How to understand not subject to compulsory social insurance. Compulsory insurance against accidents and occupational diseases. Types of financial support for these individuals

Article 2. Persons subject to compulsory social insurance in case of temporary disability and in connection with motherhood

1. Citizens are subject to compulsory social insurance in case of temporary disability and in connection with motherhood 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 Federal Law of July 25, 2002 N 115-FZ " ABOUT legal status foreign citizens in the Russian Federation"):

(see text in previous edition)

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

(see text in previous edition)

2) state civil servants, municipal employees;

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

4) members of the production cooperative, taking personal labor participation in its activities;

5) clergy;

2. Persons subject to compulsory social insurance in case of temporary disability and in connection with motherhood 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 established by law Russian Federation in private practice), 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 motherhood if they voluntarily entered into a relationship under compulsory social insurance in case of temporary disability and in connection with motherhood and pay for themselves insurance premiums in accordance with article 4.5

(see text in previous edition)

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 citizens with children" and the Federal Law "On Burial and Funeral Business". Persons who have voluntarily entered into relations on compulsory social insurance in case of temporary disability and in connection with motherhood, acquire the right to receive insurance coverage, subject to payment of insurance premiums during the period defined 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 the Federal Law of July 25, 2002 N 115-FZ "On the Legal Status of Foreign Citizens in the Russian Federation") are entitled to receive insurance coverage in in the form of temporary disability benefits, subject to the payment of insurance premiums for them by the insurers 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. Persons working under labor contracts, for the purposes of this Federal Law, shall be recognized as persons who have concluded an employment contract in accordance with the established procedure, from the day from which they were supposed to start work, as well as persons actually admitted to work in accordance with labor legislation.

6. Legislative, regulatory legal acts of the Russian Federation, constituent entities of the Russian Federation may also establish other payments for the provision of federal state civil servants, state civil servants of the constituent entities of the Russian Federation in case of temporary disability and in connection with motherhood, financed accordingly at the expense of the federal budget, budgets subjects of the Russian Federation.

(as amended by Federal Law No. 213-FZ of July 24, 2009)

1. Citizens of the Russian Federation, foreign citizens and stateless persons permanently or temporarily residing in the Russian Federation, as well as foreign citizens and stateless persons temporarily staying in the Russian Federation (for with the exception of highly qualified specialists in accordance with the Federal Law of July 25, 2002 N 115-FZ "On the Legal Status of Foreign Citizens in the Russian Federation"):

(as amended by Federal Law No. 407-FZ of December 1, 2014)

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

(As amended by Federal Law No. 379-FZ of December 3, 2011)

2) state civil servants, municipal employees;

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

4) members of the production cooperative, taking personal labor participation in its activities;

5) clergy;

6) persons sentenced to deprivation of liberty and involved in paid work.

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

3. Lawyers, individual entrepreneurs, members of peasant (farm) households, individuals who are not recognized as individual entrepreneurs (notaries engaged in private practice, other persons engaged in private practice in accordance with the procedure established by the legislation of the Russian Federation), members of family (tribal) communities of indigenous small 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 motherhood if they voluntarily entered into a relationship for compulsory social insurance in case of temporary disability and in connection with motherhood and pay insurance premiums for themselves in accordance with Article 4.5 of this Federal Law.

(as amended by Federal Law No. 164-FZ of June 27, 2018)

4. Insured persons are entitled to receive insurance coverage subject to the conditions provided for by this Federal Law, as well as the Federal Law "On State Benefits to Citizens with Children" and the Federal Law "On Burial and Funeral Business". Persons who have voluntarily entered into relations under compulsory social insurance in case of temporary disability and in connection with motherhood acquire the right to receive insurance coverage provided that insurance premiums are paid within the period specified in 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 the Federal Law of July 25, 2002 N 115-FZ "On the Legal Status of Foreign Citizens in the Russian Federation") are entitled to receive insurance coverage in in the form of temporary disability benefits, subject to the payment of insurance premiums for them by the insurers 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.

