Temporary criteria for determining the degree of loss of professional ability to work as a result of accidents at work. Determination of the degree of loss of general ability to work Accident without loss of ability to work

Examination of working capacity - This is a type of examination, which consists in determining the causes, duration, degree of temporary or permanent disability of a person due to illness, injury or other reason, as well as determining the patient's need for types of medical care and social protection measures.

Naturally, the question arises, what should be understood by a person's ability to work?

Work capacity - this is a state of the human body in which the combination of physical and spiritual capabilities allows you to perform work of a certain volume and quality. A medical worker, on the basis of data from a comprehensive medical examination, must establish the presence or absence of a disease in a particular person. The ability to work has medical and social criteria.

Medical criteria for work abilityinclude a timely clinical diagnosis, taking into account the severity of morphological changes, the severity and nature of the course of the disease, the presence of decompensation and its stage, complications, determination of the immediate and long-term prognosis of the development of the disease.

However, a sick person is not always disabled. For example, two people suffer from the same disease - panaritium. One of them is a teacher, the other is a cook. A teacher with a panaritium can fulfill his professional duties - he is able to work, but the cook is not, that is, he is disabled. In addition, the cause of disability is not always the patient's own illness. For example, the same cook may be healthy himself, but someone in his family has contracted viral hepatitis, as a result of which the cook cannot fulfill his professional duties, that is, cook food, since he has contact with a sick viral hepatitis. Hence disease

and disability are not identical concepts. In the presence of a disease, a person can be able to work, if the disease does not interfere with the performance of professional duties, and disabled, if their implementation is difficult or impossible.

Social criteria for work abilitydetermine the labor prognosis for a specific disease and working conditions, reflect everything related to the patient's professional activity: the characteristics of the prevailing stress (physical or neuropsychic), the frequency and rhythm of work, the load on individual systems and organs, the presence of unfavorable working conditions and professional harmfulness.

Using medical and social criteria for work ability, a medical worker conducts an examination, during which the fact of a patient's disability can be established. Under incapacity for work should be understood as a condition caused by illness, injury, its consequences or other reasons, when the performance of professional work is impossible in whole or in part for a limited time or constantly. Disability can be temporary and permanent.

13.2. Temporary examination

UNABILITY

If changes in the patient's state of health are temporary, reversible, and recovery or improvement is expected in the near future, as well as restoration of working capacity, then this type of disability is considered temporary. Temporary disability (VN)- this is a state of the human body caused by illness, injury and other reasons in which functional disorders are accompanied by the inability to perform professional work in normal production conditions for a certain period of time, that is, they are reversible.

Distinguish between full and partial temporary disability.

Total temporary disability - this is the impossibility of performing any work for a certain period, accompanied by the need to create a special regimen and conduct treatment.

Partial temporary incapacity for work occurs in a person in relation to his usual professional activities when

maintaining the ability to perform other work with a different light duty or reduced volume.

The establishment of the fact of temporary incapacity for work is carried out on the basis of an examination and has an important legal and economic significance, since it guarantees a citizen to be released from work and receive benefits at the expense of state social insurance funds. Timely release of sick people from work is one of the most effective preventive measures to prevent complications of diseases and their chronicity.

In this way, examination of temporary disabilityis one of the types of medical expertise, the main purpose of which is to assess the patient's health, the quality and effectiveness of the treatment, the ability to carry out professional activities, as well as to determine the degree and timing of temporary disability.

The examination of temporary disability is carried out in state, municipal and private health organizations.

The morbidity with temporary disability reflects the morbidity of the working population, therefore, in addition to medical and social, it also has great economic importance.

A document certifying the temporary disability of citizens and confirming their temporary release from work is certificate of incapacity for work,which is issued:

With diseases;

In case of injuries, poisoning and other conditions associated with temporary disability;

For the period of aftercare in sanatoriums;

If necessary, caring for a sick family member;

For the quarantine period;

At the time of prosthetics in a hospital;

For the period of maternity leave;

When a child is adopted.

There are two ways to issue certificates of incapacity for work: centralized and decentralized. Centralized wayit is more often used in large clinics, where certificates of incapacity for work are issued in the registry or in specialized offices for the centralized issuance of sick leave certificates.

The nurse working in this office must be able to correctly fill out the passport part of the certificate of incapacity for work and the items relating to exemption from work. When decentralized waya certificate of incapacity for work is drawn up and issued by the attending physician himself; a nurse helps him in filling out the passport part.

A certificate of incapacity for work, in addition to the attending physician, can be issued by paramedics and dentists of medical organizations by decision of the health management body of the subject Russian Federationagreed with the regional department of the Social Insurance Fund of the Russian Federation.

Medical workers of the following health care institutions do not issue certificates of incapacity for work:

Ambulance institutions;

Blood transfusion facilities;

Reception departments of hospitals;

Medical and physical dispensaries;

Balneological clinics and mud baths;

Health care institutions of a special type (centers for medical prevention, disaster medicine, forensic medical examination bureaus);

Health care institutions overseeing consumer protection and human welfare.

The issuance of certificates of incapacity for work is carried out upon presentation of a passport or a document replacing it. If a citizen works for several employers, several certificates of incapacity for work are issued for each place of work.

Control over compliance with the procedure for issuing certificates of incapacity for work by medical workers is carried out by the Federal Service for Surveillance in Healthcare and social development jointly with the Social Insurance Fund of the Russian Federation.

These Time Criteria for Determining the Degree of Loss of Occupational Disability as a Result of Industrial Accidents and Occupational Diseases were developed in pursuance of Decree of the Government of the Russian Federation of October 16, 2000 N 789 "On Approval of the Rules for Establishing the Degree of Loss of Occupational Disability as a Result of Industrial Accidents and Occupational Diseases "for use by institutions of medical and social expertise in determining the degree of loss of professional ability to work by persons who have suffered damage to health as a result of industrial accidents or occupational diseases (hereinafter referred to as victims), their need for measures of medical, professional and social rehabilitation.

The named criteria are temporary for the period of studying their application in practice and making possible adjustments.

I. General principles determining the degree of loss

professional working capacity as a percentage

1. The degree of loss of professional ability to work is determined based on the consequences of health damage due to an accident at work, taking into account the victim's professional abilities, psychophysiological capabilities and professionally significant qualities that allow him to continue to perform professional activities preceding an accident at work and occupational disease, of the same content and in the same volume or taking into account a decrease in qualifications, a decrease in the volume of work performed and the severity of labor in ordinary, specially created production or other conditions; expressed as a percentage and is set in the range from 10 to 100 percent.

2. The main methodological principle of the examination of the professional working capacity of the victim is the aggregate analysis of the following criteria:

clinical and functional;

the nature of professional activity (qualifications, quality and volume of work, ability to perform it);

3. Clinical and functional criteria include:

the nature and severity of injury, occupational disease;

features of the course of the pathological process caused by an industrial accident or occupational disease;

the nature (type) of violations of body functions;

the degree of dysfunctions of the body (significantly pronounced, pronounced, moderate, insignificant);

clinical and rehabilitation prognosis;

psychophysiological abilities;

clinical and labor prognosis.

