reglab/statecodes huggingface dataset:
New Mexico Administrative Code › Title 11 - LABOR AND WORKERS' COMPENSATION › Chapter 4 - WORKERS' COMPENSATION › Part 7 - PAYMENTS FOR HEALTH CARE SERVICES › Section 11.4.7.16 - RETURN-TO-WORK

Current through Register Vol. 35, No. 13, July 16, 2024
The agency website shall contain educational Return-To-Work
				  best practice tools and resources for workers' compensation
				  stakeholders.
New Mexico Administrative Code › Title 11 - LABOR AND WORKERS' COMPENSATION › Chapter 4 - WORKERS' COMPENSATION › Part 8 - INDIVIDUAL SELF-INSURANCE › Section 11.4.8.2 - SCOPE

Current through Register Vol. 35, No. 13, July 16, 2024
This rule applies to all corporations, companies or other
				  entities applying for self-insurance, those who are or were certified for
				  self-insurance, and to their agents and representatives.
New Mexico Administrative Code › Title 11 - LABOR AND WORKERS' COMPENSATION › Chapter 4 - WORKERS' COMPENSATION › Part 8 - INDIVIDUAL SELF-INSURANCE › Section 11.4.8.5 - EFFECTIVE DATE

Current through Register Vol. 35, No. 13, July 16, 2024
October 1, 2015, unless a later date is cited at the end of a
				  section.
New Mexico Administrative Code › Title 11 - LABOR AND WORKERS' COMPENSATION › Chapter 4 - WORKERS' COMPENSATION › Part 8 - INDIVIDUAL SELF-INSURANCE › Section 11.4.8.6 - OBJECTIVE

Current through Register Vol. 35, No. 13, July 16, 2024
The purpose of these rules is establish the minimum
				  qualification criteria for a private company or qualifying public entity to
				  apply to the director for permission to self-insure their workers' compensation
				  risk and to establish the criteria to maintain such self-insured status after
				  it is granted by the director.
New Mexico Administrative Code › Title 11 - LABOR AND WORKERS' COMPENSATION › Chapter 4 - WORKERS' COMPENSATION › Part 8 - INDIVIDUAL SELF-INSURANCE › Section 11.4.8.7 - DEFINITIONS

Current through Register Vol. 35, No. 13, July 16, 2024
A. "Approved excess
				insurer" means an insurer domiciled within the United States of America or an
				alien insurer listed in the national association of insurance commissioner's
				(NAIC) quarterly listing of alien insurers with a rating of "A" or better by
				A.M. Best or similar rating organization approved by the director.
B. "Approved security" means a letter of
				credit or surety bond issued by an approved financial institution or surety
				respectively and used for the payment of claims and related expenses in the
				event of default by the employer and for reimbursement to the guarantee fund
				for any benefits paid by the fund on behalf of the employer.
C. "Approved surety" means a financial
				institution with at least one location in New Mexico or a New Mexico admitted
				carrier, that is not in the control of the self-insured, and that has a rating
				of "A" or better from A.M. Best, a rating of "good" or better by Bauer
				Financial, or similar ratings from organizations approved by the
				director.
D. "Completed
				application" means an application for certificate of self-insurance that
				demonstrates all the eligibility criteria and that attaches all required
				documentation, as set forth in these rules.
E. "Director" means the director of the
				workers' compensation administration.
F. "Financially solvent" means an employer's
				current and continuing ability to pay, as they become due, all existing and
				future obligations, including workers' compensation benefits to which it is or
				becomes obligated under the act.
G.
				"Guarantee fund" means the fund created by Section 52-8-7(A) NMSA 1978 to
				provide benefits to workers and the families of workers of private individual
				self-insurers who become insolvent or otherwise unable to meet their financial
				obligations.
H. "Guarantee board"
				means the board of directors of the self-insurers' guarantee fund
				commission.
I. "Parent" means
				ownership of a subsidiary entity of greater than 50 percent.
J. "Reserves" means the value of claims
				without regard to expected excess insurance or other recoveries.
K. "Risk management program" means an
				entity's claims administration personnel, policies and procedures, safety
				program and personnel, and adequate excess insurance.
L. "Tangible net worth" means net worth less
				intangible assets.
New Mexico Administrative Code › Title 11 - LABOR AND WORKERS' COMPENSATION › Chapter 4 - WORKERS' COMPENSATION › Part 8 - INDIVIDUAL SELF-INSURANCE › Section 11.4.8.9 - SELF-INSURERS' GUARANTEE FUND

Current through Register Vol. 35, No. 13, July 16, 2024
A.
				Commission membership is composed of all self-insurers as defined in Section
				52-8-3(J)
				NMSA 1978, as a condition of their authority to individually self-insure in the
				state of New Mexico.
B. Withdrawal
				of membership:
(1) A member shall be
				automatically withdrawn from the commission upon the termination of its
				self-insurance certificate and payment of all assessments due to the date of
				such termination.
(2)
				Notwithstanding the termination of membership of a self-insured for whatever
				reason, that self-insured shall remain liable to the commission for any
				assessments imposed and based upon insolvencies occurring while the terminated
				self-insured was a member of the commission.
New Mexico Administrative Code › Title 11 - LABOR AND WORKERS' COMPENSATION › Chapter 4 - WORKERS' COMPENSATION › Part 9 - GROUP SELF-INSURANCE › Section 11.4.9.2 - SCOPE

Current through Register Vol. 35, No. 13, July 16, 2024
These rules apply to the application, qualification,
				  evaluation and regulatory requirements pertaining to group self-insureds
				  authorized pursuant to NMSA 1978, Chapter 52, Article 6.
New Mexico Administrative Code › Title 11 - LABOR AND WORKERS' COMPENSATION › Chapter 4 - WORKERS' COMPENSATION › Part 9 - GROUP SELF-INSURANCE › Section 11.4.9.3 - STATUTORY AUTHORITY

