reglab/statecodes huggingface dataset:
New Mexico Administrative Code › Title 13 - INSURANCE › Chapter 17 - WORKERS' COMPENSATION INSURANCE › Part 2 - WORKERS' COMPENSATION DISPUTE BOARD › Section 13.17.2.17 - REVIEW

Current through Register Vol. 35, No. 13, July 16, 2024
Review of decisions of the dispute board shall be accorded
				  pursuant to Section 59A-17-30 B NMSA 1978. The chair of the dispute board, or
				  the secretary appointed by the chair, shall advise each appellant in writing of
				  his or her rights of appeal and the procedure to be followed.
New Mexico Administrative Code › Title 13 - INSURANCE › Chapter 17 - WORKERS' COMPENSATION INSURANCE › Part 4 - WORKERS' COMPENSATION ASSIGNED RISK POOL › Section 13.17.4.2 - SCOPE

Current through Register Vol. 35, No. 13, July 16, 2024
This rule applies to all workers' compensation insurers
				  participating as reinsurers of the New Mexico Worker's Compensation Assigned
				  Risk Pool.
New Mexico Administrative Code › Title 13 - INSURANCE › Chapter 17 - WORKERS' COMPENSATION INSURANCE › Part 4 - WORKERS' COMPENSATION ASSIGNED RISK POOL › Section 13.17.4.3 - STATUTORY AUTHORITY

Current through Register Vol. 35, No. 13, July 16, 2024
Sections 59A-2-9, 59A-33-3, 59A-33-8 and 59A-33-9 NMSA
				  1978.
New Mexico Administrative Code › Title 13 - INSURANCE › Chapter 17 - WORKERS' COMPENSATION INSURANCE › Part 4 - WORKERS' COMPENSATION ASSIGNED RISK POOL › Section 13.17.4.5 - EFFECTIVE DATE

Current through Register Vol. 35, No. 13, July 16, 2024
January 1, 1990, unless a later date is cited at the end of a
				  section.
New Mexico Administrative Code › Title 13 - INSURANCE › Chapter 17 - WORKERS' COMPENSATION INSURANCE › Part 4 - WORKERS' COMPENSATION ASSIGNED RISK POOL › Section 13.17.4.6 - OBJECTIVE

Current through Register Vol. 35, No. 13, July 16, 2024
This rule defines the methods by which workers' compensation
				  insurers shall participate in the Workers' Compensation Assigned Risk Pool as
				  reinsurers. The methods of assessment are structured to promote the voluntary
				  assumption of workers' compensation risks by workers' compensation
				  insurers.
New Mexico Administrative Code › Title 13 - INSURANCE › Chapter 17 - WORKERS' COMPENSATION INSURANCE › Part 4 - WORKERS' COMPENSATION ASSIGNED RISK POOL › Section 13.17.4.7 - DEFINITIONS

Current through Register Vol. 35, No. 13, July 16, 2024
When used in this rule,
the agency
refers to the
				  Workers' Compensation Assigned Risk Pool as defined in Section 59A-33-4 B NMSA
				  1978.
New Mexico Administrative Code › Title 13 - INSURANCE › Chapter 17 - WORKERS' COMPENSATION INSURANCE › Part 4 - WORKERS' COMPENSATION ASSIGNED RISK POOL › Section 13.17.4.8 - PARTICIPATION OF WORKERS' COMPENSATION INSURERS

Current through Register Vol. 35, No. 13, July 16, 2024
A. The undertakings of any policy issued by
				the agency shall be fully reinsured by all members of the pool in proportion to
				the amount that the net direct workers' compensation line premium on the
				insurance written in the state during the preceding calendar year by the
				issuing member bears to the total of workers' compensation line premiums
				written in this state during the preceding calendar year by all members of the
				agency. Net direct workers' compensation line premium shall be direct written
				premium exclusive of policyholder dividends and New Mexico Workers'
				Compensation Assigned Risk Pool premiums.
B. The premium used for the basis of
				proration, as described in Subsection A of 13.17.4.8 NMACshall be those
				premiums reported to the New Mexico department of insurance in the annual
				statement. Each member company may file with the agency for exclusion of those
				premiums classified as workers' compensation premiums on the annual
				statement.
C. The exclusions
				applicable in Subsection B of 13.17.4.8 NMAC shall not reduce the member's
				assessment base below zero.
D.
				Application for exclusion under Subsection B of 13.17.4.8 NMAC shall be made
				prior to April 1 of the following calendar year and shall be certified by a
				responsible officer of the member company. Members may apply for the exclusions
				described above on a form prescribed by the agency and approved by the
				superintendent and may be required by the agency to provide other information
				as may be necessary to verify the information contained in the
				application.
New Mexico Administrative Code › Title 13 - INSURANCE › Chapter 17 - WORKERS' COMPENSATION INSURANCE › Part 4 - WORKERS' COMPENSATION ASSIGNED RISK POOL › Section 13.17.4.9 - SMALL POLICY EXEMPTIONS

Current through Register Vol. 35, No. 13, July 16, 2024
A. A
				member of the agency which insures on a voluntary basis any policyholder having
				$5,000 or less in annual workers' compensation premium shall be exempt from
				participation in the agency to the extent approved by the New Mexico insurance
				division.
B. The premium threshold
				of $5,000 applies to policies issued or renewed during 1990. The agency may
				file a request for an adjustment to the premium threshold with the New Mexico
				insurance division. No requested adjustment shall become effective nor shall it
				be used until approved by the New Mexico insurance division, at which time it
				may be used.
C. The exemption
				applicable to a member shall not reduce the member's assessment base below
				zero.
D. Eligibility for the small
				policy exemptions shall be established prior to April 1 of the following
				calendar year and shall be certified by a responsible officer of the member
				company. Members may apply for the small policy exemptions in the manner
				prescribed by the agency and approved by the New Mexico insurance division and
				may be required by the agency to provide other information as may be necessary
				to verify the information contained in the application.
New Mexico Administrative Code › Title 13 - INSURANCE › Chapter 17 - WORKERS' COMPENSATION INSURANCE › Part 4 - WORKERS' COMPENSATION ASSIGNED RISK POOL › Section 13.17.4.10 - TAKE-OUT CREDITS