4. When determining the degree of loss of professional ability to work, the severity of violations of the functions of the victim's body, leading to a limitation of the ability to labor activity, and other categories of life. Typical for traumatic injuries, occupational diseases is a variety of clinical manifestations, different both in nature and in the severity of dysfunctions. Polymorphism of the clinical picture in victims may be due to the presence of both direct consequences of injuries, occupational diseases, and their complications. In this regard, the technique of expert examination of this category of victims requires a comprehensive clinical and physiological study using modern methods of diagnosis and retrospective analysis of post-traumatic and previous periods of development of an occupational disease, a thorough study of anamnestic information, data from medical institutions, medical, expert documentation, etc. The analysis of a complex of indicators of a clinical and physiological nature helps to clarify the main biomedical factors (nature, degree of dysfunction, course of the disease, etc.), which are the basis of clinical and functional criteria for determining the degree of loss of professional ability to work.

II. Ability assessment criteria

to professional activity

5. When determining the degree of loss of professional ability to work, it is necessary to take into account the professional factor, in particular, the ability of the victim after an accident at work or the occurrence of an occupational disease to perform work in full in his previous profession (before the accident or occupational disease) in ordinary or specially created industrial or other working conditions.

(as amended by the Order of the Ministry of Health and Social Development of the Russian Federation of 18.04.2007 N 280)

6. Professional activity in full involves a full working day, full working week, fulfillment of production standards by at least 100 percent.

7. Criteria for assessing the possibility of performing professional activities are associated with the difference in tariff and qualification categories within the relevant profession.

8. The multiplicity of qualification reduction is determined taking into account the established tariff levels, classes, categories for a given professional activity.

9. The ranking of jobs according to the degree of complexity (and therefore according to the categories of qualifications) is based on the factors of labor complexity:

technological - the complexity of management (maintenance, use) of tools; the complexity of technological (work) processes;

organizational - the breadth of the complex of operations (work) performed and the degree of independence of the employee in the process of performing work;

responsibility - material and responsibility for life and health;

specific - special requirements for work, for example, work in unusual, close to extreme conditions production activities.

10. Evaluation of the category of complexity of work is carried out differentially according to work differing in the degree of mechanization: manual, machine-hand, machine, automated, hardware.

11. When determining the tariff and qualification category, the qualification of the employee is taken into account as a combination of knowledge, skills and work skills, as well as the time spent on training (study). Qualification requirements to knowledge increase from initial information in the amount of incomplete high school (1 - 2 categories) to knowledge of individual disciplines in the amount full course secondary specialized educational institutions (6th grade).

12. The tariff and qualification system for assessing the work and professions of workers is characterized by a pattern of increasing complexity of work for each of the factors taken as the basis for determining the category. For example, by the technological factor: in the transition from the 1st category to the next, the complexity, power, dimensions of a unit of serviced equipment of a similar purpose increase. According to the organizational factor of complexity, the degree of independence of the work is increasing and the functions of guiding workers of lower qualifications are connected.

13. Professions of skilled manual workers are classified by six tariff and qualification categories. The tariff and qualification category indicates the correspondence between the qualifications of the worker and the complexity of the work performed, as well as the level of his knowledge, skills and labor skills.

Skilled worker professions can have a different range of grades (1 - 6, 4 - 6, 3 - 5, etc.).

14. If the victim cannot perform work of the previous complexity (qualification), then the question arises of transferring him to work of less complexity (qualification) in accordance with the types of work provided for by the Unified Tariff and Qualification Reference Book of Work and Occupations of Workers (ETKS), with the optimal ( 1 class of working conditions) or permissible (class 2 of working conditions) physical, neuro-emotional stress, which does not contain contraindicated production factors and corresponding to the psychophysiological capabilities of the victim for its implementation.

15. At the same time, the degree of loss of professional working capacity is established depending on the level of qualification decline, taking into account the decrease in the complexity of work. For example, the transfer of a 6th grade worker to grade 2 leads to a decrease in qualifications with the loss of four grades and a decrease (by 60 percent) in the coefficient of work complexity.

16. The degree of loss of professional working capacity of a worker of unskilled physical labor is established depending on his psychophysiological state, physical ability to perform simple physical labor and is associated with an assessment of classes of working conditions in terms of the severity of labor.

The loss of professional working capacity for a given contingent of workers is determined taking into account the degree of reduction of the category (class) of the severity of labor, for example, when transferring a heavy physical worker of the 4th category of severity (lifting and transferring a load weighing more than 35 kg) to the shown work of the 1st category of severity with light physical stress (one-time lifting of a load weighing no more than 2 kg) with a pronounced decrease in the category (class) of the severity of the labor process.

17. When determining the degree of loss of professional ability to work, it is necessary to take into account the classes of working conditions in terms of hazard and hazard factors of the working environment, the severity and intensity of the labor process.

18. The set of indicators reflecting production factors is the basis for resolving the issue of the need to change the profession, qualifications of an employee, the volume of his production activity in connection with an injury or occupational disease.

19. Loss of professional working capacity of employees (engineers, managers of various levels, persons creative professions and others), to whose activities the regulation of labor is applicable, is determined taking into account the decrease in the volume of work performed, its complexity and intensity, job duties.

III. Determination of the degree of loss of professional

working capacity as a percentage

20. In cases where, as a result of an industrial accident or occupational disease with significantly pronounced violations of the body's functions, the victim has a complete loss of the ability to perform professional activities, including in specially created industrial or other working conditions, 100 percent of the loss of professional ability to work is established.

(as amended by the Resolution

21. Examples of clinical and functional criteria for establishing 100 percent loss of professional ability to work, which determine the complete loss of professional ability to work, are significantly pronounced violations of the static-dynamic function:

a) lower paraplegia; significantly pronounced tetraparesis, triparesis, paraparesis with an increase in muscle tone in a spastic type or hypotension, with a minimum volume (5.0 - 6.0 degrees) of active movements in all joints of the lower extremities, a significant decrease in muscle strength (up to 1 point), with the inability to move independently; Type III EMG - frequent fluctuations in potential, distortion of the normal structure of the electromyogram by "bursts of frequent oscillations" (marked paresis); Type IV EMG - complete bioelectric silence during functional loads (paralysis of the limbs);

b) significantly pronounced paresis of both upper limbs with a minimum range of active movements in all joints (shoulder - 5.5 - 10 degrees, elbow - 4.3 - 7.7 degrees, wrist - 5.5 - 8.5 degrees); significant limitation of the opposition of the thumb (the distal phalanx of the latter reaches the base of the second finger), flexion of the fingers into a fist (the distal phalanges of the fingers do not reach the palm at a distance of 5 - 8 cm); decrease in muscle strength of the upper limbs (up to 1 point); violation of the main function of the upper limb: it is not possible to grip and hold large and small objects, only the auxiliary function is preserved - the maintenance and pressing of objects;

c) vestibular-cerebellar disorders: significantly pronounced static, dynamic ataxia; hyperreflexia of vestibular excitability with a duration of grade III post-rotational nystagmus for more than 120 seconds, grade III caloric nystagmus for more than 130 seconds;

d) amputation stumps of both lower extremities (non-prosthetic) in combination with the stump of the upper extremity, starting with the absence of all fingers of the hand;

e) respiratory failure of the III degree, circulatory disorders of the III stage (shortness of breath at rest, respiratory rate 30 or more per minute, increased respiratory rate by 10-15 per minute after minor physical exertion without restoring the initial level, significantly pronounced cyanosis, participation at rest auxiliary respiratory muscles, severe tachycardia - 130 or more beats per minute, epigastric pulsation, enlargement of the liver, peripheral edema, a decrease in the vital capacity of the lungs to 50% due, maximum ventilation of the lungs - up to 50 percent, an increase in the minute volume of respiration up to 180 percent, a decrease in the index Tiffno less than 40 percent and the oxygen utilization rate up to 20 percent, a decrease in the contractility of the right ventricular myocardium in combination with impaired pulmonary hemodynamics);

f) significantly pronounced sensory disturbances (practical or absolute blindness of the only or better seeing eye: visual acuity with correction - 0.04 - 0, field of view equal to - 0 - 10 degrees (peripheral borders along the meridian from the fixation point and / or central or paracentral drain scotomas); visual performance - a significant decrease or absence, EFI indicators - thresholds E-U more than 300 μA or not determined, lability less than 20 Hz or absent, CFFF less than 20 p / sec. or absent - if there are contraindications to any labor);

g) significantly pronounced dysfunctions of the pelvic organs (urinary incontinence, feces).

