The degree of loss of professional ability to work is established. The degree of loss of professional ability of the insured is established by the medical and social examination institution

If you are injured at work or have an occupational disease, you have the right to benefits or compensation. Who will receive how much or not at all will be decided by the institution of a medical and social examination according to the new rules, which were recently signed by Prime Minister Mikhail Kasyanov.

Who is better to be - sick or healthy?

Conditions are getting tougher

A friend of mine once decided to jump from a parachute. As a result, he landed unsuccessfully and broke both legs. When the private company where he worked learned about what had happened, they decided to pay for the operation free of charge. A few months later, he left the hospital and sued the management of the unfortunate company to receive compensation for an injury at work. The parachutist lost the case and was also fired from his job. The story is instructive, but that’s not the point. Those rules that existed before pitted the employee and the employer head-on. The former always tried to attribute any bruise to a work injury, and the latter refused to recognize people without an arm or leg as disabled. And all because the employer had to pay for treatment and compensation. Now this function is taken over by the Social Insurance Fund.

Another key point: the new rules more clearly spell out in which cases disability is established and in which it is not. “It used to be like this,” says Elena Andreeva, deputy head of the department of labor relations of the Ministry of Labor, “a person, having graduated from a technical school, received, for example, a diploma as a plumber. But for the last 10 years he worked in a company, sitting on a home phone. And then he breaks his leg and demands compensation because he is a mechanic by profession and cannot work. But this has nothing to do with his current occupation: he is quite capable of performing his duties while sitting at home." So now compensation will be paid in relation to the job in which the victim is currently located.

In ordinary cases (fracture, sprain, etc.) this is 15% of the salary. If a person cannot work at all, he will receive 100%. If the injury is so serious that the employee will now have to limit his activities, it is realistic to receive from 40% to 90%. How much exactly will be determined by a medical and social examination.

Appeal if possible

According to the new rules, it turns out that people who become disabled in the workplace will receive less. Previously, the victim was paid a salary, a pension and compensation for the amount of damage. Now it will only be a pension and, if necessary, payment for treatment.

Depending on how badly you were injured, the Ministry of Labor, the Ministry of Health and the Social Insurance Fund will decide whether you need treatment in a sanatorium, surgery, retraining for a new specialty or not. If it decides that it is necessary, the Social Insurance Fund will pay.

In addition, another significant change was made to the rules: now the victim and the insurer will have equal conditions to appeal their position. That is, previously an employee could demand compensation, but the one who had to pay it to him could not. Now they can sue each other. By the way, in addition to the court, you will also be heard at the Main Bureau of Medical and Social Expertise and the local department of social protection. The Bureau even set a strict deadline for making a decision - a month from the date of receipt of the application.

And the last thing many of us will now have to put up with. As you know, some people are not enough for one salary and have to work part-time in several places. So, if a person is injured, then he applies for compensation for all, say, three jobs. On one it turns out to be 60%, on the other - 40%, on the third another 40%. As a result, it turns out that, having become disabled, he receives more than when he was healthy. Now officials have introduced a restriction: no matter how many jobs the victim has, he should receive no more than 100% compensation in total.

The latest rules on this subject were issued in 1994. How long the new document will last is unknown. Wait and see.

RULES FOR ESTABLISHING THE DEGREE OF LOSS OF PROFESSIONAL WORK CAPACITY AS A RESULT OF WORK ACCIDENTS AND OCCUPATIONAL DISEASES

I. General provisions

1. These Rules determine the procedure for establishing by medical and social examination institutions the degree of loss of professional ability for persons who have suffered health damage as a result of industrial accidents and occupational diseases (hereinafter referred to as victims).

2. The degree of loss of professional ability to work is established as a percentage at the time of examination of the victim, based on the assessment of the loss of ability to carry out professional activities due to an industrial accident and occupational disease, in accordance with the criteria for determining the degree of loss of professional ability to work, approved by the Ministry of Labor and Social Development of the Russian Federation according to in agreement with the Ministry of Health of the Russian Federation and the Social Insurance Fund of the Russian Federation.

3. Simultaneously with establishing the degree of loss of professional ability to work, the institution of a medical and social examination, if there are grounds, determines the need of the victim for medical, social and professional rehabilitation, and also recognizes the victim as disabled.

4. The examination of the victim is carried out in a medical and social examination institution at the place of his residence or at the place of attachment to a state or municipal medical and preventive health care institution (hereinafter referred to as a health care institution).

If, in accordance with the conclusion of a health care institution, the victim cannot come to the medical and social examination institution for health reasons, the examination can be carried out at home or in a hospital where the victim is being treated.

5. The medical and social examination institution is obliged to familiarize the victim in a form accessible to him with these Rules.

6. For citizens who were injured while not performing their work duties, the degree of loss of professional ability to work is established by forensic medical examination institutions.

II. Examination of victims

7. An examination of the victim in a medical and social examination institution is carried out on the basis of an application from the employer (insured), the insurer, by a ruling of the court (judge) or at the independent request of the victim or his representative when submitting a report on an industrial accident or a report on an occupational disease.

8. The employer (insurer) submits to the medical and social examination institution the conclusion of the state examination body of working conditions on the nature and working conditions of the victims that preceded the industrial accident and occupational disease.

9. The health care institution carries out the necessary diagnostic, therapeutic and rehabilitation measures and, based on their results, issues a referral to the victim to a medical and social examination institution for examination to determine the degree of loss of professional ability. The referral contains data on the victim’s health status, reflecting the degree of dysfunction of organs and systems, the state of the compensatory capabilities of his body and the results of the treatment and rehabilitation measures taken.

In some cases, before identifying signs of permanent loss of professional ability in a victim, a health care institution may refer him to a medical and social examination institution to determine the need for certain types of rehabilitation.

