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

Working capacity examination - this is a type of examination, which consists in determining the causes, duration, degree of temporary or permanent disability of a person due to a disease, 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 the working capacity of a person?

Ability to work - this is a state of the human body in which the totality of physical and spiritual capabilities allows you to perform work of a certain volume and quality. Based on the data of a comprehensive medical examination, a medical worker must establish the presence or absence of a disease in a particular person. Employability has medical and social criteria.

Medical Eligibility Criteria include 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, the 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 panaritium can fulfill his professional duties - he is able-bodied, but a cook is not, that is, he is disabled. In addition, the cause of disability is not always the disease of the patient himself. For example, the same cook himself may be healthy, but someone in his family has contracted viral hepatitis, as a result of which the cook cannot perform his professional duties, that is, prepare food, since he has contact with a patient with viral hepatitis. Therefore, the disease

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

Social criteria for working capacity determine the labor prognosis for a specific disease and its working conditions, reflect everything related to the patient’s professional activity: a characteristic 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 hazards.

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

13.2. Examination of temporary

INABILITY

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 due to illness, injury and other reasons, in which dysfunctions are accompanied by the impossibility of performing professional work in normal production conditions for a certain period of time, that is, they are reversible.

Distinguish between full and partial temporary disability.

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

Partial temporary disability 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.

Establishing the fact of temporary incapacity for work is carried out on the basis of an examination and is of great legal and economic importance, since it guarantees the citizen the release from work and the receipt of benefits at the expense of state social insurance. Timely release of sick people from work is one of the effective preventive measures to prevent complications of diseases, their chronicity.

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

Examination of temporary disability is carried out in state, municipal and private healthcare organizations.

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

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

With diseases;

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

For the period of aftercare in sanatorium-and-spa institutions;

If necessary, care for a sick family member;

For the period of quarantine;

For the period of prosthetics in a hospital;

For the period of maternity leave;

When adopting a child.

There are two ways of issuing disability certificates: centralized and decentralized. Centralized way more often used in large clinics, where disability certificates are issued at the registry office or in specialized offices for the centralized issuance of sick leave certificates.

A nurse working in this office must be able to correctly fill out the passport part of the disability certificate and items related to exemption from work. At decentralized way a 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 a paramedic and dentists of medical organizations by decision of the health authority of the subject Russian Federation agreed with the regional branch of the Social Insurance Fund of the Russian Federation.

Medical workers of the following health care institutions do not issue sick leave certificates:

Establishments of emergency medical care;

blood transfusion facilities;

Reception departments of hospitals;

medical and physical education dispensaries;

Balneological clinics and mud baths;

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

Health care institutions for supervision in the field of consumer protection and human well-being.

Disability certificates are issued 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 together with the Social Insurance Fund of the Russian Federation.

These Temporary criteria for determining the degree of loss of professional ability to work as a result of accidents at work 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 professional ability to work as a result of accidents at work 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 received damage to their health as a result of accidents at work or occupational diseases (hereinafter referred to as victims), their need for medical, professional and social rehabilitation measures.

These 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 work capacity in percent

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

2. The main methodological principle of the examination of the professional capacity for work of the victim is a cumulative analysis of the following criteria:

clinical and functional;

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

3. Clinical and functional criteria include:

the nature and severity of the injury, occupational disease;

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

the nature (type) of violations of body functions;

the degree of violations of body functions (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 body of the victim, leading to a limitation of the ability to work, is taken into account. labor activity, and other categories of life. Traumatic injuries and occupational diseases are characterized by a variety of clinical manifestations, which are different both in nature and in the severity of functional disorders. The polymorphism of the clinical picture in the victims may be due to the presence of both direct consequences of injuries, occupational diseases, and their complications. In this regard, the methodology for expert examination of this category of victims requires a comprehensive clinical and physiological study using modern methods 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. Analysis of a set of indicators of a clinical and physiological nature helps to clarify the main medical and biological factors (nature, degree of dysfunction , the 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 production or other working conditions.