(Part 4.1 was introduced by Federal Law No. 407-FZ of December 1, 2014)

5. Persons working under labor contracts, for the purposes of this Federal Law, shall be recognized as persons who have duly entered into an employment contract 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, regulatory legal acts of the Russian Federation, constituent entities of the Russian Federation may also establish other payments for the provision of federal state civil servants, state civil servants of the constituent entities of the Russian Federation in case of temporary disability and in connection with motherhood, financed accordingly at the expense of the federal budget, budgets subjects of the Russian Federation.

The federal law "On compulsory social insurance in case of temporary disability and in connection with motherhood" - N 255-ФЗ - specializes in regulating legal relations in the system of compulsory social security. insurance when there are situations of temporary disability and in connection with motherhood. Regulates the rights and obligations of subjects of compulsory social. maternity and temporary disability insurance. Determines the size, sequence, conditions for providing state financial assistance for pregnancy and childbirth, temporary disability, according to monthly allowance for childcare, persons obligated to social. to be insured in case of temporary disability and in connection with motherhood.

Federal Law "On Compulsory Social Insurance in Case of Temporary Disability and in Connection with Motherhood" of 2015 No. 255-FZ was adopted on December 20, 2006.

The category of compulsory social insurance provides for several categories of citizens who may qualify for financial support from the FSS in the event of insured event.

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

Who determines the classification of persons subject to compulsory insurance?

The list of persons who can and must be insured under the federal social program is drawn up and established at the state level. These lists may change depending on the resolutions adopted by the Duma, the allocation of annual appropriations 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 associated with the labor activity of different categories of insured persons, the degree of occupational hazard for certain professional groups, as well as social circumstances and civil liability requirements are taken into account.

Groups of persons that are mandatory for 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 the main list, compiled taking into account the type of social insurance:

• Payment of health benefits;
• Financial support for disability;
• Grants on the fact of temporary unemployment;
• Insurance for temporary disability.

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

What categories of citizens are subject to this?

• Government officials in high positions;
• Persons holding positions in municipal governments;
• Municipal and civil servants;
• Priests of various religious denominations registered in the country;
• Persons deprived of liberty by the verdict of the judiciary, and participating in public and industrial work with actual wages;
• Foreign citizens working in domestic institutions and organizations, subject to the payment of contributions by the insured in their favor;
• Employees of industrial, commercial enterprises and the service sector working under labor 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 a licensed private activity. 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 state and commercial institutions on a staffing basis and for whom the employer pays insurance regular contributions.

In this category of persons subject to compulsory insurance, not only the insured person is entitled to compensation from. In the event of a complete loss of his ability to work or in the event of his death, the beneficiaries may be members of his family or close relatives. Dependents who are supported by the insured person in the event of his death may also apply for benefits.

The amount of money is also paid to children under the age of majority if one of their parents was the insured person. If the children of the insured continue to receive higher education, then they are entitled to claim benefits until the end of the educational process.

Types of financial support for these individuals

At the state level, a practical scheme has been developed for financial support for mandatory insured persons and members of their families. They can receive financial support in one of the proposed formats: in the form of an insurance one-time payment, in the form lump sum on the fact of incapacity for work at the time of restoration of health. Also, payments are made in the form of regular benefits in case of disability and complete loss of health.

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

The Social Security Fund may decide to refuse payment of various categories of benefits. Such restrictive measures are taken to prevent unreasonable payments and limit the abuse of the fund's resources for personal gain. In addition, there are entire categories of citizens who, for various reasons, simply do not have the right to receive 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 at the time of application do not have Russian citizenship.

Also, do not count on social benefits for those who do not have insurance certificates and their own SNILS insurance account numbers. Usually, each citizen is assigned such a number and a certificate of compulsory insurance is issued. 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 the assigned SNILS numbers and identification numbers. Accordingly, such citizens cannot claim to receive insurance payments for compulsory insurance.

Social compulsory insurance funds are not paid to persons who work unofficially in certain categories of payments - in connection with injuries during production processes, for diseases. This also includes those workers who carry out 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. Will not be implemented insurance payments in cases where mercenary motives are clearly traced in the actions of the insured person. For example, a person who intentionally injures himself or herself, or otherwise fakes an insured event in order to receive an insurance payment, will be deprived of disability or sickness benefits.

