reglab/statecodes huggingface dataset:
New Mexico Administrative Code › Title 6 - PRIMARY AND SECONDARY EDUCATION › Chapter 50 - INSURANCE › Part 9 - COORDINATION OF BENEFITS REQUIREMENTS - DUPLICATE OR OVERLAPPING BENEFITS COVERAGES › Section 6.50.9.2 - SCOPE

Current through Register Vol. 35, No. 13, July 16, 2024
This part applies to all school districts, charter schools,
				  other educational entities, eligible employees, eligible retired employees,
				  eligible dependents, eligible participating entity governing body members, and
				  persons or entities authorized to participate in the authority's employee
				  benefits or risk-related coverages.
New Mexico Administrative Code › Title 6 - PRIMARY AND SECONDARY EDUCATION › Chapter 50 - INSURANCE › Part 9 - COORDINATION OF BENEFITS REQUIREMENTS - DUPLICATE OR OVERLAPPING BENEFITS COVERAGES › Section 6.50.9.3 - STATUTORY AUTHORITY

Current through Register Vol. 35, No. 13, July 16, 2024
Subsection D of Section
				  22-29-7 NMSA
				  1978, directs the authority to promulgate necessary rules, regulations and
				  procedures for the implementation of the New Mexico Public School Insurance
				  Authority Act, Section
				  22-29-1 et
				  seq. NMSA 1978.
New Mexico Administrative Code › Title 6 - PRIMARY AND SECONDARY EDUCATION › Chapter 50 - INSURANCE › Part 9 - COORDINATION OF BENEFITS REQUIREMENTS - DUPLICATE OR OVERLAPPING BENEFITS COVERAGES › Section 6.50.9.5 - EFFECTIVE DATE

Current through Register Vol. 35, No. 13, July 16, 2024
September 1, 2014 unless a later date is cited at the end of
				  a section.
New Mexico Administrative Code › Title 6 - PRIMARY AND SECONDARY EDUCATION › Chapter 50 - INSURANCE › Part 9 - COORDINATION OF BENEFITS REQUIREMENTS - DUPLICATE OR OVERLAPPING BENEFITS COVERAGES › Section 6.50.9.6 - OBJECTIVE

Current through Register Vol. 35, No. 13, July 16, 2024
The objective of this part is to bring Subsection F of
				  Section
				  22-29-9,
				  NMSA 1978, to the attention of members and provide direction as to what other
				  insurance may be maintained by members and to provide for claims where there is
				  duplicate coverage.
New Mexico Administrative Code › Title 6 - PRIMARY AND SECONDARY EDUCATION › Chapter 50 - INSURANCE › Part 9 - COORDINATION OF BENEFITS REQUIREMENTS - DUPLICATE OR OVERLAPPING BENEFITS COVERAGES › Section 6.50.9.8 - SCHOOL DISTRICT AUTHORITY TO MAINTAIN INSURANCE

Current through Register Vol. 35, No. 13, July 16, 2024
Each school district, charter school and other educational
				  entity participating in the authority offerings shall not separately offer any
				  competing employee-benefits insurance coverage. However, each member
				  participating in the authority offerings may separately obtain any risk-related
				  insurance coverage in addition to the coverage offered by the
				  authority.
New Mexico Administrative Code › Title 6 - PRIMARY AND SECONDARY EDUCATION › Chapter 50 - INSURANCE › Part 9 - COORDINATION OF BENEFITS REQUIREMENTS - DUPLICATE OR OVERLAPPING BENEFITS COVERAGES › Section 6.50.9.9 - AUTHORITY'S LIMITATION OF LIABILITY FOR DUPLICATE OR OVERLAPPING PREMIUMS PAID

Current through Register Vol. 35, No. 13, July 16, 2024
To the extent that the insurance coverage purchased by the
				  member or individual participant duplicates or overlaps insurance coverage
				  provided by the authority, the authority will not reduce or rebate any portion
				  of its premium nor is the authority liable to the participating entity or to
				  any individual participant for any premiums paid by the participating entity or
				  the individual participant for duplicate or overlapping
				  coverage.
New Mexico Administrative Code › Title 6 - PRIMARY AND SECONDARY EDUCATION › Chapter 50 - INSURANCE › Part 9 - COORDINATION OF BENEFITS REQUIREMENTS - DUPLICATE OR OVERLAPPING BENEFITS COVERAGES › Section 6.50.9.10 - RISK RELATED OVERLAPPING INSURANCE COVERAGES

Current through Register Vol. 35, No. 13, July 16, 2024
Where there is other insurance, no matter how acquired or
				  provided to an insured, the authority shall follow the "guiding principles for
				  overlapping insurance coverages " adopted by the association of casualty and
				  surety companies, the inland marine underwriters association, the national
				  automobile underwriters association, the national board of fire underwriters,
				  the national bureau of casualty underwriters and the surety association of
				  America to determine the obligations of the authority with respect to
				  apportionment of losses with other insurers.
New Mexico Administrative Code › Title 6 - PRIMARY AND SECONDARY EDUCATION › Chapter 50 - INSURANCE › Part 9 - COORDINATION OF BENEFITS REQUIREMENTS - DUPLICATE OR OVERLAPPING BENEFITS COVERAGES › Section 6.50.9.11 - EMPLOYEE BENEFITS COVERAGE/COORDINATION OF BENEFITS RULES

