Benefits for incapacity for work
Benefits for incapacity for work are paid by the employer and the EHIF.
A doctor can issue a certificate of incapacity for work to a person who is insured through their employer. A doctor decides whether or not to issue a certificate of incapacity for work on the basis of a person's state of health.
On the basis of this certificate, the employer and the EHIF pay the person a sickness benefit, the purpose of which is to partially compensate the employee for the loss of earnings during illness.
The EHIF usually pays the benefit within a few working days of the receipt of the information from the employer. The processing time is extended if, for example, a bailiff has filed an attachment order, the employer is late with the insurance details, etc.
The calculation of incapacity for work benefit does not take account of the social security tax paid on doctoral student benefits, parental benefit or other benefits paid by the rural municipality, city or creative associations.
You can access and, if necessary, make a statement of the information regarding your certificate of incapacity for work on the state portal www.eesti.ee under the service “My certificates of incapacity for work".
Note!
NB! From July 1, 2023, the pre-corona sickness benefit payment procedure will be restored
The government decided to restore the pre-corona order for the payment of sick leaves from July 1, 2023. This means that the sickness benefit is paid to the employee from the fourth day instead of the second day.
From July 1, when issuing a primary sick leave, the first three days are the employee's deductible, the employer pays from the fourth to the eighth day, and from the ninth day of illness, the Health Fund pays compensation.
In the case of a primary sick leave issued up to and including June 30, the first day of illness is the employee's own responsibility, the employer pays from the second to the fifth day, and the Health Insurance Fund pays compensation from the sixth day of illness.
The employer's obligation to pay sickness benefits is regulated by § 122 subsections 1 and 3 of the Occupational Health and Safety Act.
If enforcement proceedings have been instituted against you and the bailiff has submitted one or more attachment orders to the EHIF, the EHIF is obliged to withhold the amount to be seized from your temporary incapacity for work benefit and transfer the amount to the professional account of the bailiff who sent the attachment order.
If you find that your income and dependents have not been taken into account in the attachment order, please contact the bailiff conducting the enforcement proceedings. The bailiff is authorized to change the seizure order. Contact details of bailiffs can be found on the website of the Chamber of Bailiffs and Trustees in Bankruptcy
You can access the information about enforcement proceedings initiated against you on the state portal under the service "Enforcement files initiated against me".
Read more:
Comparison of benefits for incapacity for work 01.07.2023
|
Reason for release from work |
Number of the reason |
Type of certificate |
Reimbursement procedure |
Duration of payment for an insured event |
|
Illness and domestic injury |
1 |
Certificate for sick leave |
The employer pays the benefit from day 4 to day 8 of the illness. EHIF pays from day 9, the benefit rate is 70%. |
Up to 182 days (up to 240 days in case of tuberculosis) |
|
Traffic injury Complication/illness as a result of a traffic injury |
4
18 |
Certificate for sick leave |
The employer pays the benefit from day 4 to day 8 of the illness. EHIF pays from day 9, the benefit rate is 70%. |
Up to 182 days |
|
Quarantine |
10 |
Certificate for sick leave |
Based on the certificate issued due to quarantine, the employer pays the benefit from day 4 to day 8. EHIF pays from day 9, the benefit rate is 70%. |
Up to 7 days |
|
Occupational diseases |
2 |
Certificate for sick leave |
