Normative base

Every citizen should know his rights, this also applies to medical rights. Therefore, a person can independently study the procedure for issuing sick leave certificates (SL), approved by Order of the Ministry of Health and Social Development of Russia dated June 29, 2011 No. 624n (hereinafter referred to as the Procedure). The document approves an exhaustive list of cases when medical workers can refuse to issue sick leave on legal grounds.

First, let’s find out under what conditions a person can count on receiving a certificate of incapacity for work.

Therefore, there is no need to require doctors who are not on the approved list to issue a BL. They will not break the law, especially since the leaflet turns out to be invalid.

Important! When receiving the certificate, the citizen must present an identification document (clause 4 of the Procedure).

Who cannot issue a certificate of incapacity for work?

Below is an exhaustive list of medical organizations whose employees do not have the right to issue a certificate of incapacity for work, regardless of the above conditions. These organizations include:

• emergency medical care organizations;
• organizing blood transfusions;
• admission departments of hospital institutions;
• balneological clinics and mud baths;
• medical organizations of a special type (medical prevention centers, disaster medicine centers, forensic medical examination bureaus);
• healthcare institutions for supervision in the field of consumer rights protection and human well-being.

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In what cases is it legal to refuse to issue a sick leave certificate?

As we have already said, the list of legal refusals to issue sick leave is approved by subparagraphs 22 and 26 of the Procedure.

Let's list some of them:

• the patient has no symptoms or signs of the disease;
• if a person falls ill during leave at his own expense, for maternity leave, if the citizen is caring for a child until he reaches three years of age;
• the person who applied undergoes a medical examination or is sent for examination by the military registration and enlistment office;
• the citizen is in custody;
• the patient has a chronic disease, he has addressed all stages of exacerbation;
• a person is a student of educational institutions (of various types).

In addition, sick leave for caring for disabled citizens cannot be counted on in certain cases (clause 40 of the Procedure):

1. when treating a patient in a hospital over 15 years of age;
2. patient care takes place during non-exacerbation periods;
3. if the woman has already received a certificate for pregnancy and childbirth;
4. for caring for a minor child under three years old, if the parent does not go to work.

Other cases of refusal to issue a sick leave certificate are illegal. For example, if a person gets sick and turns to a medical institution for help outside his locality, the refusal is unlawful. Since a citizen, if he has a compulsory medical insurance policy, has the right to seek medical care at any medical institution in Russia, even if he does not have a residence permit in a given locality. This rule is regulated by Article 16 of the Law of November 19, 2010 No. 326-FZ.

Next, we will consider several cases about which our readers most often have questions.

In what cases is the issuance of a certificate of incapacity for work refused?

A certificate of incapacity for work is the basis for payment of temporary disability benefits or maternity benefits, as well as confirmation of absence from work for a valid reason.

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Conditions under which a certificate of incapacity for work can be issued

To issue a certificate of incapacity for work, three conditions must be met simultaneously. Failure to comply with at least one of them makes issuing a certificate of incapacity for work impossible.

1. The citizen has the right to receive a certificate of incapacity for work.

A citizen who is supposed to be issued a certificate of incapacity for work must (clause 1 of the Procedure, approved by Order of the Ministry of Health and Social Development of Russia dated June 29, 2011 N 624n):

• be insured in the compulsory social insurance system in accordance with Art. 2 of the Law of December 29, 2006 N 255-FZ (this applies, among other things, to foreign citizens and stateless persons permanently or temporarily residing in the territory of the Russian Federation, as well as foreign citizens and stateless persons temporarily staying in the Russian Federation, with the exception of highly qualified specialists);
• have the right to payment of state benefits in accordance with paragraph. 2 tbsp. 6 of the Law of May 19, 1995 N 81-FZ. This category includes women dismissed in connection with the liquidation of an organization, in connection with the termination of the employer’s activities as an individual entrepreneur, in connection with the termination of the status or powers of other employers (private notaries, lawyers, etc.), subject to pregnancy occurring within 12 months before they are recognized as unemployed in the prescribed manner;

When receiving a certificate of incapacity for work, you must present an identification document (clause 4 of the Procedure).

2. The medical worker has the right to issue a certificate of incapacity for work.

The following health workers have the right to issue a certificate of incapacity for work (part 2 of article 59 of the Law of November 21, 2011 N 323-FZ; clause 2 of the Procedure):

• attending physicians of a medical organization;
• paramedics or dentists of a medical organization;
• attending physicians at a clinic of a research institution (institute), including those involved in prosthetics or prosthetic construction.

3. The medical organization has a license for medical activities, including work (services) for the examination of temporary disability (clause 46, part 1, article 12 of the Law of May 4, 2011 N 99-FZ; paragraph 1, clause 2 of the Procedure ).

Medical organizations that do not have the right to issue certificates of incapacity for work

Expert opinion

Polyakov Pyotr Borisovich

Lawyer with 6 years of experience. Specialization: civil law. More than 3 years of experience in drafting contracts.

Clause 3 of the Procedure contains an exhaustive list of medical organizations whose employees do not have the right to issue a certificate of incapacity for work, regardless of the above conditions. These organizations include:

• emergency medical care organizations;
• organizing blood transfusions;
• admission departments of hospital institutions;
• balneological clinics and mud baths;
• medical organizations of a special type (medical prevention centers, disaster medicine centers, forensic medical examination bureaus);
• healthcare institutions for supervision in the field of consumer rights protection and human well-being.

Grounds for refusal to issue a certificate of incapacity for work

The grounds for refusal to issue a certificate of incapacity for work include the following cases (clauses 22, 26 of the Procedure):

• seeking medical help in the absence of signs of temporary disability;
• the onset of temporary disability during the period of leave at one’s own expense, maternity leave, parental leave until the child reaches the age of three years;
• undergoing a medical examination, examination or treatment as directed by military commissariats;
• a citizen being in custody or under administrative arrest;
• undergoing a periodic medical examination (examination), including at an occupational pathology center;
• a citizen has a chronic disease without exacerbation (deterioration), if he undergoes examination, undergoes procedures and manipulations in an outpatient setting;
• if the citizen is a student of an educational institution of primary vocational, secondary vocational and higher vocational education or an institution of postgraduate vocational education and does not perform paid work as part of practical training.

A certificate for caring for a sick family member is not issued in the following cases (clause 40 of the Procedure):

• caring for a sick family member over 15 years of age during inpatient treatment;
• for caring for a chronic patient during remission;
• during the period of annual leave, maternity leave or leave at your own expense;
• during the period of parental leave until the child reaches the age of three, if the citizen does not continue to work part-time or at home.

In other cases, when the conditions for issuing a certificate of incapacity for work are met and the medical organization has the right to issue it, the refusal to issue a certificate of incapacity for work is unlawful. So, for example, it would be unlawful to refuse to issue a certificate of incapacity for work by a medical organization to which a citizen who has a compulsory health insurance policy applied outside his permanent place of residence and received the specified assistance (Clause 1, Part 1, Article 16, Part 2, Art. 20, Article 45 of the Law of November 29, 2010 N 326-FZ).

Options for action in case of refusal to issue a certificate of incapacity for work

In case of disagreement with the refusal to issue a certificate of incapacity for work, the patient is recommended to resort to the following actions:

1. Submit a written application to the head of the medical organization or other authorized person of the medical organization, for example, the deputy head for clinical expert work. The application should briefly outline the circumstances surrounding the request for the issuance of a certificate of incapacity for work and ask for a reasoned answer as to why its issuance was refused.

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2. A similar application can also be submitted to Roszdravnadzor or the state authority of a constituent entity of the Russian Federation in the field of health care, since, in addition to exercising general control over compliance with legislation in the field of health care, they are also licensing authorities in relation to medical organizations in terms of issuing licenses (Article 88 of the Law of November 21, 2011 N 323-FZ; clause 2 of the Regulations on licensing of medical activities, approved by Decree of the Government of the Russian Federation of April 16, 2012 N 291).

3. You can also file a complaint with the territorial branch of the FSS of the Russian Federation. Based on the complaint, an unscheduled inspection of the person responsible for issuing certificates of incapacity should be carried out (clause 8 of the Procedure for the implementation of the FSS of the Russian Federation for checking compliance with the procedure for issuing, extending and processing certificates of incapacity for work, approved by Order of the Ministry of Health of Russia dated December 21, 2012 N 1345n).

4. If your complaints are not satisfied in the above order, you can apply to the court to protect your rights. It should be taken into account that if a refusal to issue a certificate of incapacity for work by an employee of a medical organization providing paid medical services is disputed, then before going to court it is necessary to make sure that there is no condition in the contract for the provision of medical services obliging the parties to resolve disputes arising in a pre-trial (claims) manner. The state fee when filing such an application is paid in the amount of 300 rubles. (clauses 3 and 7 of clause 1 of Article 333.19 of the Tax Code of the Russian Federation).

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Will they refuse sick leave if there is no temperature?

In case of ARVI, a person seeking medical help is initially issued a sheet for seven days. If necessary, it can be extended, even if the patient does not have a fever. The doctor examines the patient and independently makes a conclusion whether the person is ready to begin his work duties.

In addition, some diseases are not accompanied by fever, for example, with back pain, the symptoms of the disease will be different from ARVI. Therefore, temperature is not a basis for refusing to issue a certificate of temporary incapacity for work.

If a person works part-time, then he is also issued a BC, which must be presented at work to pay for days missed for a valid reason.

Will sick leave be paid if the patient is drunk?

The doctor must provide assistance to the patient even if he was intoxicated at the time of visiting the hospital or was injured in a similar state. But the medical worker is obliged to record all violations of the regime on the sick leave. In this case, a special note is made about non-compliance with the treatment regimen (a specific code is set).

The accounting department, having received such a sheet, is obliged to accrue and pay benefits, but taking into account reducing factors. Since in such cases the social insurance fund obliges to reduce the amount of temporary disability benefits (Article 8 of Law No. 255-FZ).

Features of registration of a sick leave for a disabled person

In this case, citizens may face several situations.

Let's find out what the law says:

• Patients with chronic diseases in remission, as well as if they are undergoing a medical examination or undergoing treatment procedures in an outpatient setting, are not issued a sick leave certificate. In such situations, citizens can ask the doctor to make an extract from the outpatient card (clause 26 of the Procedure);
• for a person, the certificate of incapacity for work will be closed on the last day before official registration with the bureau of medical and social examination for assignment of a disability group (Article 28 of the Procedure).

Attention! If a person has been assigned a disability group that allows him to work, then upon the onset of illness, medical workers must issue a certificate of incapacity for work on a general basis.

When a severe pathology is detected, doctors already assume that the disease cannot be cured. Therefore, in the initial stages, a cancer patient is issued a sick leave certificate , but after four months he must be sent for a medical and social examination to register his disability.

Who is entitled to issue a sick leave certificate?

Expert opinion

Polyakov Pyotr Borisovich

Lawyer with 6 years of experience. Specialization: civil law. More than 3 years of experience in drafting contracts.

A certificate of incapacity for work is issued to all citizens of Russia or foreigners officially working in the country who are subject to compulsory social insurance.

According to paragraph 26 of the Procedure for issuing certificates of incapacity for work, approved by order of the Ministry of Health and Social Development of the Russian Federation dated June 29, 2011 No. 624 n, certificates of incapacity for work are not issued to citizens undergoing a medical examination, examination or treatment at the direction of military commissariats, those in custody or administrative detention arrest, undergoing periodic medical examinations, including in occupational pathology centers, citizens with chronic diseases without exacerbation, undergoing examinations, undergoing various procedures and manipulations in outpatient settings.

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Also, sick leave is not issued to students of educational institutions of primary, secondary and higher vocational education and institutions of postgraduate vocational education. Full-time students are issued a certificate, and sick leave is given only for the period of paid work during industrial practice.

And, of course, sick leave is not issued to citizens who show no signs of temporary disability. However, a problem in recent years has been fake sick leave, which they offer to issue in just a few hours and without visiting a doctor. But it is worth remembering that the desire to cover up absenteeism with a “fake” sick leave or simply save time on going to the clinic is fraught with big troubles for the buyer himself. If the FSS has doubts about the sick leave issued, it checks at the medical institution and, if necessary, transfers the investigation to law enforcement agencies. And the latter are guided by articles of the Criminal Code of the Russian Federation, which provide for criminal liability for forgery and “purchase or sale of official documents” of both the manufacturer and the buyer of the counterfeit.

Women, starting from the 30th week of pregnancy, are issued a sick leave for pregnancy and childbirth (yes, this is sick leave, not vacation) for 140 calendar days (70 calendar days before childbirth and 70 calendar days after childbirth), in case of multiple pregnancy - from week 28 to 156 calendar days. For childbirth occurring between 22 and 30 weeks, a certificate of incapacity for work is issued for a period of 156 calendar days.

Also, sick leave can be issued to care for children or an adult family member, and the following restrictions apply:

up to 60 days a year to care for a child under 7 years old;

up to 45 days a year and no more than 15 days in each case if the child is from 7 to 15 years old;

up to 30 days a year and no more than 7 days for each case when caring for an adult family member.

If you get sick during a business trip abroad, the sick leave issued abroad must be replaced by a Russian medical institution.

If the illness occurs during the next vacation, a certificate of incapacity for work is issued for all days of illness.

Those dismissed from work are issued a sick leave certificate if the illness or injury occurs within 30 calendar days after the termination of the employment contract.

What to do if sick leave continues during the New Year holidays?

Many people think that if a person gets sick on weekends or holidays, then sick leave is not required. This is not true; there are a number of cases when doctors are required to issue a certificate. Let's find out under what conditions it is issued:

• a person falls ill or is injured at work;
• treatment must be carried out in an outpatient setting.

Therefore, people who apply are issued a sick leave certificate on the day the illness is recorded, even if this date falls on a weekend or holiday (clause 14 of the Procedure).

Who issues a certificate of incapacity for work?

By law, sick leave is issued by state clinics and commercial medical institutions that have passed state accreditation and received a license to issue sick leave. Doctors of emergency medical services, blood transfusion services, and hospital emergency departments do not have the right to issue such a document.

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Usually, a sick leave is issued by the attending physician on the day the sick leave ends; there are very strict requirements for filling it out - the form is filled out in block letters, and it must bear the seals of the medical institution and the doctor. If an error is made, it must be corrected, and the corrected text is confirmed by the entry “corrected believe”, the signature of the attending physician and the seal of the medical organization. If more than two corrections are made to a sick leave certificate, it will not be accepted for payment.

Sick leave for pregnancy and childbirth is issued at a time for the entire period by an obstetrician-gynecologist, and in his absence, by a general practitioner.

Can a father be denied sick leave to care for a child?

There is no special list of grounds for refusing to issue a certificate of incapacity for work for men who decide to care for their child during illness.

But there are a number of reasons when the father will not be able to issue a sheet:

• the child’s mother is on maternity leave or on leave to care for a child up to three years old, but she has not returned to work;
• the baby’s mother does not work anywhere and can provide care herself;
• Mom is on vacation, so she can take care of the child.

Therefore, if doctors do not have legal grounds for refusing to issue a sick leave certificate, then the father can draw up the document and care for the child during the course of treatment.

Risk group: children

For children, even without hyperthermia, doctors strongly recommend that they be treated only at home and not visit kindergartens, schools and any public institutions. Why is this so important

The fact is that during periods of intense epidemiological conditions, the infection spreads very quickly, primarily among kindergarten children and schoolchildren. A child's body often has an underdeveloped thermoregulation apparatus, and hyperthermia becomes one of the late signs of ARVI. Children under 3 years of age are especially prone to such manifestations. So mothers are always given a mini-leave to care for their children.

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A special group includes children who fall ill with ARVI; in this case, mothers are given mini-leave to care for the child.

How to challenge a refusal to issue a sick leave certificate?

If a person is faced with illegal actions by doctors, he can act in several ways.