(As amended by the Order of the Ministry of Health and Social Development of the Russian Federation of April 18, 2007 N 280)

6. Full-time professional activity involves a full-time, full-time working week, fulfillment of production standards by at least 100 percent.

7. The criteria for assessing the possibility of performing professional activities are related to the difference in tariff and qualification categories within the framework of the relevant profession.

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

9. At the heart of the ranking of work by degree of complexity (and therefore by skill categories) are the factors of labor complexity:

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

organizational - the breadth of the complex of operations (works) 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. The assessment of the level of complexity of work is carried out differentially according to work that differs in the degree of mechanization: manual, machine-manual, machine, automated, hardware.

11. When determining the tariff-qualification category, the employee's qualification is taken into account as a set of knowledge, skills and labor skills, as well as the time spent on training (study). Qualifications to knowledge increase from initial information in the amount of incomplete high school(1 - 2 categories) to knowledge of individual disciplines in the volume full course secondary special educational institutions(6th category).

12. For the tariff-qualification system for assessing work and professions of workers, a pattern of increasing complexity of work for each of the factors taken as the basis for determining the category is characteristic. For example, according to the technological factor: when moving from 1st category to the next, the complexity, power, and dimensions of a unit of serviced equipment of a similar purpose increase. According to the organizational factor of complexity, the degree of independence in the performance of work is increasing and functions are connected to manage workers of lower skill levels.

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

Skilled professions of workers 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 Works and Professions of Workers (ETKS), with the optimal ( 1st class of working conditions) or acceptable (2nd class of working conditions) physical, neuro-emotional load, which does not contain contraindicated production factors and corresponds to the psychophysiological capabilities of the victim for its implementation.

15. At the same time, the degree of loss of professional ability to work is established depending on the level of skill reduction, taking into account the decrease in the coefficient of complexity of work. For example, the transfer of a worker of the 6th category to the 2nd category leads to a decrease in qualification with the loss of four categories and with a decrease (by 60 percent) in the coefficient of complexity of work.

16. The degree of loss of professional capacity for work of a worker of unskilled physical labor is established depending on his psycho-physiological 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 capacity for work for this contingent of workers is determined taking into account the degree of reduction in the category (class) of the severity of labor, for example, when a worker transfers heavy physical labor of the 4th category of severity (lifting and carrying a load weighing more than 35 kg) to the shown work of the 1st category of severity with mild 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 harmfulness and danger of factors in the working environment, the severity and intensity of the labor process.

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

19. Loss of professional ability to work of employees (engineers, managers of various levels, persons creative professions etc.), to whose activities labor rationing is applicable, is determined taking into account the reduction in the volume of work performed, its complexity and intensity, official duties.

III. Determination of the degree of loss of professional

working capacity in percent

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

(as amended by the Decree

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 spastic muscle tone 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 impossibility of independent movement; Type III EMG - frequent potential fluctuations, distortion of the normal structure of the electromyogram by "volleys of frequent oscillations" (significantly pronounced paresis); Type IV EMG - complete bioelectrical 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); a significant limitation of opposition of the thumb (the distal phalanx of the latter reaches the base of the second finger), bending 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 grasp and hold large and small objects, only an auxiliary function is preserved - maintaining and pressing objects;

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

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

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

f) significantly pronounced sensory impairments (practical or absolute blindness of the only or better seeing eye: visual acuity with correction - 0.04 - 0, field of view is 0 - 10 degrees (peripheral boundaries along the meridian from the point of fixation and / or central or paracentral confluent scotomas); visual performance - a significantly pronounced decrease or absence, EPS indicators - E-U thresholds of 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 the implementation of any labor);

g) significant violations of the functions of the pelvic organs (incontinence of urine, feces).

