1. Mandatory social insurance in case of temporary disability and in connection with maternity, citizens are subject to Russian Federation, foreign citizens and stateless persons permanently or temporarily residing on the territory of the Russian Federation, as well as foreign citizens and stateless persons temporarily residing in the Russian Federation (with the exception of highly qualified specialists in accordance with the Federal “law” of July 25, 2002 N 115- Federal Law "On legal status foreign citizens In Russian federation"):

1) persons working under employment contracts, including heads of organizations who are the only participants (founders), members of organizations, owners of their property;

2) state civil servants, municipal employees;

3) persons holding government positions in the Russian Federation, government positions in a constituent entity of the Russian Federation, as well as municipal positions filled on a permanent basis;

4) members of a production cooperative who take personal labor participation in its activities;

5) clergy;

6) persons sentenced to imprisonment and involved in paid work.

2. Persons subject to compulsory social insurance in case of temporary disability and in connection with maternity in accordance with this Federal Law are insured persons.

3. Lawyers, individual entrepreneurs, members of peasant (farm) households, individuals, not recognized as individual entrepreneurs (notaries engaged in private practice, other persons engaged in private practice in accordance with the legislation of the Russian Federation), members of family (tribal) communities of indigenous peoples of the North, Siberia and the Far East of the Russian Federation are subject to compulsory social insurance in case of temporary disability and in connection with maternity if they voluntarily entered into a relationship under compulsory social insurance in case of temporary disability and in connection with maternity and pay for themselves insurance premiums in accordance with Article 4.5 of this Federal Law.

4. Insured persons have the right to receive insurance coverage subject to the conditions provided for by this Federal Law, as well as the Federal Law “On State Benefits for Citizens with Children” and the Federal Law “On Burial and Funeral Business”. Persons who voluntarily entered into a relationship under compulsory social insurance in case of temporary disability and in connection with maternity acquire the right to receive insurance coverage subject to payment of insurance premiums during the period determined by Article 4.5 of this Federal Law.

4.1. Foreign citizens and stateless persons temporarily staying in the Russian Federation (with the exception of highly qualified specialists in accordance with Federal Law of July 25, 2002 N 115-FZ “On the Legal Status of Foreign Citizens in the Russian Federation”) have the right to receive insurance coverage in in the form of temporary disability benefits, subject to payment of insurance premiums for them by the policyholders specified in “Part 1 of Article 2.1” of this Federal Law for a period of at least six months preceding the month in which the insured event occurred.

5. For the purposes of this Federal Law, persons working under employment contracts are persons who have concluded an employment contract in the prescribed manner from the day on which they were supposed to start work, as well as persons actually admitted to work in accordance with labor legislation.

6. Legislative and regulatory legal acts of the Russian Federation and constituent entities of the Russian Federation may establish other payments to provide federal civil servants, state civil servants of constituent entities of the Russian Federation in case of temporary disability and in connection with maternity, financed accordingly from funds federal budget, budgets of the constituent entities of the Russian Federation.

Types, volumes and conditions for providing employees with guarantees and compensation in these cases are determined by federal laws. The main law that regulates legal relations concerning the procedure for compensation for harm caused to the life and health of an employee during the performance of his duties under an employment contract is the Federal Law of July 24, 1998 No. 125-FZ “On compulsory social insurance against industrial accidents and occupational diseases” (hereinafter referred to as Law No. 125-FZ). In the article we will remind you who is subject to compulsory insurance against industrial accidents and occupational diseases, the types and amount of payments upon the occurrence of insured event, and also tell you about the changes that took effect from 01/01/2011.

Persons subject to compulsory social insurance.

Article 5 of Law No. 125-FZ states that individuals are subject to compulsory social insurance against industrial accidents and occupational diseases:

• performing work based on employment contract, concluded with the policyholder;
• those sentenced to imprisonment and recruited to work by the insurer;
• performing work on the basis of a civil contract - if, in accordance with the specified agreement The policyholder is obliged to pay insurance premiums to the insurer.

Law No. 125-FZ applies to citizens of the Russian Federation, foreign citizens and stateless persons, unless otherwise provided by federal laws or international treaties of the Russian Federation.

