Cause of disability 01 on sick leave - what does it mean how to pay in 2021

What are disability codes on sick leave?

This is the reason for the absence of a subordinate from the enterprise for a certain time. Each disease has a code indicated on the sick leave certificate. This type of encryption is required for many reasons.

Important: the employer does not have the right to ask a subordinate for a decoding of the disease codes indicated on the sick leave certificate, or for detailed explanations from him.

The diagnosis is displayed on the sick leave certificate using a code - to maintain medical confidentiality and unification

Codes can be two-digit - indicating the main cause of the ailment - and three-digit. The latter establish the employee’s need for special treatment/rehabilitation conditions, so they are used only when necessary.

The procedure for filling out and applying disease codes on sick leave is based on Order of the Ministry of Health of the Russian Federation No. 624n of 2011.

Decoding disease codes and other codes on the certificate of incapacity for work

Disease code in the bulletin

The coded cause of the disease is the same for all medical institutions issuing bulletins. The indicators are developed in accordance with international standards. When entering data on the diagnosis, the following applies:

1. Basic two-digit code represented by numbers from 01 to 15.
2. Additional three-digit code numbered from 017 to 021.
3. A clarifying two-digit code indicated when clarifying the diagnosis.

The cause of the disease, indicated by the code in the LN, is mainly contained in the first 2 digits. The rest of the coding is optional and is entered by the doctor if necessary. Information on decoding the codes is presented in Order of the Ministry of Health and Social Development of the Russian Federation dated June 29, 2011 No. 624n and on the back of the bulletin.

Important! Under code 02 in the LN the diagnosis “trauma” is encrypted, prescribed when receiving bodily injuries in everyday life.

Functions of disability codes

Codes have several functions, and protecting medical confidentiality is only one of them:

• optimization of accounting work - payments are calculated based on the numbers entered on the sheet;
• economical filling out of the form, without specifying long medical terms;
• filling out the sheet in accordance with international standards.

So, if the sickness form was opened abroad, the code indicated in it will be the carrier of one information in the territory of any country participating in international legal relations.

Decoding the main disability codes

Two-digit coding is the basic information about the reason for the employee’s absence; payments will be calculated for them and entries will be made in personnel documents. The breakdown of the diseases indicated on the sick leave is as follows.

Important: the last two points from the table are indicated only with the consent of the employee. If he does not want to provide the employer with information regarding the child’s special condition, no one has the right to insist.

Decoding additional disability codes

Additional ones include three-digit codes that are used to convey to the employer a more complete picture of the employee’s problems. They also play a significant role for the Social Insurance Fund.

Important: the role of additional codes is significant; thanks to their indication, the employer has a full picture of the employee’s problem, which can significantly increase payments. For example, the reason for disability code 05 020 indicates a complication during childbirth and provides a legally mandated increase in vacation pay.

If hospital code 05 is supplemented with code 020, this means that the established 70 days for pregnancy have increased:

• for 14 days in case of multiple pregnancy;
• for 16 days in case of complications during childbirth;
• for 40 days after birth for the birth of 2 or more children.

Cause of disability code 05 020 means complicated childbirth requiring longer recovery

There are two-digit codes indicating family ties. They are needed to identify the caregiver.

The “Other” category is supplemented with the following codes:

All stated disease codes and additions to them on sick leave are indicated by the attending physician. He must take responsibility for entering them, since not only he, but also the management of the medical institution will be responsible for incorrect information.

Disease codes in the document are filled out by a physician

What are the additional three-digit numbers and what do they mean?

Three-digit numerical values ​​are added to the main code “02”, which are also recorded in special cells on the sick leave sheet. Codes:

• «017» – treatment in a special medical institution.
• «019» – therapeutic treatment in rehabilitation clinics.
• «021» – release due to illness or injury caused while intoxicated (drugs, alcohol or toxic).

In the event that a two-digit code fully indicates why the employee was not present at the workplace, the additional three digits are not written. But if you need to indicate an additional one, the doctor enters it immediately after the main code.

How to pay for two sick days if the first is closed and the second is a continuation of the first?

There are situations when one sick leave has already been closed and the “Get to work” column is filled in, but the employee brings a new open sick leave, which is a continuation of the first one.

For example, if a woman spent 140 days at home during pregnancy and childbirth and closed her sick leave, but then brought a sheet with disability code 05 020, open for 16 days due to complications during childbirth.

In this case, the manager must be guided by Art. 255 of the Labor Code of the Russian Federation and calculate benefits according to the established social amounts.

In the example given, the medical institution initially prepared a sheet on pregnancy and childbirth. If complications occurred during labor, an additional sheet for 16 days was issued for the same insured event. The employer is obliged to pay these two sheets in total, taking as a basis the employee’s average daily earnings in the amount that existed before maternity leave.

Calculation of sick leave payment by codes

After completing the work sheet, the employee must submit it to the accounting department for calculation of payments.

Important: a payment will be made on the sheet if it is presented within 6 months from its closure. If you present the sheet even a day later, there will be no payment for sick days.

Management has 10 days to review it and calculate payments. The employee will receive the money on the next payday. The amount of payments will depend on the adopted system for calculating them and the codes indicated by the doctor in them.

In 2021, when making calculations, the accountant will take into account the following changes:

• The minimum wage for an insurance period of up to 6 months is set at 12,130 rubles;
• the calculation period will be 2021 and 2021;
• in 2021, the maximum base for calculating benefits has been increased to 1,680,000 rubles.

In addition, the number of days allocated by law for resolving health issues and recovery will be taken into account. For this purpose, the codes entered on sick leave certificates and their decoding are taken into account.