10. If it is necessary to conduct an examination using special techniques or equipment, or obtain additional data, the medical and social examination institution shall refer the victim for additional examination to a medical, rehabilitation or other institution, request the necessary information, carry out an examination of the victim’s working conditions, his social and living conditions and accept other measures.

11. If the victim refuses additional examination, an expert decision on the degree of loss of professional ability to work is made on the basis of available data, about which a corresponding entry is made in the examination report of the victim.

12. Based on the received documents and information, personal examination of the victim, the degree of loss of his professional ability to work is determined, based on an assessment of the victim’s professional abilities, psychophysiological capabilities and professionally significant qualities that allow him to continue to perform professional activities preceding the industrial accident and occupational disease, the same content and in the same volume, or taking into account the reduction of qualifications, the reduction in the volume of work performed and the severity of labor in ordinary or specially created production conditions.

Specially created production conditions mean the organization of work in which the victim is given a shortened working day, individual production standards, additional breaks at work, appropriate sanitary and hygienic conditions are created, the workplace is equipped with special technical means, systematic medical supervision and other measures are carried out.

13. An expert decision on the degree of loss of professional ability to work is made in the presence of the victim by a simple majority vote of the specialists who conducted the examination.

14. If the victim has a complete loss of professional ability to work due to a pronounced impairment of body functions in the presence of absolute contraindications for performing any type of professional activity, even in specially created conditions, the degree of loss of professional ability to work is established at 100 percent.

15. If the victim, due to a pronounced impairment of body functions, can perform work only in specially created conditions, the degree of loss of professional ability to work is established from 70 to 90 percent.

16. If a victim as a result of an accident at work and an occupational disease can, under normal production conditions, continue his professional activities with a pronounced reduction in qualifications or with a decrease in the volume of work performed, or if he has lost the ability to continue professional activities due to a moderate impairment of body functions, but can in normal in production conditions to perform professional activities of lower qualifications, the degree of loss of professional ability to work is established from 40 to 60 percent.

17. If the victim can continue his professional activity with a moderate or slight reduction in qualifications, or with a decrease in the volume of work performed, or with changes in working conditions that entail a decrease in earnings, or if the performance of his professional activity requires more stress than before, the degree of loss is established professional work capacity from 10 to 30 percent.

18. The degree of loss of professional ability to work in case of repeated industrial accidents and occupational diseases is determined at the time of examination for each of them separately, regardless of whether they occurred during the period of work for one employer or different employers, taking into account the professional knowledge and skills of the victim and generally cannot exceed 100 percent.

19. When re-examining the victim after rehabilitation measures, specialists from the medical and social examination institution, when establishing the degree of loss of professional ability to work, take into account damage to health due to an industrial accident and occupational disease, the ability to perform work in the profession acquired as a result of training or retraining, the ability of the victim to perform professional activity preceding an industrial accident and occupational disease, taking into account his existing professional knowledge and skills.

In case of evasion (refusal) of the victim from carrying out recommended rehabilitation measures, the question of the degree of loss of professional ability to work is considered taking into account the ability to perform any work activity.

20. When establishing the degree of loss of professional ability of the victim, the need of the victim for medical, social and professional rehabilitation is determined.

21. The conclusion of a medical and social examination institution on the need for medical, social and professional rehabilitation is drawn up taking into account the potential capabilities and abilities of the victim to carry out professional, household and social activities and is formalized in the form of a rehabilitation program for the victim as a result of an industrial accident and occupational disease.

The rehabilitation program for the victim determines the specific types, forms, volumes of necessary rehabilitation measures and the timing of their implementation.

The rehabilitation program for the victim is drawn up within one month after the expert decision is made in a form approved by the Ministry of Labor and Social Development of the Russian Federation in agreement with the Ministry of Health of the Russian Federation and the Social Insurance Fund of the Russian Federation.

22. The data from the examination of the victim and the expert decision are entered into the minutes of the meeting and the certificate of examination of the victim, which are signed by the head of the medical and social examination institution, the specialists who conducted the examination, certified by the seal of this institution and, along with all medical documents, are stored for 10 years in the specified institution.

23. The results of the examination are announced to the victim in a form accessible to him by the head of the medical and social examination institution in the presence of specialists who made the expert decision. The specialists who made the expert decision provide explanations to the victim or his representative.

24. A certificate from the medical and social examination institution on the results of establishing the degree of loss of professional ability to work, and, if necessary, a rehabilitation program, is issued to the victim against signature.

25. An extract from the examination report indicating the results of establishing the degree of loss of professional ability and the rehabilitation program for the victim are sent to the employer (insurer) or insurer within 3 days after their execution, and are also issued to the victim if the examination was carried out at his request.

III. Re-examination of victims

26. Re-examination of the victim is carried out in the manner established to determine the degree of loss of professional ability to work as a result of industrial accidents and occupational diseases.

27. The period for re-examination of the victim when determining the degree of loss of professional ability to work is established after six months, one year or two years based on an assessment of the victim’s health status and the forecast for the development of his compensatory and adaptive capabilities.

The degree of loss of professional ability of the victim is established indefinitely in the event of irreversible consequences of health damage due to an industrial accident and occupational disease with a persistent impairment of professional abilities and the ability to perform production activities.

28. If the victim misses the deadline for the next re-examination, the degree of loss of professional ability for the missed period is established if there is a referral from the employer (policyholder), insurer or a court (judge) order.

29. Re-examination of the victim earlier than the deadlines specified in paragraph 27 of these Rules is carried out in the event of: a change in the health status of the victim in the presence of a referral from a health care institution or a personal appeal of the victim or his representative to a medical and social examination institution and medical documents confirming this change; identifying facts of an unreasonably made decision (including based on forged documents) or an appeal by the victim, employer (insurer), or insurer of the decision of the institution of a medical and social examination in the prescribed manner.

30. The medical and social examination institution conducts an examination in order to dynamically monitor the implementation of rehabilitation measures to assess their effectiveness within the time frame established by the victim’s rehabilitation program.