22. In the case when the victim, due to pronounced disorders of the body's functions, can perform professional work (work) only in specially created production conditions, the degree of loss of professional ability to work is established from 70 to 90 percent.

At the same time, the degree of loss of professional ability to work in victims with severe disorders of body functions is established depending on the level of qualification decline and the possibility of using professional knowledge and skills when performing work in specially created working conditions:

a) is no longer valid. - Order of the Ministry of Health and Social Development of the Russian Federation of 09.24.2007 N 620;

b) in cases where the victim can perform work of a lower qualification in specially created working conditions, taking into account professional knowledge and skills, 80 percent of the loss of professional ability to work is established;

c) in cases where the victim can perform in a specially created production environment work in a profession preceding an industrial accident or occupational disease, 70 percent of the loss of professional ability to work is established.

23. Examples of clinical and functional criteria for establishing 70 - 90 percent of the loss of professional ability to work injured with the consequences of occupational injuries and occupational diseases with the possibility of professional activity in specially created conditions are pronounced violations of the static-dynamic function:

(as amended by the Resolution of the Ministry of Labor of the Russian Federation of 26.04.2004 N 61)

a) pronounced paresis of both lower extremities, tetraparesis, triparesis, hemiparesis with a pronounced increase in muscle tone in spastic type or muscle hypotonia, with a pronounced limitation of the amplitude of active movements in all joints of the lower extremities - hip (up to 20 degrees), knee (up to 10 degrees) , ankle (up to 6 - 7 degrees); with a pronounced decrease in muscle strength (up to 2 points) of the lower extremities, pronounced varus, equino-varus deformity of the feet; spastic, paretic, peroneal gait with pronounced drooping of the feet; movement with additional support (crutches);

b) a pronounced violation of the biomechanics of walking - an increase in the number of steps when walking by 100 meters to 204 - 226 (normally 80 - 120 steps), an increase in the duration of a double step to 2.6 - 3.6 seconds (normally 1.0 - 1, 3 seconds), a decrease in the pace of walking to 29 - 46 steps per minute (normally 80 - 100 steps), a decrease in the coefficient of the rhythm of walking to 0.52 - 0.58 (normal is 0.94 - 1.00), a decrease in the speed of movement up to 1.0 km per hour (normally 4 - 5 km / h); Type II EMG with a pronounced violation of the bioelectrical activity of muscles - low-frequency potentials of the "fasciculation" type with a clear rhythm at rest and during functional loads;

c) pronounced paresis of both upper extremities, contractures of the joints of the upper extremities with a range of active movements within 10 - 20 degrees, with a pronounced limitation of flexion of the fingers into a fist (the distal phalanges of the fingers do not reach the palm at a distance of 3-4 cm), with a violation of the main function of the upper limbs: it is not possible to grip small objects, long-term and firm hold of large objects, EMG - type II;

d) pronounced vestibular-cerebellar disorders (dizziness at rest, severe and frequent - 4 or more times a month attacks of dizziness), spontaneous nystagmus II-III degree, pronounced impaired statics and coordination of movements, movement with the help of aids (cane, crutches) , hyperreflexia of vestibular excitability with the duration of post-rotational nystagmus II - III degree 85 - 120 seconds, caloric nystagmus II - III degree 110 - 130 seconds;

e) amputation stumps of the thighs or lower legs at different levels, false joints of both bones of the lower leg with a faulty position of the lower extremity, with a functionally disadvantageous position of the knee joint in flexion contracture with the inability to extend more than 140 degrees, faulty positioning of the lower limb in a functionally disadvantageous position of the hip joint with limitation extension up to 150 degrees or abduction of the leg over 165 degrees with a pronounced skew of the pelvis and functional shortening of the limb by 10 cm, pronounced contracture with a range of motion no more than 30 degrees or ankylosis of the joints in a functionally disadvantageous position;

f) respiratory failure of the II degree, circulatory disturbance of the II stage (respiratory rate at rest 21 - 29 per minute, increased respiration rate by 12 - 16 per minute after physical exertion, pronounced cyanosis, participation in the act of breathing of auxiliary respiratory muscles during small physical loads, heart rate 100 - 129 beats per minute, slight peripheral edema, decrease in vital capacity of the lungs to 50 - 55% of the proper, maximum ventilation of the lungs - up to 51 - 54%, increase in minute volume of respiration up to 150%, decrease in Tiffno index to 54 - 40%, oxygen utilization rate up to 28%, a decrease in the contractility of the right ventricular myocardium in combination with impaired pulmonary hemodynamics);

g) pronounced sensory impairments: a high degree of low vision in a single or better seeing eye, visual acuity with correction is equal to or less than 0.1 - 0.05, visual field - peripheral boundaries are equal to or less than 20 degrees, but wider than 10 degrees and (or) single central scotomas, visual performance - a pronounced decrease, EFI indices - thresholds E-U - 200 - 300 μA, lability - 20 - 35 Hz, KChSM - 20 - 35 p / s;

pronounced hearing loss: perception of spoken language up to 0.5 - 1.5 meters, hearing threshold - 61 - 80 dB, speech intelligibility threshold - 80 - 90 dB;

h) severe dysfunction of the pelvic organs, lack of urge to urinate and the feeling of passing urine through the urethra; with cystometry, the bladder capacity with detrusor hypotension is 500 - 600 ml, residual urine - up to 400 ml, with detrusor hypertension, the capacity is 20 - 30 ml; long delay in bowel movements - up to 5 days; anal reflex, sphincter tone and pressure during monometry are reduced - in the anal canal of the external sphincter - 10-15 mm Hg. Art., internal sphincter - 16 - 25 mm Hg. Art. (norm 35 - 62 mm Hg).

24. In cases where the victim can, in normal working conditions, perform professional work with a pronounced decrease 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 moderate dysfunction of the body, but in normal working conditions can continue professional activities of a lower qualifications, is established from 40 to 60 percent of the loss of professional working capacity.