Current through Register Vol. 35, No. 13, July 16, 2024
Coordination of benefits ("COB") rules of the authority's
				  medical carrier shall prevail in any situation where a conflict exists with any
				  other authority benefits carrier. In the event of a conflict among authority
				  carriers addressed by COB rules, the COB rules of the carrier of coverages
				  wherein the authority is at risk will prevail. In the event of a conflict
				  between an authority carrier and a non-authority carrier addressed by the COB
				  rules of the authority carrier, the authority carrier COB rules will
				  prevail.
New Mexico Administrative Code › Title 6 - PRIMARY AND SECONDARY EDUCATION › Chapter 50 - INSURANCE › Part 10 - EMPLOYEE BENEFIT COVERAGE ENROLLMENT POLICY › Section 6.50.10.2 - SCOPE

Current through Register Vol. 35, No. 13, July 16, 2024
This part applies to all school districts, charter schools,
				  other educational entities, eligible employees, eligible retired employees,
				  eligible dependents, eligible participating entity governing body members, and
				  persons or entities authorized to participate in the authority's employee
				  benefits coverages.
New Mexico Administrative Code › Title 6 - PRIMARY AND SECONDARY EDUCATION › Chapter 50 - INSURANCE › Part 10 - EMPLOYEE BENEFIT COVERAGE ENROLLMENT POLICY › Section 6.50.10.3 - STATUTORY AUTHORITY

Current through Register Vol. 35, No. 13, July 16, 2024
Subsection D of Section
				  22-29-7 NMSA
				  1978 directs the authority to promulgate necessary rules, regulations and
				  procedures for the implementation of the New Mexico Public School Insurance
				  Authority Act, Section
				  22-29-1 et
				  seq. NMSA 1978.
New Mexico Administrative Code › Title 6 - PRIMARY AND SECONDARY EDUCATION › Chapter 50 - INSURANCE › Part 10 - EMPLOYEE BENEFIT COVERAGE ENROLLMENT POLICY › Section 6.50.10.5 - EFFECTIVE DATE

Current through Register Vol. 35, No. 13, July 16, 2024
September 1, 2014 unless a later date is cited at the end of
				  a section.
New Mexico Administrative Code › Title 6 - PRIMARY AND SECONDARY EDUCATION › Chapter 50 - INSURANCE › Part 10 - EMPLOYEE BENEFIT COVERAGE ENROLLMENT POLICY › Section 6.50.10.6 - OBJECTIVE

Current through Register Vol. 35, No. 13, July 16, 2024
The objective of this part is to establish the enrollment
				  policy for all persons or entities authorized to participate in the authority's
				  employee benefits coverage.
New Mexico Administrative Code › Title 6 - PRIMARY AND SECONDARY EDUCATION › Chapter 50 - INSURANCE › Part 10 - EMPLOYEE BENEFIT COVERAGE ENROLLMENT POLICY › Section 6.50.10.7 - DEFINITIONS

Current through Register Vol. 35, No. 13, July 16, 2024
A.
"Actively
				at work"
means performing the material duties of your own occupation at
				your employer's usual place of business. You will also meet the actively at
				work requirement if you were absent from active work because of a regularly
				scheduled day off, holiday or vacation day or if you were capable of active
				work on the day before the scheduled effective date of your insurance or
				increase in your insurance.
B.
"Employee"
means full time employee as defined in Subsection Y of
				6.50.1.7 NMAC. This definition applies to the rules related to employee
				benefits coverage contained in 6.50.10 NMAC only.
New Mexico Administrative Code › Title 6 - PRIMARY AND SECONDARY EDUCATION › Chapter 50 - INSURANCE › Part 10 - EMPLOYEE BENEFIT COVERAGE ENROLLMENT POLICY › Section 6.50.10.9 - REQUIREMENTS FOR ENROLLMENT OF PART-TIME EMPLOYEES

Current through Register Vol. 35, No. 13, July 16, 2024
A. Part-time employees who work less than 20
				hours a week but 15 hours per week or more are eligible for employee benefits
				if the member has passed a part-time resolution agreeing to provide employee
				benefits to part-time employees. A part-time resolution must be renewed in May
				of each year by the member in order for its part time employees to remain
				eligible for employee benefits.
B.
				Part-time employees who work less than 15 hours per week are not eligible for
				employee benefits.
C. Part-time
				employees eligible for employee benefits may also enroll their
				dependents.
D. The requirements for
				enrollment for full time employees under 6.50.10.8 NMAC also apply to part-
				time employees.
E. Eligibility for
				basic life is 15 hours or more per week.
New Mexico Administrative Code › Title 6 - PRIMARY AND SECONDARY EDUCATION › Chapter 50 - INSURANCE › Part 10 - EMPLOYEE BENEFIT COVERAGE ENROLLMENT POLICY › Section 6.50.10.11 - SPECIAL EVENTS ENROLLMENT

