Types of industrial injuries. My husband died while intoxicated: is the case covered by insurance? Accident statistics

From this article you will learn: Is it issued? sick leave to an employee who is injured in a condition alcohol intoxication?

How is sick leave pay calculated for alcohol intoxication?

How is sick leave paid?

Paying sick leave is one of the employer's responsibilities to reimburse employees for expenses. It manifests itself in the form of a special benefit when on sick leave in accordance with the Labor Code of the Russian Federation. An employee who was undergoing treatment and was absent from work because of this provides his employer with sick leave and receives the payments due to him.

Don't miss: the main article of the month from a practical expert What to do if an employee brings in sick leave with errors. But it is not uncommon for employees to go on sick leave or be injured at work while intoxicated. Such cases have some of their own characteristics, which we will consider below in order to know whether it is necessary to register and pay

sick leave

in such situations.

maximum size

In normal situations, the determination of the benefit amount is influenced by such factors as the employee’s length of service, the amount of his average earnings and the duration of sick leave. As is known, for calculations it is used simple formula, according to which the amount of the daily benefit is equal to the average earnings per day. If the employee has worked for more than eight years, the benefit is one hundred percent of the amount according to the formula; if he has worked for more than five but less than eight, then eighty percent; if less than five years, then sixty percent.

In cases of alcohol intoxication, everything is a little more complicated, since there is an aggravating circumstance that, regardless of length of service and merit, deprives the employee of the right to a 100% payment according to the formula.

It is also worth noting that legal acts the order of cause-and-effect relationship between drinking is not regulated alcoholic drinks and injury or illness. For this reason, if there is a note about intoxication on the sick leave, the decision to pay or deprive it remains with the policyholder - he studies the individual characteristics of each case. All documents must be taken into account, for example, certificates from medical institutions, materials from the police, traffic police, and so on. In addition, according to the letter of the Social Insurance Fund dated April 15, 2004 No. 02-10/07-1843, the explanations of the employee himself are also taken into account.

Having studied all the factors, the policyholder may decide that there is no reason to reduce the payment and will pay in full. In this case, the FSS of the Russian Federation may not accept the specified amount, then the policyholder can challenge the decision in arbitration court. If the proceedings go to court, then, according to the first paragraph of the sixty-fifth article of the Arbitration Procedure Code of the Russian Federation, it is the FSS that will be obliged to prove the existence of grounds for reducing the payment.

How is sick leave paid?

Every employee is required to receive payment sick leave for thirty days from the first day of illness. In most cases, sick leave is paid on payday, and the item on the payslip is sick pay.

In any case, sick leave must be paid in in full for the period during which the illness occurred. For this reason, sick leave must be closed on the day the employee returns to full working capacity and fully returns to work.

In situations where during sick leave employee receives the status of a disabled person, according to current legislation he must receive benefits for four consecutive months or five in a calendar year. If an employee falls ill with tuberculosis, then compensation is paid until a disability group is issued.

A slightly different approach is implied for those who care for their relatives. In such situations, if a short-term employment contract– up to six months, and the employee was absent during the period of its validity, the period of stay on paid sick leave is limited to 75 days.

Attached files

Sick leave(form).xls
Sick leave (fragment). Purpose sick leave benefit based on the minimum wage (sample).doc

Available to subscribers only

Sick leave (fragment). Assignment of sick leave benefits based on the minimum wage (form).doc
Sick leave (fragment). The employee's insurance experience is more than eight years (sample).doc

Answer:

In accordance with clause 3, part 1, part 2 of Art. 8 of the Federal Law of December 29, 2006 N 255-FZ “On Mandatory social insurance in case of temporary disability and in connection with maternity", if the illness or injury occurred as a result of alcohol intoxication, in this case the benefit is paid in an amount not exceeding the minimum wage for a full calendar month.

Order of the Ministry of Health and Social Development of Russia dated August 1, 2007 N 514 approved the Issuance Procedure medical organizations certificates of incapacity for work. IN this Procedure There are no provisions that would determine the procedure for the doctor to include notes on the state of alcohol intoxication on the certificate of incapacity for work.