EHIF pays the benefit from day 2, the benefit rate is 100%. |
Up to 182 days |
|
Occupational injury Occupational injury in traffic Complication/illness as a result of an occupational injury |
5 6
7 |
Certificate for sick leave |
EHIF pays the benefit from day 2, the benefit rate is 100%. |
Up to 182 days |
|
Injury received while preventing a criminal offence, protecting national or public interests |
8 |
Certificate for sick leave |
EHIF pays the benefit from day 2, the benefit rate is 100%. |
Up to 182 days |
|
Transfer to easier work |
17 |
Certificate for sick leave |
EHIF compensates for the difference in wages caused by the transfer to an easier work, if the person's salary at the time of the transfer to an easier work is lower than his or her average income for the previous calendar year. If a person is released from work due to lack of easier work, the benefit is paid from day 2 at the rate of 70%. The benefit can only be claimed during pregnancy until maternity leave. |
Until maternity leave |
|
Illness or injury during pregnancy |
19 |
Certificate for sick leave |
EHIF pays the benefit from day 2, the benefit rate is 70%. |
Up to 182 days |
|
Nursing a child under the age of 12 or a disabled insured person under the age of 19. |
14 |
Certificate for care leave |
EHIF pays the benefit from the first day of release, the benefit rate is 80%. Please note! An insured person is entitled to a care benefit on the basis of a certificate for care leave for nursing a child under the age of 12 for up to 60 calendar days, if the illness is caused by a malignant tumor and the child's treatment begins in a hospital. |
Up to 14 days |
|
Nursing a sick family member who is ill at home |
12 |
Certificate for care leave |
EHIF pays the benefit from the first day of release, the benefit rate is 80%. |
Up to 7 days |
|
Caring for a child of under 3 years of age or for a disabled child of under 16 years of age when the child’s mother is ill or is receiving obstetrical care |
13 |
Certificate for care leave |
EHIF pays the benefit from the first day of release, the benefit rate is 80%. |
Up to 10 days |
|
Maternity leave |
15 |
Certificate for maternity leave |
EHIF pays the benefit from the first day of release from work, the benefit rate is 100%. |
140 days |
|
Adoptive parents leave for a child under 10 years of age |
16 |
Certificate for adoption leave |
EHIF pays the benefit from the first day of release from work, the benefit rate is 100%. |
70 days |
|
Organ or haematopoietic stem cell donation |
20 |
Certificate for sick leave |
EHIF pays from day 1, the benefit rate is 100%. |
Up to 182 days |
Comparison of benefits for incapacity for work until 30.06.2023
| Reason for release from work | Number of the reason | Type of certificate | Reimbursement procedure | Duration of payment for one insured event |
|---|---|---|---|---|
| Illness and domestic injury | 1 | Sick leave certificate | The employer pays the benefit from day 2 to day 5 of the illness. EHIF pays from day 6, the benefit rate is 70%. | Up to 182 days (up to 240 days in case of tuberculosis) |
|
Traffic injury Complication/illness as a result of a traffic injury |
4 18 |
Sick leave certificate | The employer pays the benefit from day 2 to day 5 of the illness. EHIF pays from day 6, the benefit rate is 70%. | Up to 182 days |
| Quarantine | 10 | Sick leave certificate | The employer pays the benefit from day 2 to day 5. The EHIF pays the benefit from day 6, the benfit rate is 70%. | Until the end of quarantine |
| Occupational diseases | 2 | Sick leave certificate | The EHIF pays the benefit from day 2, the benefit rate is 100%. | Up to 182 days |
|
Occupational injury Occupational injury in traffic Complication/illness as a result of an occupational injury Injury received while preventing a criminal offence, protecting national or public interests |
5 6
7
8 |
Sick leave certificate
Sick leave certificate |
The EHIF pays the benefit from day 2, the benefit rate is 100%.