Current through Register Vol. 35, No. 13, July 16, 2024
In cases of "special events" as defined in Subsection GGG of
				  6.50.1.7 NMAC,
				  enrollment shall be allowed.
New Mexico Administrative Code › Title 6 - PRIMARY AND SECONDARY EDUCATION › Chapter 50 - INSURANCE › Part 10 - EMPLOYEE BENEFIT COVERAGE ENROLLMENT POLICY › Section 6.50.10.12 - REPORTING REQUIREMENT

Current through Register Vol. 35, No. 13, July 16, 2024
Authority insurance providers depend on timely reporting of
				  dismissals, resignations, change in status, reports of new employees and
				  eligible dependents and those dropping coverages. The only source of this
				  information is from the participating entity. Participating entities shall
				  report this information on or before the 15th day following notification from
				  the employee of the event. In the event they fail to so timely report, the
				  responsible participating entity shall be liable for any losses an eligible
				  employee or dependent may incur as a result of the failure to timely
				  report.
New Mexico Administrative Code › Title 6 - PRIMARY AND SECONDARY EDUCATION › Chapter 50 - INSURANCE › Part 10 - EMPLOYEE BENEFIT COVERAGE ENROLLMENT POLICY › Section 6.50.10.13 - ENROLLMENT AND ELIGIBILITY CONFLICTS

Current through Register Vol. 35, No. 13, July 16, 2024
A. In the event there is a conflict between a
				carrier's contract with the authority and this part regarding enrollment and
				eligibility, the carrier's contract shall prevail.
B. In the event there is a conflict between a
				carrier's contract with the authority and the policies of a participating
				entity regarding enrollment and eligibility, the carrier's contract shall
				prevail.
C. In the event there is a
				conflict between the policies of a participating entity policy and this part
				regarding enrollment and eligibility, this part shall prevail.
D. All disputes between a participating
				entity and an employee or part time employee in determining eligibility shall
				be resolved at the participating entity level.
E. As to questions of enrollment and
				eligibility, if miscommunication to an employee or part time employee by the
				participating entity has allegedly occurred, the participating entity shall
				provide a written statement to the authority indicating the party or parties
				who allegedly miscommunicated to the employee or part time employee and the
				circumstances in which the alleged miscommunication occurred.
F. As to questions of enrollment and
				eligibility, disputes not resolved between an employee or part time employee,
				the participating entity and the authority or its contractors shall be resolved
				according to the procedures of 6.50.16 NMAC of these rules.
G. As to all other conflicts between the
				authority and carriers, the relevant conflicts provisions of the agreements
				between them shall control with regard to conflict resolutions.
New Mexico Administrative Code › Title 6 - PRIMARY AND SECONDARY EDUCATION › Chapter 50 - INSURANCE › Part 11 - EMPLOYEE BENEFIT SAVINGS PROVISION › Section 6.50.11.2 - SCOPE

Current through Register Vol. 35, No. 13, July 16, 2024
This part applies to all school districts, charter schools,
				  other educational entities, eligible employees, eligible retired employees,
				  eligible dependents, eligible participating entity governing body members, and
				  persons or entities authorized to participate in the authority's employee
				  benefits coverages.
New Mexico Administrative Code › Title 6 - PRIMARY AND SECONDARY EDUCATION › Chapter 50 - INSURANCE › Part 11 - EMPLOYEE BENEFIT SAVINGS PROVISION › Section 6.50.11.3 - STATUTORY AUTHORITY

Current through Register Vol. 35, No. 13, July 16, 2024
Subsection D of Section
				  22-29-7, NMSA
				  1978, directs the authority to promulgate necessary rules, regulations and
				  procedures for the implementation of the New Mexico Public School Insurance
				  Authority Act, Section
				  22-29-1 et
				  seq. NMSA 1978.
New Mexico Administrative Code › Title 6 - PRIMARY AND SECONDARY EDUCATION › Chapter 50 - INSURANCE › Part 11 - EMPLOYEE BENEFIT SAVINGS PROVISION › Section 6.50.11.6 - OBJECTIVE

Current through Register Vol. 35, No. 13, July 16, 2024
The objective of this part is to protect those persons that
				  have obtained employee benefits coverage from the authority in the past and may
				  no longer be entitled to coverage under other provisions of this
				  chapter.
New Mexico Administrative Code › Title 6 - PRIMARY AND SECONDARY EDUCATION › Chapter 50 - INSURANCE › Part 11 - EMPLOYEE BENEFIT SAVINGS PROVISION › Section 6.50.11.8 - SAVINGS PROVISION (GRANDFATHER CLAUSE)

Current through Register Vol. 35, No. 13, July 16, 2024
To the extent the adoption of Title 6, Chapter 50 purports to
				  withdraw employee benefits coverage from any individual, group or class of
				  persons currently receiving coverage from the authority, the authority intends
				  by this savings clause (grandfather clause) to allow the authority to continue
				  to provide such coverage to the individual, group or class of persons until the
				  coverage lapses or is dropped.
New Mexico Administrative Code › Title 6 - PRIMARY AND SECONDARY EDUCATION › Chapter 50 - INSURANCE › Part 12 - LOSS PREVENTION MANAGEMENT SYSTEM › Section 6.50.12.2 - SCOPE