The form of the certificate of incapacity for work is approved by Order of the Ministry of Health and Social Development of Russia dated March 16, 2007 N 172 “On approval of the form of the certificate of incapacity for work,” which does not provide a special field for noting alcohol intoxication. However, if the employee presented a certificate of incapacity for work, in which a note about alcohol intoxication was made, the cause-and-effect relationship between the disease or injury that resulted in temporary disability and intoxication should be determined.

For example, a cause-and-effect relationship between injury and intoxication exists if an employee drove a car while intoxicated, caused an accident and was injured. If an intoxicated employee was a passenger in a car, got into an accident and was injured, in this case there is no cause-and-effect relationship between the injury and intoxication.

In accordance with the Decision Supreme Court RF dated March 27, 2002 N GKPI02-311, a causal connection between a disease or injury resulting in temporary disability and intoxication can be established on the basis of a medical report given in compliance with the appropriate procedure, or by conducting an investigation by authorized bodies.

The standard regulation on the commission (authorized) for social insurance, approved by the FSS of the Russian Federation on July 15, 1994 N 556a, establishes that for the implementation practical work for social insurance at an enterprise, institution, organization, a commission is formed or a social insurance commissioner is elected.

In accordance with clause 3.1 Model provision The social insurance commission has the right to take part in the investigation by the enterprise administration of the circumstances of accidents at work, at home, on the way to or from work, etc.

The Letter of the Federal Social Insurance Fund of the Russian Federation dated April 15, 2004 N 02-10/07-1843 explains that the procedure for establishing a cause-and-effect relationship between alcohol consumption and injury or illness is not regulated by current regulations. In this regard, if the certificate of incapacity for work contains a note about the fact of intoxication, the decision to pay temporary disability benefits is made by the insured in each specific case based on the actual circumstances, taking into account all available documents (certificates medical institutions, materials from the police, state traffic police, etc.), as well as explanations from the victim.

If the social insurance commission (or a representative) determines that there is no cause-and-effect relationship between the injury (illness) and the state of intoxication. In this case, sick leave can be paid by the employer in full.

According to data announced by the Chief Narcologist of the Ministry of Health of the Russian Federation, Evgeniy Brun, up to 30% of Russians abuse alcohol. They go to work just like other citizens and their salaries are paid in full. insurance premiums to the Social Insurance Fund. But because of the provisions of our legislation, people who abuse alcohol are sometimes paid sick leave only within the minimum wage. However, if you delve into regulations, it turns out that this is often done unreasonably.

Drank - go to work!

Drunken citizens darken the life of the situation Clause 3 Part 1 Art. 8 of Federal Law No. 255-FZ of December 29, 2006 “On compulsory social insurance in case of temporary disability and in connection with maternity” (hereinafter referred to as Law No. 255-FZ). It is established there that the grounds for reducing the amount of temporary disability benefits to the minimum wage are illness or injury resulting from alcohol, drug, toxic intoxication or actions related to such intoxication.

However, this wording means that the basis for reducing temporary disability benefits is precisely the illness or injury that occurred as a result of alcohol intoxication, but not the fact that the person was intoxicated when he received the injury and was admitted to a medical institution.

A causal link between illness or injury resulting in temporary disability and intoxication may be established on the basis of a medical report issued in accordance with the appropriate procedure or through an investigation authorized bodies(decision of the Supreme Court of the Russian Federation dated March 27, 2002 N GKPI 02-311 N GKPI 02-311).
According to Letter of the Federal Social Insurance Fund of the Russian Federation dated April 15, 2004 N 02-10/07-1843, if there is a mark on the certificate of incapacity regarding the fact of intoxication, the decision to pay or deprive the employee of temporary disability benefits is made by the insured in each specific case based on the actual circumstances, taking into account all available documents (certificates from medical institutions, materials from the police, state traffic inspectorate, etc.), as well as explanations from the victim.
AS PO in Resolution dated 09/08/2015 N A12-42798/2014 decided that the cause-and-effect relationship between alcohol intoxication and injury was confirmed by the accident investigation report and the conclusion of the medical institution that the victim was intoxicated. According to the investigation, the incident was classified as an accident not related to production. As a result, the court found justified the refusal of the FSS to accept for offset the excessively paid 147,531 rubles to the victim.