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

At the same time, the degree of loss of professional ability to work by victims with severe impairment of body functions is established depending on the level of skill reduction and the possibility of using professional knowledge and skills when performing work in specially created production conditions:

a) is no longer valid. - Order of the Ministry of Health and Social Development of the Russian Federation of September 24, 2007 N 620;

b) in cases where the victim can perform work of a lower qualification in specially created production 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 work in a profession under specially created production conditions that preceded an accident at work or an 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 in victims with the consequences of work-related 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 Decree of the Ministry of Labor of the Russian Federation of 26.04.2004 N 61)

a) severe paresis of both lower extremities, tetraparesis, triparesis, hemiparesis with a pronounced increase in spastic muscle tone or muscle hypotension, 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, severe 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 walking rhythm coefficient to 0.52 - 0.58 (normally 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 the muscles - low-frequency potentials such as "fasciculations" 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 restriction 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: grasping of small objects is not possible, long-term and strong holding of large objects, EMG - type II;

d) pronounced vestibular-cerebellar disorders (dizziness at rest, severe and frequent - 4 or more times a month bouts of dizziness), spontaneous nystagmus of II-III degree, pronounced disturbances in statics and coordination of movements, movement with the help of assistive devices (cane, crutches) , hyperreflexia of vestibular excitability with a duration of postrotational 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 vicious position of the lower limb, with a functionally unfavorable position of the knee joint with flexion contracture with the impossibility of extension of more than 140 degrees, vicious installation 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 pelvic tilt and functional shortening of the limb by 10 cm, severe contracture with a range of motion of no more than 30 degrees, or ankylosis of the joints in a functionally disadvantageous position;

f) respiratory failure of the II degree, circulatory disorders of the II stage (respiratory rate at rest 21 - 29 per minute, increased respiratory rate by 12 - 16 per minute after exercise, pronounced cyanosis, participation in the act of breathing of the auxiliary respiratory muscles during a slight physical load, heart rate 100 - 129 beats per minute, small peripheral edema, decrease in lung capacity to 50 - 55% due, maximum lung ventilation - up to 51 - 54%, increase in minute respiratory volume up to 150%, decrease in the Tiffno index to 54 - 40%, oxygen utilization rate up to 28%, 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 of the only 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 indicators - E-U thresholds - 200 - 300 μA, lability - 20 - 35 Hz, KChSM - 20 - 35 p / s .;

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

h) pronounced dysfunction of the pelvic organs, the absence of the urge to urinate and the feeling of passing urine through the urethra; with cystometry, the capacity of the bladder with detrusor hypotension is 500-600 ml, residual urine is up to 400 ml, with detrusor hypertension, the capacity is 20-30 ml; long delay in defecation - up to 5 days; anal reflex, sphincter tone and pressure with monometry 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, under normal production conditions, perform professional work with a pronounced decrease in qualification or with a decrease in the volume of work performed, or if he has lost the ability to continue professional activities due to moderate impairment of bodily functions, but can, under normal production conditions, continue professional activities of a lower level. qualifications, from 40 to 60 percent of the loss of professional ability to work is established.

(as amended by the Decree 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 capacity for work by victims with moderate impairment of body functions is established depending on the level of skill reduction, the volume of production activity or the category of severity of labor:

a) 60 percent 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 qualification by four wage categories;

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

paragraph is invalid. - Order of the Ministry of Health and Social Development of the Russian Federation dated May 13, 2005 N 329;

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

(clause "a" as amended by the Decree of the Ministry of Labor of the Russian Federation of 04.26.2004 N 61)

b) 50 percent loss of professional ability to work is established in the following cases:

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

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

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

c) 40 percent loss of professional ability to work is established in the following cases:

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

if the victim can perform work using professional knowledge, skills and abilities, but with a reduction in qualification by two rating categories;

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

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

if the victim can perform unskilled physical labor with a reduction 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 in victims with the consequences of work-related injuries and occupational diseases, if it is possible to perform professional activities in normal production conditions, are moderate violations of the static-dynamic function:

(as amended by the Decree 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 hypotrophy of the thigh muscles by 5–7 cm, lower legs by 4–5 cm, increased spastic muscle tone 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 drooping of the feet; movement sometimes with the use of additional support (cane);

b) moderate violation of the biomechanics of walking - an increase in the number of steps when walking 100 meters up 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 walking rhythm coefficient to 0.82 - 0.75, a moderate decrease in the speed of movement to 2.0 km per hour;

c) moderate violation of bioelectrical activity - ACBA in the range of more than 25 percent, but less than 70 percent of the norm;

d) moderate paresis of the upper limb: hemiparesis with limited range 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 flexion 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 the bioelectrical activity of the muscles of the upper limbs within 25 - 75 percent of the norm;