(as amended by the Resolution of the Ministry of Labor of the Russian Federation of 26.04.2004 N 61)

25. At the same time, the degree of loss of professional ability to work by victims with moderate impairment of body functions is established depending on the level of qualification decline, the volume of production activity or the category of labor severity:

a) 60 percent of the loss of professional ability to work is established in the following cases:

if the victim can perform work by profession, but with a decrease in qualifications by four tariff categories;

if the victim can perform work using professional knowledge, skills and abilities, but with a decrease in qualifications by four tariff categories;

the paragraph is no longer valid. - Order of the Ministry of Health and Social Development of the Russian Federation of 13.05.2005 N 329;

if the victim can perform unskilled physical labor with a decrease in the category of work by four categories of severity;

(subparagraph "a" as amended by the Resolution of the Ministry of Labor of the Russian Federation of 26.04.2004 N 61)

b) 50 percent of the loss of professional working capacity is established in the following cases:

if the victim can perform work in the profession with a decrease in qualifications by three tariff categories;

if the victim can perform work in the profession with a decrease in the volume of production activity (by 0.5 rate);

if the victim can perform unskilled physical labor with a decrease in the category of work by three categories of severity;

c) 40 percent of the loss of professional working capacity is established in the following cases:

if the victim can perform work in the profession with a decrease in the volume of production activities;

if the victim can perform work using professional knowledge, abilities and skills, but with a decrease in qualifications by two tariff categories;

(as amended by the Resolution of the Ministry of Labor of the Russian Federation of 26.04.2004 N 61)

if the victim can perform work in the profession with a decrease in qualifications by two tariff categories;

if the victim can perform unskilled physical labor with a decrease in the category of work by two categories of severity.

26. Examples of clinical and functional criteria for establishing 40 - 60 percent of the loss of professional ability to work injured with the consequences of occupational injuries and occupational diseases with the possibility of performing professional activities in normal working conditions are moderate violations of the static-dynamic function:

(as amended by the Resolution of the Ministry of Labor of the Russian Federation of 26.04.2004 N 61)

a) moderate paresis of both lower extremities, tetraparesis, triparesis, hemiparesis, monoparesis with muscle hypotrophy of the thigh by 5-7 cm, lower leg - by 4-5 cm, increased muscle tone in spastic type or muscle hypotonia, with moderate limitation of the amplitude of active movements during all joints of the lower extremities - hip (up to 15 - 20 degrees), knee - (up to 16 - 20 degrees), ankle - (up to 14 - 18 degrees); moderate decrease in muscle strength (up to 3 points), spastic, paretic, peroneal gait with slight or moderate sagging of the feet; movement sometimes with the use of additional support (cane);

b) a moderate violation of the biomechanics of walking - an increase in the number of steps when walking by 100 meters to 170 - 190, an increase in the duration of a double step to 2.0 - 3.0 seconds, a decrease in the pace of walking to 50 - 60 steps per minute, a decrease in the coefficient of gait rhythm to 0.82 - 0.75, moderate decrease in movement speed to 2.0 km per hour;

c) moderate violation of bioelectric activity - ACBA within more than 25 percent, but less than 70 percent of the norm;

d) moderate paresis of the upper limb: hemiparesis with limited amplitude of active movements in the shoulder joint (35 - 40 degrees), elbow (30 - 45 degrees), wrist (30 - 40 degrees), moderate decrease in muscle strength of the upper limb (3 points) , limiting the opposition of the thumb of the hand (the distal phalanx of the thumb reaches the base of the 4th finger), limiting the bending of the fingers into a fist (the distal phalanges of the fingers do not reach the palm at a distance of 1 - 2 cm), with difficulty grasping small objects; on EMG - a moderate decrease in the amplitude of bioelectric activity of the muscles of the upper extremities within 25 - 75 percent of the norm;

e) contracture of the shoulder joint with a range of motion within 30 - 90 degrees, elbow joint - 80 - 130 degrees, wrist joint - 120 - 130 degrees (flexion contracture and extension contracture - 200 - 220 degrees); ankylosis of joints in a functionally advantageous position; the absence of three fingers, excluding the first finger, with difficulty in grasping small objects;

f) moderate vestibular-cerebellar disorders: dizziness with sudden changes in the position of the head, trunk, driving; spontaneous nystagmus of I or I-II degree; moderate static-dynamic disturbances (staggering in the Romberg position, when walking, missing in the calcaneal-knee test); hyperreflexia of vestibular excitability with the duration of post-rotational nystagmus 50 - 80 seconds, caloric nystagmus - 90 - 110 seconds;

g) amputation stumps of the limb (thigh, lower leg, both feet at the level of the Chopard, Lisfranc joint), moderate flexion or extension contracture of the hip joint, knee joint; flexion contracture of the ankle joint (equinus foot); shortening of the lower limb by 5 - 7 cm; ankylosis of joints in a functionally advantageous position - the angle of flexion in the hip joint is within 160 - 170 degrees, in the knee joint - 170 - 180 degrees, in the ankle - 95 - 100 degrees;

h) respiratory failure of the I - II degree, circulatory disturbance of the I - II stage (shortness of breath with moderate physical exertion, increased cyanosis after moderate physical exertion, the respiratory rate at rest up to 20 per minute, increased respiratory rate by 12 - 16 per minute after physical loads with recovery to the initial level within 5 minutes, slight tachycardia (90 - 99 beats per minute), a moderate decrease in the vital capacity of the lungs to 56 - 69 percent due, maximum ventilation of the lungs - up to 55 - 58 percent, an increase in the minute volume of respiration to 142 - 148 percent, a decrease in the Tiffeneau index to 74 - 55 percent, the oxygen utilization rate to 36 - 44 percent, oxygen absorption per minute - 277 - 287 ml, signs of a moderate decrease in the contractility of the right ventricular myocardium in combination with impaired pulmonary hemodynamics);

i) moderate sensory disturbances: dysfunctions of the visual analyzer - an average degree of low vision: a decrease in visual acuity of a single or better seeing eye with correction equal to or more than 0.1, visual field - peripheral boundaries less than 40 degrees, but wider than 20 degrees, visual performance is moderately reduced , EFI indices - thresholds E-U - 100 - 150 μA, lability from 30 - 35 to 40 - 43 Hz, CFM from 30 - 35 to 40 - 43 p / s; moderate hearing loss - perception of spoken speech up to 2 - 3 meters, whispering speech - up to 0.5 - 0 meters, average hearing threshold - 41 - 60 dB, speech intelligibility threshold - 50 - 70 dB;

j) moderate dysfunction of the pelvic organs: no sensation of filling the bladder, with cystometry, the bladder capacity with detrusor hypotension is 500 - 400 ml, residual urine - more than 100 ml with detrusor hypertension, capacity - 20 - 125 ml; long delay in bowel movements - up to 3 - 4 days; sphincter insufficiency - flatulence, anal reflex is reduced, tone and volitional contractions of the sphincter are weakened, manometry reveals a moderate decrease in external sphincter pressure - 16 - 25 mm Hg. Art., internal sphincter - 26 - 40 mm Hg. Art.

27. In cases where the victim can perform professional work under normal production conditions with a moderate or insignificant decrease in qualifications, or with a decrease in the volume of work performed, or when working conditions change, entailing a decrease in the victim's earnings, or if the performance of his professional activity requires more stress, than before, from 10 to 30 percent of the loss of professional working capacity is established.

28. At the same time, the degree of loss of professional ability to work for victims with minor disorders of body functions due to occupational injuries or occupational diseases is determined depending on the level of qualification decline, the volume of production activity or the category of labor severity:

a) 30 percent of the loss of professional ability to work is established in the following cases:

if the victim can perform work in the profession with a decrease in qualifications by one tariff category,

if the victim can perform unskilled physical labor with a decrease in the category of work by one category of severity,

if the victim can perform work in the profession with a slight decrease in the volume of professional activity (decrease in the production rate by 1/3 of the previous workload);

(as amended by the Resolution of the Ministry of Labor of the Russian Federation of 26.04.2004 N 61)

b) 20 percent of the loss of professional working capacity is established if the victim can perform work with a decrease in the volume of professional activity by 1/5 of the previous workload;

c) 10 percent of the loss of professional ability to work is established if the victim can perform work in the profession with a decrease in the volume of professional activity by 1/10 of the previous workload.