The situation would look completely different if the injury were considered work-related.

In this case, temporary disability benefits are paid in accordance with Federal Law No. 125-FZ of July 24, 1998 “On compulsory social insurance against industrial accidents and occupational diseases” (hereinafter referred to as Law No. 125-FZ).

Law No. 255-FZ does not apply to relations related to the provision of citizens with temporary disability benefits in connection with an industrial accident or occupational disease(Part 2 of Article 1 of Law No. 255-FZ). Odako in part 2 art. 1 of Law No. 255-FZ lists the articles that should still be applied when calculating benefits for temporary disability resulting from an industrial accident or occupational disease.

In this list, Article 8 of Law No. 255-FZ is not named. Consequently, reduce the amount of benefits even if there are grounds listed in Art. 8 of Law No. 255-FZ, the employer has no right. In other words, if in the above case the injury were recognized as work-related, then the benefit would have to be paid in full.

They also beat me for no reason

A drunken employee of LLC A.. was beaten by unidentified persons, as a result of which he was incapacitated for 84 days. The LLC paid him benefits from the minimum wage, citing the fact that F. did not provide evidence of the absence of a cause-and-effect relationship between alcohol intoxication and bodily harm. The presented decisions to initiate a criminal case against unidentified persons who caused the damage, and the decisions to recognize the victim only confirm the receipt of bodily injuries as a result of being intoxicated.

The FSS department supported the actions of the LLC, stating that the LLC commission did not establish a cause-and-effect relationship for the injury received.

However, the court found that from the materials of the criminal case it follows that citizen Z. was discovered who committed intentional infliction moderate severity harm to health A.

The magistrate dismissed the criminal case and criminal prosecution in relation to Z. in connection with the reconciliation of the parties.
The regulations on the LLC commission stipulate that it has the right to conduct checks on the correctness of the assignment and payment of social insurance benefits as own initiative, and according to statements (complaints) of employees.
A meeting of the commission on the fact of A.’s bodily injury was not held, because he did not apply to the commission.
However, the court found that due to the fact that the injury was received by A. as a result of beatings by a person unknown at the time of the injury, he informed the employer by providing documents.

Khamatova Reseda(09/13/2014 at 15:07:25)

Most likely, it is wrong (unless alcohol intoxication caused the death of your husband).

It is a mistake to believe that if the victim was intoxicated, then the accident is non-productive, and payments for health purposes are not made. This is not entirely true. The fact is that, in accordance with clause 23 of Regulation No. 73, the following may be classified as not related to production:
- death due to a general illness or suicide, confirmed by a health care institution and investigative authorities;
- death or other damage to health, the sole cause of which was alcohol, narcotic or other toxic intoxication (poisoning) of the employee (according to the conclusion of the health care institution);
- an accident that occurred when the victim performed actions qualified law enforcement agencies as a criminal offense.

This list is exhaustive and, as emphasized in the Letter of the Federal Tax Service of the Russian Federation dated 02.02.2006 N 02-18/06-921, is not subject to expanded interpretation. In particular, as an explanation to clause 23 of Regulation No. 73, the Letter considers the following case: if an employee was injured (or died) as a result bodily injury received as a result of a sudden deterioration in his health during an attack of epilepsy (for example, when falling on a flat surface or when there is a difference in height levels, from contact blows when colliding with moving and stationary objects, parts and machines during an attack, etc.), it seems , that the accident must be qualified as production-related and documented in Act N-1, regardless of the totality of the causes of the accident established by the commission. A report in form N-1 is not issued only in cases where the only cause of death of the employee was a general illness confirmed by a health care institution.