What is an insured event?

The right of the insured to insurance coverage arises from the date of the occurrence of the insured event (Clause 1, Article 7 of Law No. 125-FZ). An insured event is a fact of damage to the health of the insured person confirmed in the prescribed manner as a result of an accident at work or an occupational disease, which entails the insurer’s obligation to provide insurance coverage. So, accident at work is an event as a result of which the insured received injury or other damage to health during the performance of his duties under an employment contract and in other established by law No. 125-FZ cases. An employee may receive such injury:

• on the territory of the policyholder (organization);
• outside the territory or while traveling to the place of work or returning from the place of work on transport provided by the insured, and which entailed the need to transfer the employee to another job, temporary or permanent loss of professional ability to work, or his death. Occupational disease is a chronic or acute illness of an employee, resulting from exposure to a harmful production factor (factors) and resulting in temporary or permanent loss of professional ability to work.

Types of security in the event of an insured event.

In accordance with Art. 8 of Law No. 125-FZ, upon the occurrence of an insured event, the employee is paid:

1. A temporary disability benefit assigned in connection with an insured event and paid from funds for compulsory social insurance against industrial accidents and occupational diseases. This benefit is paid for the entire period of temporary disability of the insured until his recovery or permanent loss of professional ability to work is established in the amount of 100% of his average earnings, calculated in accordance with the legislation of the Russian Federation on temporary disability benefits (Article 9 of Law No. 125-FZ).
2. Insurance payments:

• one-time insurance payments the insured or persons entitled to receive such payment in the event of his death. The amount of payment is determined in accordance with the degree of loss of professional ability of the insured based on the maximum amount established by the federal law on the Social Insurance Fund budget for the next fiscal year. In the event of the death of the insured, the lump sum insurance payment is established in an amount equal to the specified maximum amount(Article 11 of Law No. 125-FZ). In 2011 maximum size such payment is 68,586 rubles. (clause 1, part 1, article 6 of the Federal Law of December 8, 2010 No. 334-FZ “On the budget of the Social Insurance Fund of the Russian Federation for 2011 and for the planning period of 2012 and 2013” ​​(hereinafter referred to as Law No. 334-FZ)) .

note: in areas where regional coefficients are established, percentage increases to wages, the amount of a one-time insurance payment is determined taking into account these coefficients and premiums (clause 2 of article 11 of Law No. 125-FZ).

• monthly insurance payments to the insured or persons entitled to receive such payments in the event of his death. The size of the payment is determined as a share of the average monthly earnings of the insured, calculated in accordance with the degree of loss of professional ability (Clause 1, Article 12 of Law No. 125-FZ). Innovation: from January 1, 2011, the concept of “earnings of the insured” appeared, introduced into Law No. 125-FZ by Federal Law of December 8, 2010 No. 348-FZ “On Amendments to the Federal Law “On Compulsory Social Insurance against Industrial Accidents and Occupational Diseases” "(hereinafter referred to as Law No. 348-FZ). The earnings of the insured should be understood as all types of payments and other remuneration (both at the main place of work and part-time) in favor of the insured, paid under employment and civil law contracts and included in the base for calculating insurance premiums in accordance with Art. 20.1 of Law No. 125-FZ. The conditions, amounts and procedure for payment of such expenses are determined by the Government of the Russian Federation (clause 2 of article 8 of Law No. 125-FZ).

1. Additional expenses associated with medical, social and professional rehabilitation of the insured in the presence of direct consequences of the insured event. Such expenses, for example, include the purchase of medicines, personal care medical products, payment for travel to receive individual species medical and social rehabilitation. Full list additional expenses given in paragraphs. 3 p. 1 art. 8 of Law No. 125-FZ.

Assignment and payment of compulsory medical insurance benefits.

In accordance with Art. 15 of Law No. 125-FZ, compulsory social insurance benefits are paid to the insured, his authorized representative or the person entitled to receive insurance payments.