29. Examples of clinical and functional criteria for establishing 10-30 percent of the loss of professional ability to work for victims with the consequences of occupational injuries and occupational diseases when it is possible to perform professional activities in normal working conditions with a slight decrease in qualifications, categories of labor severity or a decrease in the volume of production activities are minor violations of the status -dynamic function:

(as amended by the Resolution of the Ministry of Labor of the Russian Federation of 26.04.2004 N 61)

a) minor paraparesis, tetraparesis, hemiparesis, monoparesis of the lower limb with hypotrophy of the muscles of the thigh and lower leg by 1.5-2.0 cm (flaccid paresis), a decrease in muscle strength (up to 4 points) with a full range of motion in all joints, with insignificant violation of walking biomechanics - an increase in the number of steps when walking by 100 meters to 150 - 160, an increase in the duration of a double step to 1.5 - 1.7 seconds, a decrease in the pace of walking to 64 - 70 steps per minute, a decrease in the coefficient of rhythm of walking to 0.85 - 0.90, reduction of movement speed to 3.0 km per hour; with a slight decrease in the amplitude of fluctuations in bioelectric activity on EMG up to 25 percent of the norm;

b) insignificant paresis of one or both upper limbs with hypotrophy of the muscles of the shoulder, forearm by 1.5-2.0 cm (flaccid paresis), a decrease in muscle strength in all parts of one or both upper limbs up to 4 points, while maintaining active movements in the joints in full and the main function of the hand - grasping and holding objects; on EMG - a slight decrease in the amplitude of bioelectric activity of the muscles of the upper extremities to 25 percent of the norm;

c) minor contracture of the shoulder, elbow or wrist joints; absence of one or two fingers, excluding the first finger, while maintaining the main function of the hand;

d) minor vestibular-cerebellar disorders: dizziness that occurs sporadically; sometimes spontaneous grade I nystagmus;

e) minor statodynamic disturbances (instability in the Romberg, Sarbo position), hyperreflexia of vestibular excitability with a duration of post-rotational nystagmus 50 - 80 seconds, caloric nystagmus 80 - 90 seconds;

f) slight contracture of the joints of the lower extremities: in the ankle joint, extension to an angle of 100 degrees with the equinus position of the foot (flexion contracture), flexion to an angle of 80 degrees - heel foot (extension contracture);

g) respiratory failure of the 1st degree, circulatory disturbance of the 1st stage (shortness of breath with significant physical exertion, fast walking, the breathing rate at rest within the normal range of up to 16-20 per minute, an increase in the respiratory rate by 10-12 per minute after physical exertion - 10 squatting or forward bending of the trunk with recovery to the initial level within 3 minutes, a slight increase in cyanosis after physical exertion, a slight decrease in the vital capacity of the lungs to 80 - 90 percent due, maximum ventilation of the lungs - up to 60 - 74 percent, an increase in the minute volume of respiration to 130 - 140 percent, oxygen absorption per minute - up to 260 - 270 ml, signs of compensatory hyperfunction of the right ventricular myocardium);

h) minor sensory impairments: dysfunctions of the visual analyzer - a low degree of low vision of the only eye or better seeing eye, visual acuity with correction of more than 0.3, visual fields - peripheral boundaries are normal or the fields are narrowed to 40 degrees, visual performance is normal, EFI indicators - thresholds E-U from 80 to 100 μA, lab. over 40 to 43 - 45 Hz, KChSM over 40 to 43 - 45 p / s; hearing impairment - perception of spoken language up to 3 - 5 meters, whisper speech - up to 1.5 - 2.0 meters, average hearing threshold 20 - 40 dB, speech intelligibility threshold - 30 - 40 dB;

i) minor dysfunctions of the pelvic organs: weak severity of the feeling of urge to urinate, with cystometry, the bladder capacity is 200 - 250 ml, residual urine - up to 50 ml; delay in defecation - within 2 - 3 days; gas incontinence, anal reflex is reduced, sphincter tone is reduced, monometry reveals a decrease in external sphincter pressure - 22 - 33 mm Hg. Art., internal sphincter - 41 - 58 mm Hg. Art.

30 - 31. Abolished. - Resolution of the Ministry of Labor of the Russian Federation of December 30, 2003 N 92.

32. The degree of loss of professional ability to work in case of repeated accidents at work or newly arisen occupational diseases is established for the victim for each of them separately, depending on the impact of their consequences on his ability to perform professional activities preceding the repeated accident, taking into account the results of the implementation of the individual rehabilitation program of the victim for the restoration of professional working capacity in the previous profession (previous to the previous accident) and in total cannot exceed 100 percent.

33. The degree of loss of professional ability to work during the next re-examination is established taking into account the results of the victim's rehabilitation.

Ability to work is the ability of a citizen to fulfill professional duties of appropriate quality and volume. Termination of activity due to illness or accident is called loss of ability to work.

Loss of ability to work

A citizen cannot work due to health problems. This impossibility is defined as disability. Lead to this:

1. Acquired acute and chronic diseases;
2. Congenital anomalies
3. Pathology as a result of injury;
4. Occupational morbidity.

There are the following types of disability:

1. General and professional - depends on the type of employment;
2. Temporary and permanent - from the duration of the disease;
3. Partial or complete - from the severity of the violations.

Persistent or persistent

The state of the body, in which there is a long-term disorder of functions, the impossibility of complete recovery is called persistent disability. This concept is equated with the term disability.

The reasons for permanent loss are:

1. Chronic pathology;
2. Congenital anomalies and hereditary diseases;
3. Consequences of injuries, accidents and poisoning associated with production.

In case of an unfavorable prognosis of professional activity and health, they are given a referral from the polyclinic, where the patient is served, to a meeting of the territorial bureau of medical and social expertise (MSE) for examination.

Do you have labor restrictions?

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Yes, but I continue to work 18%, 3 vote

05.12.2018

Temporary

A condition when a dysfunction of the body as a result of illness or injury does not allow starting work in a relatively short period is a temporary disability. It is reversible under the influence of medical measures. Temporarily a sick leave is issued for the period of treatment. It is required for:

1. Official confirmation of the absence of an employee.
2. Securing payments.
3. Analysis of the causes and terms of incapacity for work at the medical area, in the organization.

Partial

Completely or partially lost functions of the body are observed in case of disability with a temporary or permanent nature.

The victim is unable to perform the job for a relatively short time. But due to the severity of the disease, he is not released from labor, but transferred to lighter work within the organization. This is a partial disability.

“The nurse in the treatment room sustained injury to the tendon of the left thumb. She cannot let go of the procedures for 21 days, but her health condition allows her to have an appointment at the clinic. After complete recovery, the specialist will be transferred to his previous position. "

With persistent partial loss, the employee is not able to work as usual. Therefore, on the recommendation of the medical commission, the employer reduces qualifications or changes working conditions, reducing the tension and length of the day.

“The locksmith has been assigned a disability group regarding the amputation of a finger on the machine. The victim is unable to perform professional duties due to the injury received. But a worker can do lighter work at the same plant. "

Such a change in activity leads to loss of qualifications and a decrease in earnings, but has a favorable labor outcome.