Of course, a medical institution’s conclusion that an employee is intoxicated seriously complicates the investigation procedure and decision-making on payments. IN controversial situations the victim (his representative) may go to court to protect his interests.

Sometimes enterprises or branches of the Social Insurance Fund themselves come forward with claims in such cases. Among the judicial acts there are some that are positive for the victims (Resolutions of the Federal Antimonopoly Service of Ukraine dated September 22, 2005 N F09-4225/05-S1, dated September 22, 2005 N F09-4221/05-S1, dated August 24, 2005 N F09-3600/05-S1 ), and negative (for example, Resolution of the Federal Antimonopoly Service UO dated 01.11.2006 N F09-4671/06-S7).

Let's look at one of the judicial acts in more detail. The territorial branch of the FSS appealed to the invalid investigation documents of an industrial accident drawn up by members of a commission consisting of representatives of the state labor inspectorate and the enterprise. This time, an accident was investigated that occurred with a security guard during his duty shift while protecting the organization’s territory and resulted in his death. The commission conducted an investigation into the accident at work, and in paragraph 9 of the act of form N-1, the cause of the accident was stated to be the lack of proper control over labor discipline on the part of the head of the security service.
According to an extract from the forensic medical examination report, the death of the security guard was caused by carbon monoxide poisoning, and it was established that the victim was intoxicated at the time of death.
Believing that the fact that the employee was intoxicated was the only cause of the accident that led to his death, which, by virtue of Art. 230 of the Labor Code of the Russian Federation eliminates the need to draw up an act in form N-1, the FSS appealed to the court with a demand to recognize the above-mentioned acts drawn up by the organization and the state labor inspectorate as invalid. These documents, in the opinion of the Foundation, oblige it to unreasonably spend public funds to pay benefits to family members of the victim.

The judges refused to satisfy the Fund's stated demands, since the accident investigation materials confirmed that the immediate cause of the security guard's death was carbon monoxide poisoning. Since the FSS department did not provide evidence of a cause-and-effect relationship between the deceased being in a state of alcoholic intoxication and his death, the court ruled that drawing up an act of form N-1 complies with the requirements of the law and does not oblige the Fund to misuse public funds (Resolution of the Federal Antimonopoly Service of Ukraine dated September 22, 2005 N F09-4225/05-S1).

One of our employees was injured while drunk - in work time. The commission decided that it was an industrial accident. But is it possible to recognize a work-related injury if it was received in a state of severe intoxication? It is hardly correct in our situation to draw up a report of an accident at work.

In accordance with Art. 227 Labor Code RF (hereinafter referred to as the Labor Code of the Russian Federation) Accidents that occur with employees and other persons involved in the work are subject to investigation and recording. production activities, when performing their job duties or performing any work, as well as when performing other lawful actions, conditioned labor relations with the employer or committed in his interests.

Issues of qualification of industrial accidents were also considered in the Resolution of the Plenum of the Supreme Court of the Russian Federation dated March 10, 2011 No. 2 “On the application by courts of legislation on compulsory social insurance against industrial accidents and occupational diseases” (hereinafter referred to as Resolution No. 2 of March 10, 2011).

What additional payment can a personnel officer claim?

The court explained that in order to correctly qualify an event that resulted in harm to the life or health of a citizen, it is necessary to examine the following legally significant circumstances in each specific case:

whether the victim is one of the persons participating in the employer’s production activities;
whether the event that occurred is indicated in the list of events qualified as accidents;
Do the circumstances (time, place and others) accompanying this event correspond to the circumstances specified in Part 3 of Art. 227 Labor Code of the Russian Federation;
whether an accident occurred at work with a person subject to compulsory social insurance against accidents at work and occupational diseases;
whether there were circumstances in which the accidents could be qualified as not related to production.

KEEP IN MIND

The decision whether an injury is an industrial accident or not is made by a commission or government inspector labor who independently conducted the investigation

Thus, if an employee is injured at work, this does not mean that he or she has had an accident at work. It all depends on the specific circumstances and reasons for the injury.

