Violation of the sick leave regime - how it is paid, marks and codes

Hello! In this article we will talk about violation of the sick leave regime with the appropriate marks.

Today you will learn:

1. What applies to such violations;
2. How their code designation is deciphered;
3. How to calculate payment for sick leave with violations.

Sick leave is not a vacation; it has its own regime and strict rules. Violations of sick leave are very rare in practice, but every employer should know how such a situation will affect the amount of sick leave benefits for the employee.

What is a violation of hospital regulations?

If a person’s health condition does not allow him to go to work, then he needs to go to the hospital. This is done so that the employer does not have questions in the future regarding where his employee was during working hours.

Important: it does not matter which medical institution - private or public - a person goes to. The main thing is that this clinic has a license to issue documents on temporary disability.

After the diagnosis, the doctor prescribes the necessary therapy for the patient and opens a sick leave. It is on the basis of this document that benefits are subsequently assigned.

Payment of sick leave before and after July 1, 2020

One of the main conditions for receiving this payment is compliance with the treatment regimen. You cannot ignore a doctor’s orders, as this may be regarded as a violation and become a strong argument in favor of reducing sick pay.

What are the consequences for the employee?

However, if the employer knows that the employee violated the work rules established by the doctor, but this is not noted on the temporary disability certificate, then he has no right to reduce the benefit. The fact is that, according to labor legislation, the subject of the contract between the organization and the employee is exclusively labor relations.

Only a doctor can monitor compliance with the treatment regimen.

Read more about the consequences at work if sick leave is violated here.

Reasons for violation

May be intentional, or occur as a result of force majeure situations.
The result of this action will directly depend on the motives that prompted the employee to violate the treatment regimen. An employee who has ignored medical orders must present an explanatory note to the employer. It is advisable that the person has documents confirming the impossibility of doing otherwise in this situation. Valid reasons for non-compliance will be considered:

• emergencies;
• inability to perform official duties for 6 months or longer;
• deterioration of health;
• change of place of residence (moving);
• death of a loved one.

Other circumstances will be considered insignificant and will become the basis for reducing the amount of the benefit.

Attention: the sick leave certificate most often reflects only a few main disrespectful reasons. For example, missed doctor's appointments, non-compliance with prescriptions. The presence of these marks in the statement will become the basis for reducing the amount of payment for “authorized” absence from work (Article 8 of Federal Law No. 255 “On compulsory insurance in case of temporary disability”, paragraph 21 of Regulation No. 375 “On the procedure for calculating benefits for temporary disability”). Download for viewing and printing:

Federal Law of December 29, 2006 No. 255 “On compulsory social insurance in case of temporary disability and in connection with maternity”

Decree of the Government of the Russian Federation of June 15, 2007 N 375 “On approval of the Regulations on the specifics of the procedure for calculating benefits for temporary disability, pregnancy and childbirth, monthly child care benefits for citizens subject to compulsory social insurance in case of temporary disability and in connection with maternity”

If there is a mark about non-compliance with the order

The benefit is paid according to the following example:

. The benefit is not paid if the medical clinic is not closed or the employee does not show up for an appointment with the doctor. Total material compensation should be close to the minimum wage.

We present a special formula for calculating material payments. It’s easy to calculate the amount, see for yourself :

Please note that if treatment procedures are not followed, the benefit will be reduced. But if there is a good reason, this will not happen. We have already discussed all types of reasons above.

Sick leave standards

When a patient violates the instructions, the medical worker has two options: close the sick leave or extend it. However, information about non-compliance with the regime must still be recorded in the bulletin.

Filling out a sick leave certificate

If the doctor decides to discharge a person, then the period of validity of the sick leave will be calculated from the date of admission of the patient. The day of discharge will be the date of the violation of the regime (for example, a missed dose). In addition, the paper must contain information:

• Document Number;
• patient medical card number;
• his full name;
• the person's place of work;
• date of opening of sick leave;
• end date of treatment;
• special marks;
• doctor's signature;
• seal of the medical institution.

Special marks are codes that are used when filling out a document. They display the cause of the disease, the violation code (if there was one), and so on.

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The dependence of temporary disability benefits is observed not only on the insurance period, but also on how conscientiously the employee follows the prescribed treatment regimen. If a violation of sick leave was recorded, the consequences are regulated by Law 255-FZ of December 29, 2006 (hereinafter referred to as the Law). Each employee must strictly follow the recommendations of doctors, otherwise payment of compensation will be in question. The new sick leave certificates provide special columns for notes on the patient’s improper performance of duties in compliance with medical prescriptions.