Full

This type implies the impossibility of performing any work.

With a complete temporary loss, a positive outcome of the disease is observed. The patient is given a bulletin until the moment of final recovery, then the employee starts his professional duties.

“The accountant of the organization is admitted to a hospital with acute appendicitis for emergency surgical treatment. The specialist completely loses the ability to work, but short term - 10 days. The patient is given a bulletin, and after she recovers, she resumes her previous activity. "

In contrast, total permanent loss has a poor prognosis in terms of treatment and labor. In such cases, a disability group is established with a contraindication to work.

“The patient has a neoplasm of the pancreas for which he is receiving appropriate therapy. The impossibility of a cure is the reason for referral to the ITU for examination for the group. The severity of the condition is a contraindication to any work. "

Labor restrictions

IN regulations according to the purpose of disability, the main categories of human activity are determined. In addition to labor, there are 6 more categories:

1. Self-care;
2. Moving around without assistance;
3. Orientation in space and time;
4. Communication with others and strangers;
5. Controlling your behavior;
6. Learning skill.

Each of them, after causing harm to health, has limitations to varying degrees. With a particular disease, violations are present only in one or several areas at once.

“A patient suffering from a mental illness shows changes in almost all categories, with the exception of independent movement. The following problems are reported:

1. Cannot take care of himself;
2. Not oriented in space and time;
3. Difficulty communicating with family and others;
4. Cannot control actions, conversation, movements;
5. Due to a decrease in intelligence, it is not trained;
6. Not capable of performing the simplest activities. "

Depending on the severity of violations, the categories have 3 degrees.

Easy - there are restrictions on the main profession. But with a change in qualifications, volumes, complexity, it is possible to continue working experience.

Average - there is admission to work with the help of unauthorized persons and with the use of assistive devices.

Extreme severity - a citizen is not able to perform the simplest work or it is forbidden to work, because there are contraindications due to significant changes in health.

In conclusion, the ITU indicates the disability group, established contraindications, conditions for work activities... Disability groups have different limitations.

“The patient is assigned to a group with 1 degree of restriction to work. This means that it is allowed to work, but it is necessary to change the working conditions or tension. "

General

General working capacity is understood as performing simple work that does not require special qualifications. Violation of the state of health due to a pathological process, due to which a person cannot go to work and perform official duties is called a persistent loss of general working capacity.

Conclusion on this kind the losses are caused by the doctors of the forensic medical examination bureau. In the course of expert actions, the state of the victim is established and the relationship with the incident is identified. Carried out to assess and determine:

1. Consequences of traffic accidents;
2. The level of damage at work injury;
3. Attack harm;
4. Unintentional actions of medical staff and others.

Examination by experts is appointed only at the request of the court.

How the degree of disability is determined

The degree of professional disability is set as a percentage. This type of loss is registered when an employee of a certain specialty after an occupational disease or injury at the enterprise is not able to continue to perform professional duties.

The function of determining the degree belongs to the ITU regional bureaus on the basis of the legislative acts of the Russian Federation.

In cases of temporary disability, the assessment of the degree is carried out at a commission in a medical institution. The composition includes:

1. Deputy Head for Clinical Expert Work - Chairman of the Commission;
2. Heads of departments;
3. Doctors are specialists.

Incapacity for work

An official document confirming the temporary fact of the inability to work is a sick leave. The responsibilities of registration lie with the attending physician of the medical institution where the patient is being observed. The doctor alone issues a document for half a month. If necessary, the bulletin is extended to a meeting of the medical commission, where the patient is sent.

Depending on the severity of the disease, a citizen is on sick leave for up to 10 months, with certain pathologies up to a year.

According to the conclusion of the chairman of the commission, a patient with persistent health problems, a negative prognosis in clinical and labor aspects, is sent for examination to the ITU bureau.

At the examination, a disability is assigned to a citizen, and a group is determined depending on the severity of disabilities.

Required documents

The patient for the meeting of the commission at ITU must arrive at the appointed time and have on hand:

1. Passport or other ID, original and copy.
2. Extract from the medical history, registration form No. 027 / y. Issued at a medical institution at the place of observation.
3. Referral to the ITU by a medical organization providing treatment and prophylactic care, registration form No. 088 / u-06.
4. Sick leave.
5. For working citizens a copy work bookcertified by the personnel department at the place of work.
6. Card of a patient receiving medical care on an outpatient basis, registration form No. 025 / y.
7. Help with information about working conditions.
8. If a citizen is sent for re-examination, then a copy of the previous ITU opinion.
9. Pension insurance certificate, copy and original.

Competent authorities

Registration of temporary loss is the responsibility of a medical institution that has a license to operate and expertise for incapacity for work. To extend sick leave, a meeting of the medical commission is held.

Persistent loss is registered by the regional bureaus of medical and social expertise at the patient's place of stay. To challenge the decision to award disability and group, citizens should contact the ITU Main Bureau for the subject or the Federal Agency for Russia.

In court proceedings and assessment of general disability, documents are submitted to the territorial department of the Bureau of Forensic Medical Examination at the place of stay.

Percentage of disability

The assessment of the loss of general and professional working capacity is carried out according to special tables as a percentage of the initial level of ability to work. The examination is carried out by specialists of the bureau of medico-social and forensic medical examination.

Complete loss is equal to 100% and is recorded with persistent dysfunctions.

The interval from 70 to 90% corresponds to significant disabilities. In these cases, it remains possible to perform work only in special conditions.

If the victim works under normal conditions, but with a decrease in his qualifications or tension, this is an insignificant degree of impairment, equal to a decrease in working capacity from 40 to 60%.

From 10 to 30% - the minimum decrease in working capacity. The victim continues to work on the same placebut with shorter working hours.

Payments and benefits

Depending on the type of disability, a citizen has social security.

Average sick leave is paid wage at the place of employment. The position remains with the patient.

Disability registration entitles you to the following benefits:

1. Getting free qualified medical care.
2. Free rehabilitation.
3. Preferential drug provision.
4. Reimbursement of housing costs and utilities at a rate of 50%.
5. Employment guarantee.
6. Annual paid vacation.
7. Reduced working hours for disabled people of the first and second groups.
8. Additional payments to Chernobyl victims - Chernobyl liquidators.
9. Payment of pensions, benefits, insurance amounts.

Conclusion

If a person has a case of incapacity for work, then depending on the type and degree of disorders of the body's functions, the state guarantees the receipt of free medical care, rehabilitation and special benefits.

Hello everyone! Once I put one on the back burner unusual situation. And so I tuned in, I take it out for general review and discussion. If you remember, at the very beginning of your virtual journey, i promised - "to share the most expensive, or rather priceless, that a person has - his own experience" (a fragment from the main page of the blog). I share 😎

In practice, it is very difficult to transform your experience into a clear and readable presentation, and nevertheless, guys, I try 💡 I hope that someone will find it useful.
Further in the text, the organization in which the incident occurred will be depersonalized. Let's assume that this is a situation based on real events 😉

Somehow the head of one isolated structural unit, and says:
RSP: "Anton, I have an accident, an injury at work, what should I do?"
Me: "What happened?"
RSP: “Last night, when I was gone, my employee cut something with a clerical knife and severely ripped open his left hand. His foreman, provided him with first aid and called an ambulance. And this morning this employee came to work with a rewound hand, sort of like working, but I decided to give him a day off and let him go home for a couple of days. What should we do now on this occasion? You need to investigate? "
Me: “Did this employee get sick leave? Did you bring a certificate of incapacity for work? "
RSP: "No, he didn’t register, he said he refused."
Me: “If there is no certificate of incapacity for work with code 04, then there is no industrial accident. You can breathe out calmly and forget about it. "
RSP: “Well, how ?! After all, he was injured in the performance of his official duties. Moreover, the "ambulance" took him away from our unit, and they clearly record everything. "
Me: “I say, there is no cause for concern. You will not have any problems about this. Industrial accidents are investigated on the basis of the "sick leave" certificate of incapacity for work. "
RSP: "Is that correct?"
Me: "Yes."