IV. Appealing the decision of the medical and social examination institution

31. The victim, his representative, employer (insurer) or insurer, in case of disagreement with the decision of the medical and social examination institution, may appeal it by submitting a written statement to the institution that examined the victim, or to the main bureau of medical and social examination, or to the social authority protection of the population of a constituent entity of the Russian Federation.

The Bureau of Medical and Social Expertise, which examined the victim, sends this application with all documents to the main Bureau of Medical and Social Expertise within 3 days from the date of receipt of the application.

32. The Main Bureau of Medical and Social Expertise, within a month from the date of receipt of the application, conducts a re-examination of the victim and makes a decision based on the results obtained.

The decision of the main bureau of medical and social examination can be appealed within a month to the social protection body of the population of the constituent entity of the Russian Federation, which can entrust the re-examination of the victim to another group of specialists of the required profile of the specified institution.

33. The decision of the institution of medical and social examination can be appealed to the court in the manner established by the legislation of the Russian Federation.

DECREE OF THE GOVERNMENT OF THE RUSSIAN FEDERATION of October 16, 2000 N 789 ON APPROVAL OF RULES FOR ESTABLISHING THE DEGREE OF LOSS OF PROFESSIONAL CAPACITY AS A RESULT OF WORK ACCIDENTS AND OCCUPATIONAL DISEASES

In accordance with the Federal Law “On Compulsory Social Insurance against Industrial Accidents and Occupational Diseases” (Collected Legislation of the Russian Federation, 1998, No. 31, Art. 3803), the Government of the Russian Federation decides:

1. Approve the attached Rules for determining the degree of loss of professional ability to work as a result of industrial accidents and occupational diseases.

2. The Ministry of Labor and Social Development of the Russian Federation, in agreement with the Ministry of Health of the Russian Federation and the Social Insurance Fund of the Russian Federation, approve:

criteria for determining the degree of loss of professional ability to work as a result of industrial accidents and occupational diseases;

form of a rehabilitation program for a victim of an industrial accident or occupational disease.

3. The Ministry of Labor and Social Development of the Russian Federation and the Ministry of Health of the Russian Federation provide the necessary clarifications on issues related to the application of the Rules approved by this resolution.

4. Recognize as invalid Resolution of the Government of the Russian Federation of April 23, 1994 N 392 “On approval of the Regulations on the procedure for establishing by medical and labor expert commissions the degree of loss of professional ability in percentage to workers who have received injury, occupational disease or other damage to health associated with the performance of their labor duties" (Collected Legislation of the Russian Federation, 1994, No. 2, Art. 101).

Chairman of the Government of the Russian Federation M. KASYANOV

If the damage has resulted in loss or limitation of ability to work, which in turn may affect the earnings and financial situation of the victim, then monetary compensation is issued for the damage caused, the amount of which depends on the degree of permanent loss of ability to work.

Loss of ability to work can be temporary or permanent.

Temporary disability is a loss of ability to work for a limited period. It is established by the attending physician and the VKK (medical control commission), and is issued with a certificate of temporary incapacity for work (sick leave). According to the current situation, a certificate of temporary incapacity for work is issued (periodically extended) for a period of up to four months, but if necessary, with the permission of the VTEC (medical labor expert commission) it can be extended for a longer period.

Persistent disability is longer lasting and often permanent. There is a distinction between loss of general, professional and special ability to work. General working capacity is understood as the ability to perform unskilled labor. Professional ability to work is the ability to work in one’s own profession or another that is equal in qualifications and pay. Special ability to work is the ability to work in one’s narrow specialty.

When compensating for damage caused, only the degree of loss of professional ability to work is taken into account; the degree of loss of general and special ability to work is not taken into account.

Duration of health disorder as a qualifying feature is used in two categories:

a) long-term health disorder for more than three weeks (21 days);

b) short-term health disorder for no more than three weeks (21 days or less). In the first case, the damage is assessed as harm to health of moderate severity, in the second - as slight harm to health.

The “rules” define the duration of a health disorder as a temporary loss of ability to work or as a temporary disability. At the same time, they propose to establish disability in children, as well as in adults. The last provision is of an uncertain nature, because ability to work is established by law from the age of 14. And if for schoolchildren under 14 years of age, temporary disability can be conditionally equated to a temporary inability to study at school, then for preschoolers there will be no even such a conditional criterion. Consequently, temporary disability as a reflection of a health disorder is not a general absolute qualifying feature applicable in all age groups.

In addition, even among adults, the use of temporary disability as a criterion for a health disorder is associated with a number of reservations and exceptions.

Thus, the “Rules” recommend critically evaluating medical documents (medical history, outpatient card, surgical log, etc.), relying only on objective data on the nature and duration of impaired functions, since the length of stay in a hospital or other hospital, the duration of outpatient treatment, the validity period The “certificate of incapacity for work” may not correspond to the true duration of the health disorder.

On the one hand, an unreasonably long stay in a hospital or outpatient treatment can only be associated with subjective complaints, simulation or aggravation (exaggeration of symptoms) of the victim. On the other hand, the victim may refuse the “certificate of incapacity for work” and start work prematurely, which is often observed in modern conditions. Those who are not working and pensioners may not use the “certificate of incapacity for work” at all.

The resulting injury can worsen the victim’s existing chronic disease, and a patient admitted to the hospital for injury may remain on treatment for a long time to correct the health status of the disease that preceded the injury. In such cases, to assess the severity of harm to health, it is necessary to distinguish between impairment of body functions in connection with the injury and in connection with a previous disease, taking into account only the duration of the consequences of the injury when determining the severity of harm to health.

The approach to performing surgical operations also seems to be different. If a surgical operation was carried out for therapeutic purposes to eliminate the consequences of an injury, then the entire duration of the health disorder must be taken into account during the entire period of treatment. If a surgical operation is undertaken for diagnostic purposes, then the harm to health caused by the surgical intervention is not taken into account when assessing the severity of the harm to health.