Current through Register Vol. 35, No. 13, July 16, 2024
The authority for this part derives from the director's
				  powers under NMSA 1978, Sections
				  52-6-1
				  through
				  52-6-25 and
				  52-1-4
				  A.
New Mexico Administrative Code › Title 11 - LABOR AND WORKERS' COMPENSATION › Chapter 4 - WORKERS' COMPENSATION › Part 9 - GROUP SELF-INSURANCE › Section 11.4.9.5 - EFFECTIVE DATE

Current through Register Vol. 35, No. 13, July 16, 2024
August 1, 1996, unless a later date is cited at the end of a
				  section.
New Mexico Administrative Code › Title 11 - LABOR AND WORKERS' COMPENSATION › Chapter 4 - WORKERS' COMPENSATION › Part 9 - GROUP SELF-INSURANCE › Section 11.4.9.6 - OBJECTIVE

Current through Register Vol. 35, No. 13, July 16, 2024
The purpose of these rules is to provide criteria and
				  procedures to apply to the issuance and maintenance of certificates of
				  self-insurance to group employers under the group Self-Insurance Act, NMSA
				  1978, Chapter 52, Article 6.
New Mexico Administrative Code › Title 11 - LABOR AND WORKERS' COMPENSATION › Chapter 4 - WORKERS' COMPENSATION › Part 9 - GROUP SELF-INSURANCE › Section 11.4.9.7 - DEFINITIONS

Current through Register Vol. 35, No. 13, July 16, 2024
The definitions adopted below shall apply to all WCA rules,
				  especially those for group self insurance.
A. "Same or similar type of business" means
				that each individual business to be insured by a group at the time the risk is
				bound, without regard to ownership, is appropriate under the by-laws and the
				underwriting guidelines of the group on file with the WCA. Each such business
				must have at least 50 percent of the workers' compensation manual premium for
				each individual business member in risks normally associated with either the
				general division groupings (designated by lettered headings in the standard
				industrial classification manual) or any other three or four digit
				classifications specifically designated from within the standard industrial
				classification manual, which has received prior approval from the director.
				Where more than one business shares common ownership, the businesses may be
				considered one entity for purposes of eligibility determination.
B. "Standard industrial classification
				manual" means the most current edition of standard industrial classification
				manual published by the executive office of the president of the United States,
				office of management and budget. Major groups of businesses are designated by a
				two digit code in the standard industrial classification manual.
New Mexico Administrative Code › Title 11 - LABOR AND WORKERS' COMPENSATION › Chapter 4 - WORKERS' COMPENSATION › Part 10 - SELF-INSURANCE POOLING OF PUBLIC ENTITIES › Section 11.4.10.2 - SCOPE

Current through Register Vol. 35, No. 13, July 16, 2024
These rules apply to the qualification, evaluation and
				  regulating requirements pertaining to the governmental entities insured for
				  workers' compensation benefits by the New Mexico county insurance authority,
				  the New Mexico self-insurer's fund and the New Mexico public school insurance
				  authority or any other organization formed, organized or reorganized,
				  contemplating the pooling of the risks of workers' compensation by governmental
				  entities.
New Mexico Administrative Code › Title 11 - LABOR AND WORKERS' COMPENSATION › Chapter 4 - WORKERS' COMPENSATION › Part 10 - SELF-INSURANCE POOLING OF PUBLIC ENTITIES › Section 11.4.10.3 - STATUTORY AUTHORITY

Current through Register Vol. 35, No. 13, July 16, 2024
The authority for this part derives from the director's
				  powers under NMSA 1978, Sections
				  52-1-2,
				  52-1-4(A),
				  52-1-6
				  and
				  52-5-4.1.
New Mexico Administrative Code › Title 11 - LABOR AND WORKERS' COMPENSATION › Chapter 4 - WORKERS' COMPENSATION › Part 10 - SELF-INSURANCE POOLING OF PUBLIC ENTITIES › Section 11.4.10.5 - EFFECTIVE DATE

Current through Register Vol. 35, No. 13, July 16, 2024
November 29, 1997 unless a later date is cited at the end of
				  a section.
New Mexico Administrative Code › Title 11 - LABOR AND WORKERS' COMPENSATION › Chapter 4 - WORKERS' COMPENSATION › Part 10 - SELF-INSURANCE POOLING OF PUBLIC ENTITIES › Section 11.4.10.6 - OBJECTIVE

Current through Register Vol. 35, No. 13, July 16, 2024
The purpose of these rules is to provide criteria and
				  procedures to apply to the issuance and maintenance of certificates of
				  self-insurance for governmental entities insured through the organizations
				  identified in
				  11.4.10.2
				  NMAC.
New Mexico Administrative Code › Title 11 - LABOR AND WORKERS' COMPENSATION › Chapter 4 - WORKERS' COMPENSATION › Part 10 - SELF-INSURANCE POOLING OF PUBLIC ENTITIES › Section 11.4.10.7 - DEFINITIONS

Current through Register Vol. 35, No. 13, July 16, 2024
For the purposes of these rules:
A. "workers' compensation" also means
				"workman's compensation";
B.
				"administrator" means an individual, partnership or corporation engaged by a
				pool's board of trustees to carry out the policies established by that board to
				provide day-by-day management of the pool;
C. "pool" means an entity, regarded as an
				"agency" under the State Audit Act, that provides insurance collectively to
				governmental entities for workers' compensation benefits;
D. "service company" means a person or entity
				which provides services not provided by the administrator which may include
				claims adjustment; safety engineering; compilation of statistics and the
				preparation of premium; loss and tax reports; preparation of other required
				self-insurance reports; development of members' assessments and fees; and
				administration of a claim fund;
E.
				"director" means the director of the workers' compensation
				administration;
F. "workers'
				compensation benefits" means benefits paid pursuant to the Workers'
				Compensation Act or the New Mexico Occupational Disease and Disablement
				Law.
New Mexico Administrative Code › Title 11 - LABOR AND WORKERS' COMPENSATION › Chapter 4 - WORKERS' COMPENSATION › Part 10 - SELF-INSURANCE POOLING OF PUBLIC ENTITIES › Section 11.4.10.8 - POOL SELF-INSURANCE