Current through Register Vol. 35, No. 13, July 16, 2024
A. The
				following policies shall be eligible for take-out credit:
(1) $5,000 or less in estimated standard
				annual workers' compensation premium as shown on the expiring policy as
				provided for in 13.17.4.9 NMAC; and
(2) any other such policy that was an
				assigned risk policy immediately prior to being voluntarily assumed by the
				member company.
New Mexico Administrative Code › Title 13 - INSURANCE › Chapter 17 - WORKERS' COMPENSATION INSURANCE › Part 5 - CLASSIFICATION AND RATING FOR EMPLOYERS AND LEASING CONTRACTORS › Section 13.17.5.1 - ISSUING AGENCY

Current through Register Vol. 35, No. 13, July 16, 2024
New Mexico State Corporation Commission [Public Regulation
				  Commission], Department of Insurance, Post Office Box 1269, Santa Fe, NM
				  87504-1269.
New Mexico Administrative Code › Title 13 - INSURANCE › Chapter 17 - WORKERS' COMPENSATION INSURANCE › Part 5 - CLASSIFICATION AND RATING FOR EMPLOYERS AND LEASING CONTRACTORS › Section 13.17.5.2 - SCOPE

Current through Register Vol. 35, No. 13, July 16, 2024
This rule applies to workers' compensation and employer's
				  liability insurance as defined in Section 59A-7-6 A(3) NMSA
				  1978.
New Mexico Administrative Code › Title 13 - INSURANCE › Chapter 17 - WORKERS' COMPENSATION INSURANCE › Part 5 - CLASSIFICATION AND RATING FOR EMPLOYERS AND LEASING CONTRACTORS › Section 13.17.5.3 - STATUTORY AUTHORITY

Current through Register Vol. 35, No. 13, July 16, 2024
Sections 59A-2-9, 59A-3-6, 59A-17-5, 59A-18-29, 59A-33-9.1,
				  and 59A-33-10 and 59A-2-9.1 NMSA 1978.
New Mexico Administrative Code › Title 13 - INSURANCE › Chapter 17 - WORKERS' COMPENSATION INSURANCE › Part 5 - CLASSIFICATION AND RATING FOR EMPLOYERS AND LEASING CONTRACTORS › Section 13.17.5.5 - EFFECTIVE DATE

Current through Register Vol. 35, No. 13, July 16, 2024
September 6, 1991, unless a later date is cited at the end of
				  a section or paragraph. Repromulgated in NMAC format effective July 1,
				  1997.
Compiler's note: The words or paragraph, above, are no
					 longer applicable. Later dates are now cited only at the end of sections, in
					 the history notes appearing in brackets.
New Mexico Administrative Code › Title 13 - INSURANCE › Chapter 17 - WORKERS' COMPENSATION INSURANCE › Part 5 - CLASSIFICATION AND RATING FOR EMPLOYERS AND LEASING CONTRACTORS › Section 13.17.5.6 - OBJECTIVE

Current through Register Vol. 35, No. 13, July 16, 2024
The purpose of this rule is to carry out the requirements of
				  Laws 1990 (2nd Special Session), Chapter 2 relating to proper workers'
				  compensation classification and rating, including defining temporary and leased
				  employees, providing for proper classification and rating, providing for the
				  prevention of experience modifier reductions through employee leasing
				  arrangements and imposing penalties for the use of subterfuge to evade the
				  proper application of workers' compensation classification and
				  rating.
New Mexico Administrative Code › Title 13 - INSURANCE › Chapter 17 - WORKERS' COMPENSATION INSURANCE › Part 5 - CLASSIFICATION AND RATING FOR EMPLOYERS AND LEASING CONTRACTORS › Section 13.17.5.8 - SUBTERFUGE; GENERAL PROHIBITION; PENALTY

Current through Register Vol. 35, No. 13, July 16, 2024
A. The use of subterfuge or any other action
				to evade the proper application of workers' compensation insurance
				classifications, ratings based upon experience or other premium rating
				procedures is prohibited.
B. In
				addition to any other penalty provided by law or this rule, any person whom the
				Superintendent finds, after hearing, to have committed subterfuge shall be
				subject to the penalties provided in 59A-1-18 NMSA 1978. Each act of
				subterfuge, whether like or unlike other acts, shall constitute a separate
				violation.
New Mexico Administrative Code › Title 13 - INSURANCE › Chapter 17 - WORKERS' COMPENSATION INSURANCE › Part 5 - CLASSIFICATION AND RATING FOR EMPLOYERS AND LEASING CONTRACTORS › Section 13.17.5.9 - COVERAGE OF TEMPORARY WORKERS

Current through Register Vol. 35, No. 13, July 16, 2024
In the voluntary market and in the assigned risk pool,
				  coverage for temporary workers shall be through a standard workers'
				  compensation policy issued to that employer which has the right to control
				  hiring, salary, assignment and payment of the temporary
				  workers.
New Mexico Administrative Code › Title 13 - INSURANCE › Chapter 17 - WORKERS' COMPENSATION INSURANCE › Part 5 - CLASSIFICATION AND RATING FOR EMPLOYERS AND LEASING CONTRACTORS › Section 13.17.5.10 - COVERAGE OF LEASED WORKERS IN THE VOLUNTARY MARKET

Current through Register Vol. 35, No. 13, July 16, 2024
A. In the voluntary insurance market, a
				leasing contractor shall obtain or cause to be obtained workers' compensation
				coverage for leased workers either through individual policies issued to each
				client or, with the voluntary market insurer's knowledge and consent, through a
				standard workers' compensation policy issued to the leasing contractor as
				co-employer of and covering all such leased workers. The leasing contractor's
				voluntary market insurer may take all reasonable steps to ascertain exposure
				under any such policy and to collect the appropriate premium, including the
				following:
(1) requiring a complete
				description of the leasing company's and its predecessors-in-interest's clients
				and operations, past and present;
(2) conducting periodic audits and requiring
				periodic reports of payroll, classifications, ratings based upon experience and
				jurisdictions with exposure. In addition, the insurer may require the leasing
				contractor to submit its IRS Form 941 or its equivalent to the insurer on a
				quarterly basis;
(3) conducting
				audits of client operations; and
(4) taking or requiring the leasing
				contractor to take other reasonable measures appropriate to determining
				payroll, worker classifications, loss experience, ratings based upon experience
				and premium.
New Mexico Administrative Code › Title 13 - INSURANCE › Chapter 17 - WORKERS' COMPENSATION INSURANCE › Part 5 - CLASSIFICATION AND RATING FOR EMPLOYERS AND LEASING CONTRACTORS › Section 13.17.5.11 - COVERAGE OF LEASED WORKERS IN THE ASSIGNED RISK POOL

Current through Register Vol. 35, No. 13, July 16, 2024
A. In the assigned risk pool, a leasing
				contractor shall obtain or cause to be obtained workers' compensation coverage
				for leased workers through individual policies issued to and in the name of
				each client for whom the leased workers work.
B. The assigned risk pool shall cooperate in
				facilitating the joint administration of workers' compensation policies
				covering all workers leased by a single leasing contractor. Such cooperation
				may include assignment of all client policies to a single servicing carrier, a
				common effective date for all client policies if the leasing contractor so
				requests, and joint auditing.
New Mexico Administrative Code › Title 13 - INSURANCE › Chapter 17 - WORKERS' COMPENSATION INSURANCE › Part 5 - CLASSIFICATION AND RATING FOR EMPLOYERS AND LEASING CONTRACTORS › Section 13.17.5.12 - PROVISIONS APPLICABLE TO VOLUNTARY MARKET AND ASSIGNED RISK POOL

Current through Register Vol. 35, No. 13, July 16, 2024
A. An insurer or
				the assigned risk pool may require the following information from an employer,
				client or leasing contractor making application for coverage:
(1) a list by jurisdiction of every name
				under which an employer, client or leasing contractor has operated at any time
				during the preceding five years, including but not limited to business names of
				all predecessors-in-interest, together with the names of all insurers and
				policy numbers of policies issued to the employer, client or leasing contractor
				under each such name, and a copy of the leasing contractor's most recently
				filed internal revenue service form 941 or equivalent;
(2) a list of every person and entity which
				has owned a five percent or greater interest in the employer, client or leasing
				contractor or any of their predecessors-in-interest at any time during the
				five-year period immediately preceding the application;
(3) for each person and entity identified in
				the preceding paragraph, a list of all other businesses in which each such
				person and entity has owned a five percent or greater interest at any time
				during the five-year period immediately preceding the application;
(4) a list by jurisdiction of every current
				client of a leasing contractor, together with every name under which each
				client has operated at any time during the five-year period immediately
				preceding the application, and a copy of the most recently filed internal
				revenue service form 941 or equivalent for each client;
(5) a sworn affidavit, signed by the chief
				executive officer of each client and a responsible officer of its leasing
				contractor, stating the names of each insurer and policy number of each
				workers' compensation insurance policy issued to the client under each name
				under which the client has operated at any time during the five-year period
				immediately preceding the application;
(6) a list by name of all workers, giving the
				social security number, classification code and wage of each; and
(7) a sworn affidavit, signed by the chief
				executive office of each client and a responsible officer of its leasing
				contractor, stating that all non-leased workers are covered by workers'
				compensation coverage. In addition, the affidavit may be required to state the
				name of all insurers, the policy numbers, the policy periods, the number of
				workers and the aggregate payroll applicable to each classification code of the
				non-leased workers. This affidavit may be required as often as an insurer or
				the pool deems reasonably necessary.
New Mexico Administrative Code › Title 13 - INSURANCE › Chapter 17 - WORKERS' COMPENSATION INSURANCE › Part 5 - CLASSIFICATION AND RATING FOR EMPLOYERS AND LEASING CONTRACTORS › Section 13.17.5.13 - TERMINATION OF EMPLOYEE LEASING ARRANGEMENT; RATING OF CLIENT

Current through Register Vol. 35, No. 13, July 16, 2024
When any employee leasing arrangement terminates, all prior
				  experience of the client's own direct workers and its previously leased workers
				  shall be used in rating the client. Every rating organization and insurer shall
				  make a reasonable effort, including a special audit if necessary, to obtain and
				  verify the information necessary to calculate a rating based upon experience,
				  where premium is sufficient to make such rating applicable.
New Mexico Administrative Code › Title 13 - INSURANCE › Chapter 17 - WORKERS' COMPENSATION INSURANCE › Part 5 - CLASSIFICATION AND RATING FOR EMPLOYERS AND LEASING CONTRACTORS › Section 13.17.5.14 - REVIEW

Current through Register Vol. 35, No. 13, July 16, 2024
A. Any rating
				determination made pursuant to this rule may be appealed as provided under
				Section 59A-17-30B NMSA 1978.
B.
				Any other determination or decision made pursuant to this rule may be reviewed
				through seeking a hearing pursuant to Section 59A-4-15 NMSA 1978.
C. If the application for review concerns an
				assigned risk pool policy, the assigned risk pool shall continue to provide
				coverage, if requested, during the period of any review proceeding, through a
				final decision by the superintendent. Premiums, other than premiums subject to
				dispute, shall be timely paid in full in order to continue coverage during
				review. The superintendent may require the amount of all premiums subject to
				dispute to be deposited in an interest-bearing trust account to be distributed
				after all decisions are final.
New Mexico Administrative Code › Title 13 - INSURANCE › Chapter 17 - WORKERS' COMPENSATION INSURANCE › Part 5 - CLASSIFICATION AND RATING FOR EMPLOYERS AND LEASING CONTRACTORS › Section 13.17.5.15 - GENERAL PENALTY

Current through Register Vol. 35, No. 13, July 16, 2024
A. In addition
				to any other penalty provided by law or rule, violation of any provision of
				this rule by an employer, client or leasing contractor is grounds for
				cancellation or non-renewal of workers' compensation insurance. Notice of such
				cancellation or non-renewal, stating the reason, shall be provided the insured
				at least 30 days in advance of the effective date of the
				cancellation.
B. In addition to any
				other penalty provided by law or this rule, violation of the provisions of this
				rule is subject to other penalties for violation of the Insurance Code (Chapter
				59A NMSA 1978).
C. In addition to
				any other penalty imposed for violation of this rule, the person or entity
				violating the rule may be required to pay any unpaid premium found to be due
				plus interest at the rate of 15% a year from the date such premium should have
				been paid.
D. An insured covered
				through the assigned risk pool may avoid cancellation or non-renewal pursuant
				to 13 NMAC 17.5.15.1 [now Subsection A of 13.17.5.15 NMAC] by taking such
				corrective action as the pool may specify in a timely manner. The pool may
				grant an insured a reasonable grace period, not to exceed 30 days, if the
				insured pays to the pool sufficient deposit premiums to cover ultimate
				premiums, as estimated by the pool.
New Mexico Administrative Code › Title 13 - INSURANCE › Chapter 17 - WORKERS' COMPENSATION INSURANCE › Part 5 - CLASSIFICATION AND RATING FOR EMPLOYERS AND LEASING CONTRACTORS › Section 13.17.5.16 - TRANSITION PROVISION

Current through Register Vol. 35, No. 13, July 16, 2024
All leasing contractors and all employers providing temporary
				  workers covered through the assigned risk pool on the effective date of this
				  rule shall submit a new application for coverage to the pool on or before
				  September 30, 1991, in order to establish eligibility for pool coverage in
				  accordance with this rule. The application shall contain and be accompanied by
				  all the information and documentation specified in 13 nmac 17.5.12, paragraphs
				  17.5.12.1.1 through 17.5.12.1.7 [now Paragraphs (1) through (7) of Subsection A
				  of
				  13.17.5.12
				  NMAC]. Effective October 30, 1991, the pool shall recreate and reissue coverage
				  to all such persons or entities to the extent they qualify for pool coverage
				  under this rule, and shall cancel all others to the extent they do not qualify
				  under this rule, giving 30 days' notice of cancellation. Within 10 days of the
				  date of the notice of cancellation, every such person and entity shall deliver
				  written notice of cancellation to every client and shall seek replacement
				  coverage in accordance with this rule.
New Mexico Administrative Code › Title 13 - INSURANCE › Chapter 17 - WORKERS' COMPENSATION INSURANCE › Part 6 - PREMIUM ADJUSTMENT PROGRAM › Section 13.17.6.2 - SCOPE

Current through Register Vol. 35, No. 13, July 16, 2024
This rule authorizes premium credits for workers'
				  compensation and employer's liability insurance as defined in NMSA 1978 Section
				  59A-7-6 A(3) for those employers utilizing certain qualifying classifications.
				  The premium credit calculation in this rule shall apply to new or renewal
				  qualifying policies effective on and after July 1, 1992.
New Mexico Administrative Code › Title 13 - INSURANCE › Chapter 17 - WORKERS' COMPENSATION INSURANCE › Part 6 - PREMIUM ADJUSTMENT PROGRAM › Section 13.17.6.3 - STATUTORY AUTHORITY

Current through Register Vol. 35, No. 13, July 16, 2024
NMSA 1978 Sections 59A-2-9, 59A-3-6, and
				  59A-17-5.
New Mexico Administrative Code › Title 13 - INSURANCE › Chapter 17 - WORKERS' COMPENSATION INSURANCE › Part 6 - PREMIUM ADJUSTMENT PROGRAM › Section 13.17.6.6 - OBJECTIVE

Current through Register Vol. 35, No. 13, July 16, 2024
The purpose of this rule is to implement NMSA 1978 Section
				  59A-17-8 C directing the Superintendent of Insurance to equalize and calculate
				  workers' compensation premium rates on a basis that does not discriminate
				  against or penalize employers who pay higher wages than other employers to
				  workers in the same job classification. The legislative objective is satisfied
				  by retaining the present payroll-based system modified by the application of
				  progressively greater premium credits to progressively higher hourly wages on
				  policies for qualifying classifications.
New Mexico Administrative Code › Title 13 - INSURANCE › Chapter 17 - WORKERS' COMPENSATION INSURANCE › Part 6 - PREMIUM ADJUSTMENT PROGRAM › Section 13.17.6.7 - DEFINITIONS