The EHIF pays the benefit from day 2, the benefit rate is 100%. |
Up to 182 days
Up to 182 days |
| Transfer to easier work | 17 | Sick leave certificate |
The EHIF compensates for the difference in wages caused by the transfer to an easier work, if the person's salary at the time of the transfer to an easier work is lower than his or her average income for the previous calendar year. If a person is released from work due to lack of easier work, the benefit is paid from day 2 at the rate of 70%. |
Until the mother’s parental benefit is granted or up to 182 days |
| Illness or injury during pregnancy | 19 | Sick leave certificate | The EHIF pays the benefit from day 2, the benefit rate is 70%. | Up to 182 days |
| Nursing a child under the age of 12 or a disabled insured person under the age of 19. | 14 | Care leave certificate |
EHIF pays the benefit from the first day of release, the benefit rate is 80%. Please note! An insured person is entitled to a care benefit on the basis of a certificate for care leave for nursing a child under the age of 12 for up to 60 calendar days, if the illness is caused by a malignant tumour and the child's treatment begins in a hospital. |
Up to 14 days |
| Nursing a sick family member who is ill at home | 12 | Care leave certificate | EHIF pays the benefit from the first day of release, the benefit rate is 80%. | Up to 7 days |
| Caring for a child of under 3 years of age or for a disabled child of under 16 years of age when the child’s mother is ill or is receiving obstetrical care | 13 | Care leave certificate | EHIF pays the benefit from the first day of release, the benefit rate is 80%. | Up to 10 days |
| Adoptive parents leave for a child under 10 years of age | 16 | Adoption leave certificate | The EHIF pays the benefit from the first day of release from work, the benefit rate is 100%. | 70 days |
| Organ or haematopoietic stem cell donation | 20 | Sick leave certificate | The EHIF pays from day 1, the benefit rate is 100%. | Up to 182 days |
Calculation of the temporary incapacity for work benefit
- The amount of calculated or paid social security tax is divided by 0.33 to obtain annual income;
- For calendar day average wage calculation the annual wages is divided by 365:
- For the amount of the benefit, the daily wage is multiplied by the corresponding benefit rate and multiplied by the number of days to be reimbursed;
- Sickness benefit is subject to income tax of 20%.
| A person working under an employment contract or in the public service | Member of the management body of a legal person who receives remuneration or services on the basis of a contract under the law of obligations | Self-employed person |
|---|---|---|
| Calculation of average per-calendar day wage | ||
| Income calculated on the basis of social security tax calculated for the insured person in the calendar year preceding the beginning of the certificate of incapacity for work divided by 365 | Income calculated for the insured person in the calendar year preceding the beginning of the certificate of incapacity for work or on the basis of social security tax paid by them or for them divided by 365 | Income calculated for the insured person in the calendar year preceding the beginning of the certificate of incapacity for work or on the basis of social security tax paid by them or for them divided by 365 |
| Calculation of the average wage per calendar day if there was no income in the previous calendar year or was less than the minimum monthly wage | ||
|
daily wage = basic wage / 30, but not more than the minimum monthly wage divided by 30
If the basic wage is equal to or higher than the minimum monthly wage, then daily wage = minimum monthly wage / 30 |
Daily wage = the monthly rate established in the Social Tax Act / 30 |
If there is no obligation to pay advance payments of social security tax, the EHIF does not pay the benefit.
If the FIE has no obligation to pay advance payments of social tax, no compensation is paid |
| Calculation of the average income of a calendar day, if the average income of the previous calendar year is less than the minimum wage | Calculation of the average income of a calendar day, if the average income of the previous calendar year is less than the monthly rate of social tax | Calculation of the average income of a calendar day, if the average income of the previous calendar year is less than the monthly rate of social tax |
|
If the basic salary is higher than the minimum salary, the minimum salary is divided by 30 to get the income for the calendar day If both the basic salary and the average income of the previous calendar year are lower than the minimum wage, the income of the calendar day is calculated at a more favorable rate for the person |
Income calculated on the basis of paid social tax is divided by 365 | Income calculated on the basis of paid social tax is divided by 365 |
In the event of an illness or injury, an insured person has the right to receive sickness benefit until the date on which their capacity for work is restored as specified in the certificate for sick leave, but not for more than 240 consecutive calendar days in the event of tuberculosis or 182 consecutive calendar days in the event of any other illness.
If necessary, a doctor may issue a certificate for sick leave for a longer time than the reimbursable period. This limitation applies only to the period for which the benefit is paid, and not to the duration of the sick leave certificate.