Current through Register Vol. 35, No. 13, July 16, 2024
A. A
				governmental entity not insured by an insurance company in the voluntary market
				nor certified as an individually self-insured employer shall be deemed in
				compliance with NMSA 1978, Section
				52-1-4
				if the director has issued a certificate of pool self-insurance pursuant to
				these rules.
B. In order to obtain
				and maintain a certificate of pool self-insurance a governmental entity shall
				meet the following requirements:
(1) Within 30
				days of the effective date of these rules the governmental entities shall
				direct the pool's administrator to provide the director with a current
				membership roster and contact information for each governmental entity insured
				by the pool. All governmental entities on the roster will be deemed to have
				applied for a certificate of pool self-insurance.
(2) A governmental entity that has not
				applied pursuant to Paragraph (1) of Subsection B of 11.4.10.8 NMAC shall apply
				to the director at least 30 days prior to the desired effective date of the
				certificate for pool self-insurance, on forms approved by the
				director.
(3) A governmental entity
				insured under a certificate of pool self-insurance shall be responsible for
				compliance with the provisions of Articles 1-5 of the Workers' Compensation
				Act, NMSA 1978, Chapter 52 and all rules promulgated thereunder and shall be
				subject to sanction by the director for violations, acts or omissions by itself
				or by any person or entity acting in an agency relationship with the
				governmental entity, including its administrator and service company.
(4) Specific occurrence excess insurance or
				specific occurrence reinsurance for all governmental entities insured through a
				pool in a form and in an amount acceptable to the director is required. The
				insurance shall be written by an acceptably rated company admitted to write
				insurance in the state of New Mexico or a company that is otherwise approved by
				the director. The policy must include the New Mexico amendatory
				endorsement.
(5) A fidelity bond or
				commercial crime policy for any officer, agent or member of the board of
				trustees of the pool having signatory authority with respect to the pool's
				funds or investments, or as a condition precedent to any board of trustees
				action creating or changing such signatory authority, is required and shall be
				written at a minimum of two hundred fifty thousand dollars ($250,000), unless
				the director prescribe a higher amount.
New Mexico Administrative Code › Title 11 - LABOR AND WORKERS' COMPENSATION › Chapter 4 - WORKERS' COMPENSATION › Part 10 - SELF-INSURANCE POOLING OF PUBLIC ENTITIES › Section 11.4.10.9 - INFORMATION REQUIREMENTS

Current through Register Vol. 35, No. 13, July 16, 2024
A. As a
				condition precedent to maintenance of a certificate of pool self-insurance,
				each pool shall compel its administrator and any service company to provide to
				the director the following information and access to records:
(1) a copy of any reinsurance or excess
				insurance agreements;
(2) an
				explanation of reserving methodology and accident year claims data on an annual
				basis;
(3) rate change information
				within thirty days of approval by the board of directors of the pool;
(4) loss runs in a format acceptable to the
				director within 60 days of receipt by the administrator of the director's
				request; and
(5) an annual
				actuarial opinion.
(a) This opinion shall
				include actuarially appropriate reserves for (1) known claims and associated
				expenses; and (2) claims incurred but not reported and associated
				expenses.
(b) This actuarial
				opinion shall also include a rate adequacy evaluation.
(c) The actuarial opinion shall be given by a
				member of the American academy of actuaries.
(6) a copy of any rate adequacy evaluations
				and reviews of loss and loss adjustment expenses prepared for the pool by an
				actuary who shall be a member of the American academy of actuaries.
(7) notification to the director of any
				additions or deletions to the pool's membership roster; additionally, each pool
				shall provide within 30 days of the end of each calendar quarter a roster of
				members, including the number of employees employed by each member on the last
				day of the quarter.
New Mexico Administrative Code › Title 11 - LABOR AND WORKERS' COMPENSATION › Chapter 4 - WORKERS' COMPENSATION › Part 10 - SELF-INSURANCE POOLING OF PUBLIC ENTITIES › Section 11.4.10.10 - WAIVER AND ENFORCEMENT

Current through Register Vol. 35, No. 13, July 16, 2024
A. Any
				requirement contained in these rules may be waived by specific written
				authorization of the director. Any interested person may request such a
				variance or waiver in writing. Such waiver requests will be considered,
				approved or denied dependent upon the nature of the request and the conditions
				pertinent to the request prevailing at the time of the request.
B. Enforcement: failure to comply with any
				provision of Articles 1-5 of the Workers' Compensation Act, NMSA 1978, Chapter
				52, or the rules promulgated thereunder may be sanctioned by impositions of the
				monetary penalty pursuant to NMSA 1978, Section
				52-1-61, or
				any other lawful remedy.
New Mexico Administrative Code › Title 11 - LABOR AND WORKERS' COMPENSATION › Chapter 4 - WORKERS' COMPENSATION › Part 11 - PROOF OF COVERAGE › Section 11.4.11.2 - SCOPE

Current through Register Vol. 35, No. 13, July 16, 2024
This rule applies to all insurers issuing workers'
				  compensation coverage in the state of New Mexico, all self-insured groups
				  issuing workers' compensation coverage in the state of New Mexico and all
				  vendors submitting proof of coverage information either on behalf of themselves
				  or for others who are required to report such coverage.
New Mexico Administrative Code › Title 11 - LABOR AND WORKERS' COMPENSATION › Chapter 4 - WORKERS' COMPENSATION › Part 11 - PROOF OF COVERAGE › Section 11.4.11.3 - STATUTORY AUTHORITY