Rules

The document must be filled out in block letters; it is not allowed to exceed the boundaries of the designated fields. Between words it is necessary to make spaces, punctuation marks, and also fill out the form from the first cell, do not put dashes (clause 65 of the Procedure for issuing certificates of incapacity for work, approved by Order of the Ministry of Health and Social Development of Russia No. 624n dated June 29, 2011 - hereinafter referred to as the Procedure).

Since 2020, it is allowed to use an electronic signature when drawing up a document.

Important: if an error is found in the document, the sick leave certificate will be considered invalid. The situation can only be corrected by filling out a new form.

What is non-compliance with doctor's orders?

Depending on the disease and its severity, one of the main types of regime may be prescribed, which is indicated when issuing a certificate of incapacity for work:

• strict bed;
• bed;
• semi-bed;
• general.

If the treatment takes place inpatiently, then the attending physician and medical staff monitor the implementation of the instructions. If the patient is treated on an outpatient basis, then the hospital regime implies visits to the hospital or clinic within the time frame established by the doctor. This also includes following doctor's orders.

Expert opinion

Davydov Alexander Yurievich

Civil law consultant with 20 years of practice. Author of numerous articles on legal topics

When the patient’s condition does not improve or complete recovery occurs within the period determined by the doctor, the reason for this may be a violation of the regime.

Circumstances for reducing the benefit amount

The circumstances that cause a reduction in the amount of compensation are indicated in Federal Law No. 255. What is regarded as non-compliance with the recommendations:

• if the employee starts work earlier than the time recommended by the doctor;
• interruption of inpatient treatment;
• failure to attend a doctor's appointment;
• non-compliance with medical prescriptions;
• evasion of examination;
• visiting another medical institution without first informing the attending physician.

Any of these violations will be recorded in the discharge document in the line “Notes on violation of the regime” there will be a code from 23 to 28 and next to the date of the violation of the regime.

Rules for calculating sick leave

Non-compliance code

After the employee’s treatment, this document is processed in the organization’s human resources department. This is necessary to calculate the payment amount.

So, what are the different codes and what do they mean?

• 24 – this code indicates failure to show up for an appointment ; this mark is often found on sick leave. You need to understand that treatment consists of constant medical supervision, diagnosis and monitoring. If this rule is violated, the possibility of timely and correct treatment is minimal. Please note that if you do not come for doctor’s examinations, then prolongation of treatment entails unnecessary absences from work.
• 25 – code is set when going to work without being discharged . Have you decided to go to work ahead of time? You will not receive benefits and salary at the same time. Even if you decide to quit with subsequent dismissal, but earlier than the due date, be prepared to see this code on your sick leave.
• 26 – you will be given this code if you refuse to undergo a medical and social examination . Without it, it is impossible to consider sick leave legally strong. This procedure is mandatory, and failure to do so makes the entire treatment pointless.
• 27 – you will see this code if you miss a medical and social examination for no apparent reason.
• 28 – this code implies all other violations . If you have done something “out of the ordinary,” then this code will appear on your sick leave.

Your doctor will oversee your treatment. And even if they later find out at work that you went on vacation at sea instead of hospital treatment, but you have a sick leave certificate that is closed according to all the requirements, no one has the right to deprive you of payments.

Your doctor is responsible for your care . And if he considers it necessary to issue you a sick leave certificate, then its legal force will be the same as if you actually underwent the required treatment.

This is important to know: Resolution on the appointment of a forensic examination

Failure to comply with sick leave regulations for caring for a sick child

Applies to situations when sick leave is provided to a parent who is caring for a sick child.
A note about a violation is made by a pediatrician. The most common reason for this is failure to show up for an appointment. When you return to work, you will need to provide the employer with a written explanation of the reasons for this action. Important: in such situations, determining the amount by which the benefit may be reduced is a controversial issue, since family members are not among the insured persons. The general procedure for applying for compensation for caring for a sick child is as follows: payment for the first 10 days will be determined by the insurance length of the parent who remains at home with the baby. Subsequent days - in the amount of ½ of the average salary.

What constitutes failure to comply with medical orders?

Violations of the hospital regime include any deliberate actions that contradict the prescribed course of treatment. So, for example, this includes :

1. failure to show up for an appointment;
2. violations of treatment regimen;
3. leaving the territory of the clinic (unauthorized);
4. early return to work;
5. refusal/failure to appear for medical examination.

If you repeat the violation again and again, then very soon it will turn out that payments have been reduced. In this case, special attention is paid to the absence of valid reasons.

Watch a video about types of violations of hospital regulations:

What are the consequences of non-compliance with the regime?