Let us note that according to paragraph 1 of Art. 7 of Law No. 125-FZ, the following have the right to receive insurance payments in the event of the death of the insured as a result of an insured event:

• disabled persons who were dependent on the deceased or who had the right to receive maintenance from him on the day of his death;
• a child of the deceased born after his death;
• one of the parents, spouse or other family member, regardless of his ability to work, who does not work and is busy caring for the deceased’s dependent children, grandchildren, brothers and sisters who have not reached the age of 14 or, although they have reached the specified age, but upon conclusion of the institution civil service medical and social examination or treatment and preventive institutions state system health care recognized as requiring outside care for health reasons;
• persons who were dependent on the deceased and who became disabled within five years from the date of his death;
• one of the parents, spouse or other family member who is not working and is caring for the children, grandchildren, brothers and sisters of the deceased and who becomes disabled during the period of care, retains the right to receive insurance payments after the end of care for these persons. Dependency of minor children is assumed and does not require proof.

At the same time, paragraph 3 of Art. 7 of Law No. 125-FZ establishes some restrictions for persons who are entitled to receive insurance payments in the event of the death of the insured, namely they are paid:

• for minors - until they reach the age of 18;
• students over 18 years of age - until they graduate from full-time educational institutions, but not more than 23 years of age;
• women who have reached the age of 55 years and men who have reached the age of 60 years - for life;
• for disabled people - for the period of disability;
• one of the parents, spouse or other family member who is not working and is caring for the deceased’s dependent children, grandchildren, brothers and sisters - until they reach the age of 14 years or their health status changes.

According to paragraph 4 of Art. 15 of Law No. 125-FZ, in order to assign benefits for an insured event, the following documents (or copies of documents) must be provided to the insurer:

• application of the insured, his authorized representative or a person entitled to receive insurance payments;
• act on an industrial accident or occupational disease;
• a certificate of the average monthly earnings of the insured for the period chosen by him to calculate monthly insurance payments in accordance with Law No. 125-FZ;
• conclusion of a medical and social examination institution on the degree of loss of professional ability of the insured;
• conclusion of a medical and social examination institution on the necessary types of social, medical and professional rehabilitation of the insured;
• a civil contract providing for the payment of insurance premiums in favor of the insured, as well as a copy of the work record book or other document confirming that the victim is in an employment relationship with the insured;
• death certificate of the insured;
• a certificate from the housing maintenance authority, or in its absence from the local government authority, on the composition of the family of the deceased insured;
• notification of a medical institution about the establishment of a final diagnosis of an acute or chronic occupational disease (poisoning);
• conclusion of the center of occupational pathology on the presence of an occupational disease;
• a document confirming that one of the parents, spouse or other family member of the deceased, caring for children, grandchildren, brothers and sisters of the insured, who have not reached the age of 14 years or have reached the specified age, but according to the conclusion of a medical and social examination institution or a medical institution recognized as needing outside care for health reasons is not working;
• a certificate from an educational institution stating that a family member of the deceased insured person entitled to receive insurance payments is studying full-time at this educational institution;
• documents confirming the costs of carrying out, according to the conclusion of the medical and social examination institution, the social, medical and professional rehabilitation of the insured person, provided for in paragraphs. 3 p. 1 art. 8 of Law No. 125-FZ;
• conclusion of a medical and social examination institution on the connection between the death of the victim and an industrial accident or occupational disease;
• a document confirming the fact of being a dependent or establishing the right to receive maintenance;
• rehabilitation programs for the victim.

For each specific case, the list of documents (their certified copies) is determined by the insurer based on the list provided.

The object of taxation of insurance premiums and the basis for calculating insurance premiums.

As mentioned above, upon the occurrence of an insured event, the insured person is paid payments established by Art. 8 of Law No. 125-FZ, at the expense of the Social Insurance Fund. According to Art. 20 of Law No. 125-FZ, funds for making these payments are generated from:

• mandatory insurance contributions from policyholders;
• fines and penalties collected;
• capitalized payments received in the event of liquidation of policyholders;
• other income that does not contradict the legislation of the Russian Federation.

