What Does Short Term Disability Insurance Cover?

Types of insurance coverage:

1) allowance for temporary disability;

2) a one-time insurance payment;

3) monthly insurance payment;

4) payment of additional costs associated with the medical, social, and professional rehabilitation of the insured in the presence of direct consequences of the insured event.

Benefit for temporary disability due to an accident at work or an occupational disease

Temporary disability insurance┬ábenefit due to an accident at work or an occupational disease 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 percent of his average earnings, calculated in accordance with Federal Law No. 29 December 2006 255-FZ “On compulsory social insurance in case of temporary disability and in connection with motherhood”.

The maximum amount of temporary disability benefits due to an accident at work or occupational disease for a full calendar month cannot exceed four times the maximum amount of the monthly insurance payment established in accordance with paragraph 12 of Article 12 of Federal Law No. 125-FZ.

Lump-sum insurance payment

The amount of one-time insurance payment is determined in accordance with the degree of loss of professional disability by the insured based on the maximum amount established by the federal law on the budget of the Social Insurance Fund of the Russian Federation for the next financial year (in 2021, the maximum amount is 108,600.52 rubles, excluding the district coefficient).

In areas where regional coefficients are established, percentage bonuses to wages, the amount of a one-time insurance payment assigned to the insured person depending on the degree of loss of his professional ability to work is determined taking into account these coefficients and bonuses.

In the event of the death of the insured, the lump-sum insurance payment is 1 million rubles. The payment is made in equal shares to the spouse of the deceased (deceased), as well as to other persons specified in paragraph 2 of Article 7 of Federal Law No. 125-FZ, who had the right to receive a lump-sum insurance payment on the day of death of the insured.

The degree of loss of professional capacity for work by the insured is established by the institution of medical and social expertise. The procedure for establishing the degree of loss of professional ability to work as a result of accidents at work and occupational diseases is determined by the Government of the Russian Federation.

One-time insurance payments are paid to the insured no later than one calendar month from the date of assignment of these payments, and in the event of the death of the insured – to persons entitled to receive them, within two days from the date of submission to the insurer of all documents necessary for the appointment of such payments.

Monthly insurance payment

Monthly insurance payments are assigned and paid to the insured for the entire period of loss of his professional ability to work from the day from which the institution of medical and social expertise established the fact that the insured person lost his professional ability to work, excluding the period for which the insured was assigned temporary disability benefits.

The amount of the monthly insurance payment is determined as a share of the average monthly earnings of the insured, calculated in accordance with the degree of loss of professional capacity for work by him. The average monthly earnings are calculated by dividing the total amount of his earnings for the 12 months preceding the month in which he had an accident at work, was diagnosed with an occupational disease, or (at the choice of the insured) was diagnosed with loss (reduction) of his professional ability to work, by 12.

For persons entitled to receive insurance payments in the event of the death of the insured, the amount of the monthly insurance payment is calculated on the basis of his average monthly earnings minus the shares attributable to himself and able-bodied persons who were his dependents, but who are not entitled to receive insurance payments. To determine the number of monthly insurance payments to each person entitled to receive them, the total amount of these payments is divided by the number of persons entitled to receive insurance payments in the event of the death of the insured.

The calculated and assigned monthly insurance payment is not subject to further recalculation, except for cases of a change in the degree of loss of professional ability to work, a change in the circle of persons entitled to receive insurance payments in the event of the death of the insured, as well as cases of indexation of the monthly insurance payment. The amount of the monthly insurance payment is indexed taking into account the level of inflation within the funds provided for these purposes in the budget of the Social Insurance Fund of the Russian Federation for the corresponding financial year. The indexation coefficient and its frequency are determined by the Government of the Russian Federation.

In 2021, indexed monthly insurance payments cannot exceed the maximum amount of 83,502.9 rubles (excluding the district coefficient).

Monthly insurance payments are paid to the insured during the entire period of permanent loss of his professional ability to work, and in the event of the death of the insured, to persons entitled to receive them, within the periods established by paragraph 3 of Article 7 of Federal Law No. 125-FZ. Monthly insurance payments are made by the insurer no later than the expiration of the month for which they are accrued.

Payment of additional expenses related to the medical, social, and professional rehabilitation of the insured in the presence of direct consequences of the insured event

Rehabilitation includes activities such as:

– treatment of the insured carried out immediately after a severe accident at work until the restoration of working capacity or the establishment of a permanent loss of professional ability to work;

– purchase of medicines, medical devices, and personal care;

– outside (special medical and domestic) care of the victim, including those carried out by members of his family;

– sanatorium-and-spa treatment, including payment for the vacation established by the legislation of the Russian Federation, for the entire period of Sanatorium-and-spa treatment and travel to and from the place of treatment, travel of the victim, and, if necessary, also of the person accompanying him to the place of Sanatorium-and-spa treatment and back, his accommodation and meals;

– prosthetics and provision of devices necessary for the victim for work and at home, as well as their repair;

– provision of special vehicles in the presence of relevant medical indications and the absence of contraindications to driving, their maintenance, and overhaul, the purchase of fuels and lubricants;

– vocational training (retraining).

Payment of additional expenses provided for by subparagraph 3 of paragraph 1 of Article 8 of Federal Law No. 125-FZ, with the exception of payment of expenses for the treatment of the insured immediately after a serious accident at work, is made by the insurer if the institution of medical and social expertise establishes that the insured needs compliance with a rehabilitation program in the specified types of assistance, provision of care. The conditions, amounts, and procedures for payment of such expenses are determined by the Government of the Russian Federation.

If the insured person simultaneously has the right to free or preferential receipt of the same types of assistance, provision of care in accordance with Federal Law No. 125-FZ and other federal laws, regulatory legal acts of the Russian Federation, he is given the right to choose the appropriate type of assistance, provision of care on one basis.

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