Current through Register Vol. 35, No. 13, July 16, 2024
This part applies to all school districts, charter schools,
				  other educational entities and persons or entities authorized to participate in
				  the authority's coverage on matters involving risk-related
				  coverages.
New Mexico Administrative Code › Title 6 - PRIMARY AND SECONDARY EDUCATION › Chapter 50 - INSURANCE › Part 12 - LOSS PREVENTION MANAGEMENT SYSTEM › Section 6.50.12.3 - STATUTORY AUTHORITY

Current through Register Vol. 35, No. 13, July 16, 2024
Subsection D of Section
				  22-29-7 NMSA
				  1978, directs the authority to promulgate necessary rules, regulations and
				  procedures for the implementation of the New Mexico Public School Insurance
				  Authority Act, Section
				  22-29-1 et
				  seq. NMSA 1978.
New Mexico Administrative Code › Title 6 - PRIMARY AND SECONDARY EDUCATION › Chapter 50 - INSURANCE › Part 12 - LOSS PREVENTION MANAGEMENT SYSTEM › Section 6.50.12.6 - OBJECTIVE

Current through Register Vol. 35, No. 13, July 16, 2024
The objective of this part is to establish a loss control and
				  a loss prevention management system for the purpose of reducing claims and
				  costs.
New Mexico Administrative Code › Title 6 - PRIMARY AND SECONDARY EDUCATION › Chapter 50 - INSURANCE › Part 12 - LOSS PREVENTION MANAGEMENT SYSTEM › Section 6.50.12.8 - LOSS PREVENTION PROGRAM

Current through Register Vol. 35, No. 13, July 16, 2024
A.
				The loss prevention program is hereby created to provide a mechanism for the
				identification and abatement of hazards relating to all lines of coverage
				provided by the authority.
B. The
				loss prevention program is a service provided to the member school districts,
				charter schools and other educational entities in order to protect the
				insurance fund and its members from claims that could otherwise be prevented.
				The authority, through the program, provides recommendations for compliance to
				the members. It is the responsibility of the members to implement the
				recommendations for abatement.
C.
				All visits or inspections shall be performed by the loss prevention
				representative (LPR).
D. The LPR
				shall conduct evaluations of members. These evaluations shall include, but are
				not limited to:
(1) physical inspection of
				any or all of the members' structures, facilities, vehicles or
				equipment;
(2) review of the
				members' policies and procedures;
(3) observation of the members' scholastic
				and non-scholastic activities and operations; and
(4) interviews with members' administration,
				teachers, maintenance and other support personnel.
New Mexico Administrative Code › Title 6 - PRIMARY AND SECONDARY EDUCATION › Chapter 50 - INSURANCE › Part 12 - LOSS PREVENTION MANAGEMENT SYSTEM › Section 6.50.12.9 - LOSS PREVENTION REVIEW BOARD

Current through Register Vol. 35, No. 13, July 16, 2024
A. The LPRB is hereby created to provide a
				mechanism for the review of loss prevention activities within the authority's
				jurisdiction. The LPRB is appointed by the board and, except as provided in
				Subsection B of this section, its membership shall be made up of the risk
				advisory committee.
B. In the event
				an LPRB is appointed in place of the risk advisory committee, it shall consist
				of five members, four of whom are appointed by the president of the authority
				board with the board's advice and consent. The risk advisory committee chairman
				shall be the fifth member of the LPRB and shall serve as the LPRB
				chairman.
C. The LPRB shall meet as
				required and as scheduled from time to time.
D. Special meetings may be called by the LPRB
				chairman, if he determines the need for a special meeting is justified, upon
				the request of any LPRB or authority board member, any chief executive officer
				of any member, or the LPR.
E.
				Notice of special meetings of the LPRB shall be sent to all LPRB members, the
				individual requesting the special meeting, and the LPR.
F. The notice required in Subsection E above
				shall indicate the date, time and place of the special meeting. It shall also
				clearly set forth the purpose for which the meeting is being called, said
				purpose being the only matter the LPRB may consider and act upon at the special
				meeting.
New Mexico Administrative Code › Title 6 - PRIMARY AND SECONDARY EDUCATION › Chapter 50 - INSURANCE › Part 12 - LOSS PREVENTION MANAGEMENT SYSTEM › Section 6.50.12.10 - LOSS PREVENTION REVIEW BOARD DUTIES

Current through Register Vol. 35, No. 13, July 16, 2024
A. The LPRB shall consider and act upon:
(1) requests by the LPR that a member be
				required to implement a specific recommendation;
(2) requests by a member that a
				recommendation by the LPR be vacated;
(3) any other matter with regard to the
				enforcement of the authority's loss prevention management system not
				specifically covered in this part.
New Mexico Administrative Code › Title 6 - PRIMARY AND SECONDARY EDUCATION › Chapter 50 - INSURANCE › Part 12 - LOSS PREVENTION MANAGEMENT SYSTEM › Section 6.50.12.11 - LOSS PREVENTION REVIEW BOARD PROCEEDINGS

Current through Register Vol. 35, No. 13, July 16, 2024
When considering a request as specified above, the LPRB
				  chairman shall:
A. provide
				notification to all LPRB members, the LPR, and the affected member;
B. conduct the meeting allowing the LPR and
				the member representative the opportunity to present arguments and
				justifications for their respective requests, and permit members of the LPRB to
				ask questions of either party;
C.
				issue the decision of the LPRB within five days and:
(1) if the decision of the LPRB is in
				agreement with the member, the LPR's recommendation shall be vacated;
(2) if the decision of the LPRB is in
				agreement with the LPR, the recommendation shall be affirmed and the member
				directed to implement the recommendation;
(3) if the affirmed recommendation is not
				implemented as specified by the member, the LPR shall refer the matter to the
				authority board for action.
New Mexico Administrative Code › Title 6 - PRIMARY AND SECONDARY EDUCATION › Chapter 50 - INSURANCE › Part 12 - LOSS PREVENTION MANAGEMENT SYSTEM › Section 6.50.12.12 - ENFORCEMENT

Current through Register Vol. 35, No. 13, July 16, 2024
The responsibility for enforcement of LPRB decisions shall be
				  vested in the authority board which may act as it sees fit to protect the
				  integrity of the authority. These actions may include, but are not limited to
				  issuing a notice of no coverage to the participating member. This notice shall
				  state the specific circumstances for which coverage shall not be in effect, the
				  reason for issuing the notice that no coverage is in effect and the date and
				  time of inception of the no coverage notice. The notice of no coverage shall
				  not affect any other area of coverage for the member. It shall only affect
				  those specific circumstances stated in the notice of no coverage. Upon
				  verification by the LPR to the authority board in writing that a hazard giving
				  rise to a notice of no coverage has been abated, the authority board shall
				  cancel the notice of no coverage.
New Mexico Administrative Code › Title 6 - PRIMARY AND SECONDARY EDUCATION › Chapter 50 - INSURANCE › Part 12 - LOSS PREVENTION MANAGEMENT SYSTEM › Section 6.50.12.13 - PROCEDURE FOR APPEAL OF AGENCY DECISIONS UNDER THIS PART

Current through Register Vol. 35, No. 13, July 16, 2024
An aggrieved member may appeal any final determination of the
				  authority under this part by following the procedures specified in 6.50.16
				  NMAC, Administrative Appeal of Authority Coverage Determinations. Review of any
				  final decision or order of the authority under this part can only be sought as
				  provided by 6.50.16 NMAC, by statute or by rules promulgated by the supreme
				  court for appeal of state agency decisions.
New Mexico Administrative Code › Title 6 - PRIMARY AND SECONDARY EDUCATION › Chapter 50 - INSURANCE › Part 13 - CLAIMS SETTLEMENT POLICY › Section 6.50.13.2 - SCOPE

Current through Register Vol. 35, No. 13, July 16, 2024
This part applies to all school districts, charter schools,
				  other educational entities and persons or entities authorized to participate in
				  the authority's risk-related coverages.
New Mexico Administrative Code › Title 6 - PRIMARY AND SECONDARY EDUCATION › Chapter 50 - INSURANCE › Part 13 - CLAIMS SETTLEMENT POLICY › Section 6.50.13.3 - STATUTORY AUTHORITY

Current through Register Vol. 35, No. 13, July 16, 2024
Subsection D of Section
				  22-29-7 NMSA
				  1978, directs the authority to promulgate necessary rules, regulations and
				  procedures for the implementation of the New Mexico Public School Insurance
				  Authority Act, Section
				  22-29-1 et
				  seq. NMSA 1978.
New Mexico Administrative Code › Title 6 - PRIMARY AND SECONDARY EDUCATION › Chapter 50 - INSURANCE › Part 13 - CLAIMS SETTLEMENT POLICY › Section 6.50.13.8 - SETTLEMENT POLICIES

Current through Register Vol. 35, No. 13, July 16, 2024
The authority retains the right at its sole discretion to
				  decide the terms and conditions of settlement of any claim against any
				  authority insured. The authority will not settle a claim against an authority
				  insured for an amount in excess of $25,000 without first notifying the insured
				  of the proposed settlement and the rationale supporting the proposed
				  settlement. After the authority has notified an insured of a proposed
				  settlement, the authority retains the power to proceed to settle the claim as
				  the authority deems in the best interest of the authority. Should the insured
				  object to the proposed settlement by the authority, the insured shall (if the
				  proposed settlement is a payment of money damages) be offered a payment in an
				  amount equal to the money damages proposed to be paid by the authority under
				  the settlement. The offer to the insured shall be made on condition that the
				  insured release the authority from any further liability on the claim. If the
				  insured accepts the offer, the authority will not consummate the proposed
				  settlement with the claimant. The insured shall then be responsible for defense
				  and settlement or payment of any judgment with regard to the claim and the
				  authority on payment of the settlement amount to the insured shall be released
				  by the insured from all further responsibility for the claim.
New Mexico Administrative Code › Title 6 - PRIMARY AND SECONDARY EDUCATION › Chapter 50 - INSURANCE › Part 14 - PARTICIPATING ENTITY WORKERS' COMPENSATION POLICY STATEMENT › Section 6.50.14.2 - SCOPE