The operation itself, although it is a surgical injury, is not assessed as harm to health.

Harm to health caused as a result of a defect in the provision of medical care is assessed independently, separately from the damage caused and its consequences, in accordance with the qualifying criteria provided for by the “Rules”.

In cases where, as a result of a surgical operation or some other medical intervention, there was a defect in the provision of medical care and additional suffering was caused to the victim, the latter are not grounds for increasing the severity when assessing the harm to health caused by the previous injury.

Sometimes, with a presumptive diagnosis (for example, a concussion), when there are no objective signs of injury (impairment of structure and function), the victim may be admitted to a hospital for clinical observation, because Signs of injury may not appear immediately, but may take several days. If such signs do not appear, the time spent in hospital is not taken into account as the duration of the health disorder.

Thus, based on the essence of the presented provisions, we can conclude that in order to determine the duration of the health disorder, it is necessary to establish the time during which the dysfunction caused by the injury continued. This criterion - the duration of the dysfunction - is the single general basis for determining the duration of the health disorder.

Unfortunately, the “Rules” contain two provisions that contradict each other. According to clause 25.4 "small few damage (abrasions, bruises, small superficial wounds) that do not entail short-term health problems or minor permanent loss of ability to work are not regarded as harm to health." However, paragraph 2 of the "Rules" states that harm to health means damage. In other words, " The rules "consider some damage as damage, and other damage as not being damage. Such a statement "damage is not damage" contradicts all logic. It is possible that there may be damage that does not entail permanent irreversible loss of ability to work. But there cannot be damage which is not accompanied by a functional disorder, i.e. does not entail a health disorder. Even the “small, few injuries” mentioned in the “Rules” are always accompanied by at least pain (painful sensations), which is an expression of a functional disorder and, therefore, a health disorder. It is difficult to imagine that the impact, leading to the formation of abrasions, bruises and wounds, is indifferent to health, imperceptible to a living person, and does not lead to dysfunction and health disorders (albeit short-term). The “Rules” do not define the minimum period for a health disorder (they only speak about a health disorder of no more than three weeks, without establishing a lower limit for this period). Therefore, with the establishment of the fact of damage, the fact of health disorder is also established, and, consequently, the presence of harm to health (albeit brief and temporary). In this regard, one cannot help but pay attention to the uncertainty of the proposed characteristics of damage: “small” (dimensional boundaries are not proposed), “few” (quantitative characteristics are absent), “superficial” (depth parameters that allow distinguishing deep wounds from superficial ones are not given ).

Chapter 34. Examination of disability

34.1. General provisions

Forensic medical examination of determining the extent of disability is carried out by expert commissions of the Forensic Medical Examination Bureau for various reasons: in connection with transport and domestic injuries; regarding injury to health at work and in a number of other cases, but only by court determination.

Compensation for harm caused by damage to health (injury) is made in the form of an award of damages associated with the loss of earnings to the victim. The amount of damages in these cases is determined in accordance with the degree of disability lost by the victim and the average earnings of the victim for 12 calendar months, and in the case of temporary disability - for 2 calendar months of the salary received by the victim from the accident. In this case, the right to compensation for injury belongs to the victim from the day the harm was caused, and not from the moment he filed a claim in court. If, as a result of the injury, the victim has partially lost his professional and general ability to work, then the amount of compensation is determined in proportion to the degree of loss of his professional ability to work.

In the event of a complete loss of professional working capacity and partial retention of the total working capacity, the compensation due to the victim must be reduced by the amount that an unskilled worker or employee could earn with the corresponding percentage of the total working capacity. If, in the event of an injury, according to the conclusion of a medical examination, the victim requires outside care, then the court, in addition to the awarded compensation for loss of earnings, may oblige the person who caused the harm to pay him the cost of care. The court may also impose on the person who caused the harm the obligation to compensate the victim for the actual expenses incurred for additional food, prosthetics, special treatment, including sanatorium-resort treatment, if the victim, according to the conclusion of a medical examination, really needs these types of assistance and does not receive it through the relevant organizations for free.

In case of injury to a minor who does not have any income at the time of the injury, the court, at the request of the minor or his legal representatives (parents or guardians), may recover from the person who caused the harm the costs of caring for the victim, providing him with enhanced nutrition, prosthetics and treatment, and also make a decision on recognition of the victim's right to compensation upon reaching the age of 16 for losses for loss of ability to work.

If significant changes occur in the financial situation of the parties or in the health of the victim after the court decision (increase or decrease in working capacity), then both the victim and the person who caused the harm may file a claim in court for a corresponding reduction or increase in the amount of compensation awarded for harm.

Before the hearing of the case in court, the judge must, in accordance with Art. 80 of the Code of Civil Procedure of the RSFSR to require that the parties present evidence that is important for making the right decision. The following should be attached to the case for compensation for damage caused by damage to health (injury): a) an accident report drawn up by the administration of the enterprise, the relevant supervisory authorities (technical, construction, sanitary inspection, etc.) or the police; b) a certificate about the amount of earnings of the victim at the time of the injury; c) a certificate of the amount of the pension or social insurance or social security benefit assigned to the victim; d) a certificate about the family and property status of the victim. In addition, in order to clarify the issue of the extent of the victim’s loss of professional and general ability to work from the harm caused by the accident, the court is obliged to require that the parties present the conclusions of the medical commission and technical inspection, and if this is impossible or difficult, order a forensic medical and technical examination on these issues.

The court decision must indicate in detail the circumstances in which the harm was caused and provide an exact calculation of the damages awarded in compensation for harm. Compensation for damage caused by damage to health (injury) must be awarded in the form of periodic, monthly payments, which the defendant is obliged to pay to the plaintiff, depending on the degree of permanent disability, for a certain period or for life.