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

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

g) amputation stumps of a limb (thigh, lower leg, both feet at the level of the Chopard, Lisfranc joint), moderate flexion or extensor 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 the 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 I-II degree, circulatory disorders of I-II stage (shortness of breath with moderate physical exertion, increased cyanosis after moderate physical exertion, 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 lung capacity to 56 - 69 percent due, maximum lung ventilation - up to 55 - 58 percent, an increase in minute respiratory volume up to 142 - 148 percent, decrease in the Tiffno index to 74 - 55 percent, oxygen utilization rate to 36 - 44 percent, oxygen uptake per minute - 277 - 287 ml, signs of a moderate decrease in the contractility of the right ventricular myocardium in combination with a violation of pulmonary hemodynamics);

i) moderate sensory impairments: impaired functions of the visual analyzer - medium degree of low vision: decreased visual acuity of the only or better seeing eye with a 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 indicators - E-U thresholds - 100 - 150 μA, lability from 30 - 35 to 40 - 43 Hz, KChSM from 30 - 35 to 40 - 43 p / s .; moderate hearing loss - perception of colloquial 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 capacity of the bladder with detrusor hypotension is 500-400 ml, residual urine is more than 100 ml with detrusor hypertension, the capacity is 20-125 ml; long delay in defecation - up to 3 - 4 days; sphincter insufficiency - gas incontinence, the anal reflex is reduced, the tone and volitional contractions of the sphincter are weakened, manometry reveals a moderate decrease in the pressure of the external sphincter - 16 - 25 mm Hg. Art., internal sphincter - 26 - 40 mm Hg. Art.

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

28. At the same time, the degree of loss of professional ability to work by victims who have minor impairments of body functions due to work-related injuries or occupational diseases is determined depending on the level of skill reduction, the volume of production activity or the category of severity of labor:

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

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

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

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

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

29. Examples of clinical and functional criteria for establishing 10-30 percent loss of professional capacity for victims with the consequences of work-related injuries and occupational diseases, if it is possible to perform professional activities in normal production conditions with a slight decrease in qualification, category of severity of work or a decrease in the volume of production activity, are minor violations of the statistical - dynamic function:

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

a) slight 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 a slight violation of the biomechanics of walking - an increase in the number of steps when walking 100 meters up 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 walking rhythm coefficient to 0.85 - 0.90, reduction of movement speed to 3.0 km per hour; with a slight decrease in the amplitude of fluctuations of bioelectrical activity on EMG up to 25 percent of the norm;

b) slight 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 brush - grasping and holding objects; on EMG - a slight decrease in the amplitude of the bioelectrical activity of the muscles of the upper limbs up to 25 percent of the norm;

c) minor contracture of the shoulder, elbow or wrist joints; the 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 nystagmus I degree;

e) minor static-dynamic 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 - calcaneal foot (extensor contracture);

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

h) minor sensory impairments: impaired functions of the visual analyzer - a small degree of low vision of the only or better seeing eye, visual acuity with a 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 - E-U thresholds 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 speech up to 3 - 5 meters, whispered speech - up to 1.5 - 2.0 meters, average hearing threshold 20 - 40 dB, speech intelligibility threshold - 30 - 40 dB;

i) minor dysfunction of the pelvic organs: a weak sense of urge to urinate, with cystometry, the capacity of the bladder is 200-250 ml, residual urine is up to 50 ml; delayed 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. Lost their power. - Decree 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 emerging 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 program for the rehabilitation of the victim on the restoration of professional capacity for work in the previous profession (preceding 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 rehabilitation of the victim.

Employability is the ability of a citizen to perform professional duties good quality and volume. Termination of activity due to illness or accident is called the loss of ability to work.

Disability

A citizen cannot work due to a health disorder. Such impossibility is defined as disability. Lead to this:

  1. Acquired acute and chronic diseases;
  2. congenital anomalies;
  3. Pathologies as a result of traumatism;
  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 violations.