Current through Register Vol. 35, No. 13, July 16, 2024
This part applies to all school districts, charter schools
				  and other educational entities authorized to participate in the authority's
				  workers' compensation program.
New Mexico Administrative Code › Title 6 - PRIMARY AND SECONDARY EDUCATION › Chapter 50 - INSURANCE › Part 14 - PARTICIPATING ENTITY WORKERS' COMPENSATION POLICY STATEMENT › Section 6.50.14.3 - STATUTORY AUTHORITY

Current through Register Vol. 35, No. 13, July 16, 2024
Subsection D of Section
				  22-29-7 NMSA
				  1978, directs the authority to promulgate necessary rules, regulations and
				  procedures for the implementation of the New Mexico Public School Insurance
				  Authority Act, Section
				  22-29-1 et
				  seq. NMSA 1978.
New Mexico Administrative Code › Title 6 - PRIMARY AND SECONDARY EDUCATION › Chapter 50 - INSURANCE › Part 14 - PARTICIPATING ENTITY WORKERS' COMPENSATION POLICY STATEMENT › Section 6.50.14.5 - EFFECTIVE DATE

Current through Register Vol. 35, No. 13, July 16, 2024
September 14, 2014 unless a later date is cited at the end of
				  a section.
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 6 - PRIMARY AND SECONDARY EDUCATION › Chapter 50 - INSURANCE › Part 14 - PARTICIPATING ENTITY WORKERS' COMPENSATION POLICY STATEMENT › Section 6.50.14.6 - OBJECTIVE

Current through Register Vol. 35, No. 13, July 16, 2024
The objective of this part is to direct school districts,
				  charter schools and other educational entities to adopt a policy in order to
				  establish the particular entity's procedure for the selection of health care
				  providers, for use of sick leave and for payment of insurance premiums when a
				  worker has filed a workers' compensation claim.
New Mexico Administrative Code › Title 6 - PRIMARY AND SECONDARY EDUCATION › Chapter 50 - INSURANCE › Part 14 - PARTICIPATING ENTITY WORKERS' COMPENSATION POLICY STATEMENT › Section 6.50.14.8 - WORKERS' COMPENSATION CLAIM POLICY

Current through Register Vol. 35, No. 13, July 16, 2024
All school districts, charter schools, other educational
				  entities and any other entities participating in the authority's workers'
				  compensation coverages shall adopt a workers' compensation claim policy for its
				  employees substantially in the form as set forth in Subsections A through I of
				  6.50.14.9
				  NMAC, selecting one of two options available for the selection of health care
				  providers, for use of sick leave and for payment of insurance premiums while an
				  employee is disabled from work. The form policy is also downloadable from the
				  authority's website at:
https://nmpsia.com
and will be updated from
				  time to time.
New Mexico Administrative Code › Title 6 - PRIMARY AND SECONDARY EDUCATION › Chapter 50 - INSURANCE › Part 14 - PARTICIPATING ENTITY WORKERS' COMPENSATION POLICY STATEMENT › Section 6.50.14.9 - WORKERS' COMPENSATION FORM POLICY FOR SCHOOL DISTRICTS, CHARTER SCHOOLS, OTHER EDUCATIONAL ENTITIES AND OTHER ENTITIES PARTICIPATING IN AUTHORITY WORKERS' COMPENSATION INSURANCE PROGRAM

Current through Register Vol. 35, No. 13, July 16, 2024
All entities participating in the authority workers'
				  compensation coverage shall adopt a policy substantially in the following form,
				  selecting one of two options available for the selection of health care
				  providers, for use of sick leave and for payment of insurance premiums while an
				  employee is disabled from work.
A.
Workers' compensation eligibility.
In accordance with applicable
				workers' compensation statutes, all employees of (insert name of participating
				entity) who have a work-related injury are eligible for coverage.
B.
Reporting accidents.
An
				injured worker must report all work-related accidents or injuries immediately
				to his immediate supervisor by completing and submitting the notice of accident
				form, whether or not medical care is needed. The worker's supervisor must then
				complete the supervisor's accident investigation report form. Both documents
				must be submitted to the employer's designated workers' compensation
				administrator within 24 hours from the time the supervisor is informed of the
				accident. The workers' compensation administrator then must complete the
				employer's first report of accident form and forward all three forms to the
				third party administrator within 72 hours from the employer's first knowledge
				of the accident. The forms are available to download on the authority's website
				at: https://nmpsia.com.
C.
Emergency medical treatment.
When an injury or illness is life
				threatening in nature, the injured worker shall seek emergency treatment at the
				nearest emergency facility or by calling 911. After the emergency has abated,
				the injured worker will notify the employer in writing of the work related
				injury and present any disability or return to work notices.
D.
Selection of health care provider
				policy options.
(1) Each employer shall
				determine as a matter of policy whether it elects to initially select the heath
				care provider or whether the injured worker is permitted to make the initial
				selection. Each employer shall also provide at the time of hiring or during
				employee orientation the following information in writing:
(a) Option 1 for selection of health care
				provider: (name of participating entity) elects to have injured workers treated
				at (insert name and location of facility); or
(b) Option 2 for selection of health care
				provider: (name of participating entity) permits the injured worker to
				initially select the health care provided as provided by Subsection B of
				Section
				52-1-49
				NMSA 1978.
New Mexico Administrative Code › Title 6 - PRIMARY AND SECONDARY EDUCATION › Chapter 50 - INSURANCE › Part 14 - PARTICIPATING ENTITY WORKERS' COMPENSATION POLICY STATEMENT › Section 6.50.14.10 - CONFLICT WITH STATUTE