When determining the extent of damage to health, the court, when establishing the amount of damages, must proceed from the size, i.e. percentage of the victim’s lost ability to work. If the victim has partially lost his professional and general ability to work, then again it is necessary to establish the dimensions, i.e. the percentage of the victim’s loss of professional ability to work, as well as the remaining general ability to work. Therefore, the courts require that the loss of professional and general working capacity of the victim be determined as a percentage. In this regard, experts need to establish the loss of general and professional ability to work as a percentage.

When determining the ability to work, the commission of the forensic medical examination bureau is guided by the relevant regulatory documents of the Ministry of Finance of the Russian Federation, the Ministry of Health of the Russian Federation and the Ministry of Labor and Social Protection of the Population of the Russian Federation.

Consideration of disputes regarding compensation for harm to persons who received injury or other damage to health at work; compensation for harm is carried out not in court, but by the administration of the institution together with representatives of trade union organizations. The examination to determine the extent of disability in such cases is no longer carried out by a forensic medical examination, but by the State Service for Medical and Social Expertise.

General working capacity refers to the ability to perform unskilled labor.

The examination in conclusion also answers the questions of whether the victim needs outside care, additional nutrition, prosthetics, or special treatment, including sanatorium-resort treatment.

Current legislation provides for compensation for injury or other damage to health. Unfortunately, there is essentially no definition of the concept of “injury” in legislation. The concept of “damage to health” is broader; it also includes the concept of “injury”. Therefore, in essence, health damage and its volume are always determined.

For persons under 15 years of age, loss of ability to work is not determined until adulthood.

If the victim's disability increases or decreases, some time after the incident the amount of compensation awarded to him for harm may be changed. Therefore, the examination of disability is carried out repeatedly.

Claims for compensation for damage are related only to permanent disability, since for temporary disability benefits are determined by social insurance in the amount of 100%, if the temporary disability is related to the work performed by the victim.

Thus, the determination of the extent of permanent disability due to injury or other damage to health is carried out:

a) expert commissions of the State Service for Medical and Social Expertise, social security authorities;

b) expert commissions of the forensic medical examination bureau in disputes considered by the court. A forensic medical examination to determine the extent of permanent disability is carried out by court determination.

Example.

Expert opinion.

June 13, 1997, based on the ruling of the people's court of the city of M. dated June 10, 1997, forensic experts of the Bureau of Forensic Medical Examination of the city of M.: forensic expert Katin A.V., therapist Petrov I.I., psychiatrist Sidorov Z.D. In the premises of the bureau's outpatient clinic, citizen A.A. Muntyan was examined. to determine the amount of disability.

Circumstances of the case and documentary data. Citizen Muntyan A.A. On February 14, 1997, a cerebral hemorrhage developed during heavy physical work at work. Until April 18, 1997, he was treated in hospital, and from April 18, 1997 to May 8, 1997, he was in a psychiatric hospital due to a psychopathic outburst.

Examination by a therapist. Complaints of limited movement in the right leg and right arm, periodic cough, at times with a large amount of sputum.

Objective examination: correct physique, reduced nutrition; the skin and visible mucous membranes are colored normally. The shape of the fingernails is close to that of a watch glass; the nail phalanges are somewhat thickened. Lymphatic glands are not changed. Lungs - boxy sound in the lower lateral regions, breathing is harsh throughout, dry wheezing. In the lower sections there are not constant, isolated, moist rales. Heart: the boundaries are not changed, the tones are clear, pure; pulse 70 beats per minute, rhythmic, satisfactory tension and filling. Blood pressure 130/90 mmHg. The tongue is moist and clean. The abdomen is soft and painless. The liver and spleen are not enlarged.

Diagnosis: chronic bronchitis, bronchiectasis, pneumosclerosis; hypertension of the 1st degree.

Examination by a psychiatrist. The pupils are uniform, of regular shape, their reaction to light and convergence is satisfactory. The right corner of the mouth is motionless, assimilation of the nasolabial folds: pronounced right-sided hemiparesis. Muscle tone in the right extremities is increased; tendon reflexes on the right are higher than on the left. There is almost no movement in the right hand (hand, fingers). Slight atrophy of the muscles of the right arm and leg. Speech with elements of motor aphasia. The gait is disordered, hemiparetic. Intelligence is reduced; weak-hearted; criticism is violated.

Diagnosis: residual effects of circulatory disorders in the middle cerebral artery basin, severe right-sided hemiparesis.

Conclusions. Having studied the presented case materials, medical documents, previous expert opinions and examined citizen A.A. Muntyan, forensic experts established: citizen A.A. Muntyan. For many years he has been suffering from a neurovascular disease and since 1991 has had a 3rd group disability due to this disease. Performed by Muntyan A.A. On February 14, 1997, heavy physical work was not the main cause of the development of cerebral hemorrhage, but could only contribute to its development. The main cause of cerebral hemorrhage in citizen Muntyan A.A. caused by hypertension.

Loss of ability to work in connection with the incident of February 14, 1997 is determined: for general ability to work - 50% (fifty), for professional - 60% (sixty).

Forensic experts (signatures).

Rights and obligations of an expert according to Art. 82 of the Code of Criminal Procedure of the RSFSR are known, according to Art. Art. 307 and 310 of the Criminal Code of the Russian Federation were warned. Forensic experts (signatures).

34.2. Methodology for determining the amount of permanent disability

Expert commissions consisting of several specialists (therapist, surgeon, traumatologist, neurologist, ophthalmologist, etc.) and medical experts from the State Service for Medical and Social Expertise or forensic experts establish the extent of permanent disability based on a detailed medical examination of the victim. The commission of the State Service for Medical and Social Expertise also includes representatives of the social security authority and the trade union organization.

The commissions determine the permanent loss of professional and general ability to work as a percentage.