And now the n-th amount of time passes. I already forgot about this conversation. Call from this unit from the foreman:
Brigadier: “Anton, today an employee came who was injured a long time ago, cut his hand with a clerical knife. He brought a statement with some kind of medical certificate. "
Me: "What is in the application and what kind of certificate?"
Brigadier: “In the statement, she asks us to pay compensation for her injury at work. Medical certificate, usual, issued by a doctor, with a hospital stamp. The help says that this employee was observed by the surgeon. "
Me: "Okay, please pass these papers to the central office."
Brigadier: "Ok, today I will send it by internal mail."
Me: “Between us, how would you characterize this employee yourself? Why did he suddenly decide to get compensation ?! "
Brigadier: “The employee is a problematic one, he constantly complains. And about compensation - his relative advised. They say that he is a young lawyer ... "
Me: “I see, I understand, I'm waiting for this statement with a certificate. I will prepare a response in writing and send it to you for subsequent delivery to this employee and his relative, against signature. "

To assess the semantic load of the statement of this employee, I will give his text. Further, the text of the statement:

“On April 11, 2013, I received an industrial injury in the form of a cut wound in my left hand.
This incident occurred in work time at 19 hours 50 minutes in the department H.
The fact of receiving this work injury confirmed by medical certificate No. 01 and registered by the police department of such and such, the city of Novosibirsk.
Based on the above, I ask you to pay the insurance indemnity for the insured event that occurred on April 11, 2013.
Attached:
A copy of the medical certificate "

So, somehow the employee decided to get compensation from the organization. To his regret, he himself, at the very beginning of this whole story, deliberately decided this issue in the wrong direction.

Response text:

“By this letter we inform you the following:
Society with limited liability "LABOR PROTECTION" is an organization strictly observing the provisions of the legislation in force in the territory of the Russian Federation.

In accordance with Article 184 of the Labor Code of the Russian Federation, if an employee's health is damaged as a result of an industrial accident, the employee (his family) is reimbursed for his lost earnings (income), as well as additional costs associated with health damage for medical, social and vocational rehabilitation. The types, volumes and conditions for granting guarantees and compensations to employees in these cases are determined by federal laws.

Insurance coverage for certain types compulsory social insurance are:
insurance payments in connection with an industrial accident and occupational disease, payment of additional costs for medical, social and vocational rehabilitation (under 6, p. 2, art. 8 Federal law from 16.07.1999 N 165-FZ "On the basics of compulsory social insurance").

Compulsory insurance coverage is also legally established, which is carried out in the form of a temporary disability allowance assigned in connection with an insured event (under 1, item 1, article 8 of the Federal Law of 24.07.1998 N 125-FZ "On compulsory social insurance against industrial accidents and occupational diseases").

The basis for the accrual and payment of insurance indemnity "in the event of an insured event" is a certificate of incapacity for work presented by the employee, issued by a medical organization in the form and in the manner established federal body executive power (Clause 5, Article 13 of the Federal Law of December 29, 2006 N 255-FZ (as amended on 04/05/2013) "On compulsory social insurance in case of temporary disability and in connection with motherhood").

The certificate of a medical institution (No. 01 dated 04/11/2013) provided by you is not proof of loss (temporary or permanent) of your ability to work. This document, certifies the fact that you have applied to a medical pre-emption (indicates the reason for your absence from the workplace during working hours).

In accordance with Article 227 of the Labor Code of the Russian Federation, as well as paragraph 10 of Art. 3 of the Federal Law of 24.07.1998 N 125-FZ, part 3 of paragraph 3 of the Regulations on the specifics of the investigation of accidents, approved by the Resolution of the Ministry of Labor of Russia of 24.10.2002 N 73, it is established that investigation according to the procedure established for accidents, the events as a result of which the injured were received are subject to: bodily injury (injury), including those caused by another person; heatstroke; burn; frostbite; drowning; electric shock, lightning, radiation; bites and other injuries caused by animals and insects; damage due to explosions, accidents, destruction of buildings, structures and structures, natural disasters and other emergencies, other damage to health caused by external factors that entailed the need to transfer victims to another job, temporary or permanent disability or death of victims.

The injury you received (recorded in medical certificate No. 01 - "cut wound of the left hand") is not a basis for investigating the accident in accordance with the established procedure, since you have not submitted a document (certificate of incapacity for work) confirming the occurrence of one of the consequences specified in paragraph ... 1 h. 3 tbsp. 227 of the Labor Code of the Russian Federation (it became necessary to transfer the victims to another job, temporary or permanent disability or death of the injured). Consequently, the LLC "PROTECTION OF LABOR" did not have the obligation to conduct an investigation and draw up an Accident Act.

Based on the foregoing, we believe that LLC "OHRANA LABORA" has no grounds provided for by law for calculating and paying you an insurance benefit. "

All this statement in the legal context was registered with an outgoing number and sent in duplicate, for handing over to this employee against signature.
The hard worker took his copy, in the second he signed for the receipt personally, and, since then, I have not heard anything else on this issue.

I hope that my experience has been transformed into a useful note for you.

Establishing the percentage of loss of general working capacity 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 used in the process of legal proceedings in cases related to situations that are dangerous to human life and health. This examination is one of the most demanded, since its results are relied on when sentencing the guilty party and awarding compensation and monetary payments.

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

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

The harm caused to health is measured as a percentage of the conditional indicator of general working capacity. In general, distinguish between general, professional and special work ability. General working capacity is understood as the performance of simple operations that do not require special qualifications, that is, such operations, the implementation of which may be impeded by an injury that has consequences. Professional performance means the ability of a given person to carry out qualified activities in a profession - for example, working as an economist. Special working capacity means the qualification of a person to work in a certain specialty. For example, the profession of "economist" includes a whole range of specialties - economic analysts, specialists in the field of banking, financiers, accountants, and so on.

Also distinguish between temporary and permanent disability. Temporary disability occurs as a result of diseases and injuries that can be treated - for example, uncomplicated limb fractures, soft tissue injuries, minor injuries, and so on. Permanent disability occurs when the injuries and injuries (or their consequences) are not subject to complete recovery. For example, amputation of limbs or decreased intelligence and impaired coordination resulting from a traumatic brain injury. Percentage of total disability is measured relative to the persistent consequences of injury.

To calculate this indicator, forensic medical examination relies on normative document, namely - a table of percent of permanent loss of general working capacity. This table is an attachment to the Order of the Ministry of Health and Social Development, which approves the criteria for establishing the size and severity of harm to human health.

According to the above table, a 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 \u200b\u200bof disability, expressed as a percentage, are indicated.

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

• Central nervous system and peripheral nervous system.
• The digestive organs.
• Organs of vision.
• Respiratory system.
• Hearing organs.
• The cardiovascular system.
• Genitourinary system.
• Soft tissue.
• The musculoskeletal system.