This threatens to include a special note in the document on incapacity for work. The results of this may be:

• reduction in the amount of the due payment on the basis of clause 1 of Article 8 of Law No. 255-FZ;
• closing of sick leave;
• if the patient applied for a disability group, the requirements were denied.

In addition, the employer has the right to consider this day as absenteeism, which will entail certain sanctions.

How to record a violation of the regime

Only a doctor can indicate that a company employee ignored treatment recommendations. Next, there are two possible options for indicating the degree of guilt of the employee:

• the head of the enterprise does this personally;
• a special commission is convened, which includes employees of the accounting department and representatives of the social insurance service.

Based on the results of the decision made during the consideration of the reasons for this misconduct, an order is issued ordering that the amount of compensation be reduced or paid in full.

Note: the formation of a commission is not a prerequisite, but the labor inspectorate and the Social Insurance Fund insist on this option.

Registration of the act

The results of the inspection conducted by the commission must be included in the report. What is indicated when drawing up the paper:

• Title of the document;
• date of;
• information about the members of the commission (full name, position);
• data on the certificate of incapacity for work (number, date of opening and closing);
• violation code;
• information from the explanatory note;
• resolution passed by the commission;
• signatures of all commission members (with transcript).

  
  Sample report on violation of treatment

The violation code is a special classification approved by Order of the Ministry of Health and Social Development No. 624n. The identifier is a numeric value from 23 to 28:

• 23 - failure of the patient to comply with medical recommendations, unauthorized interruption of inpatient treatment, referral to another medical specialist;
• 24 - late or missed appointment;
• 25 - leaving for service earlier than the established period;
• 26 — refusal of examination;
• 27 - untimely visit to a medical institution to assess health status;
• 28 - other cases.

Note: when filling out a sick leave certificate, the date of the violation must be recorded.
Download for viewing and printing: Order of the Ministry of Health and Social Development of Russia dated June 29, 2011 N 624n “On approval of the Procedure for issuing certificates of incapacity for work”

Registration of the act

This document must reflect the following points:

• indication of the two-digit code of the violation that occurred;
• description of the circumstances of the incident;
• a brief content of the citizen’s explanatory note indicating that it is attached to the act being drawn up;
• information about the members of the commission (names and positions held);
• information about available witnesses (if there were any);
• decision made by the commission;
• signatures of all commission members with transcripts;
• date of document execution.

Payment of sick leave in case of non-compliance with the regime

Usually, when calculating compensation, the average daily earnings of a person are used. If a violation was noted, this value will be replaced by the daily minimum wage (minimum wage). And it is several times lower. That is, the employee will receive only partial compensation.

Changes in the minimum wage in the Russian Federation

Important: if during illness the patient violated the regime several times, then this will be added up, which can lead to a complete loss of benefits.

Algorithm for calculating benefits in case of violation of the regime

If the employee is unable to provide arguments that the motive for his misconduct was due to insurmountable circumstances or there was a good reason, then the calculation will be made according to the following scheme:

1. The billing period is indicated. The basis is the last two years (730 days) that preceded this sick leave.
2. The average daily wage is calculated. To do this, all earnings received by the employee during this time are summed up (only those from which deductions were made to the social insurance fund are taken into account). The resulting value is divided by 730.

The benefit amount is then calculated. It will depend on the employee’s insurance coverage:

• 6 months or less - not lower than the minimum wage;
• from six months to 5 years - 60%;
• 5-8 years - 80%;
• more than 8 years - 100%.

Note: the maximum duration of an employee’s absence on a certificate of incapacity for work cannot exceed two weeks (15 days). If there is a need to extend treatment, the decision on this is made only by the medical commission.

How is sick leave calculated with some violations?

For a sample calculation, you can take the following situation: Mr. Tarasov V.V. took sick leave from March 11 to March 22.
A follow-up appointment was scheduled for March 18, but the patient saw the doctor only on the 20th. Tarasov's average daily earnings is 1000 rubles, and his work experience is 7 years.

A nuance: he will be paid the minimum not only for the missed two days, but also for all subsequent days until discharge. That is, when making calculations, the accounting department will focus not on his average salary, but on the minimum wage, which currently amounts to 12,130 rubles (the national minimum).

The calculation will look like this:

1000 × 0.8 × 7 = 5600 (rubles) - the amount of payment before the date of violation of the regime (that is, from March 11 to March 18).

Subsequent days will be calculated as follows:

(12,130 ÷ 31) × 5 = 1,956.45 (rubles), where 31 is the number of days in a month.

The amount to be paid will be: 5600 + 1,956.45 = 7,556.45 (rubles).