Persistent or permanent

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

With an unfavorable prognosis of professional activity and health, they give a referral from the clinic where the patient is being served to a meeting of the territorial bureau of medical and social expertise (ITU) for examination.

Do you have any work restrictions?

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Temporary

The state when a violation of the functions of the body as a result of illness or injury does not allow you to start work in a relatively short period is a temporary disability. Under the influence of medical measures is reversible. Sick leave is issued temporarily for the period of treatment. It is needed for:

  1. Official confirmation of the absence of the employee.
  2. Securing payments.
  3. Analysis of the causes and terms of disability at the medical site, in the organization.

Partial

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

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

“The sister of the treatment room suffered damage to the tendon of the thumb of the left hand. For 21 days she cannot go for procedures, but her state of health allows her to see her at the clinic. After a full recovery, the specialist will be transferred to his previous position.


With a 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.

“In connection with the amputation of the finger on the machine, the locksmith was assigned a disability group. The victim is unable to perform professional duties due to the injury. But a worker can do lighter work in the same factory.”

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

Complete

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 final recovery, then the employee begins his professional duties.

“The organization's accountant is hospitalized with acute appendicitis for emergency surgical treatment. The specialist completely loses the ability to work, but on short term- 10 days. The patient is given a bulletin, and after recovery, she proceeds to the previous type of activity.

Complete permanent loss, on the contrary, has a poor prognosis in terms of treatment and work. In such cases, a disability group with a contraindication to work is established.

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

Labor restrictions

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

  1. Self care;
  2. Movement 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, there are violations only in one or several areas at once.

“In a patient suffering from a mental illness, changes are observed in almost all categories, with the exception of independent movement. The following issues are logged:

  1. Cannot take care of himself;
  2. Not oriented in space and time;
  3. Difficulties in communicating with family and others;
  4. Cannot control actions, conversation, movements;
  5. Due to a decrease in intelligence, he does not learn;
  6. Unable to perform simple 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 the work experience.

Medium - there is a permit 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 job or it is forbidden to work because there are contraindications due to significant changes in health.

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

“The patient was assigned 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

Under the general working capacity is understood the performance of 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 permanent disability.

Conclusion on this species losses are given by doctors of the Bureau of Forensic Medical Examination. In the course of expert actions, the state of the victim is established and the relationship with the incident is revealed. Conducted to evaluate and determine:

  1. Consequences of traffic accidents;
  2. The level of damage in case of industrial injury;
  3. Harm when attacked;
  4. Unintentional actions of medical staff and other persons.

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

How is the degree of disability determined?

The degree of loss of professional ability to work is set as a percentage. This type of loss is recorded 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 on a commission in a medical institution. The composition includes:

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

Registration of incapacity for work

An official document confirming the temporary fact of the inability to work is a sick leave. The responsibility for registration lies with the attending physician of the medical institution where the patient is observed. The doctor alone issues a document for half a month. If necessary, the bulletin is extended for 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 the clinical and labor aspects, is sent for examination to the ITU bureau.

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

Required documents

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

  1. Passport or other proof of identity, original and copy.
  2. Extract from the medical history, registration form No. 027 / y. Issued in medical institution at the place of observation.
  3. Referral to ITU medical organization providing medical and preventive care, registration form No. 088 / y-06.
  4. Hospital sheet.
  5. For working citizens a copy work book, certified 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 conclusion.
  9. Certificate of pension insurance, copy and original.

Competent authorities

Registration of temporary loss is the responsibility of a medical institution that has a license to operate and an examination of disability. To extend sick leave, a meeting of the medical commission is held.

A permanent loss is registered by the regional bureaus of medical and social expertise at the place of residence of the patient. To challenge the decision to award a disability and a group, citizens should contact the ITU Main Bureau for the subject or the Federal Authority for Russia.

In litigation 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 incapacity for work

The assessment of the loss of general and professional ability to work 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 Medical and Social and Forensic Medical Examination.