In particular, an injury is not recognized as an industrial accident if its sole cause was the employee’s alcohol, drug or other toxic intoxication, not related to violations technological process, which uses technical alcohols, aromatic, narcotic and other toxic substances (Part 6 of Article 229 2 of the Labor Code of the Russian Federation).

That is, the state of intoxication in itself does not indicate non-productive nature injuries.

IN otherwise The law would have explicitly stated that health injuries sustained by an employee while under the influence of alcohol or other intoxication are not considered industrial accidents. It says otherwise.

Thus, the presence of alcohol in the victim’s blood is not a decisive argument for classifying his injury as domestic. Of fundamental importance is whether the injury was sustained under the influence of alcohol or for other reasons independent of the worker’s condition.

IMPORTANT!

When investigating every accident, it is first necessary to obtain an explanation from the victim, if this is, of course, possible.

EXAMPLE

By prescription State Inspectorate labor, the employer was obliged to draw up a report of an accident at work.

The employer admitted that the employee was injured, but did not agree with the order and went to court.

It turned out that the employee was injured as a result of falling from a chair. And the only reason for such a fall was alcohol intoxication - according to a medical report, the alcohol content in the victim’s blood at the time of hospitalization was 2 ppm, which corresponds to a severe degree of intoxication.

Thus, the court came to the conclusion that the employee’s injury was solely of a domestic nature and there was no reason to consider it an industrial accident (cm. appellate ruling Arkhangelsk regional court dated July 18, 2013 in case No. 33-4181/2013).

Here is a reverse example: the injury was recognized as an industrial accident, despite the fact that the employee was intoxicated at the time of its receipt.

Example

During night duty at railway the worker was hit by a diesel locomotive.

The commission came to the conclusion that the accident was the fault of the victim himself, who grossly violated safety requirements on the railway tracks: being intoxicated, he walked towards the diesel locomotive, not paying attention to the signals it gave.

The worker, on the contrary, claimed that he was hit by a diesel locomotive due to the lack of light signaling and loudspeakers on the tracks.

The court put an end to this dispute, finding no evidence of the employee’s guilt in what happened. Regarding alcohol intoxication, the court explained that it was not the only cause of the injury, and therefore cannot be considered as a basis for recognizing the accident as not related to production (see the appeal ruling of the Irkutsk Regional Court dated October 4, 2012 in case No. 33-8058/2012).

Please note: a decision to refuse to recognize an injury as an industrial accident can only be made if there is an appropriate medical report confirming that the employee was intoxicated at the time of the injury.

Only testimonies, acts and official memos in in this case won't be enough.

IT IS FORBIDDEN!

Dismiss an employee for showing up to work while intoxicated while he is temporarily disabled.

For comparison: to dismiss such an employee for a one-time gross violation of labor duties, medical examination is not required, since in sub. “b” clause 6, part 1, art. 81 Labor Code of the Russian Federation medical report not mentioned.

Even the Plenum of the Supreme Court of the Russian Federation came to this conclusion, indicating that when an employee is dismissed, the state of intoxication can be confirmed both by a medical report and other types of evidence (clause 42 of the resolution of the Plenum of the Supreme Court of the Russian Federation dated March 17, 2004 No. 2 “On the application by courts Russian Federation Labor Code of the Russian Federation").

But, let us repeat, if we are talking about an accident, the employer needs a medical report: it proves that the injury was sustained by the employee while intoxicated.

Moreover, literally according to the law, it turns out that the conclusion must already indicate: the injury occurred due to intoxication.

But still, the main purpose of this document is to confirm the employee’s alcohol intoxication at the time of injury. If the case goes to court, issues of causality between the victim’s intoxication and his injury will be resolved taking into account all the circumstances and the evidence available in the case (Clause 10 of the Resolution No. 2 dated March 10, 2011).

There is one more important point that is worth paying attention to.

By law, an employer does not have the right to allow employees who are intoxicated to perform their job duties. According to Art. 76 of the Labor Code of the Russian Federation they are suspended from work without preservation wages for the entire period until the circumstances that required intervention are eliminated, that is, until they sober up.