According to the notes indicated in the table, in the event of a dysfunction of two or more organs of the same system, the percentage of total disability is established according to one of the criteria reflecting the most pronounced damage. In the event of damage to several body systems, the percentage of disability is added up, however, the total indicator should not exceed 100 percent. In the table, the percentages for each case are displayed in increments of five units. The most severe (from seventy to one hundred percent) consequences of injury, poisoning and other influences 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 pronounced decrease in the strength and range of motion in the limbs, a significant violation of the ability to coordinate, a strong decrease in intellectual abilities - 75%.
• Strongly expressed disorders of movement and sensitivity in both legs, significant dysfunction of the pelvic organs, severe pressure sores and trophic ulcers - 100%.
• Trophic ulcers, lack of sensitivity and movement in the joints of the legs - 70%.
• Loss of both seeing eyes - 100%.
• The absence of a nose, entailing a change in the victim's face - 70%
• Congestion in the lung (or in both parts of the lung), liver cirrhosis, ascites, respiratory rhythm disturbance, effusion in the pericardial cavity and / or pleura - 90%.
• Obstruction of the pharynx as a result of poisoning with caustic poisons, injury or burns - 90%.
• Absolute immobility of the spine, severe deformity of the spine - 70%.
• The absence of an upper limb - 80% (for the right hand) and 75% (for the left).
• The absence of a leg or stump at the level of the upper third of the thigh - 70%.
• The absence of the jaw - 80%.
• Complete lack of language - 70%.
• Gastric resection to compensate for the consequences of trauma - 80%.
• The absence of the forearm - 70% (65% for the left hand).

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

• Cicatricial trichiasis, keratitis, conjunctivitis, twist of the eyelid of one eye, which do not cause a decrease in vision - 5%.
• The same for both eyes - 10%.
• Removal of an eyeball that did not have vision - 5%.
• Decrease in visual acuity by one tenth - 5%.
• The presence of rough scars on the tongue resulting from injury, frostbite or burns that make it difficult to eat - 5%.
• Scars on the body (including the scalp), occupying from 2% to 4% of the body surface - 10%.
• Absence of the nail phalanx - 10%.
• The absence of a big toe - 10%.
• Moderate peripheral damage to the hypoglossal, facial or trigeminal nerve, which caused a violation of their function - 5%.
• Violation of 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 working capacity is one of the criteria in determining the severity of harm caused to the health of the victim. However, permanent disability deprives the victim of the opportunity to earn money - in part or in full. As a result, the determination of the percentage of disability may be the reason for the appointment of an independent examination.

The basis for conducting an examination to establish the percentage of loss of general working capacity may also be harm to the health of the injured person through the fault of the health worker, as well as other officials responsible for the safety of the people entrusted to them.

An expert examination to establish the percentage of loss of general working capacity is carried out only by a court ruling. When carrying out expert measures, the specialist takes into account all the case materials. The presence of any chronic diseases is not taken into account when establishing the percentage of total loss of capacity for work that occurred as a result of an incident, an attack, an accident or a catastrophe.

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

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

What documents should be provided to an expert to establish the percentage of loss of general working capacity

• The identity document of the initiator of the examination.
• Court ruling.
• All available medical documents, including the certificate of examination of the Medical and Social Expert Commission.
• Accident report or accident investigation report. To determine the percentage of loss of general working capacity as a result of a road accident - a certificate from the traffic police.
• If necessary - the results of other examinations.

The legal framework governing the process of establishing the percentage of total disability

1. Order No. 194n of the Ministry of Health and Social Development of the Russian Federation dated April 24, 2008. "On the approval of the Medical criteria for determining the severity of harm to human health."
2. Appendix to this order - "Table of percentages of persistent general disability resulting from poisoning, injuries and other effects on the human body."

Questions that the specialist answers in the process of establishing the percentage of loss of general working capacity

1. What is the total percentage of total disability loss?
2. What percentage of total disability is associated with a given functional disorder?
3. What is the percentage of total disability caused by this particular incident?
4. What is the largest percentage of disability among functional disorders of organs of one body system?
5. What functional systems were malfunctioning?
6. What disorders or injuries were taken into account when establishing the percentage of total disability?

Cost and terms

• Forensic examination

  The forensic examination is carried out according to the decision of the court. To appoint an examination to our organization, you must submit an application for the appointment of an examination and attach an information letter to it indicating the details of the organization, the possibility of performing an examination on the issues 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 will prepare a newsletter within one working day, after which we send its scanned copy to e-mail... 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 of the information letter, it is enough to submit a copy of it.

  The service of writing an information letter is provided is free.

• Extrajudicial investigation

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

• Expert opinion review

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

• Obtaining written advice from an expert (reference)

  Help is not a conclusion, it is informational in nature and contains answers to questions that do not require full research, but allow us to assess the feasibility of a full examination.

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

• Obtaining preliminary expert advice

  Our experts are ready to answer any of your questions regarding the conduct of forensic and extrajudicial examinations, assess the feasibility of conducting an examination, assist in the formulation of questions for research, inform the possibility of conducting one or another analysis, and much more.

  The 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 an examination, preliminary questions, if possible, attach all possible documents and descriptions of objects.

  The more details you give the circumstances of the case, the more productive the expert's help will be.

• Additional services

  Reduction of the period for the production of expertise in half

  30% to the cost

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

  Departure of the expert within the Moscow region

  Departure of the expert to other regions of Russia

  Travel 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 5000 rubles

  Drawing up a statement of claim

Experts

Expert psychiatrist

Graduated from the Russian State Medical University with a degree in Pediatrics. She was a member of the student scientific society of psychiatry. In November 2011, she passed certification at the central certification commission at the Department of Health of the city of Moscow (at the Department of Psychiatry, Narcology and Psychotherapy FPDO MGMSU) with the assignment of the first qualification category in psychiatry. In 2012 she was awarded the second qualification category in psychiatry. In 2013, she attended advanced training courses in psychiatry at the Department of Social and Forensic Psychiatry FPPOV First Moscow State Medical University named after I. IM Sechenov and advanced training courses in psychotherapy at the Department of Psychiatry, Narcology and Psychotherapy FPDO MGMSU.

Expert psychiatrist, full member of the Professional Psychotherapeutic League, member of the Board and Academic Secretary of the Russian Psychoanalytic Society

Graduated from residency in psychiatry at the Moscow Research Institute of Psychiatry, MZRF. During her postgraduate studies at the Moscow Research Institute of Psychiatry, MZRF, she worked on the problem of the occurrence of cognitive-behavioral disorders with prolonged use of benzodiazepine tranquilizers and cyclodol in schizophrenic patients. She underwent advanced training in the specialty: psychoanalytic psychiatry at the State Scientific Center for Social and Forensic Psychiatry. V.P. Serbian; with a degree in psychotherapy at the Russian State Medical University. N.I. Pirogov of the Ministry of Health and Social Development of the Russian Federation. She studied at Moscow State University. MV Lomonosov on the program "Psychological counseling and psychodiagnostics of personality"; at the Moscow Institute of Economics, Politics and Law under the program "Modern psychoanalysis, psychoanalytic psychotherapy, psychoanalytic counseling." Conducts professional activities in the field of personality psychodiagnostics, psychological counseling and psychoanalytic psychotherapy, scientific activities in the framework of seminars and conferences in the field of modern psychoanalysis.

 

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