When determining the percentage of loss of professional ability, i.e. ability to work in their profession, the commissions are guided by the “Regulations on the procedure for establishing by medical labor expert commissions the degree of loss of professional ability in percentage to workers who have received injury, occupational disease or other damage to health associated with the performance of their work duties”, approved by the Decree of the Government of the Russian Federation dated April 23, 1994 No. 392. However, it should be taken into account that different professions place different demands on the body, and the same consequences of injury to varying degrees impair the ability to work of people in different professions.

When determining the loss of professional ability to work, the commission of the State Service for Medical and Social Expertise must proceed from the ability of the victim after an injury or other damage to health to continue his professional work or work of equal qualifications.

When determining the degree of loss of professional ability to work, the commission of the State Service for Medical and Social Expertise in each specific case takes into account the severity of violations of body functions, the degree of compensation for lost functions, the ability of the victim to perform work in one degree or another in the main profession, including the ability to perform work in ordinary or specially created conditions, as well as rehabilitation measures, including vocational training and retraining.

100% loss of professional ability to work is established in cases where the victim has suffered a complete loss of ability to work due to pronounced impairment of body functions in the presence of absolute medical contraindications for performing any type of professional activity, even in specially created conditions.

Estimated from 70 to 90% loss of professional ability to work in cases where the victim can perform work only in specially created conditions due to severe impairment of body functions.

The loss of professional ability to work is established at 60%, when the victim has lost his main profession and can perform light unskilled labor.

In case of repeated work injuries, the degree of loss of professional ability to work is determined by the consequences of each of them separately.

The Commission of the State Service for Medical and Social Expertise makes a conclusion that the victim needs to learn a new profession if, due to a work injury, he cannot perform work in his previous profession.

If injury or other damage to health caused loss of ability to work in an amount that provides grounds for establishing one of three disability groups, The expert commission, in addition to determining the amount of permanent disability as a percentage, establishes a disability group and gives labor recommendations to the victim, guided by the instructions and regulations on medical labor examination.

The commissions establish the amount of permanent loss only of that disability that was caused and related to the work of the victim. Other illnesses and defects not related to a specific incident at work are not taken into account.

In some cases, the victim is re-examined to determine the possibility of changes in the amount of disability. Repeated examination is carried out within a period of 6 months to 2 years. This takes into account the nature of the consequences of health damage and the possibility of their elimination as a result of treatment, and also determines the existing extent of loss of permanent ability to work.

If a disability group is established on the basis of the Instructions for an indefinite period, then the amount of permanent loss of general and professional ability to work can also be established indefinitely. In these cases, a re-examination of the victims can be carried out either at their request or at the request of other interested parties.

Forensic medical examination to determine the extent of permanent disability.

An examination to determine the extent of permanent disability is carried out in connection with:

a) with injuries received from various types of transport;

b) with domestic injuries;

c) with claims for the recovery of alimony: against a spouse in divorce cases; to parents - for the maintenance of children who, upon reaching adulthood, remain unable to work; to children - from sick and disabled parents;

d) causing harm to health at work when considering such cases in court;

d) for other reasons.

The commissions of the Bureau of Forensic Medical Examination, as well as the expert commissions of the State Service for Medical and Social Expertise, when determining the extent of permanent disability, are guided by the above-mentioned regulatory documents.

In practice, the question may arise: how to determine the amount of disability in the case of several injuries, each of which led to permanent disability (for example, eye damage with incomplete loss of vision and traumatic amputation of the hand). In this case, the determination of the volume of permanent disability is made to assess the severity of the injury. The amount of disability caused only by this injury is determined; pre-existing defects are not taken into account, and permanent disability is determined in the same way as in a healthy person.

Example.

Due to the injury, the thumb of the right hand was amputated. The victim's index finger of the same hand had previously been amputated. In this case, only the disability associated with amputation of the thumb is determined, equal to 25%. The existing defect, the absence of the index finger, is not taken into account, while the absence of the thumb and index finger of the right hand corresponds to 50% permanent disability.

If several injuries are located on one organ, then disability is determined for each injury and then added up. The resulting percentage of disability cannot exceed the maximum percentage provided in the table for the total loss of a given organ.

Example.

Loss of the thumb and index finger of the right hand is 50% of disability, and limited mobility in the shoulder joint is 40%. In this case, the loss of ability to work should not be determined at 90% (50 + 40), but at 75%, since the loss of the entire right hand is estimated at 75%.

If several organs are damaged, disability is determined for each defect separately and the results obtained are added up. However, the amount cannot exceed 100%.

Example.

Partial loss of vision in one eye (30%) and at the same time traumatic amputation of the right hand (75%) account for 105%. However, permanent disability for both injuries should be defined as 100%.

In the event of injury or other damage to the health of a citizen under 15 years of age and without income, the organization or citizen responsible for the harm is obliged to reimburse the costs associated with restoring the victim’s health. Once the victim reaches 15 years of age, the organization or citizen responsible for the harm is obliged to compensate the victim for harm associated with the loss or reduction of his ability to work based on the average earnings of an unskilled worker in the area.

Control questions

1. On the basis of what document is the examination of loss of ability to work carried out?

2. What is the methodology for determining the amount of permanent disability?

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Chapter 33. Beatings, torture, tortureChapter 35. Examination of determining health status

Establishing the percentage of loss of general ability to work is one of the types of forensic medical examination designed to assess the damage caused to a person’s health, as a result of which he loses the ability to work, providing himself with a means of subsistence. This type of research is resorted to during legal proceedings in cases involving situations dangerous to human life and health. This examination is one of the most in demand, since its results are relied upon when sentencing the guilty party and assigning compensation and monetary payments.

The percentage of loss of general working capacity is determined in the following cases:

• To assess the consequences of road incidents and disasters, as well as other transport incidents.
• To determine the level of damage resulting from an industrial injury, as well as from man-made disasters at work.
• To establish the severity of injuries inflicted during an attack and attempted murder.
• To establish the severity of harm caused to human health through the fault of a medical worker or other officials.