A complete loss is 100% and is recorded with persistent functional impairment.

The interval from 70 to 90% corresponds to significant disability. 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 violation, 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 same place but with reduced working hours.

Payments and benefits

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

Sick leave pays average wage at the place of employment. The position is retained for the patient.

Disability registration entitles you to the following benefits:

  1. Getting free qualified medical care.
  2. Free rehabilitation.
  3. Discounted drug coverage.
  4. Reimbursement for housing expenses and utilities in the amount of 50%.
  5. Job security.
  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, allowances, sums insured.

Conclusion

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

Hello everyone! Somehow she put one on the back burner non-standard situation. And so I tuned in, I take it out for general viewing and discussion. If you remember, at the very beginning of your virtual journey, I promised- “sharing the most precious, or rather priceless, thing a person has - their own experience” (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 it will be useful to someone.
Further in the text, the organization in which the incident occurred will be anonymized. We will assume that this is a situation based on real events 😉

Calls me once the head of a separate 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 cut his left hand. His team leader gave him first aid and called an ambulance. And this morning this employee came to work with a rewound hand, it seems 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? Should we investigate?"
Me: “Did this employee take sick leave? Did you bring sick leave?
RSP: “No, I didn’t, he said he refused.”
Me: “If there is no sick leave with code 04, then there is no accident at work. You can calmly exhale and forget about it.
RSP: How so?! He was injured in the performance of his duties. Moreover, the ambulance took him away from our unit, and they are clearly recording everything.”
Me: “I’m telling you, there’s no reason to worry. You won't have any problems with this. Accidents at work are investigated on the basis of a “sick leave” certificate of incapacity for work.”
RSP: "Is that right?"
Me: "Yes."

And now the n-th amount of time passes. I already forgot about this conversation. A 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 is the certificate?”
FOREMAN: “In the application, she asks that we pay her compensation for the injury she received at work. Medical certificate, ordinary, issued by a doctor, with a hospital stamp. The manual says that this employee seen by a surgeon.
Me: "Okay, please pass these papers to the central office."
FOREMAN: "OK, I'll send it by internal mail today."
Me: “Between us, how would you characterize this employee? Why did he suddenly decide to receive compensation ?!
BRIGADIER: “The employee is really problematic, he constantly complains. And about the 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 cite his text. Here is the text of the statement:

“On April 11, 2013, I received an industrial injury in the form of a cut wound of the left hand.
This incident took place in work time at 19:50 in department X.
The fact of receiving this work injury confirmed by medical certificate No. 01 and registered by the police department of such and such, Novosibirsk.
Based on the foregoing, I ask you to pay insurance compensation for the insured event that occurred on April 11, 2013.
Attached:
Copy of medical certificate"

Here, in some way, the employee decided to receive compensation from the organization. To his own regret, he himself, at the very beginning of this whole story, deliberately decided this issue not in his favor.

Response text:

“We hereby announce the following:
Society with limited liability LABOR PROTECTION is an organization that strictly observes 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, in case of damage to the health of an employee due to an accident at work, the employee (his family) is reimbursed for his lost earnings (income), as well as additional costs associated with damage to health for medical, social and professional 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 accident at work and occupational disease, payment of additional expenses for medical, social and professional rehabilitation (under 6, paragraph 2, art. 8 federal law dated July 16, 1999 N 165-FZ "On the basics of compulsory social insurance").

It is also legally established mandatory provision for insurance, which is carried out in the form of temporary disability benefits, assigned in connection with an insured event(under 1, paragraph 1, article 8 of the Federal Law of July 24, 1998 N 125-FZ "On the mandatory social insurance from accidents at work and occupational diseases).

The basis for the accrual and payment of insurance compensation "in the event of an insured event" is the certificate of incapacity for work presented by the employee, issued by a medical organization in the form and in the manner that are established federal body executive branch (clause 5, article 13 of the Federal Law of December 29, 2006 N 255-FZ (as amended on April 5, 2013) “On compulsory social insurance in case of temporary disability and in connection with motherhood”).