Current through Register Vol. 35, No. 13, July 16, 2024
In addition to the definitions in the Workers' Compensation
				  Act, NMSA 1978 Sections
				  52-1-1 et
				  seq., as used in this rule:
A.
aggregate call for experience
means the requests by the WCSO to workers'
				compensation carriers for summaries of payroll, premium or loss experience
				data;
B.
ARAP
				calculations
means the Assigned Risk Adjustment Program approved by the
				Superintendent pursuant to NMSA 1978 Section 59A-33-10;
C.
basic manual
means the Basic
				Manual for Workers' Compensation and Employers Liability Insurance applicable
				to New Mexico filed by the WCSO and approved by the Superintendent;
D.
experience rating
means any
				workers' compensation premium rating plan which provides for premium
				adjustments based upon an insured's prior loss experience;
E.
final earned premium
means
				that premium which applies after the application of payroll audits and
				retrospective rating adjustments;
F.
manual premium
means the
				product of payroll per $100 and the manual rate for a given classification.
				Manual premium for a policy means the sum of the manual premiums for the
				classification applicable to that policy;
G.
manual rate
means workers'
				compensation base rates filed by authorized insurers or the workers'
				compensation assigned risk pool and approved by the Superintendent;
H.
qualifying classifications
means those workers' compensation classifications listed in subsection C of
				13.17.6.8 NMAC;
I.
qualifying policy
means a workers' compensation or employer's liability
				policy the premium for which is attributable to one or more qualifying
				classifications;
J.
rate
				service organization
has the meaning given in NMSA 1978 Section
				59A-17-4;
K.
remuneration
shall have the meaning used in Rule V of the Basic Manual
				for Workers Compensation and Employers Liability Insurance;
L.
standard earned premium
means the premiums on which general rate levels are set as defined in the Basic
				Manual for Workers' Compensation;
M.
Workers' Compensation Service
				Organization (WCSO)
means either a rate service organization licensed in
				accordance with NMSA 1978 Section 59A-17-19 or an advisory organization
				licensed in accordance with NMSA 1978 Section 59A-17-24 that is designated by
				the Superintendent of Insurance in workers' compensation matters.
New Mexico Administrative Code › Title 13 - INSURANCE › Chapter 17 - WORKERS' COMPENSATION INSURANCE › Part 6 - PREMIUM ADJUSTMENT PROGRAM › Section 13.17.6.9 - ADMINISTRATIVE REQUIREMENTS

Current through Register Vol. 35, No. 13, July 16, 2024
The premium credit program shall be administered in the
				  following manner:
A. Each workers'
				compensation carrier shall issue a premium credit application form for each
				qualifying policy. This form must be issued by each individual carrier and
				shall be sent to each insured employer prior to policy issuance or within sixty
				(60) days after the policy's effective date. The Superintendent shall approve
				such forms prior to their use. The carrier shall maintain proof of mailing in
				its files and shall make such proof available to the New Mexico Insurance
				Division upon request.
B. The
				employer shall complete the required information and shall mail the completed
				form to the WCSO not later than 180 days after the policy's effective
				date.
C. The WCSO shall compute the
				insured's average hourly wage for each qualifying classification and shall
				apply the percentage of premium credit using the criteria and Premium Credit
				Schedule established in this rule. These calculations shall be displayed on a
				Policy Credit Worksheet. The WCSO shall mail a copy of the completed worksheet
				to the insured's carrier.
D. The
				carrier shall use the applicable credits to calculate the insured's estimated
				premium at policy issuance.
E. The
				experience used to determine loss cost and/or manual rates for each
				classification shall be reflective of the premium credit program in subsequent
				rate filings.
F. The applicable
				premium credits shall be reflected in the experience rating and ARAP
				calculations.
G. Standard earned
				premium reported to the WCSO on the aggregate call for experience must include
				the effects of premium credits.
New Mexico Administrative Code › Title 13 - INSURANCE › Chapter 17 - WORKERS' COMPENSATION INSURANCE › Part 6 - PREMIUM ADJUSTMENT PROGRAM › Section 13.17.6.10 - AUDIT; PREMIUM CREDIT REVISION

Current through Register Vol. 35, No. 13, July 16, 2024
Upon audit at the end of the policy term, the carrier shall
				  use the same credits in the calculation of the insured's final earned premium,
				  provided that the carrier may verify the original qualification criteria as
				  well as the data originally provided by the insured for the computation of the
				  premium credits by reviewing those records upon which the insured's data were
				  originally based. If this process uncovers any errors, revised payroll and/or
				  hours worked data must be submitted to the WCSO. The carrier shall use the
				  revised data to calculate corrected premium credits and revised
				  premium.
New Mexico Administrative Code › Title 13 - INSURANCE › Chapter 17 - WORKERS' COMPENSATION INSURANCE › Part 6 - PREMIUM ADJUSTMENT PROGRAM › Section 13.17.6.11 - CALCULATION OF AVERAGE HOURLY WAGE AND PREMIUM CREDIT

