee (unlike calculating benefits for ordinary illness, where payments cannot exceed 624,000 rubles for 2014, and 670,000 rubles for 2015. Part 4, Article 8 Law of July 24, 2009 No. 212-FZ; Government Decrees of November 30, 2013 No. 1101, of December 4, 2014 No. 1316).

By the way, look at what amounts of earnings are indicated in paragraph 3 of the salary certificate at the previous place of work for the 2 previous calendar years, Appendix 1 to Order of the Ministry of Labor dated April 30, 2013 No. 182n; Part 5 Art. 13 of Law No. 255-FZ from an employee who came to you recently. If there are maximum amounts for the base for insurance premiums (for 2014 - 624,000 rubles, for 2015 - 670,000 rubles), then this may mean that his salary was higher. Therefore, ask the employee to submit an application to the former employer with a request to issue a salary certificate indicating: “The certificate is required to calculate temporary disability benefits due to an industrial accident.”

SITUATION 2. The employee did not work for 2 calendar years preceding the year the insured event occurred. Then, to calculate the benefit, earnings are taken in the amount of the minimum wage established on the day of the onset of temporary disability for 24 months. 1.1 art. 14 Law No. 255-FZ; clause 11(1) of the Regulations, approved. Government Decree No. 375 dated June 15, 2007.

SITUATION 3. The employee earned an amount less than 24 times the minimum wage or his earnings are not known for all 2 calendar years. Then, to calculate, you need to take the amount that is greater. Letter from the Social Insurance Fund dated March 11, 2011 No. 14-03-18/05-2129:

<or>the employee’s earnings known to you. 2.1 Art. 15, part 1.1 art. 14 Law No. 255-FZ;
<or>24 minimum wage.

If the employee subsequently brings a salary certificate from his previous place of work for the previous 2 calendar years. 3 hours 2 tbsp. 4.1, part 5 art. 13 of Law No. 255-FZ; Appendix 1 to Order of the Ministry of Labor dated April 30, 2013 No. 182n, then the amount of the benefit will have to be recalculated based on the earnings that have become known.

STEP 4. Determine the amount of daily allowance.

One of the features of the work injury benefit is that its amount is not affected by the length of the victim’s work experience. That is, sick leave for an injury is paid in the amount of 100% of the average earnings of the injured employee, even if his work experience is less than 6 months. 1 tbsp. 9 of Law No. 125-FZ. That's why:

STEP 5. We compare the amount of the employee’s daily allowance with the amount of the maximum allowable daily allowance.

That is, the maximum allowable daily allowance since February 2016:

The employee's average daily earnings for a particular month cannot exceed the maximum allowable daily benefit.

STEP 6. Determine the amount of the benefit.

We calculate the amount of benefits that an employee is entitled to during illness. 5 tbsp. 14 of Law No. 255-FZ:

<if the average daily allowance of an employee in any month does not exceed the maximum allowable, then according to the formula:

<if>the average daily allowance of an employee is greater than the maximum allowable amount in at least one of the months, then according to the formulas:

If the employee’s average daily earnings are greater than the maximum allowable amount in all months of illness, then also calculate the benefit for each month of incapacity for work depending on the number of days of sick leave in a particular month, and then sum up the resulting values.

For example, a deputy director with an average daily salary above the maximum allowable amount was injured at work. You were on sick leave from February 25 to March 15, 2021. You must:

Payment of benefits directly from the Social Insurance Fund

; (hereinafter referred to as the Regulations.

due to an accident at work):

temporary disability benefit due to an industrial injury (in connection with an industrial accident or occupational disease) starting from the 1st day;
monthly child care allowance;
a one-time benefit for women registered with medical institutions in the early stages of pregnancy;
payment of leave to an employee injured at work (in addition to the annual paid leave established by the legislation of the Russian Federation), for the entire period of treatment and travel to and from the place of treatment.
maternity benefits;
lump sum benefit for the birth of a child;
temporary disability benefits due to illness starting from the 4th day;

The employer does not accrue or pay these types of benefits to its employees. Their calculation and payment is handled directly by the territorial body of the Social Insurance Fund.

Cause of disability 04 on sick leave - what does it mean to pay the employer in 2021

“Family connection” (recorded when a bulletin is issued in connection with caring for a sick family member). “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). “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 an industrial injury is encrypted. Read also the article: →.According to legislative norms, the code “04” is entered directly by the doctor if an accident occurred during work or a professional injury aggravated

Taking into account the allowance

By the amount of benefits paid to the injured employee in connection with an industrial emergency, you reduce contributions to the Social Insurance Fund “for injuries.” If this amount exceeds the contributions, then contact the Social Insurance Fund for reimbursement of the difference. 7 tbsp. 15 of Law No. 125-FZ.

Injury benefits paid to the victim cannot be taken into account as expenses for income tax purposes. 252, sub. 48.1 clause 1 art. 264 Tax Code of the Russian Federation. And the money reimbursed from the Social Insurance Fund for the payment of benefits does not need to be taken into account in income. 250 Tax Code of the Russian Federation.

***

If you learned about an industrial accident only when the employee brought in his sick leave with code “04,” it means that the company has not yet conducted an investigation, there is no investigation report or materials confirming the industrial nature of the injury.

However, you are required to pay the victim temporary disability benefits. First, you will have to pay and spend sick leave as for a domestic injury, taking into account the length of service of the victim. And when, based on the results of an internal investigation, a report on an industrial accident is drawn up, then it is necessary to accrue and pay additional benefits based on 100% of the employee’s average earnings.

After this, you can submit an updated calculation for the period in which you suffered a domestic injury.

Topic: Sick leave with code 04 (accident at work)

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