Current through Register Vol. 35, No. 13, July 16, 2024
Sections
				  52-1-4.1 and
				  52-5-4
				  NMSA 1978 (Repl. Pamp. 1991) and department of insurance regulation 17, rule
				  2.
New Mexico Administrative Code › Title 11 - LABOR AND WORKERS' COMPENSATION › Chapter 4 - WORKERS' COMPENSATION › Part 11 - PROOF OF COVERAGE › Section 11.4.11.5 - EFFECTIVE DATE

Current through Register Vol. 35, No. 13, July 16, 2024
September 30, 2016 unless a later date is cited at the end of
				  a section.
New Mexico Administrative Code › Title 11 - LABOR AND WORKERS' COMPENSATION › Chapter 4 - WORKERS' COMPENSATION › Part 11 - PROOF OF COVERAGE › Section 11.4.11.7 - DEFINITIONS

Current through Register Vol. 35, No. 13, July 16, 2024
A. "Certified
				vendor" (also referred to as a "vendor") means a company or business which
				electronically transmits proof of coverage insurance information to the
				workers' compensation administration either for itself or for others and is
				certified by the WCA as being qualified to submit POC data using the IAIABC
				format. The terms "certified vendor" and "vendor" are used interchangeably
				within this rule and carry the same meaning. A vendor's identity is not
				considered a record of the workers' compensation administration and is
				therefore not protected by the confidentiality provision.
B. "Filed" means that the policy information
				required under these rules has successfully passed all edits and has been
				accepted, date and time stamped and uploaded into the workers' compensation
				administration's database.
C.
				"IAIABC" means the international association of industrial accident boards and
				commissions.
D. "Insurer" means any
				insurance carrier or self-insured group or other entity that issues a workers'
				compensation insurance policy or provides workers' compensation coverage for
				itself or subsidiaries by any other means.
E. "POC" means proof of coverage.
F. "POC flat file" or "POC flat file format"
				means the IAIABC defined standard in which proof of coverage data is
				electronically submitted to the WCA.
G. "WCA certified" or "WCA certification"
				means a vendor has received approval from the WCA to submit POC data
				electronically. WCA certification is required prior to submitting POC
				data.
New Mexico Administrative Code › Title 11 - LABOR AND WORKERS' COMPENSATION › Chapter 4 - WORKERS' COMPENSATION › Part 11 - PROOF OF COVERAGE › Section 11.4.11.8 - PROOF OF COVERAGE

Current through Register Vol. 35, No. 13, July 16, 2024
A. Filing
				requirements:
(1) Every insurer shall file
				proof of coverage with the workers' compensation administration within 30 days
				of the effective date of any workers' compensation policy or within 30 days of
				the date of extension, renewal, reinstatement or amendment to such
				policy.
(2) Every insurer shall, in
				the event of a policy cancellation, file a notice of cancellation with the
				workers' compensation administration within 10 days of such
				cancellation.
(3) Vendor
				certification
(a) In order to be certified as
				a vendor for submission of POC data with the workers' compensation
				administration, an entity must receive certification from the workers'
				compensation administration.
(b) In
				order to maintain certified vendor status, the vendor must maintain
				certification with the workers' compensation administration, which includes
				continuous compliance with the workers' compensation administration POC
				business plan.
New Mexico Administrative Code › Title 11 - LABOR AND WORKERS' COMPENSATION › Chapter 4 - WORKERS' COMPENSATION › Part 12 - UNINSURED EMPLOYERS' FUND › Section 11.4.12.2 - SCOPE

Current through Register Vol. 35, No. 13, July 16, 2024
This rule applies to all employers in the state of New Mexico
				  who are subject to the Workers' Compensation Act and Occupational Disease and
				  Disablement Law.
New Mexico Administrative Code › Title 11 - LABOR AND WORKERS' COMPENSATION › Chapter 4 - WORKERS' COMPENSATION › Part 12 - UNINSURED EMPLOYERS' FUND › Section 11.4.12.3 - STATUTORY AUTHORITY

Current through Register Vol. 35, No. 13, July 16, 2024
Chapter 258, Laws of 2003 and NMSA 1978, Section
				  52-5-4,
				  authorizes the director to adopt reasonable rules and regulations for
				  implementing the purposes of the act.
New Mexico Administrative Code › Title 11 - LABOR AND WORKERS' COMPENSATION › Chapter 4 - WORKERS' COMPENSATION › Part 12 - UNINSURED EMPLOYERS' FUND › Section 11.4.12.5 - EFFECTIVE DATE

Current through Register Vol. 35, No. 13, July 16, 2024
October 15, 2003 unless a later date is cited at the end of a
				  section.
New Mexico Administrative Code › Title 11 - LABOR AND WORKERS' COMPENSATION › Chapter 4 - WORKERS' COMPENSATION › Part 12 - UNINSURED EMPLOYERS' FUND › Section 11.4.12.6 - OBJECTIVE

Current through Register Vol. 35, No. 13, July 16, 2024
The purpose of this rule is to establish requirements
				  governing the uninsured employers' fund and establishing penalties against
				  uninsured employers pursuant to Chapter 258, Laws of 2003.
New Mexico Administrative Code › Title 11 - LABOR AND WORKERS' COMPENSATION › Chapter 4 - WORKERS' COMPENSATION › Part 12 - UNINSURED EMPLOYERS' FUND › Section 11.4.12.7 - DEFINITIONS