At the same time, if Tarasov V.V. had fully complied with the doctor’s requirements, he would have received:

1000 × 0.8 × 12 = 9600 (rubles).

It turns out that because of his carelessness, a person loses 2,043.55 rubles.

Consequences of violations

In private cases, the violator may receive not only a reduction in the amount of payment, but also an administrative penalty: a fine or even termination of the employment agreement.
This is possible if the patient comes for discharge much later than the specified period. That is, the employer will have reason to believe that the employee was simply absent. And this is already considered a serious violation of labor discipline and can lead to dismissal under an article of the Labor Code of the Russian Federation. Verification of compliance with the treatment regimen is aimed, first of all, at minimizing possible fraud associated with receiving payments. If ignoring medical prescriptions was a consequence of force majeure circumstances, then it is better for the employee to immediately stock up on convincing evidence of the “respect” of the action. Otherwise, the mark placed on the sick leave may lead to negative consequences.

In this case, the validity of violation of the hospital regime is completely determined by the employer. There may be situations when an employer, in case of violation of the sick leave regime, can pay benefits in full, and then the Social Insurance Fund can conduct an inspection and request additional documents from the company (clause 4 of Article 4.6 No. 255-FZ). And based on the results of this audit, the amount of benefits from the Social Insurance Fund may be changed.

Download for viewing and printing:

Article 81 of the Labor Code of the Russian Federation “Termination of an employment contract at the initiative of the employer”

How to pay for a certificate of incapacity for work if the doctor’s recommendations are violated?

Payment for a certificate of incapacity for work in violation of the regime is made in two stages. For the period when no deviations in compliance with the requirements were identified, the calculation is performed in the usual manner:

1. The calculation period is determined. To do this, wages are summed up for two years before the start of sick leave.
2. Average daily earnings are calculated.
3. The resulting value is multiplied by the number of days.
4. The amount of temporary disability benefits is determined taking into account length of service.

The second part of the compensation (for days with violations), the average wage per day is calculated based on the minimum wage . This amount must be divided by the number of days in the month for which the benefit is calculated. If the sick leave with a violation affects two months, then it is necessary to make separate calculations for each of them.

Read more about how to calculate payment for sick leave in case of violation of the regime with or without a good reason, here.

Compliance with your treatment regimen is important not only for reasons of concern for your health. There may also be financial penalties. For any violations recorded by the doctor on the certificate of incapacity for work, the employer will decide to change payments. There may be more serious consequences, for example, refusal to be included in the disability group.

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An employee of the organization can provide a sick leave certificate, in which there will be a clause indicating that he violated the regime. Is it worth paying compensation in such cases, and in what amount should it be paid?

Concepts such as violation of the prescribed regime, hospital records and compensation due to disability can be found in the Code of the Russian Federation, which prescribes all the main provisions and responsibilities of both parties.

What violations are provided for by law?

If you have any questions, you can consult for free via chat with a lawyer at the bottom of the screen or call by phone (consultation is free), we work around the clock.

In accordance with Article 8 of the Law and paragraph 21 of the Regulation number 375, approved by the Government of Russia on June 15, 2007 (hereinafter referred to as the Regulation), the grounds for reducing the amount of disability benefits may be the following:

• non-compliance with the treatment regimen prescribed by the doctor, without a good reason,
• admission without a reason for a medical examination or medical examination.

It is important for an enterprise accountant to understand whether the existing reasons for violating the regime are valid. They are indicated by two-digit codes, which are placed in the corresponding column, and have the following meaning:

• in case of non-compliance with the regimen prescribed by the attending physician - leaving the hospital without the permission of doctors, independent treatment in another area without consultation with the attending physician - code 23 is assigned,
• in case of violation of the doctor’s visit schedule and untimely appearance at the appointment, code 24 will be entered on the sick leave certificate,
• when leaving the workplace without an extract to perform one’s job duties, code 25 is entered,
• if you refuse to undergo a medical examination, code 26 is assigned,
• in case of untimely attendance at the place of medical examination, code 27 is assigned,
• if other reasons arise that are not included in the above list, code 28 is set.

It is worth noting that if the reasons indicated by codes 26 and 27 occur, the employee cannot be considered disabled. The sick leave certificate will be necessarily closed with the date when the employee refused the medical examination, despite the existing pathologies. To document the existing fact of violation of the sick leave regime, a commission is created at the enterprise, which consists of representatives of the enterprise administration and the trade union. The employees included in its composition are elected at a general meeting of the team. The law does not stipulate the creation of such a commission at every enterprise. But its absence in the decision to recognize a violation of the regime as disrespectful, with a subsequent reduction in the amount of benefits, may be considered illegal by the labor inspectorate.