The category of persons not eligible to claim disability benefits includes those who undergo rehabilitation procedures or treatment under the verdict of the judiciary involuntarily.

Restrictions can also be used for bureaucratic reasons. This is especially evident in situations where one or more of the required documents are drawn up incorrectly or were submitted after the expiration of the established period.

The types, volumes and conditions for granting guarantees and compensations to employees 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 in the performance of duties under an employment contract is Federal Law No. 125-FZ of July 24, 1998 “On Compulsory Social Insurance against Industrial Accidents and Occupational Diseases” (hereinafter - Law No. 125-FZ). In the article, we recall who is subject to compulsory insurance against industrial accidents and occupational diseases, the types and amount of payments in the event of an insured event, and also talk about the changes that came into effect on 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 on the basis of an employment contract concluded with the insured;
• sentenced to imprisonment and employed by the insured;
• performing work on the basis of a civil law contract - if, in accordance with the said contract, the insured 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 person to insurance coverage arises from the day the insured event occurs (clause 1, article 7 of Law No. 125-FZ). Insured event - the fact of damage to the health of the insured as a result of an accident at work or an occupational disease, confirmed in accordance with the established procedure, which entails the insurer's obligation to provide insurance coverage. So, industrial accident is an event as a result of which the insured received an injury or other damage to health in the performance of duties under an employment contract and in other cases established by Law No. 125-FZ. An employee may suffer such injury:

• on the territory of the insured (organization);
• outside the territory or during the journey to the place of work or return from the place of work on the transport provided by the insured, and which entailed the need to transfer this employee to another job, temporary or permanent loss of his professional ability to work or his death. Occupational disease - 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. Temporary disability benefit, assigned in connection with an insured event and paid out of the funds for compulsory social insurance against industrial accidents and occupational diseases. This allowance is paid for the entire period of temporary disability of the insured person until his recovery or the establishment of a permanent loss of professional ability to work 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:

• lump-sum insurance payments to the insured person or persons entitled to receive such payment in the event of his death. The amount of the payment is determined in accordance with the degree of loss of the insured's professional ability to work based on the maximum amount established by the federal law on the FSS budget for the next financial year. In the event of the death of the insured, the lump-sum insurance payment is established in the 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 Federal Law No. 334-FZ of 08.12.2010 “On the budget of the Social Insurance Fund of the Russian Federation for 2011 and for the planned period of 2012 and 2013” ​​(hereinafter - Law No. 334-FZ)) .

note: in areas where installed district coefficients, percentage surcharges to wages, the size of the lump-sum insurance payment is determined taking into account these coefficients and allowances (clause 2, 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 amount 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 his professional ability to work (clause 1, article 12 of Law No. 125-FZ). Innovation: from 01/01/2011, the concept of "insurant's earnings" appeared, introduced into Law No. 125-FZ by Federal Law No. 348-FZ dated 08.12.2010 "On Amendments to the Federal Law" On Compulsory Social Insurance against Occupational Accidents and Occupational Diseases "(hereinafter - Law No. 348-FZ). The earnings of the insured should be understood as all types of payments and other remunerations (both at the main place of work and part-time) in favor of the insured, paid under labor 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 paying such expenses are determined by the Government of the Russian Federation (clause 2, article 8 of Law No. 125-FZ).

1. Additional costs associated with the 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, medical products for individual care, travel expenses for 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.

Appointment and payment of benefits for CHI.

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

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 dependents of the deceased or had the right to receive maintenance from him by the day of his death;
• the child of the deceased, born after his death;
• one of the parents, spouse (wife) or other family member, regardless of his ability to work, who does not work and is busy caring for the dependent children of the deceased, his grandchildren, brothers and sisters who have not reached the age of 14 years, or although they have reached the specified age, but at the conclusion of the institution public service medical and social expertise or medical institutions state system health care recognized as needing outside care for health reasons;
• persons dependent on the deceased who became disabled within five years from the date of his death;
• one of the parents, spouse (wife) or other family member who is unemployed and busy caring for the children, grandchildren, brothers and sisters of the deceased and who became 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:

• minors - until they reach the age of 18 years;
• students over 18 years of age - until the end of their studies in educational institutions in full-time education, but not more than up to 23 years;
• women who have reached the age of 55 and men who have reached the age of 60 - for life;
• disabled people - for the period of disability;
• one of the parents, spouse (wife) or other family member who is not working and is busy caring for the dependent children, grandchildren, brothers and sisters of the deceased - until they reach the age of 14 or change their state of health.