The certificate of the medical institution presented by you (No. 01 dated 11.04.2013) is not evidence of loss (temporary or permanent) of your ability to work. This document, certifies the fact that you applied for a medical notice (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, clause 3 of the Regulations on the features of the investigation of accidents, approved by the Decree of the Ministry of Labor of Russia of 24.10.2002 N 73, it is established that investigation in the order established for accidents, events are subject, as a result of which the victims received: bodily injuries (injuries), including those inflicted by another person; heatstroke; burn; frostbite; drowning; electric shock, lightning, radiation; bites and other bodily 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 exposure external factors resulting in the need to transfer the victims to another job, temporary or permanent loss of their ability to work or death of the victims.

The injury you received (recorded in medical certificate No. 01 - “cut wound of the left hand”) is not a basis for conducting an accident investigation in the prescribed manner, since you have not submitted a document (disability certificate) confirming the occurrence of one of the consequences specified in paragraph . 1 hour 3 tbsp. 227 of the Labor Code of the Russian Federation (there was a need to transfer the victims to another job, temporary or permanent loss of their ability to work or death of the victims). Consequently, OOO Okhrana Truda did not have an obligation to conduct an investigation and draw up an Accident Report.

Based on the foregoing, we believe that LAB PROTECTION LLC does not have the grounds provided by law for accruing and paying you an insurance payment.

All this statement in a legal context was registered as an outgoing number and sent in duplicate, for delivery to this employee against signature.
The hard worker took his copy, signed the second in person, and since then, I have heard nothing more on this issue.

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

Establishing the percentage of loss of general ability to work is one of the types of forensic medical examination designed to assess the damage done to a person’s health, as a result of which he loses the ability to work, providing himself with a livelihood. This type of research is used in the process of legal proceedings in cases related to situations dangerous to human life and health. This examination is one of the most demanded, as its results are relied upon when sentencing the guilty party and assigning compensation and cash payments.

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

  • To assess the consequences of road incidents and disasters, as well as other traffic accidents.
  • To determine the level of damage received as a result of an industrial injury, as well as as a result of 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 medical worker or other officials.

The harm caused to health is measured as a percentage of the conditional indicator of general ability to work. In general, a distinction is made between general, professional and special work capacity. The general ability to work is understood as the performance of simple operations that do not require special qualifications, that is, such operations, the implementation of which may be hampered 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, work as an economist. Special performance means the qualification of a person to work in a particular 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 if the injuries and injuries (or their consequences) are not subject to complete recovery. For example, amputations of limbs or a decrease in intelligence and impaired coordination resulting from a traumatic brain injury. The percentage of loss of general ability to work is measured relative to the persistent consequences of the injuries received.

To calculate this indicator, forensic medical examination relies on normative 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 determining the size and severity of harm to human health.

According to the above table, the specialist who establishes the percentage of loss of general ability to work 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 disability are indicated, expressed as a percentage.

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.
  • Hearing organs.
  • The cardiovascular system.
  • Urogenital system.
  • Soft fabrics.
  • The musculoskeletal system.

According to the notes indicated in the table, in the event of a violation of the function of two or more organs of the same system, the percentage of total disability 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, 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 injuries, poisoning and other effects 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 strength and range of motion in the limbs, a significant impairment of the ability to coordinate, a strong decrease in intellectual abilities - 75%.
  • Severe disorders of movement and sensitivity in both legs, a significant violation of the functions of the pelvic organs, pronounced bedsores and trophic ulcers - 100%.
  • Trophic ulcers, lack of sensitivity and movements in the joints of the legs - 70%.
  • Loss of both seeing eyes - 100%.
  • Absence of a nose, entailing a change in the face of the victim - 70%
  • Congestion in the lung (or in both parts of the lung), cirrhosis of the liver, 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, wounds or burns - 90%.
  • Absolute immobility of the spine, sharp deformation of the spine - 70%.
  • Lack of upper limb - 80% (for 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 the jaw - 80%.
  • Complete lack of language - 70%.
  • Resection of the stomach to compensate for the consequences of trauma - 80%.
  • Absence of the forearm - 70% (65% for the left hand).