Calculation of benefit for incapacity for work
| Employer calculates the sickness benefit: | The EHIF calculates the benefit for incapacity to work: |
|---|---|
|
on the basis of the employee's average salary for the last six months. |
on the basis of the data on social security tax calculated or paid for the employee for the previous calendar year, as received from the Tax and Customs Board. See the information on the state portal www.eesti.ee under the service "My incapacity for work certificates". |
In the event of an illness or injury, an insured person has the right to receive sickness benefit until the date on which their capacity for work is restored as specified in the certificate for sick leave, but not for more than 240 consecutive calendar days in the event of tuberculosis or 182 consecutive calendar days in the event of any other illness.
If necessary, a doctor may issue a certificate for sick leave for a longer time than the reimbursable period. This limitation applies only to the period for which the benefit is paid, and not to the duration of the sick leave certificate.
Korduma kippuvad küsimused - KKK
Töövabastuse perioodi kohta vormistab arst Sulle elektroonilise töövõimetuslehe ja edastab selle Tervisekassa andmekogusse. Kui arst töövõimetuslehe lõpetab, siis palun teavita sellest oma tööandjat!
Selleks, et Tervisekassa määraks ja maksaks töövõimetuslehe alusel hüvitist, peab tööandja arsti poolt lõpetatud töövõimetuslehe andmed Tervisekassale esitama elektroonselt riigiportaalis www.eesti.ee. Pärast seda, kui tööandja on andmed Tervisekassale edastanud ja töövõimetuslehe andmed ei vaja täpsustamist, kantakse hüvitis Su arvelduskontole paari tööpäeva jooksul.
Infot oma töövõimetuslehtede kohta näed riigiportaalis www.eesti.ee teenuses “Minu töövõimetuslehed".
Ravikindlustatud inimesel on õigus haiguse või vigastuse korral hüvitist saada kuni haiguslehel märgitud töövõime taastumise päevani, kuid mitte rohkem kui 240 järjestikust kalendripäeva tuberkuloosi või 182 järjestikust kalendripäeva mõne muu haiguse korral. Haiguslehe kestusel piirangut pole., Arst saab vajadusel haiguslehe väljastada ka pikemaks ajaks kui hüvitise maksmise periood.
Kalendriaastas kindlustatule kokku makstavate päevade piirangut ei ole, st ühe haigusjuhtumi korral makstakse haigushüvitist järjest kuni 182 päeva. Kui inimene haigestub uuesti, saab ta taas kuni 182 päeva järjest hüvitist.
FIE-le maksab Tervisekassa haigushüvitist alates üheksandast töövabastuse päevast. Kaheksa esimese töövabastuse päeva eest FIE-dele haigushüvitist ei maksta.
Töölepingu seaduse kohaselt on töötajal õigus puhkus katkestada, edasi lükata või enneaegselt lõpetada töötajast tulenevatel olulistel põhjustel.
Töötajal on õigus nõuda kasutamata jäänud puhkuseosa vahetult pärast puhkuse kasutamist takistava asjaolu äralangemist või poolte kokkuleppel muul ajal. Töötaja on kohustatud tööandjale teatama puhkuse kasutamist takistavast asjaolust esimesel võimalusel.
Kui töötaja puhkust ei katkesta, ei ole tal õigust töövõimetushüvitist saada.
Töövõimetusleht väljastatakse töötajale haiguse või vigastuse korral kalendripäevade alusel ning avatakse päevast, mil töötaja ei saa asuda tööülesandeid täitma.
Tagasiulatuvalt (ka algusega puhkepäeval või riigipühal) võib töövõimetuslehe avada, kui ravikindlustatud inimene haigestub või hoolduse või põetuse vajadus tekib nädalavahetusel, rahvuspühal või riigipühal ja inimene teavitab sellest tervishoiutöötajat sidevahendite teel või vastuvõtule tulles vahetult järgneval tööpäeval ja kui kindlustatu haigestumise kohta on tehtud kanne tervise infosüsteemi.