Current through Register Vol. 35, No. 13, July 16, 2024
In the event of a conflict between this part and the Workers'
				  Compensation Act, Sections
				  52-1-1 et
				  seq. NMSA 1978, the provisions of the act shall prevail.
New Mexico Administrative Code › Title 6 - PRIMARY AND SECONDARY EDUCATION › Chapter 50 - INSURANCE › Part 14 - PARTICIPATING ENTITY WORKERS' COMPENSATION POLICY STATEMENT › Section 6.50.14.11 - CLAIMS DETERMINATION

Current through Register Vol. 35, No. 13, July 16, 2024
No school district, charter school or educational entity has
				  the authority to accept or acknowledge liability for any workers' compensation
				  claim. There is no liability for a workers' compensation claim until liability
				  is acknowledged in writing by an authorized employee of the authority's third
				  party administrator.
New Mexico Administrative Code › Title 6 - PRIMARY AND SECONDARY EDUCATION › Chapter 50 - INSURANCE › Part 14 - PARTICIPATING ENTITY WORKERS' COMPENSATION POLICY STATEMENT › Section 6.50.14.12 - WORKERS' COMPENSATION IS THE EXCLUSIVE REMEDY

Current through Register Vol. 35, No. 13, July 16, 2024
In any case where an insured under the authority's workers'
				  compensation program is eligible to receive workers' compensation benefits for
				  an injury, the exclusive remedy for such injury is workers' compensation
				  benefits. Such injured insured shall have no claim for additional benefits
				  under either the authority benefits or risk programs, including but not limited
				  to underinsured, uninsured and unknown motorist coverages. Provided, however,
				  this does not prohibit an insured from claiming benefits (in addition to
				  workers' compensation) if provided under a short or long-term disability
				  policy, life insurance policy or medical benefits policy (so long as an insured
				  is limited to one recovery for medical expenses).
New Mexico Administrative Code › Title 6 - PRIMARY AND SECONDARY EDUCATION › Chapter 50 - INSURANCE › Part 15 - INSURANCE FRAUD › Section 6.50.15.2 - SCOPE

Current through Register Vol. 35, No. 13, July 16, 2024
This part applies to all school districts, charter schools,
				  other educational entities, eligible employees, eligible retired employees,
				  eligible dependents, eligible participating entity governing body members and
				  persons or entities authorized to participate in the authority's employee
				  benefits, risk-related and due process reimbursement
				  coverages.
New Mexico Administrative Code › Title 6 - PRIMARY AND SECONDARY EDUCATION › Chapter 50 - INSURANCE › Part 15 - INSURANCE FRAUD › Section 6.50.15.3 - STATUTORY AUTHORITY

Current through Register Vol. 35, No. 13, July 16, 2024
Subsection D of Section
				  22-29-7 NMSA
				  1978, directs the authority to promulgate necessary rules, regulations and
				  procedures for the implementation of the New Mexico Public School Insurance
				  Authority Act, Section
				  22-29-1 et
				  seq. NMSA 1978.
New Mexico Administrative Code › Title 6 - PRIMARY AND SECONDARY EDUCATION › Chapter 50 - INSURANCE › Part 15 - INSURANCE FRAUD › Section 6.50.15.6 - OBJECTIVE

Current through Register Vol. 35, No. 13, July 16, 2024
The objective of this part is to establish appropriate
				  penalties for insurance fraud in order to deter fraudulent conduct and thus
				  minimize unnecessary expense to the authority and its participating
				  members.
New Mexico Administrative Code › Title 6 - PRIMARY AND SECONDARY EDUCATION › Chapter 50 - INSURANCE › Part 15 - INSURANCE FRAUD › Section 6.50.15.8 - INSURANCE FRAUD

Current through Register Vol. 35, No. 13, July 16, 2024
A.
Forfeiture of rights to coverage and benefits.
Anyone who knowingly or
				willfully:
(1) makes any false or fraudulent
				statement or representation as to any material fact in or with reference to any
				application for insurance or other coverage; or
(2) for the purpose of obtaining any money or
				benefit, presents or causes to be presented a false or fraudulent claim, or any
				proof in support of such a claim for payment of loss under a policy;
				or
(3) prepares, makes or
				subscribes to a false or fraudulent account, certificate, affidavit or proof of
				loss, or other document, with intent that the same may be presented or used in
				support of such a claim; or
(4)
				makes any false or fraudulent statements or representations on or relative to
				any application for a policy, for the purpose of obtaining any benefit.
shall forfeit all employee and dependent rights to coverage
				  or benefits.
New Mexico Administrative Code › Title 6 - PRIMARY AND SECONDARY EDUCATION › Chapter 50 - INSURANCE › Part 16 - ADMINISTRATIVE APPEAL OF AUTHORITY COVERAGE DETERMINATIONS › Section 6.50.16.2 - SCOPE