Current through Register Vol. 35, No. 13, July 16, 2024
A.
"Claim"
means any allegation of entitlement to benefits under
				Chapter 258, Laws of 2003, which has been communicated to the uninsured
				employer's fund or to the fund through the workers' compensation
				administration.
B.
"Eligible"
and
"eligibility"
mean that the claim is
				properly subject to payment by the fund to the extent that the claim is
				compensable. The compensability determination is independent of the eligibility
				determination. Eligibility and compensability shall be determined in accordance
				with applicable law.
C.
"Fund"
means the uninsured employers' fund established by Chapter
				258, Laws of 2003 as administered by the workers' compensation
				administration.
D.
"Fund
				administrator"
means a designee of the director charged with
				administering the fund and implementing the provisions of this rule.
E.
"TRD"
means the New Mexico
				taxation and revenue department.
F.
"UEF in-house counsel"
means lawyers who are employees of the
				workers' compensation administration who litigate claims on their merits on
				behalf of the fund and who pursue reimbursement from uninsured employers after
				the UEF has paid benefits to or on behalf of the worker.
G.
"WCA"
means the workers'
				compensation administration of the state of New Mexico.
New Mexico Administrative Code › Title 11 - LABOR AND WORKERS' COMPENSATION › Chapter 4 - WORKERS' COMPENSATION › Part 12 - UNINSURED EMPLOYERS' FUND › Section 11.4.12.8 - PROCEDURES FOR SUBMISSION OF CLAIMS

Current through Register Vol. 35, No. 13, July 16, 2024
A. All claims shall be submitted on the
				mandatory complaint form available on the WCA website for workers' compensation
				benefits naming the uninsured employers' fund.
(1) The date of presentation to the fund
				shall be deemed to be the earliest date shown on the claim or complaint by an
				official WCA date stamp.
(2) If a
				claim is presented to the fund administrator prior to the running of the
				statute of limitations, the date of presentation shall toll the statute of
				limitations for purposes of filing against the fund.
New Mexico Administrative Code › Title 11 - LABOR AND WORKERS' COMPENSATION › Chapter 4 - WORKERS' COMPENSATION › Part 12 - UNINSURED EMPLOYERS' FUND › Section 11.4.12.9 - CLAIMS ADMINISTRATION

Current through Register Vol. 35, No. 13, July 16, 2024
A. The
				WCA may contract with a an independent adjusting company for the adjusting of
				those claims that are determined to be eligible for payment by the fund,
				purchase a loss portfolio transfer covering some or all of the liabilities of
				the fund, or may purchase a policy of commercial insurance to cover the
				liabilities of the fund upon a finding by the director that such purchases are
				in the best interests of the workers eligible to receive benefits from the fund
				and the entities paying assessment to support the fund.
(1) The fund, in conjunction with the
				independent adjusting company, if any, shall pay, or oppose, claims on their
				merits, and shall be treated for purposes of mediation and adjudication of
				disputes as a party with all rights and responsibilities applicable under
				law.
(2) With approval of the
				director, the independent adjusting company may engage outside counsel for
				representation when necessary.
(3)
				The fund or the independent adjusting company may solicit information
				concerning the average weekly wage of the worker from the employer. Provision
				of such information to the fund or the independent adjusting company shall not
				constitute an admission that the worker was an employee. In the event that the
				employer does not respond to the request for wage information, the employer
				will be informed, in writing, at the last known address of the employer, or by
				any means authorized by the director or his designee, that wages are in dispute
				and that the worker's evidence concerning wages shall be used to calculate
				average weekly wage. In the event that the employer does not respond within a
				reasonable time from the date the letter described in this paragraph, an
				affidavit from the worker concerning the wages earned while employed by the
				uninsured employer shall be deemed sufficient evidence upon which to pay
				benefits. Any suspected fraudulent reporting of wages by any party shall be
				reported to the enforcement bureau for investigation.
(4) In the event of a dispute concerning the
				wage basis for benefits, or in the event of other disputed benefits, the fund
				and the independent adjusting company may pay indemnity or other benefits,
				under reservation of rights, to the worker based upon available wage or other
				claim information.
New Mexico Administrative Code › Title 11 - LABOR AND WORKERS' COMPENSATION › Chapter 4 - WORKERS' COMPENSATION › Part 12 - UNINSURED EMPLOYERS' FUND › Section 11.4.12.10 - FINANCIAL RESPONSIBILITY OF EMPLOYER

Current through Register Vol. 35, No. 13, July 16, 2024
The employer shall pay claims, costs, interest and penalties
				  for which it becomes obligated under the New Mexico Workers' Compensation Act,
				  the Occupational Disease Disablement Law, and Uninsured Employers' Fund (UEF)
				  Act.
New Mexico Administrative Code › Title 11 - LABOR AND WORKERS' COMPENSATION › Chapter 4 - WORKERS' COMPENSATION › Part 12 - UNINSURED EMPLOYERS' FUND › Section 11.4.12.11 - CAP ON BENEFITS

Current through Register Vol. 35, No. 13, July 16, 2024
A.
				Notwithstanding the provisions of the Workers' Compensation Act and
				Occupational Disease Disablement Law, injured employees or an employee's
				beneficiaries who pursue a claim for benefits from the uninsured employers'
				fund (UEF) are not guaranteed payment for full workers' compensation benefits
				from the UEF.
B. The liability of
				the state, the uninsured employers' fund and the state treasurer, with respect
				to payment of any compensation benefits, expenses, fees or disbursements
				properly chargeable against the UEF, is limited to the assets in the UEF, and
				they are not otherwise liable for any payment.
C. For any job-related accident date
				occurring on or before June 30, 2023, the liability of the UEF for payment of
				indemnity benefits to an injured worker or their beneficiary shall not exceed
				$40,000 for each date of accident, nor shall payment of medical expenses
				$40,000 for each date of accident. If indemnity benefit payments do not reach
				$40,000, any unused portion can be applied to payment of medical expenses, over
				and above the $40,000 limit for medical benefits.
D. For any job-related accident date
				occurring on or after July 1, 2023, payment of indemnity benefits to an injured
				worker or their beneficiary shall not exceed $60,000 for each date of accident,
				nor shall payment of medical expenses exceed $60,000 for each date of accident.
				If indemnity benefit payments do not reach $60,000, any unused portion can be
				applied to payment of medical expenses, over and above the $60,000 limit for
				medical benefits.
E. For any
				job-related accident date occurring on or after July 1, 2025, and subject to
				the financial solvency of the UEF as determined by the director, payment of
				indemnity benefits to an injured worker or their beneficiary shall not exceed
				$75,000 for each date of accident, nor shall payment of medical expenses exceed
				$75,000 for each date of accident. If indemnity benefit payments do not reach
				$75,000, any unused portion can be applied to payment of medical expenses, over
				and above the $75,000 limit for medical benefits.
New Mexico Administrative Code › Title 11 - LABOR AND WORKERS' COMPENSATION › Chapter 4 - WORKERS' COMPENSATION › Part 12 - UNINSURED EMPLOYERS' FUND › Section 11.4.12.13 - ASSESSMENTS