Ajutise töövõimetuse hüvitist arvutatakse sotsiaalmaksuga maksustatud tulult. Makstav hüvitis arvutatakse eelneva kalendriaasta sotsiaalmaksu alusel, mille andmed saab Tervisekassa maksu- ja tolliametist.
Vastavalt ravikindlustuse seadusele (§55 lg 1) ei võeta töövõimetushüvitise arvestamisel arvesse doktoranditoetusi, vanemahüvitist ja teisi valla, linna või loomeliidu poolt makstavaid toetusi ning nendelt makstud sotsiaalmaksu.
Hüvitise summa saamiseks arvutatakse töötaja kalendripäeva keskmisest tulust hüvitise määr ning see korrutatakse hüvitamisele kuuluvate päevade arvuga. Hüvitiselt peetakse kinni tulumaks.
Ajutise töövõimetuse hüvitise maksmise kord sõltub töövõimetuslehe liigist ja põhjusest. Täpsemalt saab hüvitise määramise ja maksmise korrast lugeda hüvitiste lehelt.
Kui eelmisel kalendriaastal sotsiaalmaksuga maksustatav tulu puudus, lähtutakse hüvitise arvutamisel inimesega kokkulepitud töötasust ja alampalgast. Lisainfot selle kohta saab Tervisekassa kodulehelt.
Tervisekassa maksab ajutise töövõimetuse hüvitise välja 30 kalendripäeva jooksul alates päevast, kui kindlustatud inimese tööandja on teinud nõuetekohased kanded elektroonilisele töövõimetuslehele või kui paberil lisadokumendid on laekunud Tervisekassasse.
Tööandja peab maksma haigushüvitise välja palgapäeval, kuid mitte hiljem kui 30 kalendripäeva jooksul pärast seda, kui arst on riigiportaalis eesti.ee nõuetekohaselt vormistatud haiguslehe lõpetanud.
Jah, saab küll. Hüvitise saaja nime ja arvelduskonto andmeid on võimalik muuta:
- Riigiportaali eesti.ee teenuses „Arvelduskonto ja andmed Tervisekassas“;
- saates digiallkirjaga avalduse aadressile info [at] tervisekassa.ee (info[at]tervisekassa[dot]ee).
Töösuhte ajal alanud töövõimetuslehe ning järglehed maksab Tervisekassa välja, olenemata sellest, et vahepeal töösuhe lõpeb.
Välisriigi arstilt saadud paberil tõend esita oma tööandjale, kes edastab selle koos vajalike lisadokumentidega Tervisekassasse. Kui vajad töövabastust pikemaks perioodiks kui välismaa arsti tõendil märgitud töövabastuse lõpu kuupäev, pöördu viie päeva jooksul pärast tõendil märgitud töövabastuse lõpu kuupäeva oma perearsti poole. Perearst saab Sulle väljastada järglehe pärast seda, kui välismaa arsti poolt väljastatud tõend on Tervisekassa poolt esmase haiguslehena Tervisekassa andmekogusse sisestatud.
Euroopa Liidu liikmesriigi kindlustusasutuselt Eestis ravi saanud inimesele haigushüvitise maksmiseks peab arst täitma „Arstliku läbivaatuse vastuse“.
Arstil tuleb dokument välja printida, allkirjastada ning anda inimese kätte. Inimene pöördub antud dokumendiga oma tööandja või oma kindlustajariigi hüvitist maksva asutuse poole.
On ka lubatud, et inimene edastab vastava originaaldokumendi koos avaldusega („Avaldus töövõimetushüvitise taotlemiseks EL liikmesriigis“ lingil https://www.tervisekassa.ee/partnerile/avaldused-partnerile) Tervisekassale ning Tervisekassa edastab selle ise välisriigi kindlustusasutusele.
Töövaidluste lahendamiseks tuleb pöörduda Tööinspektsiooni poole https://www.ti.ee/et/node/9646. Samuti on võimalik pöörduda kohtu poole