The table also displays violations of the functioning of the systems and organs of the body, as well as the consequences of injuries that cause a slight loss of the opportunity 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, inversion of the eyelid of one eye, not causing vision loss - 5%.
  • The same for two eyes - 10%.
  • Removal of an eyeball that did not have vision - 5%.
  • Decreased visual acuity by one tenth - 5%.
  • The presence of rough scars on the tongue, which are the result of 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%.
  • Absence of the 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 ability to work is one of the criteria for determining the severity of harm caused to the health of the victim. However, persistent disability deprives the victim of the opportunity to earn - partially or completely. As a result, determining 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 ability to work may also be the infliction of harm to the health of the victim through the fault of a medical worker, as well as other officials responsible for the safety of the people entrusted to them.

Examination to establish the percentage of loss of general ability to work is carried out only by court order. When carrying out expert measures, the specialist takes into account all the materials of the case. The presence of any chronic diseases is not taken into account when determining the percentage of loss of general ability to work that occurred as a result of an incident, attack, accident or catastrophe.

If the injuries were inflicted on a minor who did not have an income 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), to provide the victim with enhanced nutrition. The court may also secure for the victim the right to compensation for losses incurred due to disability upon reaching the age of sixteen by the plaintiff.

When establishing the percentage of loss of general ability to work 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 determine the percentage of loss of general ability to work

  • Document proving the identity of the initiator of the examination.
  • Court ruling.
  • All available medical documents, including the certificate of examination of the Medical and Social Expert Commission.
  • Act on an accident at work or an act of investigation of an accident. To determine the percentage of loss of general ability to work 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 loss of general ability to work

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

Questions answered by a specialist in the process of establishing the percentage of loss of general ability to work

  1. What is the total percentage of loss of general ability to work?
  2. What percentage of the 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 the organs of one system of the body?
  5. What functional systems were disrupted?
  6. What disorders or injuries were taken into account when determining the percentage of loss of general ability to work?

Cost and terms

  • Forensic examination

    Judicial examination is carried out according to the decision of the court. In order to appoint an examination to our organization, it is necessary to 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 candidates for 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 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 information letter, it is enough to present a copy of it.

    Information letter writing service is provided is free.

  • Out-of-court research

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

  • Reviewing the expert opinion

    A review is necessary in cases where it is necessary to challenge the conclusions of the examination, in order to then re-examine. The conditions for concluding a contract for peer review are exactly the same as for an extrajudicial study.

  • Obtaining written expert advice (reference)

    The certificate is not a conclusion, it is informational in nature and contains answers to questions that do not require full study, but allow assessing the feasibility of a full-fledged examination.

    The conditions for concluding a contract for a certificate are exactly the same as for an extrajudicial investigation.

  • Obtaining preliminary expert advice

    Our specialists are ready to answer any of your questions regarding the conduct of forensic and out-of-court examinations, assess the feasibility of conducting an examination, assist in formulating questions for a study, inform you about the possibility of conducting a particular analysis, and much more.

    The consultation is carried out on the basis of a written request.

    To do this, you must 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 you want to achieve with the help of an examination, preliminary questions, 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 help of an expert will be.

  • Additional services

    Reducing the time for the production of expertise by 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 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.

    Drafting a claim

Experts

Expert psychiatrist

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

Expert psychiatrist, full member of the Professional Psychotherapeutic League, member of the Board and scientific secretary of the Russian Psychoanalytic Society

She graduated from residency in psychiatry at the Moscow Research Institute of Psychiatry of the Ministry of Health of the Russian Federation. During her postgraduate studies at the Moscow Research Institute of Psychiatry of the Ministry of Health of the Russian Federation, she worked on the problem of the occurrence of cognitive-behavioral disorders with prolonged use of benzodiazepine tranquilizers and cyclodol in patients with schizophrenia. Passed advanced training in the specialty: psychoanalytic psychiatry at the State Scientific Center for Social and Forensic Psychiatry. V.P. Serbian; specializing 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. M.V. Lomonosov under 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 activity within the framework of seminars and conferences in the field of modern psychoanalysis.

 

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