Current through Register Vol. 35, No. 13, July 16, 2024
The average hourly wage and premium credit shall be
				  calculated in the following manner:
A.
				The average hourly wage for each policy's qualifying classifications shall be
				determined by dividing the total payroll or remuneration for each
				classification by the number of actual hours worked.
B. Total payroll and hours worked during the
				third calendar quarter of the year preceding the policy effective date as
				reported to taxing authorities shall be utilized in determining average hourly
				wage. If the insured did not engage in operations for the complete quarter,
				then the first complete quarter after policy inception shall be used.
C. In the absence of specific employer
				records demonstrating actual hours worked for a given employee, remuneration
				for such an employee shall not be included in the determination of average
				hourly wage, and the premium attributable to such remuneration shall not be
				subject to the premium credit program.
D. The percentage credit to be applied to the
				manual rate shall be determined separately for each classification, and shall
				initially be in accordance with the following Premium Credit Schedule until the
				schedule is amended pursuant to subsection F of this section:
INITIAL PREMIUM CREDIT SCHEDULE
Average Hourly
Wage
Credit From Manual Premium
Average Hourly
Wage
Credit From Manual Premium
$10.99 or less
None
$14.50 - $14.99
13%
$11.00 - $11.49
6%
$15.00 - $15.49
14%
$11.50 - $11.99
7%
$15.50 - $15.99
15%
$12.00 - $12.49
8%
$16.00 - $16.49
16%
$12.50 - $12.99
9%
$16.50 - $16.99
17%
$13.00 - $13.49
10%
$17.00 - $17.49
18%
$13.50 - $13.99
11%
$17.50 - $17.99
19%
$14.00 - $14.49
12%
$18.00 and above
20%
E.
				The credit shall be calculated for each qualifying classification utilizing the
				percentage credit determined in accordance with subsection D of this section.
				The discounted rates shall then be utilized to develop the manual
				premium.
F. By September 1 of each
				year beginning in 1992, the WCSO shall file for approval by the Superintendent
				an amended Premium Credit Schedule to adjust the starting and ending points for
				each of the wage groups in increments of $.10 to reflect any increase or
				decrease in the maximum compensation rate for total disability as established
				pursuant to NMSA 1978 Section
				52-1-41.
				To determine the updated starting point for a wage increment, the previous
				starting point shall be adjusted by a percentage equal to the percentage
				increase in the maximum compensation rate for total disability. The result
				shall be rounded to the nearest $.10. No amendment of this rule shall be
				necessary in order to implement an adjustment made pursuant to this
				section.
New Mexico Administrative Code › Title 13 - INSURANCE › Chapter 17 - WORKERS' COMPENSATION INSURANCE › Part 6 - PREMIUM ADJUSTMENT PROGRAM › Section 13.17.6.12 - PERIODIC UPDATING OR REVISION

Current through Register Vol. 35, No. 13, July 16, 2024
Pursuant to NMSA 1978 Section 59A-17-8 D the rate
				  classification system relied on for workers' compensation shall be updated and
				  revised periodically to reflect changes in the workplace.
New Mexico Administrative Code › Title 13 - INSURANCE › Chapter 17 - WORKERS' COMPENSATION INSURANCE › Part 6 - PREMIUM ADJUSTMENT PROGRAM › Section 13.17.6.13 - REVIEW

Current through Register Vol. 35, No. 13, July 16, 2024
A.
By rate
				service organization or insurer.
Any rating determination made pursuant
				to this rule may be appealed as provided in NMSA 1978 Section
				59A-17-30B.
B.
By
				Superintendent.
Any other determination or decision made pursuant to
				this rule may be reviewed by requesting a hearing pursuant to NMSA 1978 Section
				59A-4-15.
New Mexico Administrative Code › Title 13 - INSURANCE › Chapter 17 - WORKERS' COMPENSATION INSURANCE › Part 6 - PREMIUM ADJUSTMENT PROGRAM › Section 13.17.6.14 - PENALTIES

Current through Register Vol. 35, No. 13, July 16, 2024
The Superintendent may revoke, suspend or refuse to continue
				  the license or certificate of authority of any person who fails to comply with
				  this rule and may impose such other applicable administrative penalties as may
				  be authorized by the Insurance Code.
New Mexico Administrative Code › Title 13 - INSURANCE › Chapter 18 - CREDIT INSURANCE › Part 2 - CREDIT LIFE AND CREDIT HEALTH INSURANCE › Section 13.18.2.2 - SCOPE

Current through Register Vol. 35, No. 13, July 16, 2024
This rule applies to all life insurance and accident and
				  health insurance sold in connection with loans or other credit transactions,
				  except such insurance sold in connection with a loan or other credit
				  transaction of more than ten (10) years' duration, and except for such
				  insurance the issuance of which is an isolated transaction on the part of the
				  insurer not related to an agreement or plan for insuring debtors of the
				  creditor.
New Mexico Administrative Code › Title 13 - INSURANCE › Chapter 18 - CREDIT INSURANCE › Part 2 - CREDIT LIFE AND CREDIT HEALTH INSURANCE › Section 13.18.2.5 - EFFECTIVE DATE

Current through Register Vol. 35, No. 13, July 16, 2024
July 1, 1997, unless a later date is cited at the end of a
				  section or paragraph.
The words or paragraph, above, are no longer applicable.
					 Later dates are now cited only at the end of sections, in the history notes
					 appearing in brackets.
New Mexico Administrative Code › Title 13 - INSURANCE › Chapter 18 - CREDIT INSURANCE › Part 2 - CREDIT LIFE AND CREDIT HEALTH INSURANCE › Section 13.18.2.6 - OBJECTIVE

Current through Register Vol. 35, No. 13, July 16, 2024
The purpose of this rule is to implement the Law for
				  Regulation of Credit Life Insurance and Credit Health Insurance, Sections
				  59A-25-1 to 59A-25-14 NMSA 1978.
New Mexico Administrative Code › Title 13 - INSURANCE › Chapter 18 - CREDIT INSURANCE › Part 2 - CREDIT LIFE AND CREDIT HEALTH INSURANCE › Section 13.18.2.7 - DEFINITIONS

Current through Register Vol. 35, No. 13, July 16, 2024
A.
"Account"
means the aggregate credit life insurance or credit
				accident and health coverage for a single plan of insurance for a single class
				of business written through a single creditor, or written through more than one
				creditor under common control or ownership, by the insurer, whether coverage is
				written on a group or individual basis.
B.
"Average number of life
				years"
means the average of the number of group certificates or
				individual policies in force each month during the experience period (without
				regard to multiple coverage) times the number of years in the experience
				period.
C.
"Case"
means either a single account case or a multiple account case as follows.
(1) Single account case means an account that
				is at least 25 percent credible or, at the option of the insurer, any higher
				percentage as determined by the credibility table. An insurer exercising this
				option must notify the superintendent, in writing, of the credibility factor it
				will use to define a single account case. Once the superintendent is so
				notified, the credibility factor will remain in effect for the insurer until a
				different election has been filed in writing by the insurer and approved by the
				superintendent.
(2) Multiple
				account case means a combination of all the insurer's accounts of the same plan
				of insurance and class of business which combination has experience in this
				state, excluding all single account cases defined in (1) above, or with the
				approval of the superintendent, multiple account case also means two or more
				accounts of the insurer having like underwriting characteristics which are
				combined by the insurer for premium rating purposes, excluding all single
				account cases defined in (1) above and other multiple account cases defined
				above.
New Mexico Administrative Code › Title 13 - INSURANCE › Chapter 18 - CREDIT INSURANCE › Part 2 - CREDIT LIFE AND CREDIT HEALTH INSURANCE › Section 13.18.2.8 - TERMINATION UPON DISCHARGE OF INDEBTEDNESS