According to paragraph 4 of Art. 15 of Law No. 125-FZ, in order to assign benefits for an insured event, it is necessary to provide the insurer with the following documents (or copies of documents):

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

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

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

As mentioned above, in the event of an insured event, the insured person is paid the payments established by Art. 8 of Law No. 125-FZ, at the expense of the FSS. According to Art. 20 of Law No. 125-FZ, funds for these payments are formed from:

• mandatory insurance premiums of insurers;
• collected fines and penalties;
• capitalized payments received in the event of liquidation of insurers;
• other receipts that do not contradict the legislation of the Russian Federation.

We are interested in mandatory insurance premiums of policyholders. From 01.01.2011, the insurance rate is the rate of the insurance premium calculated on the basis of the amounts of payments and other remunerations accrued in favor of the insured under employment contracts and civil law 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). We note that Art. 20.1 - new, it establishes the basis for calculating insurance premiums for compulsory insurance against industrial accidents and occupational diseases. According to clause 1 of this article, payments and other remuneration paid by policyholders in favor of the insured within the framework of labor relations and civil law contracts are recognized as the object of taxation of insurance premiums, if in accordance with the civil law contract the insured is obliged to pay insurance premiums to the insurer. At the same time, the base for calculating insurance premiums is determined as the amount of payments and other remunerations provided for in clause 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 recall that until 2011 there was a List of payments for which insurance contributions to the Social Insurance Fund of the Russian Federation were not charged, approved by Decree of the Government of the Russian Federation of 07.07.1999 No. 765. As of 01/01/2011, this resolution has become invalid. From 01/01/2011 Law No. 348-FZ supplemented Law No. 125-FZ Art. 20.2, in which the amounts not subject to insurance premiums are named.

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 persons subject to compulsory social insurance, who have the right to receive appropriate security, were determined in the event of an insured event specified by law.

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Basic provisions

As provided for by the provisions on compulsory social insurance, the risks of 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:

• Properly confirmed 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 causing harm to health and the occurrence of an accident precisely at work.

The discrepancy between the incident and any one of the listed points deprives the insured subject of the opportunity to receive the insurance compensation due to him.

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

• Entities operating under labor contracts, including heads of companies that are direct owners of the latter's property.
• Subjects in the state civil service, as well as employees of municipalities.
• Entities 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 of farms.
• Members of tribal communities of a few northern peoples who have voluntarily entered into social insurance relations.

Social insurance at work

The state also implements mandatory protection from various kinds of accidents that occur at the workplace and from diseases of professional origin.

The fundamental principles and general tasks of all this are enshrined in the law "On Compulsory Social Insurance against Industrial Accidents and Occupational Diseases".

The standards fixed in Article 5 of the above-mentioned act determine specific persons subject to compulsory social insurance from accidents, namely:

• Individuals working under a contract with an insured.
• Individuals sentenced to imprisonment, however, at the same time involved in labor activity.
• Individuals engaged in labor activities under a civil law type agreement, if, in accordance with the latter, the insured is obliged to make contributions to the FSS.

The insured here means a legal entity (individual) employing the above-mentioned entities.

About social payments and security can be viewed on the video:

Social security provision

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

• Benefits (from the FSS) for temporary disability paid due to an insured event.
• Lump-sum insurance payment for an insured event.
• Insurance payments (having a monthly frequency) to the affected subject.
• Payment of additional costs associated with the medical and socio-professional rehabilitation of the insured subject.
• Compensation for lost earnings under a civil law contract (which did not stipulate the employer's obligation to pay insurance premiums) is carried out by the tortfeasor.

It is quite obvious that the circle of persons to whom the provisions of compulsory social insurance apply is quite extensive.