For example, for child care, code 12 is entered if the problem is from the special list, the child is under 7 years old, and the sick leave lasts no more than 90 days. But if he gets better at a dispensary, the doctor can indicate code 017, and the mother’s paid sick leave will be extended.

Calculation of sick leave payment by codes

After establishing the picture of the illness and studying the doctor’s records, the employer must indicate a code that is the basis for payments and indicating the features of their accrual.

How is a domestic injury paid?

When calculating the amount for sick leave, the following are taken into account:

• insurance experience;
• average earnings for the last two years;
• the number of sick days indicated on the sick leave form.

The bulletin is issued regardless of where the patient is being treated:

• outpatient;
• in a day hospital;
• in a hospital setting.

The number of days of incapacity for work is counted in calendar days, including weekends and holidays.

For minor injuries, sick leave is given for 3 days. Read about paying for sick leave for child care in this article.

The period for which a certificate of incapacity for work is opened in the event of a domestic injury has limitations, as with other diseases:

• over 15 days is extended by decision of the medical commission;
• if painful phenomena persist and there is no positive prognosis after 4 months, a medical and social examination is appointed to resolve the issue of disability;
• in some cases, the VKK may extend sick leave for a maximum period of up to 10 months.

Injury means the inability to perform specific job duties, which is taken into account when the patient is discharged.

For example, if an office worker has a cut on the left hand, sick leave will be issued for the period when daily dressing changes are required in a clinic. Final healing will take place at the workplace. If there is a similar wound on the right hand, which is the working hand, then the certificate of incapacity for work will be closed during the final adjustment. Find out about calculating temporary disability benefits here.

For injuries to the head, upper limbs, and torso, discharge occurs after removal of the sutures. Such decisions are not regulated by law. The attending physician accepts them based on the appropriateness and health status of the patient. You should also know that only a doctor can correct an error on a sick leave certificate.

If a domestic injury occurs during the employee’s regular vacation, then sick leave during the vacation is issued and paid on a general basis. The vacation period is extended by the number of days noted in the bulletin.

Diseases not related to domestic trauma

Code 02 is not entered if there is:

• exacerbation of a chronic disease;
• infectious infection;
• oncology;
• emergency surgery;
• planned operations.
• caring for a sick child or other family member;
• injury at work;
• isolation due to quarantine;
• childhood diseases.

The causes of disability listed above are coded 01, 03, 04, 07, 09, 10, 11, 12, 13, 14, 15.

Reasons for refusal to pay for sick leave

The main reason for refusal is the lack of a certificate of incapacity for work. In addition, there are several more justified reasons for completely refusing to pay for the period of illness:

• the employee took leave at his own expense, during which he fell ill;
• during the regular vacation period, the employee’s child fell ill;
• removal of an employee from performing duties without maintaining his salary;
• imprisonment of the employee, sickness benefits are not paid during this period;
• if the employee fell ill during the period of administrative arrest;
• if a forensic medical examination is carried out regarding the employee;
• when the illness occurred after the start of the plant’s downtime. If an employee has previously fallen ill and his illness continues during the period of inactivity, his sick leave is paid in full;
• Also, sick pay for caring for a relative may be denied if the employee has used more time than required by law.

In addition, the legislation identifies several points when an employee, in principle, cannot count on sick leave:

• when the employee intentionally committed a crime that resulted in illness;
• the employee deliberately inflicted serious injuries on himself.

Important: to justify the refusal to accrue benefits, a court decision is required, which will indicate the harmful intent of the subordinate.

Specialists working under a civil contract or without official registration are also deprived of payments.

Also, refusal to issue money will follow if:

• the employer will discover that the document is fake, is an old-style form, bears a fake seal and signature. For such fraud, the employer has the right to hold the employee accountable;
• the employer identified errors in filling out the sheet made by the doctor, for example, the name of the enterprise was incorrectly indicated or the diagnosis codes entered on the sick leave sheet diverged from the real picture. Errors must be corrected at the medical institution and until they are corrected, payments are not accrued.

If the employer made errors in filling out the form, the Social Insurance Fund may refuse payment.

Results

A sick leave certificate is a document on the basis of which the employer determines, firstly, the amount of compensation for the employee’s temporary disability, and secondly, the duration of paid sick leave. To do this, the various codes recorded on the certificate of incapacity for work are deciphered. When applying sick leave, the employer needs to take into account their correlation.

You will learn more about the peculiarities of using sick leave by employers from the articles:

• “Is sick leave (sick leave) subject to personal income tax?”;
• “Payment for sick leave to care for a sick relative”.

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

Reasons for reducing the amount of payment for sick leave

The manager has the right to reduce the amount of payments or pay only part of the period of illness. There are the following reasons for this:

• violation by the patient of the treatment period without good reason;
• the illness or injury was caused by alcohol or intoxication;
• the patient did not appear during the period of illness for medical procedures prescribed by the doctor or for an appointment with him.

These cases of violation of the treatment regimen lead to a reduction in payments. The employee will receive no more than the minimum monthly wage established by federal law. If the minimum wage is adjusted by local regulations, the payment will correspond to its size.

If the patient maliciously ignored the doctor’s orders, this may be indicated with the corresponding code on the sick leave, which will lead to a reduction in payments

Payment reductions will be made for certain periods of incapacity:

• if the patient violates the regime established by the doctor, the payment will be reduced by the number of days of violation;
• when the illness is a consequence of the employee’s improper condition, the payment can be canceled for the entire period of illness.

The following category of codes indicates a violation of the treatment prescribed by the doctor: