The inability to work or perform other normal activities is called a disability. Due to an injury or illness, a person cannot lead a normal life, provide for himself and his family. We figure out who is entitled to a sick leave in such a situation and how to independently protect yourself from disability with the help of insurance.
What is disability
Disability is the inability to carry out a professional activity. This definition is used by personnel officers. In a broader sense, the concept is used not only in professional, but also in everyday life. A disabled person cannot carry out his usual activities without outside help. For example, to perform simple household activities, to serve yourself.
Disability can be caused by various reasons. In a professional sense, these include not only injuries or illnesses. Even a healthy person will become disabled if he needs to look after relatives. A simple example is parents who cannot work because their child is ill.
In a state of illness, people cannot work. And it’s not always about a common cold. Due to some diseases, it is impossible to perform professional duties for months. This is a dangerous situation for the financial well-being of the family. Especially if you need to take care not only of yourself, but also of children or elderly relatives. Officially employed people can count on benefits, but these funds are usually not enough to pay for treatment or rehabilitation.
Types of disability
If a person is unable to work for medical reasons, doctors determine the severity of their condition. For this, an examination of temporary disability is carried out. Only medical institutions with a special license can organize it. Usually these are public hospitals and clinics, but private medical centers also conduct an examination if they have permission.
Examination of temporary disability is an assessment of the patient’s state of health. Usually this is a standard medical examination, through which all patients go through. Its purpose is not only to determine the tactics of treatment, but also to find out the severity of the condition. Based on this, the nature of the disability will be clear:
- temporary loss. The patient will be able to return to their usual activities after recovery. Temporary loss of working capacity can be complete when professional activity is impossible. Or partial, when it is allowed to perform work in a smaller volume or with restrictions.
- Persistent loss. This means that a complete cure is not possible. This situation leads to disability, and additional medical and social expertise is required to determine its degree.
An examination of temporary disability is necessary so that the patient can receive social insurance payments or other benefits from the state. If a person was treated on his own and did not go to the doctor, it will be impossible to prove the fact of the disease. Accordingly, no compensation can be obtained. For the correct registration of the sick leave, you must contact a medical institution.
Who is eligible for paid sick leave?
If a person is sick and cannot perform his work duties, he is entitled to an allowance for the duration of the illness. To receive it, a sick leave is issued. The official name of this document is “temporary disability certificate”. Not everyone can get it. To do this, the patient must belong to one of the categories:
- employees under an employment contract;
- civil servants and municipal employees;
- employees of a production cooperative;
- registered unemployed.
These categories are subject to compulsory social insurance. Employers pay contributions for them, thanks to which you can receive benefits in case of illness. Also, some categories of citizens can voluntarily pay contributions to the FSS and also qualify for compensation in case of illness. These include:
- individual entrepreneurs;
- heads of peasant farms;
- Foreign citizens.
These people are not required to make social security contributions and do not normally receive sickness compensation. The allowance will be assigned only if the person voluntarily paid the due amounts in the years preceding the disease. From 2023, benefits can also be received by those working under a civil law contract (GPA), if the employer made contributions for them.
Thus, sick leave is issued only to persons who have made social insurance contributions (either independently or through an employer). If a person is not officially employed and is not registered with the employment service, he is not entitled to benefits. The only exception is for those who fall ill within 30 days of being fired from their previous job. They receive payment from their former employer.
Sick leave is issued by medical institutions with a special license that allows examination of temporary disability. This may be a public hospital, clinic or private medical center. The position of the employee also matters. It is allowed to issue a disability certificate to a doctor, paramedic or dentist.
To receive disability benefits, you need to apply for a sick leave in accordance with all the rules. If this is not done, the payment will not be assigned. For example, in case of injury or illness, it is not enough to call an ambulance. Its employees cannot issue sick leave. It is necessary to contact a licensed medical institution, issue a certificate of incapacity for work, and then transfer its data to the employer.
In what cases sick leave
Sick leave under social insurance can be obtained not only in case of illness. The law provides for different situations in which a person is temporarily disabled:
- pregnancy, abortion, IVF procedure;
- caring for a sick family member;
- adoption of a newborn child;
- prosthetics in a hospital;
- aftercare in a sanatorium;
- quarantine, including for disabled family members.
In some cases, the sick leave will not be paid, even if the employee has become disabled. For example, when he inflicted injuries on himself or received them at the time of the crime. Also, they do not pay for periods of examinations or one-time medical procedures, ordinary rest in a sanatorium, treatment in the direction of the military registration and enlistment office.
Sick leave is paid for the entire period of incapacity for work until the employee begins his duties or disability is established. This is a general rule, but in some cases there are restrictions on the maximum period. For example, temporary disability due to illness of a child under 7 is paid up to 60 days a year in total. But if the child is disabled, then the disability certificate is paid up to 120 days per year. You can be treated in a sanatorium for no more than 24 days. There is no maximum length of time for inpatient treatment.
The first three days of sick leave are paid by the employer. He will transfer the amount on the date of the next salary or advance payment. The rest will be calculated and paid by the Social Insurance Fund. Since 2023, it has merged with the Pension Fund and is now called the Social Fund of Russia (SFR).
sick leave payment rules
The amount of the disability benefit depends on the insurance period. This is the total time of a person’s activity, during which he was subject to compulsory insurance. This includes not only work under an employment contract, but also military service, state and municipal service, activity in the status of an individual entrepreneur (if voluntary contributions were paid).