But the reality is that this requirement The law is not always observed, although it is provided for in the interests of the employer, since in itself it is designed to minimize the risk of accidents in the territory under its control.

What does the employer risk in such a situation?

Firstly, he may be held accountable for violating labor legislation (Article 76 of the Labor Code of the Russian Federation).

NOT FORGET!

Immediately remove the drunk employee from work.

Secondly, if some kind of trouble suddenly happens to an employee at the workplace, the employer will be blamed, since he should have promptly removed the drunken employee.

That is, an injury sustained while intoxicated will be considered an industrial accident.

EXAMPLE

An intoxicated employee was found at work with serious injuries.

The employer tried to justify himself, claiming that the victim, being intoxicated, ignored his verbal demand to stop work and continued to perform job responsibilities on their own initiative. Therefore, the employer should not be held liable for an accident that occurs to him.

But the court was not satisfied with such explanations. The employer knew that the employee was drunk and should have done everything in his power to prevent him from working. However, the actual suspension did not occur and this resulted in the injury.

Taking into account the employer’s inaction, the court concluded that the victim’s injury was an industrial accident, although it was sustained while intoxicated (see definition of Perm regional court dated 05/04/2011 in case No. 33-4299).

To be fair, it must be said that management does not always know that one of the employees has been drinking at work or has already arrived drunk. If they drink in a group, it is, as a rule, secret from their superiors. And after drinking, they don’t confess, because they understand perfectly well that they can be fired for such things.

And if the employer proves that he did not know about the employee’s condition and that was the only reason he did not suspend him from work, most likely he will not be held accountable. An injury received by an employee will not be recognized as an industrial accident if it is established that it was caused by the fault of the victim himself - due to alcohol intoxication.

However, all of the above does not negate the employer’s obligation to monitor employees’ compliance with labor discipline, as well as to create for them safe conditions labor.

YOU SHOULD KNOW THIS It is important for a worker to have his injury recognized as an industrial accident. The amount of temporary disability benefits depends on this, as well as the possibility of receiving other payments related to the injury.
Thus, Article 184 of the Labor Code of the Russian Federation directly establishes that in the event of damage to health or in the event of the death of an employee as a result of an accident at work or an occupational disease, he or his family is compensated for lost earnings (income), as well as additional medical and social expenses associated with damage to health. and vocational rehabilitation or related death expenses.
The types, volumes and conditions for the provision of such guarantees and compensation are determined by federal laws.
First, about temporary disability benefits. According to paragraph 1 of Art. 9 of Federal Law No. 125-FZ of July 24, 1998 “On compulsory social insurance against industrial accidents and occupational diseases” (hereinafter referred to as Law No. 125-FZ) temporary disability benefits due to an industrial accident or occupational disease are paid for the entire period of temporary disability of the employee until his recovery or permanent loss of professional ability is established in the amount of 100% of his average earnings.
In addition, in accordance with paragraph 1 of Art. 10 of Law No. 125-FZ, in the event of loss of professional ability to work based on the conclusion of a medical and social examination, the employee has the right to receive one-time and monthly insurance payments.
Additional expenses associated with medical, social and professional rehabilitation are reimbursed on the basis of sub-clause. 3 p. 1 art. 8 of Law No. 125-FZ.
But, as already mentioned, the employee is entitled to all this only if it is established that the injury was received as a result of an industrial accident.
If the only cause of injury was alcohol, drug or other toxic intoxication, only temporary disability benefits will be paid, and even then in a reduced amount.
According to Part 2 of Art. 8 of the Federal Law of December 29, 2006 No. 255-FZ “On compulsory social insurance in case of temporary disability and in connection with maternity”, temporary disability benefits will be paid to such an employee in an amount not exceeding for a full calendar month minimum size wages established federal law, and in areas and localities where they are used regional coefficients, - not exceeding the minimum wage, taking into account these coefficients, for the entire period of temporary disability.

Summary

If an employee is injured while intoxicated, it may be considered an industrial accident unless the injury is related to intoxication.