New Mexico Administrative Code › Title 6 - PRIMARY AND SECONDARY EDUCATION › Chapter 50 - INSURANCE › Part 16 - ADMINISTRATIVE APPEAL OF AUTHORITY COVERAGE DETERMINATIONS › Section 6.50.16.7 - DEFINITIONS

Current through Register Vol. 35, No. 13, July 16, 2024
As used in this rule:
A.
"Authority
" means the New
				Mexico public school insurance authority or its authorized
				representatives.
B.
"Authority board"
or
"board"
means the board of directors
				of the New Mexico public school insurance authority.
C.
"Appellant"
means any party
				who complains that a coverage determination may be in violation of any law,
				rule, regulation, or order administered or promulgated by the authority and who
				initiates a proceeding under this rule by filing a petition for review with the
				authority.
D.
"Coverage
				determination"
and
"determination"
mean any decision, order
				or disposition by the authority denying coverage, limiting the scope of
				coverage or limiting the amount of payment of a claim of a member or employee,
				except for workman's compensation claims.
E.
"Document"
means, except as
				otherwise used in the provisions of this rule governing discovery, any written
				submission in a formal proceeding which is not a pleading or which is required
				to be filed by authority rule or order outside a formal pleading; this includes
				items such as reports, exhibits, and studies; at the option of the party or
				staff making a filing, any document may additionally be presented in a form the
				hearing officer so orders.
F.
"Employee"
means a person employed by a member school district,
				charter school or other educational entity, or an employee's representatives in
				the event of legal incapacity, and includes volunteers or officials entitled to
				authority liability coverage pursuant to the Tort Claims Act, Subsection F of
				Section
				41-4-3
				NMSA 1978.
G.
"Final
				coverage determination by the authority"
with respect to a member means
				a coverage letter from the authority's contracted general counsel or contracted
				claims adjuster or with respect to an employee means a coverage letter from the
				authority's contracted third party benefits administrator or authorized
				authority staff member.
H.
"Hearing"
means any proceeding that is noticed for "hearing" by the
				authority or hearing officer and shall include an opportunity for the parties
				to present such evidence, argument, or other appropriate matters as the
				presiding officer shall deem relevant and material to the issues; hearings may
				be conducted by telephone conference call at the discretion of the presiding
				officer.
I.
"Hearing
				officer"
means a person appointed by the authority as a hearing
				examiner, who is designated by the authority to conduct any hearing or
				investigation which the authority is authorized to conduct, to take testimony
				in respect to the subject under investigation, report such testimony and
				provide to the authority a proposed decision with regard to the
				issues.
J.
"Member school
				districts, charter schools and other participating entities"
herein
				referred to collectively as
"members"
means all public school
				districts and charter schools mandated by the act to be members of the
				authority and all other educational entities voluntarily participating in the
				authority.
K.
"Party"
means any person or entity that initiates or responds to an authority
				proceeding by filing a petition for review with the authority and includes the
				authority; unless the context indicates otherwise, the term "party" may also
				refer to counsel of record for the party.