We are interested in mandatory insurance premiums from policyholders. From 01/01/2011, the insurance tariff is the insurance premium rate calculated based on the amounts of payments and other remunerations accrued in favor of the insured under employment contracts and civil contracts and included in the base for calculating insurance premiums in accordance with Art. 20.1 of Law No. 125-FZ (Article 3 of Law No. 125-FZ). Let us note that Art. 20.1 is new, it establishes the basis for calculating insurance premiums for compulsory insurance against industrial accidents and occupational diseases. According to paragraph 1 of this article, the object of taxation with insurance premiums is payments and other remuneration paid by policyholders in favor of the insured within the framework of labor relations and civil law contracts, if, in accordance with the civil law contract, the policyholder is obliged to pay insurance premiums to the insurer. In this case, the base for calculating insurance premiums is determined as the amount of payments and other remunerations provided for in paragraph 1, accrued by policyholders in favor of the insured, with the exception of the amounts specified in Art. 20.2 of Law No. 125-FZ.

In conclusion, we would like to remind you that until 2011, there was a List of payments for which insurance contributions to the Social Insurance Fund of the Russian Federation are not charged, approved by Decree of the Government of the Russian Federation dated July 7, 1999 No. 765. From 01/01/2011 this resolution has lost its power. From 01.01.2011 Law No. 348-FZ supplemented Law No. 125-FZ Art. 20.2, which names the amounts not subject to insurance premiums.

Soboleva E. A.,

Compulsory social insurance is a special system of measures established by the state aimed at providing social security to working citizens in the event of an unforeseen change in their financial situation due to disability.

Based on this, legislative norms have identified persons subject to compulsory social insurance who have the right to receive appropriate security in the event of an insured event specified by law.

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Basic provisions

As provided for in the regulations compulsory social insurance provisions, risks for compulsory social insurance in case of temporary disability are considered to be a short-term loss of earnings or a number of other payments by the insured entity due to the occurrence of an insured event.

The legislation establishes three fundamental characteristics of an insured event, namely:

• A duly verified fact of a health disorder.
• The victim must have the status of an insured subject.
• The presence of a direct connection between the fact of harm to health and the occurrence of an accident at work.

Failure of the incident to comply with any one of the listed points deprives the insured entity of the opportunity to receive the insurance compensation due to it.

The provisions set forth in Art. 2 of the Federal Law “On Compulsory Social Insurance” defines the subjects subject to compulsory social insurance, which include:

• Entities operating under labor contracts, including heads of companies who are the direct owners of the latter’s property.
• Subjects in the state civil service, as well as municipal employees.
• Subjects that are members of a production cooperative.
• Subjects with the status of clergy.
• Subjects sentenced to imprisonment, but at the same time involved in activities subject to payment.
• Lawyers and private practitioners.
• Individual entrepreneurs and participants farms.
• Participants of tribal communities of a few northern peoples who voluntarily entered into legal relations under social insurance.

Social insurance at work

The state also provides mandatory protection against various types of accidents that occur at work and against diseases of professional origin.

The fundamental principles and general objectives of all this are enshrined in the law “On compulsory social insurance against industrial accidents and occupational diseases.”

The standards set forth in Article 5 of the above-mentioned act define specific persons who are subject to mandatory social insurance against accidents, namely:

• Individuals working under a contract concluded with the insured.
• Individuals sentenced to imprisonment, however, at the same time brought to labor activity.
• Individuals carrying out labor activities under a civil law contract, if, according to the latter, the policyholder is obligated to make contributions to the Social Insurance Fund.

The policyholder here refers to the legal entity (individual) hiring the above-mentioned entities.

About social payments and support can be seen in the video:

Social insurance coverage

According to legislative standards, persons subject to compulsory social insurance at work have the right to receive appropriate social insurance benefits, namely:

• Benefits (from the Social Insurance Fund) for temporary disability paid due to an insured event.
• A one-time insurance payment for an insured event.
• Insurance payments (having a monthly frequency) to the injured subject.
• Payment of additional costs associated with medical and socio-professional rehabilitation of the insured subject.
• Reimbursement of lost earnings under a civil contract (which did not stipulate the employer’s obligation to pay insurance contributions) is carried out by the causer of harm.

It is quite obvious that the circle of persons who are subject to the provisions on compulsory social insurance is quite extensive.