Current through Register Vol. 35, No. 13, July 16, 2024
A. The fiscal year
				of the fund coincides with the fiscal year of the state.
B. Beginning with the calendar quarter ending
				September 30, 2004, and for each calendar quarter thereafter, there is assessed
				against each employer who is required or elects to be covered by the Workers'
				Compensation Act a fee equal to two dollars thirty cents ($2.30) per covered
				employee. Thirty cents per employee of the fee assessed against an employer
				shall be distributed to the credit of the uninsured employers' fund.
C. Penalties, pursuant to NMSA 1978, Section
				52-1-61 for
				non-reporting, incorrect reporting or non-payment of assessments due shall
				accrue on a monthly basis, with each month of noncompliance constituting a
				separate offense.
(1) Penalties pursuant to
				this provision shall be in addition to any penalties imposed by the New Mexico
				department of insurance or the New Mexico taxation and revenue
				department.
(2) The director may
				seek any remedy available under law for enforcement of penalties imposed
				pursuant to this provision.
(3) The
				respondent shall pay costs incurred to enforce penalties.
New Mexico Administrative Code › Title 11 - LABOR AND WORKERS' COMPENSATION › Chapter 4 - WORKERS' COMPENSATION › Part 12 - UNINSURED EMPLOYERS' FUND › Section 11.4.12.14 - MISCELLANEOUS PROVISIONS

Current through Register Vol. 35, No. 13, July 16, 2024
A. The
				fund may purchase excess insurance from the fund corpus if, in the judgment of
				the director, it is fiscally prudent to do so.
B. Auditing of the fund by the superintendent
				of insurance shall occur yearly, commencing thirty (30) days after the close of
				the fund's fiscal year.
(1) The final report
				of the audit of the fund (after an opportunity to contest and respond to
				findings made by the auditor) shall be treated as a public document.
(2) In the event of any audit exceptions in
				the final report of the audit, the fund will issue a public statement of
				corrective actions that it will implement to prevent future
				exceptions.
(3) The fund shall
				comply with all requirements for the reporting of losses and claims
				expenditures for statistical purposes that would apply to a self-insured
				employer.
New Mexico Administrative Code › Title 11 - LABOR AND WORKERS' COMPENSATION › Chapter 4 - WORKERS' COMPENSATION › Part 13 - CONTROLLED INSURANCE PLANS › Section 11.4.13.2 - SCOPE

Current through Register Vol. 35, No. 13, July 16, 2024
These rules cover all parties regulated pursuant to NMSA
				  1978, Section
				  52-1-4.2
				  and all parties seeking to establish a "controlled insurance plan" or a
				  "wrap-up " insurance plan, as defined below, for the purpose of insuring
				  workers' compensation liability.
New Mexico Administrative Code › Title 11 - LABOR AND WORKERS' COMPENSATION › Chapter 4 - WORKERS' COMPENSATION › Part 13 - CONTROLLED INSURANCE PLANS › Section 11.4.13.3 - STATUTORY AUTHORITY

Current through Register Vol. 35, No. 13, July 16, 2024
The director is authorized by NMSA 1978, Section
				  52-5-4
				  to adopt reasonable rules and regulations to implement the legislative purposes
				  of the Workers' Compensation Act (Act). The director is empowered to seek
				  administrative penalties pursuant to NMSA 1978, Section
				  52-1-61.
				  Regulatory authority over controlled insurance plans is set forth at NMSA 1978,
				  Section
				  52-1-4.2.
New Mexico Administrative Code › Title 11 - LABOR AND WORKERS' COMPENSATION › Chapter 4 - WORKERS' COMPENSATION › Part 13 - CONTROLLED INSURANCE PLANS › Section 11.4.13.5 - EFFECTIVE DATE

Current through Register Vol. 35, No. 13, July 16, 2024
November 15, 2004 unless a later date is cited at the end of
				  a section.
New Mexico Administrative Code › Title 11 - LABOR AND WORKERS' COMPENSATION › Chapter 4 - WORKERS' COMPENSATION › Part 13 - CONTROLLED INSURANCE PLANS › Section 11.4.13.6 - OBJECTIVE

Current through Register Vol. 35, No. 13, July 16, 2024
This part sets forth the requirements and processes for
				  application and regulation of controlled insurance plans, enumerates prohibited
				  acts and sets forth enforcement procedures.
New Mexico Administrative Code › Title 11 - LABOR AND WORKERS' COMPENSATION › Chapter 4 - WORKERS' COMPENSATION › Part 13 - CONTROLLED INSURANCE PLANS › Section 11.4.13.7 - DEFINITIONS