All sick leave payment rules are regulated by the law on compulsory social insurance. The employee is entitled to temporary disability benefits depending on the length of service:
- less than 6 months – the minimum wage is used to calculate the sick leave;
- less than 5 years – 60% of the average salary;
- from 5 to 8 years – 80% of the average salary;
- more than 8 years – 100% of the average salary.
The average salary is calculated for the last two years. Only official payments are taken into account: wages, bonuses, vacation pay. If part of the amount was transferred “in an envelope”, it will not be accepted for calculation. All payments for two years are summed up and divided by 730 days. This is how the average daily earnings for sick leave are calculated.
The state also sets the maximum and minimum amount of temporary disability benefits. Sick leave payments must be within the limits:
- At least the minimum wage for a full month of sick leave. For the calculation, the minimum wage is used, taking into account the regional coefficient, if any.
- No more than the maximum average daily amount. In 2023, this is 2,736.99 rubles. At any salary, daily payments cannot exceed this limit.
In some cases, the amount of temporary disability benefits is reduced. If an employee is injured while intoxicated, violates the regime or does not show up for an examination, payments will be calculated based on the minimum wage.
Other payments from the state
A permanent disability is a disability in which a person is limited in their abilities. If such health problems are detected, a medical and social examination is appointed, which determines the degree of disability. There are three of them, and the first one is the most difficult. Disabled people receive a pension from the state, as well as some benefits. For example, partial compensation for payment of housing and communal services and property taxes.
There are two types of disability pension:
- Social. Appointed from the moment the disability is established, including for children.
- Insurance. Appointed in the presence of any insurance experience. That is, it is due to those who worked officially, even if for a short time. The circumstances and reasons for the onset of disability do not matter.
The amount of the pension depends on the group of disability. The amounts are also regularly indexed. For example, in 2023, the amount of the disability insurance pension is as follows:
- for group 1 – 15,423.50 rubles;
- for group 2 — 7,711.75 rubles;
- for group 3 – 3,855.88 rubles.
Also, the amount of the insurance pension is affected by the number of dependents, the region of residence, whether the disabled person currently has a job and the total length of insurance.
If a working person is seriously injured or seriously ill, he will receive a disability insurance pension from the state. As you can see from the numbers above, its size is not too large. In case of disability of the first group, when it is impossible to continue working, the compensation will be 15,423.50 rubles. monthly. It is very difficult to live on this money. In addition, people with disabilities need medicines and rehabilitation procedures, and not all of them can be obtained free of charge under compulsory medical insurance. That is why many people also take out additional insurance. Sickness benefits will help cover all expenses and maintain a normal standard of living.
Why insure yourself
Compulsory social insurance of employees guarantees them the payment of sick leaves. But these benefits do not cover the cost of treatment and rehabilitation, especially if the illness is long-term. Many categories of citizens generally cannot count on assistance from the state in case of illness. In the absence of official employment, compensations are not paid during periods of temporary disability, and in a difficult situation, one can only rely on the help of relatives or one’s own savings.
Voluntary insurance is a good option for financial protection in case of illness. Many companies understand this and insure their employees against accidents themselves. Then, in addition to the sick leave, employees receive a payment under the policy, which can be spent on treatment or other purposes. If there is no corporate insurance program at the enterprise or a person does not work, he can issue a policy on his own. To protect against disability, the following options are suitable:
- Disability insurance. Payments are made upon the onset of a disease, due to which a person received a disability of 1, 2 or 3 groups.
- Accident insurance. Compensation is paid for various injuries and diseases: fractures, burns, frostbite and other insured events.
- Cumulative insurance. A program for those who want to gradually accumulate a certain amount. A person regularly deposits funds into the account, and in the event of an insured event, he receives compensation. Upon the death of the insured, the company will pay the entire amount that it was planned to accumulate.
- Investment insurance. Extra income program. The insurance company invests money and pays the profit to the insured. At the same time, the safety of funds is guaranteed. Additionally, there is life insurance coverage.
You can issue a policy not only for yourself, but also for family members: spouses, children or parents. Working people also have access to a tax deduction for long-term insurance programs (from 5 years). You can return up to 13% of the amount of contributions annually.
Anyone can apply for a policy. The presence of official work and experience do not affect the amount of payments. The insured himself chooses the amount he wants to receive in case of temporary disability. You can also include additional risks in the program, depending on your lifestyle. For example, there are special policies for the duration of sports competitions or travel.
Everyone needs financial protection during temporary disability. But in some cases it becomes critical:
- If a person provides not only himself, but also other family members. Children and elderly relatives will not be left without a livelihood if the main breadwinner cannot work.
- If there are no relatives who will help in a difficult situation. The bank will not issue a loan for treatment to a disabled person, so there is a high probability of being without funds.
- If there is no official employment and the employer does not pay sick leave in case of illness.
- If there is no financial airbag that will cover the unexpected costs of treatment and recovery.
- If a person works in hazardous conditions or has an injury-prone hobby.
The incapacity for work can be long-term, and the payment of the sick leave will not cover all the expenses of the family. In this case, insurance payments will help maintain the usual standard of living, no matter what happens.
How to get paid on a policy
To receive a payment, you need to contact the insurance company in which the policy is issued. You will need to provide the following documents:
- application for reimbursement;
- a copy of the policy;
- documents confirming the occurrence of an insured event (an extract from a medical card, a certificate from a doctor or other papers issued in a medical institution).
In the Renaissance Life insurance company, you can submit documents online, on the website or in the application. Specialists will consider the appeal, determine the amount of compensation and transfer it to the specified details. The insured himself decides how to spend the received funds. You can pay for treatment, rehabilitation, or just the family’s current expenses. You do not need to submit any reports to the insurance company.