Compulsory social insurance against industrial accidents and occupational diseases

After studying this section you will know:

• categories of persons subject to compulsory social insurance against industrial accidents and occupational diseases;
• how funds for compulsory social insurance are generated;
• what form of insurance coverage is provided;
• who administers payments to compensate for harm to victims at work;
• What is the employer's responsibility?

List of basic documents required when studying the section:

1. Labor Code Russian Federation dated December 30, 2001 No. 197-FZ.
2. Civil Code Russian Federation, Part I dated November 30, 1994 No. 51-FZ, Part II dated January 26, 1996 No. 14-FZ, Part III dated November 26, 2001 No. 146-FZ.
3. Code of the Russian Federation on administrative offenses dated December 30, 2001 No. 195-FZ.
4. Federal Law of July 24, 1998 No. 125-FZ. On compulsory social insurance against accidents at work and occupational diseases (as amended on November 28, 2009 No. 295-FZ).
5. Federal Law of July 16, 1999 No. 165-FZ. On the basics of compulsory social insurance. (with changes and additions)
6. Government Decree No. 713 dated December 1, 2005 “Rules for assigning species economic activity to occupational risk classes."
7. Decree of the Government of the Russian Federation of December 1, 2005 No. 713. On approval of the rules for classifying types of economic activities as professional risk.
8. Order of the Ministry of Health and Social Development of Russia dated January 10, 2006 No. 8. On approval of the classification of types of economic activities by occupational risk classes.
9. Decree of the Government of the Russian Federation of October 16, 2000 No. 789. On approval of the Rules for determining the degree of loss of professional ability to work as a result of industrial accidents and occupational diseases. (as amended by Government Decree No. 49 dated 01.02.2005; as amended by the definition Supreme Court RF dated 04/08/2003 No. CAS 03-132)
10. Decree of the Government of the Russian Federation of September 6, 2001 No. 652. On approval of the Rules for establishing discounts and allowances for insurers to insurance rates for compulsory social insurance against industrial accidents and occupational diseases. (as amended by Government Decree No. 207 dated April 11, 2005)

Related to this section:

Section 8.1 Investigation of industrial accidents.

Section 8.2 Investigation of occupational diseases.

The Federal Law on Compulsory Social Insurance establishes the legal, economic and organizational foundations compulsory social insurance against industrial accidents and occupational diseases, and also determines the procedure for compensation for harm caused to the life or health of an employee during the performance of his work duties.

BASIC CONCEPTS

Basic principles of compulsory social insurance against accidents at work and occupational diseases.

Mandatory social insurance against accidents at work and occupational diseases provides for:

• guarantee of the right of insured citizens to ensure payments for this species insurance;
• economic interest of insurance entities in improving working conditions and reducing occupational risk;
• mandatory registration as insurers of all persons hiring workers subject to compulsory social insurance against industrial accidents and occupational diseases;
• mandatory payment of insurance premiums by policyholders;
• differentiation of insurance rates depending on the class of professional risk.

PERSONS SUBJECT TO COMPULSORY SOCIAL INSURANCE

Persons performing work on the basis of an employment agreement (contract) concluded with the insured.

Persons sentenced to imprisonment and recruited to work by the insurer.

Persons performing work on the basis of a civil contract, if in accordance with the contract the policyholder is obliged to pay insurance premiums to the insurer.

In the category of compulsory social insurance, there are several categories of citizens who may qualify for financial support from the Social Insurance Fund in the event of an insured event.

In relation to them, conditions have been developed regulating the procedure for paying insurance premiums, receiving compensation and their amounts. Also state regulations The categories of such persons themselves are also defined.

Who determines the classification of persons subject to compulsory insurance?

List of persons who can and should be insured under the federal social program, compiled and established on state level. These lists may be modified depending on resolutions adopted by the Duma, annual allocations from the budget reserve and amendments to federal laws.

The compilation of such a list is based on the priorities of preserving the health of the nation, in respect of which the federal social insurance program operates. In addition, the circumstances accompanying the work activities of different categories of insured persons, the degree of occupational hazard for individual professional groups, as well as social circumstances and requirements for civil liability are taken into account.