Current through Register Vol. 35, No. 13, July 16, 2024
A. "Unit
				statistical data" means the detailed exposure, premium, and loss (claim)
				information at the classification code level. Data providers submit unit
				statistical data to the designated rate service organization for use in
				ratemaking and experience rating.
B. "Single construction site" means the
				defined contiguous geographical area in which all accidents that occurred
				during the duration of the controlled insurance plan shall be covered by the
				controlled insurance plan.
C.
				"Noncontiguous construction site" means an area, or areas, in which
				construction is taking place that is not described on the official application,
				or amended application, as being within the controlled insurance plan by both a
				narrative description and a map designation which shows the construction site
				outlined by a single, non intersecting, boundary line.
D. "Controlled insurance plan," "OCIP,"
				"CCIP," "wrap-up," "owner controlled insurance plan," and "contractor
				controlled insurance plan" individually and collectively mean the controlled
				insurance plan subject to regulation under this rule.
E. "Same project" means a construction
				project on a single construction site defined and funded at the time of the
				application required by these rules.
F. "Director" means the director of the
				workers' compensation administration or his designee.
G. "WCA" or "agency" means the workers'
				compensation administration of the state of New Mexico.
H. "Applicant" means the person or entity
				that sought approval of a controlled insurance plan, any person designated by
				the applicant as their agent for interaction with the WCA and any substituted
				applicant approved as a substitute in writing by the director.
I. "Equipment and furnishings" means any item
				that is shown in, or specified on, construction documents for the single
				construction site.
New Mexico Administrative Code › Title 11 - LABOR AND WORKERS' COMPENSATION › Chapter 4 - WORKERS' COMPENSATION › Part 13 - CONTROLLED INSURANCE PLANS › Section 11.4.13.8 - APPLICATIONS

Current through Register Vol. 35, No. 13, July 16, 2024
A. Any party
				proposing a controlled insurance plan pursuant to Section
				52-1-4.2 NMSA 1978, shall submit
				an application for approval to the director on a form provided for that purpose
				not less than 30 days prior to the commencement of bidding procedures for the
				primary contractor.
(1) A provisional or
				contingent application for approval shall be allowed, provided that neither
				final approval nor permission to break ground may be given to any provisional
				or contingent application.
(2)
				Approvals of provisional or contingent applications are advisory only and no
				approval that is not designated as a final approval and that does not bear the
				signature of the director shall be deemed final.
(3) Every application for approval of a
				controlled insurance plan shall contain a detailed financial statement
				demonstrating that the aggregate construction cost, as statutorily defined, has
				been satisfied, and further showing that the sources of funding for the project
				conform with the definition of the term, "same project" contained in these
				rules. The financial statement shall be supported by an affidavit executed by
				the signatory to the application attesting to the accuracy and completeness of
				the financial statement.
New Mexico Administrative Code › Title 11 - LABOR AND WORKERS' COMPENSATION › Chapter 4 - WORKERS' COMPENSATION › Part 13 - CONTROLLED INSURANCE PLANS › Section 11.4.13.9 - CONTROLLED INSURANCE PLAN CONSIDERATION UNDER THE EXTRA-HAZARDOUS EMPLOYER PROVISIONS OF THE WORKERS' COMPENSATION ACT

Current through Register Vol. 35, No. 13, July 16, 2024
The controlled insurance plan shall be considered a single
				  employer for purposes of WCA regulations concerning extra-hazardous employers,
				  promulgated pursuant to Subsection (E) of Section
				  52-1-6.2 NMSA 1978. The North
				  American industrial classification system (NAICS) code applicable to the
				  general contractor shall be the industry code utilized for comparison of the
				  controlled insurance plan loss record to its industry standard. The controlled
				  insurance plan project shall be examined every 90 days, while construction is
				  ongoing, for purposes of determining extra- hazardous employer
				  status.
New Mexico Administrative Code › Title 11 - LABOR AND WORKERS' COMPENSATION › Chapter 4 - WORKERS' COMPENSATION › Part 13 - CONTROLLED INSURANCE PLANS › Section 11.4.13.11 - WAIVERS

Current through Register Vol. 35, No. 13, July 16, 2024
A waiver of any non-statutory requirement in this part may be
				  sought by the applicant. No waiver of any requirement of this part shall be
				  effective unless documented in writing, signed by the director. No waiver shall
				  be granted under circumstances where the waiver has the effect of increasing
				  the risk of injury or accident to any worker on the project, or increasing the
				  impact or effect of any accidental injury or occupational disease upon any
				  worker on the project. The director may consult with in-house or independent
				  safety experts in making a determination under this section, but his
				  determination shall not be overturned unless it is arbitrary, capricious,
				  abusive of discretion or otherwise not in compliance with
				  law.
New Mexico Administrative Code › Title 11 - LABOR AND WORKERS' COMPENSATION › Chapter 4 - WORKERS' COMPENSATION › Part 13 - CONTROLLED INSURANCE PLANS › Section 11.4.13.12 - BID NOTICES TO CONTRACTORS AND SUBCONTRACTORS

Current through Register Vol. 35, No. 13, July 16, 2024
A. All bid notices to contractors and
				subcontractors shall include specification of the single construction site
				proposed, and shall include a copy of the proposed controlled insurance safety
				plan.
B. The bid procedure utilized
				by the applicant must include a mechanism for contractors and subcontractors to
				have questions concerning the controlled insurance plan answered before the bid
				is due.
New Mexico Administrative Code › Title 11 - LABOR AND WORKERS' COMPENSATION › Chapter 4 - WORKERS' COMPENSATION › Part 13 - CONTROLLED INSURANCE PLANS › Section 11.4.13.13 - REPORTS AND OFFICIAL VISITS

Current through Register Vol. 35, No. 13, July 16, 2024
A. The
				controlled insurance plan shall submit a report on a quarterly basis or as
				otherwise determined by the director.
B. The director may require an official visit
				to the controlled insurance plan site to keep apprised of the progress of the
				controlled insurance plan and its compliance with the Workers' Compensation Act
				and WCA rules.
New Mexico Administrative Code › Title 11 - LABOR AND WORKERS' COMPENSATION › Chapter 4 - WORKERS' COMPENSATION › Part 13 - CONTROLLED INSURANCE PLANS › Section 11.4.13.14 - DISPUTES CONCERNING APPROVAL OF THE APPLICATION FOR APPROVAL OF A CONTROLLED INSURANCE PLAN AND FOR THE REQUIRED SAFETY PLAN