Damage to health is measured as a percentage of the conditional indicator of general working capacity. In general, a distinction is made between general, professional and special ability to work. General working capacity is understood as the performance of simple operations that do not require special qualifications, that is, operations the implementation of which may be prevented by an injury that has consequences. Professional performance means the ability of a given person to carry out qualified activities in some profession - for example, working as an economist. Special performance means a person’s qualifications to work in a specific specialty. For example, the profession of “economist” includes a whole set of specialties - economic analysts, banking specialists, financiers, accountants, and so on.

There is also a distinction between temporary and permanent disability. Temporary disability occurs as a result of diseases and injuries that can be cured - for example, uncomplicated limb fractures, soft tissue injuries, minor injuries, and so on. Permanent disability occurs when the inflicted injuries and injuries (or their consequences) cannot be completely cured. For example, amputations of limbs or decreased intelligence and coordination problems resulting from a traumatic brain injury. The percentage of total disability is measured in relation to the lasting effects of the injuries sustained.

To calculate this indicator, forensic medical examination is based on a regulatory document, namely, a table of percentages of permanent loss of general ability to work. This table is an appendix to the Order of the Ministry of Health and Social Development, which approves the criteria for establishing the extent and severity of harm caused to human health.

According to the above table, the specialist who determines the percentage of loss of general working capacity determines the harm caused to human health and identifies the corresponding percentage of loss. The table contains the most common consequences of injuries, poisoning and other external influences, for which the corresponding values ​​of loss of ability to work, expressed as a percentage, are indicated.

Functional disorders of human organs are classified in the table according to the systemic principle. It highlights the following areas where the consequences of an incident may be observed:

• Central nervous system and peripheral nervous system.
• Digestive organs.
• Organs of vision.
• Respiratory system.
• Organs of hearing.
• The cardiovascular system.
• Genitourinary system.
• Soft fabrics.
• Musculoskeletal system.

According to the notes indicated in the table, in the event of dysfunction of two or more organs of the same system, the percentage of loss of general ability to work is determined according to one of the criteria that reflects the most pronounced damage. In case of damage to several body systems, the percentage of disability is added up, however, the total indicator should not exceed 100 percent. The table displays percentages for each case in increments of five units. The most severe (from seventy to one hundred percent) consequences of injuries, poisoning and other impacts include the following:

• Paralysis, severe dementia, epileptic seizures recurring at least once a week, aphasia, apraxia, agnosia ataxia, severe cerebellar and vestibular disorders - 100%.
• A marked decrease in strength and range of motion in the limbs, a significant impairment of the ability to coordinate, a severe decrease in intellectual abilities - 75%.
• Severe disorders of movement and sensitivity in both legs, significant dysfunction of the pelvic organs, severe bedsores and trophic ulcers - 100%.
• Trophic ulcers, lack of sensitivity and movement in the joints of the legs - 70%.
• Loss of both seeing eyes - 100%.
• Absence of a nose, resulting in a change in the victim’s face - 70%
• Congestion in the lung (or in both parts of the lung), liver cirrhosis, ascites, respiratory rhythm disturbances, effusion in the pericardial cavity and/or pleura - 90%.
• Obstruction of the pharynx as a result of poisoning with caustic poisons, injury or burn - 90%.
• Absolute immobility of the spine, severe deformation of the spine - 70%.
• Absence of the upper limb - 80% (for the right hand) and 75% (for the left).
• Absence of a leg or stump at the level of the upper third of the thigh - 70%.
• Absence of jaw - 80%.
• Complete absence of language - 70%.
• Gastric resection to compensate for the consequences of injury - 80%.
• Absence of forearm - 70% (65% for the left hand).

The table also shows disturbances in the functioning of systems and organs of the body, as well as the consequences of injuries that cause a slight loss of the ability to carry out their professional activities. The mildest functional disorders that cause a low percentage of loss of general ability to work (from five to ten percent) include:

• Cicatricial trichiasis, keratitis, conjunctivitis, entropion of one eye, which do not cause decreased vision - 5%.
• The same for two eyes - 10%.
• Removal of an eyeball that did not have vision - 5%.
• A decrease in visual acuity by one tenth - 5%.
• The presence of rough scars on the tongue resulting from injury, frostbite or burns, making it difficult to eat - 5%.
• Scars on the body (including on the scalp), occupying from 2% to 4% of the body surface - 10%.
• Absence of nail phalanx - 10%.
• Absence of the big toe - 10%.
• Moderate peripheral damage to the hypoglossal, facial or trigeminal nerve, causing impairment of their function - 5%.
• Impaired reflexes and/or sensitivity as a result of damage to the lumbar and/or sacral plexus and its nerves (without movement disorder, paresis, atrophy, contractures) - 5%.
• Non-concentric narrowing of vision in one eye - 5-10%.
• Partial ptosis (drooping of the upper eyelid) of one eye - 10%.
• Purulent inflammation of one ear - 5%. Inflammation of both ears - 10%.

Persistent loss of general ability to work is one of the criteria when determining the severity of harm caused to the victim’s health. However, permanent disability deprives the victim of the opportunity to earn money - partially or completely. As a result, determining the percentage of disability may be a reason for ordering an independent examination.

The basis for conducting an examination to establish the percentage of loss of general ability to work may also be harm to the health of the victim due to the fault of a health worker, as well as other officials responsible for the safety of the people entrusted to them.

An examination to determine the percentage of loss of general ability to work is carried out only by court determination. When carrying out expert activities, the specialist takes into account all the materials of the case. The presence of any chronic diseases is not taken into account when establishing the percentage of loss of general working capacity that occurred as a result of an incident, accident or disaster.

If the injuries were inflicted on a minor who had no income at the time of the injury, the court can recover from the culprit only compensation for the costs of caring for the victim, his treatment and prosthetics (if any), and for providing the victim with enhanced nutrition. The court may also reserve the right of the victim to compensation for losses incurred due to loss of ability to work when the plaintiff reaches the age of sixteen.