Groups of persons required to obtain insurance

There is a clear classification of individual social groups subject to compulsory insurance within the framework of the activities of the social insurance fund. They make up main list compiled taking into account the type of social insurance:

• Payment of benefits for health reasons;
• Financial support for disability;
• Grants for temporary unemployment;
• Insurance for temporary disability.

This list also includes maternity benefits, auto liability, financial risks, insurance for members of large families.

Which categories of citizens are subject to this?

• Government officials holding high positions;
• Persons holding positions in municipal government bodies;
• Municipal and civil servants;
• Clergymen of various religious denominations registered in the country;
• Persons deprived of liberty by a sentence of judicial authorities and participating in public and production work with actual wages;
• Foreign citizens working in domestic institutions and organizations, subject to the payment of contributions by the policyholder in their favor;
• Employees of manufacturing, commercial enterprises and the service sector working under employment contracts;
• Women who are at any stage of pregnancy before childbirth, as well as after the birth of a child;
• Persons without status individual entrepreneur, but conducting licensed private activities. This category includes, in particular, notaries, lawyers;
• Founders, managers and employees of private farms;
• Persons carrying out their activities within the framework of individual entrepreneurship;
• Persons working in government and commercial institutions on a full-time basis and for whom the employer pays regular insurance premiums.

In this category of persons subject to compulsory insurance, not only the insured person has the right to compensation from. In the event of his complete loss of ability to work or in the event of his death, the beneficiaries may be members of his family or immediate relatives. Dependents who are supported by the insured person in the event of his death can also claim benefits.

A sum of money is also paid to children under the age of majority if the insured person was one of their parents. If the insured's children continue to receive higher education, then they have the right to apply for benefits until the completion of the training process.

Types of financial support for these individuals

At the state level, a practical scheme of financial support for those insured has been developed. mandatory individuals and members of their families. Get financial support they can in one of the proposed formats: in the form of a one-time insurance payment, in the form lump sum benefit upon loss of ability to work during the period of recovery of health. Payments are also made in the form of regular benefits in the event of disability and complete loss of health.

In some cases, the fund pays benefits aimed at covering additional costs associated with undergoing treatment or staying in health resort-type institutions. This may be payment of expenses associated with necessary medical, social or professional rehabilitation after treatment or due to the occurrence of other insured events.

The Social Insurance Fund may make decisions to refuse payments of various categories of benefits. Such restrictive measures are taken to prevent unreasonable payments and limit the abuse of the fund’s funds for personal gain. In addition, there are entire categories of citizens who, for various reasons, simply do not have the right to FSS funds.

For example, no types of benefits will be accrued to persons who have only recently arrived on the territory of the Russian Federation in order to obtain citizenship, but who do not have Russian citizenship at the time of filing the application.

Also, don't count on social payments for those who do not have insurance certificates and their own SNILS insurance account numbers. Typically, each citizen is assigned such a number and issued a certificate compulsory insurance. However, this rule does not apply to some categories of residents of the country. For example, in some religious movements it is not customary to use assigned SNILS numbers And identification numbers. Accordingly, such citizens cannot qualify for insurance payments under compulsory insurance.

Compulsory social insurance funds are not paid to persons who work unofficially individual categories payments - in connection with injuries during production processes, illnesses. This also includes those workers who conduct unregistered private activities.

Since the listed categories of citizens will not be able to qualify for social benefits, they will also not be able to become subjects of the social insurance system - they will be denied this.

In some cases, the social insurance fund may refuse to pay benefits even to some insured persons. Insurance payments will not be made in cases where selfish motives are clearly visible in the actions of the insured person. For example, a person who intentionally caused injury or injury to himself, or otherwise imitated an insured event in order to receive an insurance payment, will be deprived of disability or illness benefits.

The category of persons who do not have the right to claim benefits due to loss of ability to work also includes those who undergo rehabilitation procedures or compulsory treatment by a court verdict.

Restrictions can also be used for bureaucratic reasons. This is especially true in situations where one or more of necessary documents were filed incorrectly or were submitted after the expiration of the established period.