Current through Register Vol. 35, No. 13, July 16, 2024
Each individual policy or group certificate of credit life
				  insurance or credit accident and health insurance delivered or issued for
				  delivery in this state shall, in addition to the other requirements of law,
				  contain a statement indicating that upon discharge of the indebtedness the
				  insurance shall be terminated, but without prejudice to any claim originating
				  prior to such termination, and that in all cases of termination prior to
				  scheduled maturity, a refund of any unearned premium paid by or charged to the
				  debtor for insurance shall be made in accordance with the appropriate formula
				  set forth in
				  13.18.2.35 NMAC.
				  Such refund shall be paid or credited to the debtor or paid to the second
				  beneficiary if the debtor is not living. No such refund is required if the
				  total amount of the refund is three dollars ($3.00) or less.
New Mexico Administrative Code › Title 13 - INSURANCE › Chapter 18 - CREDIT INSURANCE › Part 2 - CREDIT LIFE AND CREDIT HEALTH INSURANCE › Section 13.18.2.9 - CONTINUATION OF ACCIDENT AND HEALTH INSURANCE BENEFITS

Current through Register Vol. 35, No. 13, July 16, 2024
If an accident and health insurance claim is in progress at
				  the time of discharge of indebtedness, such claim shall continue during the
				  originally scheduled term of insurance, as if there has been no such discharge
				  of indebtedness.
New Mexico Administrative Code › Title 13 - INSURANCE › Chapter 18 - CREDIT INSURANCE › Part 2 - CREDIT LIFE AND CREDIT HEALTH INSURANCE › Section 13.18.2.10 - REFUND OF PREMIUMS

Current through Register Vol. 35, No. 13, July 16, 2024
A. Upon
				the termination of such continuing claim within the original scheduled term of
				insurance a refund shall be made of any then unearned premium. If, however,
				during the pendency of an accident and health insurance claim the insurer
				elects to prepay and discharge the full remaining balance thereon immediately
				in one payment, the accident and health premium paid or then due and payable to
				the insurer is earned and no refund is required.
B. In the case of termination of credit life
				insurance in which death benefits are not payable due to the exclusions in the
				policy, the insurer will refund the unearned premium in accordance with
				13.18.2.35 NMAC. In the case of termination of credit life insurance by payment
				of death benefits, the life insurance premiums paid or then due and payable to
				the insurer are deemed earned and no refund thereof is required; however, in
				such instances the accident and health premium is not deemed earned and shall
				be refunded to the second beneficiary in accordance with 13.18.2.35
				NMAC.
New Mexico Administrative Code › Title 13 - INSURANCE › Chapter 18 - CREDIT INSURANCE › Part 2 - CREDIT LIFE AND CREDIT HEALTH INSURANCE › Section 13.18.2.11 - PAYMENTS OF BENEFITS TO THE INSURED

Current through Register Vol. 35, No. 13, July 16, 2024
A. Excess benefit checks or drafts made in
				accordance with Section 59A-25-7B NMSA 1978 shall be delivered only by the
				insurer or, at the option of the insurer, by the creditor. In any case, the
				insurer shall be responsible for the delivery of such excess benefit checks or
				drafts. Electronic funds transfers may be used.
B. The creditor agent or group policyholder
				shall not require that any benefit be applied to the reduction of any
				indebtedness other than the indebtedness in connection with which the insurance
				was written.
C. Notice of payments
				under credit life insurance shall be provided to the insureds' estate. The
				insured shall be provided notice of initiation of benefits under a credit
				accident and health insurance policy along with a statement that such benefits
				will continue while the insured is disabled under the terms of the insurance
				policy. The insurer shall be responsible for such notice; however, such duty
				may be delegated to the creditor provided the insurer maintains the
				responsibility for seeing that these notice requirements are met.
D. Benefit checks or drafts payable to a
				beneficiary or an insured may not be offset by any insurer against amounts due
				from a creditor or an agent to the insurer or anyone acting on behalf of the
				insurer unless the benefit check or draft is endorsed by the beneficiary or the
				insured to whom it was made payable.
New Mexico Administrative Code › Title 13 - INSURANCE › Chapter 18 - CREDIT INSURANCE › Part 2 - CREDIT LIFE AND CREDIT HEALTH INSURANCE › Section 13.18.2.12 - POLICY PROVISIONS