When establishing the percentage of loss of total working capacity for disabled people, the loss is assessed as for a practically healthy person, regardless of the disability group.

What documents should be provided to the expert to establish the percentage of loss of general ability to work?

• Identity document of the initiator of the examination.
• Court ruling.
• All available medical documents, including the certificate of examination by the Medical and Social Expert Commission.
• An industrial accident report or an accident investigation report. To determine the percentage of loss of general ability to work as a result of a traffic accident - a certificate from the traffic police.
• If necessary, the results of other examinations.

Legal framework governing the process of establishing the percentage of loss of total working capacity

1. Order No. 194n of the Ministry of Health and Social Development of the Russian Federation dated April 24, 2008. “On approval of Medical criteria for establishing the severity of harm caused to human health.”
2. The appendix to this order is “Table of percentages of permanent loss of general ability to work resulting from poisoning, injuries and other effects on the human body.”

Questions that a specialist answers in the process of establishing the percentage of loss of general ability to work

1. What is the total percentage of loss of total working capacity?
2. What percentage of loss of general ability to work corresponds to this functional disorder?
3. What is the percentage of total disability caused by this particular incident?
4. What is the highest percentage of disability among functional disorders of organs of one body system?
5. Which functional systems were disrupted?
6. What disorders or injuries were taken into account when establishing the percentage of loss of general ability to work?

Cost and terms

• Forensic examination

  A forensic examination is carried out as determined by the court. To appoint an examination to our organization, it is necessary to submit a petition for the appointment of an examination and attach to it an information letter indicating the details of the organization, the possibility of carrying out an examination on the questions raised, the cost and duration of the study, as well as the candidacy of experts indicating their education and work experience. This letter must be certified by the seal of the organization and the signature of its head.

  Our specialists prepare an information letter within one working day, after which we send a scanned copy of it by email. Also, if necessary, the original letter can be picked up at the office of our organization. As a rule, the court does not require the original information letter; it is enough to provide a copy of it.

  The service for compiling an information letter is provided for free.

• Extrajudicial research

  Extrajudicial research is carried out on the basis of a contract with 100% prepayment. The agreement can be concluded with both a legal entity and an individual. To conclude an agreement, it is not necessary to be present at the office of our organization; in this case, the sending of all documents, including the expert opinion, will be carried out using the services of postal operators (Dimex, DHL, PonyExpress), which will take no more than 2-4 working days.

• Review of expert opinion

  A review is necessary in cases where it is necessary to challenge the conclusions of the examination carried out in order to then conduct a repeat study. The conditions for concluding a contract for peer review are exactly the same as for out-of-court research.

• Receiving written expert advice (certificate)

  The certificate is not a conclusion, it is of an informational nature and contains answers to questions that do not require a full study, but allow one to assess the feasibility of conducting a full examination.

  The conditions for concluding a contract for a certificate are exactly the same as for an out-of-court research.

• Obtaining preliminary expert advice

  Our specialists are ready to answer any of your questions regarding the conduct of judicial and extrajudicial examinations, assess the feasibility of conducting an examination, provide assistance in formulating research questions, advise on the possibility of conducting a particular analysis, and much more.

  Consultation is carried out on the basis of a written request.

  To do this, you need to fill out an online application form (or send us a request by e-mail), where you should describe the circumstances of the case in as much detail as possible, formulate the goals that need to be achieved with the help of the examination, preliminary questions, and, if possible, attach all possible documents and descriptions of objects.

  The more detailed you are about the circumstances of the case, the more productive the expert’s assistance will be.

• Additional services

  Reducing the examination period by half

  30% to cost

  Departure of an expert within the city of Moscow to inspect objects, select samples for research, participate in a court hearing or other events requiring the presence of an expert

  Departure of an expert within the Moscow region

  Departure of an expert to other regions of Russia

  Transport and travel expenses

  Preparation of an additional copy of the expert opinion

  Legal advice on issues not related to the conduct and appointment of examinations

  from 5,000 rub.

  Drawing up a statement of claim

Experts

Medical expert, surgeon, lawyer (medical law)

Specialist in the field of outpatient and hospital surgery, medical and economic examination, insurance medicine and examination of the quality of medical care. Author of a number of scientific and methodological publications, including in peer-reviewed publications (list of Higher Attestation Commission). He was actively involved in teaching and research activities at the Department of General Surgery. Has experience in clinical practice in hospitals and clinics. In addition to higher medical education, he has a higher legal education. Has experience in comprehensive expert assessment of the volume and quality of medical care, settlement of disputes and conflicts between patients, insurance and medical organizations. Regular participant in various conferences and seminars at both national and international levels. Currently carries out expert activities in the field of healthcare on an ongoing basis

General practitioner, cardiologist, ultrasound diagnostician

Graduated with honors from the Russian National Research Medical University. N.I. Pirogov, specializing in general medicine. Based on the 15th State Clinical Hospital named after. O.M. Filatova completed her residency in therapy. She graduated from a master's degree in economics at Moscow State University, and underwent professional retraining in the specialty of cardiology at the Federal State Budgetary Institution State Scientific Center FMBC named after. A.I. Burnazyan, completed professional training in ultrasound diagnostics at Moscow State Medical University named after. THEM. Sechenov. She worked as a therapist in the 15th City Clinical Hospital named after. O.M. Filatov, senior laboratory assistant and assistant at the Department of Hospital Therapy No. 1 of the Faculty of Medicine of the Russian State Research Medical University named after N.I. Pirogov. She was engaged in teaching and research activities, and took part in clinical studies.

Dentist, expert

Specialist in the field of aesthetic dentistry and prosthetics. He has original developments on the preservation and restoration of teeth, planning complex interdisciplinary treatment. Takes part in international congresses on aesthetic dentistry, prosthetics and implantology. She trained abroad for a long time with the world's leading doctors in the field of dentistry. Conducts scientific work.