Current through Register Vol. 35, No. 13, July 16, 2024
A. All application materials, and safety plan
				materials shall be submitted to the director at least 30 days before the
				planned commencement of construction.
B. Amendments to the application or safety
				plan, and any waivers of requirements, that are negotiated between the WCA and
				the applicant shall only be effective if reduced to writing and signed by both
				parties.
C. In the event that an
				impasse develops in negotiations or disputes arising from the application
				process, the safety plan or request for waivers of requirements, the director
				shall designate an informal dispute resolution coordinator to attempt to bring
				the parties together to help them reach a mutually agreeable
				solution.
D. In the event the
				informal dispute resolution fails to resolve the dispute, either the applicant
				or the WCA can request a formal hearing before the director.
E. The director, or his hearing officer,
				shall hear the positions of both sides and render an initial ruling within 15
				days of the hearing. Motions practice and discovery procedures shall not be
				allowed. The rules of evidence are relaxed to the extent possible, consistent
				with the need to maintain order in the hearing and reach a fair
				decision.
F. Appeal from the ruling
				the director or his hearing officer after a formal hearing shall be by writ of
				certiorari to the district court, pursuant to SCRA 01-075.
New Mexico Administrative Code › Title 11 - LABOR AND WORKERS' COMPENSATION › Chapter 4 - WORKERS' COMPENSATION › Part 13 - CONTROLLED INSURANCE PLANS › Section 11.4.13.16 - ENFORCEMENT

Current through Register Vol. 35, No. 13, July 16, 2024
A. In the event of
				violation of any of these rules, or in the event of the occurrence of any
				prohibited acts specified in these rules, the WCA may seek any or all of the
				following penalties singly or in combination, against the applicant, any
				individual responsible for the performance or non-performance of any duty or
				prohibited act and, with respect to injunctive relief, against the continuation
				of the controlled insurance project:
(1) A
				fine of up to $1000 for each violation pursuant to NMSA 1978, Section
				52-1-61.
(2) A fine of up to $1000 for each day of the
				continuing violation, after notice is served upon the designated representative
				of the applicant that the director has made a finding of probable cause that a
				continuing violation of these rules has occurred.
(3) Injunctive relief for the cessation of
				construction activities at the single construction site for the noncontiguous
				construction site until full compliance with these rules is achieved, as
				specifically authorized in these rules.
New Mexico Administrative Code › Title 11 - LABOR AND WORKERS' COMPENSATION › Chapter 5 - OCCUPATIONAL HEALTH AND SAFETY › Part 1 - OCCUPATIONAL HEALTH AND SAFETY - GENERAL PROVISIONS › Section 11.5.1.2 - SCOPE

Current through Register Vol. 35, No. 13, July 16, 2024
All employment and places of employment covered by the
				  Occupational Health and Safety Act.
New Mexico Administrative Code › Title 11 - LABOR AND WORKERS' COMPENSATION › Chapter 5 - OCCUPATIONAL HEALTH AND SAFETY › Part 1 - OCCUPATIONAL HEALTH AND SAFETY - GENERAL PROVISIONS › Section 11.5.1.3 - STATUTORY AUTHORITY

Current through Register Vol. 35, No. 13, July 16, 2024
Sections
				  50-9-7,
				  50-9-13
				  and
				  74-1-9
				  NMSA 1978.
New Mexico Administrative Code › Title 11 - LABOR AND WORKERS' COMPENSATION › Chapter 5 - OCCUPATIONAL HEALTH AND SAFETY › Part 1 - OCCUPATIONAL HEALTH AND SAFETY - GENERAL PROVISIONS › Section 11.5.1.5 - EFFECTIVE DATE

Current through Register Vol. 35, No. 13, July 16, 2024
May 1, 1995, except where a later effective date is indicated
				  in the history note at the end of a section.
A.
Initial promulgation:
sections 1 through 14 of this part were effective May 1, 1995.
B.
Amendments and additions:
the amendments to sections 5 and 7 through 13 of this part and sections 15
				through 24 of this part are effective January 1, 1996.
New Mexico Administrative Code › Title 11 - LABOR AND WORKERS' COMPENSATION › Chapter 5 - OCCUPATIONAL HEALTH AND SAFETY › Part 1 - OCCUPATIONAL HEALTH AND SAFETY - GENERAL PROVISIONS › Section 11.5.1.6 - OBJECTIVE

Current through Register Vol. 35, No. 13, July 16, 2024
To establish definitions and procedures applicable to all
				  employers subject to the Occupational Health and Safety Act.
New Mexico Administrative Code › Title 11 - LABOR AND WORKERS' COMPENSATION › Chapter 5 - OCCUPATIONAL HEALTH AND SAFETY › Part 1 - OCCUPATIONAL HEALTH AND SAFETY - GENERAL PROVISIONS › Section 11.5.1.8 - AMENDMENT AND SUPERSESSION OF PRIOR REGULATIONS; REFERENCES IN OTHER REGULATIONS

Current through Register Vol. 35, No. 13, July 16, 2024
This part shall be construed as amending and superseding all
				  prior regulations. See history of 11.5.1 NMAC at the end of this
				  part.
New Mexico Administrative Code › Title 11 - LABOR AND WORKERS' COMPENSATION › Chapter 5 - OCCUPATIONAL HEALTH AND SAFETY › Part 1 - OCCUPATIONAL HEALTH AND SAFETY - GENERAL PROVISIONS › Section 11.5.1.9 - SEVERABILITY

Current through Register Vol. 35, No. 13, July 16, 2024
If any provision or application of 11.5.1 NMAC through 11.5.4
				  NMAC or 11.5.6 NMAC is held invalid, the remainder, or its application to other
				  situations or persons, shall not be affected.