Current through Register Vol. 35, No. 13, July 16, 2024
A. The
				policy or certificate shall not contain provisions which would encourage
				misrepresentation or are unjust, unfair, inequitable, misleading, deceptive, or
				contrary to the law of this state.
B. Provisions in individual policies or group
				certificates pertaining to underwriting rules, conditions of eligibility or
				issue, or maximum amounts or terms of insurance may be used only to determine
				initial eligibility and may not, except as provided herein, be used as the
				basis for the termination or reduction of coverage or the denial of
				claims.
C. The policy may state
				that if coverage is issued in excess of a maximum amount or term limitation,
				the insurer has the right, within ninety days of effective date of coverage, to
				reduce the excess coverage and refund the charge for excess insurance, or
				terminate the coverage and refund the full charge for insurance, provided such
				adjustment is accomplished and the appropriate refund is made prior to the
				incurred date of any claim under such coverage.
D. The policy may state that if a debtor
				exceeds the eligibility age defined in Subsection B of 13.18.2.22 NMAC for
				credit life and Subsection D of 13.18.2.27 NMAC for credit accident and health,
				and has not incorrectly stated his or her age in writing, and the coverage is
				issued in error, the insurer has the right, within ninety days of the effective
				date of coverage, to terminate the coverage and refund the full charge for
				insurance, provided such termination is accomplished and the appropriate refund
				is made prior to the incurred dated of any claim under such coverage.
E. Coverage issued in connection with
				open-end transactions may contain provisions limiting the maximum amount of
				insurance which may become effective thereunder, and may contain provisions for
				automatic termination of coverage upon the attainment of a specified age of
				72.
F. Nothing herein is intended
				to preclude an insurer, during the contestable period, from contesting coverage
				on the basis of a material misstatement by a debtor, subject to the requirement
				that the misstatement must be contained in a written statement signed by the
				debtor, and a copy of the statement must be furnished to the debtor or to his
				or her beneficiary.
New Mexico Administrative Code › Title 13 - INSURANCE › Chapter 18 - CREDIT INSURANCE › Part 2 - CREDIT LIFE AND CREDIT HEALTH INSURANCE › Section 13.18.2.13 - INSURANCE FOR PERIODS BEYOND PAYMENT PERIOD OF THE POLICY

Current through Register Vol. 35, No. 13, July 16, 2024
A. If a group
				certificate of insurance is issued to a debtor under any plan charging the
				debtor an identifiable amount for insurance for a period of time greater than
				that of the shortest premium payment period of the group policy issued to the
				creditor, the following rules shall apply.
B. The certificate shall in addition to all
				other requirements of this rule and the laws of this state, clearly and
				prominently set forth that:
(1) the creditor
				alone is liable for such excess charges as are unearned;
(2) the insurance company is not liable for
				such excess unearned charges not received;
(3) the liability of the insurance company
				for the benefit is on a month to month basis, or otherwise as set out in the
				group policy of insurance;
(4) the
				coverage may be terminated by the insurance company or the creditor upon thirty
				days written notice to the debtor;
(5) the insurer is not liable for claims
				beyond such interval; and
(6) the
				certificate shall be so phrased as not to violate the public policy of the
				state of New Mexico not to indicate to the ordinary debtor that the insurance
				coverage had been provided commensurate to the identifiable charge appearing
				upon the certificate for the full term of the indebtedness nor that the insurer
				would be obligated to the debtor for any such excess unearned
				charges.
New Mexico Administrative Code › Title 13 - INSURANCE › Chapter 18 - CREDIT INSURANCE › Part 2 - CREDIT LIFE AND CREDIT HEALTH INSURANCE › Section 13.18.2.14 - GROUP POLICY TERMINATION PROVISIONS

Current through Register Vol. 35, No. 13, July 16, 2024
The following provisions apply to termination of coverage
				  under a group policy.
A. If a debtor
				is covered by a group credit insurance policy providing for the payment of a
				single premium to the insurer, the master policy and certificate shall provide
				that in the event of termination of the group policy for any reason, insurance
				coverage with respect to any debtor then insured under such policy shall be
				continued for the entire period for which the single premium has been paid,
				subject to the provisions of the policy relative to early termination of a
				debtor's insurance.
B. If a debtor
				is covered by a group credit insurance policy providing for payment of premium
				to the insurer on a monthly outstanding balance basis, then the policy and
				certificate shall provide that, in the event of termination of such group
				policy for any reason, the insured debtor shall be given written notice that
				coverage will continue for thirty (30) days from the date of such notice,
				except where replacement of the coverage by the same or another insurer in the
				same or greater amount takes place without interruption of coverage and a new
				certificate reflecting such replacement coverage is delivered to such debtor.
				The notice of termination required by this paragraph shall be given by the
				insurer or, at the option of the insurer, by the creditor.
New Mexico Administrative Code › Title 13 - INSURANCE › Chapter 18 - CREDIT INSURANCE › Part 2 - CREDIT LIFE AND CREDIT HEALTH INSURANCE › Section 13.18.2.15 - INSURED FINANCE CHARGES, ETC

Current through Register Vol. 35, No. 13, July 16, 2024
If the creditor adds identifiable insurance charge or
				  premiums for credit insurance to the indebtedness, and any direct or indirect
				  finance, carrying credit or service charge is made to the debtor on such
				  insurance charge or premiums, the charge to the debtor shall be of the same
				  mode and in an amount not to exceed the insurer's charge.
New Mexico Administrative Code › Title 13 - INSURANCE › Chapter 18 - CREDIT INSURANCE › Part 2 - CREDIT LIFE AND CREDIT HEALTH INSURANCE › Section 13.18.2.16 - OPEN END TRANSACTIONS

Current through Register Vol. 35, No. 13, July 16, 2024
The following rules shall apply to open-end transaction
				  forms.
A. The policy and certificate
				must be identified when used for open-end transactions by either a form number
				followed by the suffix (25-OE) or a check-off block and may be used for
				coverage of any other types of indebtedness if previously approved by the
				superintendent.
B. The premiums
				paid by the creditor and any insurance charges paid by the debtor for such
				insurance must be at the same mode.
C. If the insurer imposes conditions of
				insurability for an increase in coverage, then the policy must state such
				conditions. The conditions must be consistent with 13.18.2.25 NMAC and
				13.18.2.28 NMAC of this rule.
D. If
				the disability benefit for an open-end indebtedness is based upon a minimum
				payment, then the method of determining the minimum payment must be stated in
				the policy.