Compulsory insurance against industrial accidents and occupational diseases: new since 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 on the basis of an 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 contract, 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.

How insurance funds are formed

In order to pay compensation to its employees, the insurance entity must create an insurance fund. The flow of these funds is reflected in the revenue and expenditure parts of the budget of the Social Insurance Fund of the Russian Federation.

These funds are federal property, and therefore cannot be withdrawn from the moment they are transferred to the budget.

Insurance funds are formed in the following way:

insurers pay insurance premiums on a mandatory basis;
violators are subject to fines and penalties, after which the funds are transferred to the fund;
upon liquidation of policyholders, capitalized funds are transferred to the fund;
receipts from other sources that do not contradict the legislation 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, an 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 cases established by Law No. 125-FZ. 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:

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).
Insurance payments:

one-time insurance payments to the insured or to persons entitled to receive such a 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 financial 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, the maximum amount of 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)) .

Please note: in areas where regional coefficients and percentage increases in wages are established, the size of the one-time insurance payment is determined taking into account these coefficients and allowances (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).

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, and payment for travel to receive certain types of medical and social rehabilitation. A complete list of additional costs is given in paragraphs. 3 p. 1 art. 8 of Law No. 125-FZ.

What the employer must do

Based on Art. 228 of the Labor Code of the Russian Federation, in case of accidents, the employer (his representative) is obliged to:

immediately organize first aid for the victim and, if necessary, transport him to a medical organization.

take immediate measures to prevent the development of an emergency or other emergency situation and the impact of traumatic factors on other persons.

until the investigation of the accident begins, preserve the situation as it was at the time of the incident, if this does not threaten the life and health of other persons and does not lead to a catastrophe, accident or other emergency circumstances, and if it is impossible to preserve it, record the current situation (draw up diagrams , take photographs or videos, and other events).

immediately inform the authorities and organizations specified in the Labor Code, other federal laws and other regulatory legal acts of the Russian Federation about the accident, and about a serious accident or fatal accident - also the relatives of the victim (in accordance with Article 228.1 of the Labor Code of the Russian Federation). *

take other necessary measures to organize and ensure a proper and timely investigation of the accident and registration of investigation materials in accordance with the Labor Code.

*Notification of a group accident (serious accident, fatal accident) is transmitted within 24 hours after the accident, by telephone, fax, telegraph and other available means of communication to the following authorities and organizations:

to the prosecutor's office at the scene of the accident.

to the executive body of a constituent entity of the Russian Federation and (or) local government body at the place of state registration of a legal entity or individual as an individual entrepreneur.

the employer who sent the employee with whom the accident occurred.

to the territorial body of the relevant federal executive body exercising state control (supervision) in the established field of activity, if the accident occurred in an organization or facility controlled by this body.

to the executive body of the Social Insurance Fund (at the place of registration of the employer as an insurer).

Forms of documents required for the investigation and recording of industrial accidents are available.
Please note: The procedure for the provision and list of benefits and other payments related to accidents and occupational diseases is regulated by Law 125-FZ of July 24, 1998.

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 the conclusion of the institution of the state medical and social examination service or treatment and preventive institutions of the state health care system, recognized as needing 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, 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.

Time frame for the investigation

In accordance with the requirements of Article 229.1 of the Labor Code of the Russian Federation, the investigation of an accident (including a group one), as a result of which one or more victims received minor health injuries, is carried out by the commission:

in three days.

The investigation of an accident (including a group one), as a result of which one or more victims received severe health injuries, or an accident (including a group one) with a fatal outcome is carried out by the commission:

within 15 days.

An accident that was not reported to the employer in a timely manner or as a result of which the victim’s disability did not occur immediately, is investigated in the manner established by the Labor Code of the Russian Federation, other regulatory legal acts of the Russian Federation, at the request of the victim or his authorized representative:

within one month from the date of receipt of the said application.

If it is necessary to conduct additional verification of the circumstances of the accident, obtain relevant medical and other conclusions, the periods specified in this article may be extended by the chairman of the commission, but not more than by 15 days.
If it is not possible to complete the investigation of an accident within the established time frame due to the need to consider its circumstances in organizations carrying out examinations, bodies of inquiry, investigative bodies or in court, then the decision to extend the period of investigation of the accident is made in agreement with these organizations, bodies or taking into account the decisions they have made.