Current through Register Vol. 35, No. 13, July 16, 2024
This part applies to all appeals of authority coverage
				  determinations by school districts, charter schools, other educational
				  entities, eligible employees, eligible retired employees, eligible dependents,
				  eligible participating entity governing body members and persons or entities
				  authorized to participate in the authority's programs.
New Mexico Administrative Code › Title 6 - PRIMARY AND SECONDARY EDUCATION › Chapter 50 - INSURANCE › Part 16 - ADMINISTRATIVE APPEAL OF AUTHORITY COVERAGE DETERMINATIONS › Section 6.50.16.3 - STATUTORY AUTHORITY

Current through Register Vol. 35, No. 13, July 16, 2024
Subsection D of Section
				  22-29-7 NMSA
				  1978, directs the authority to promulgate necessary rules, regulations and
				  procedures for the implementation of the New Mexico Public School Insurance
				  Authority Act, Section
				  22-29-1 et
				  seq. NMSA 1978.
New Mexico Administrative Code › Title 6 - PRIMARY AND SECONDARY EDUCATION › Chapter 50 - INSURANCE › Part 16 - ADMINISTRATIVE APPEAL OF AUTHORITY COVERAGE DETERMINATIONS › Section 6.50.16.5 - EFFECTIVE DATE

Current through Register Vol. 35, No. 13, July 16, 2024
September 1, 2014 unless a later date is cited at the end of
				  a section.
New Mexico Administrative Code › Title 6 - PRIMARY AND SECONDARY EDUCATION › Chapter 50 - INSURANCE › Part 16 - ADMINISTRATIVE APPEAL OF AUTHORITY COVERAGE DETERMINATIONS › Section 6.50.16.6 - OBJECTIVE

Current through Register Vol. 35, No. 13, July 16, 2024
The objective of this rule is to clarify the relationship
				  between the authority and its members and to establish a fair and uniform
				  procedure for school districts, charter schools, other educational entities,
				  eligible employees, eligible retired employees, eligible dependents, eligible
				  participating entity governing body members and persons or entities authorized
				  to participate in the authority's programs to appeal authority coverage
				  determinations.
New Mexico Administrative Code › Title 6 - PRIMARY AND SECONDARY EDUCATION › Chapter 50 - INSURANCE › Part 16 - ADMINISTRATIVE APPEAL OF AUTHORITY COVERAGE DETERMINATIONS › Section 6.50.16.8 - RELATIONSHIP BETWEEN THE AUTHORITY, ITS MEMBERS AND COVERED EMPLOYEES

Current through Register Vol. 35, No. 13, July 16, 2024
These findings and policy considerations guide the authority
				  in adopting the following regulations and providing a procedure for
				  administrative appeal of authority coverage determinations:
A. The authority is an agency of the state of
				New Mexico and is endowed only with those powers and duties stated in the New
				Mexico Public School Insurance Authority Act, Section
				22-29-1 et
				seq. NMSA 1978 ("act"). The relationship between the authority and its members
				or employees, and any coverage provided by the authority to them, is defined
				and constrained by the act and by authority rules, regulations and procedures
				lawfully promulgated under the act.
B. The members of the authority participate
				pursuant to Section
				22-29-9,
				NMSA 1978 of the act, which provides that school districts and charter schools
				shall participate in the authority unless they are granted a waiver of
				participation pursuant to the procedures provided in that section of the act.
				Section
				22-2-9
				NMSA 1978 also provides that other educational entities may participate in the
				authority.
C. The act does not
				empower the authority to contract with its members or employees. There is no
				relationship between the authority and its members or employees based upon or
				arising out of any contract between the authority and its members or
				employees.
D. The insurance
				protection provided by the authority to its members is provided either by
				insurance policies contracted through private insurers or through the statutory
				self-insurance program administered by the authority.
E. For the benefit of the authority and its
				members and their employees, the following regulations provide a formal
				procedure for members and employees to appeal authority coverage
				determinations. Therefore, the following procedures for appeal from any
				coverage determination or ruling of the authority are provided as the exclusive
				remedy for any person or entity challenging a coverage determination of the
				authority.
New Mexico Administrative Code › Title 6 - PRIMARY AND SECONDARY EDUCATION › Chapter 50 - INSURANCE › Part 16 - ADMINISTRATIVE APPEAL OF AUTHORITY COVERAGE DETERMINATIONS › Section 6.50.16.9 - PROCEDURE FOR APPEAL OF A FINAL COVERAGE DETERMINATION OF THE AUTHORITY

Current through Register Vol. 35, No. 13, July 16, 2024
An aggrieved member or employee may appeal any final coverage
				  determination of the authority by following the procedures specified herein.
				  Review of any final decision or order of the authority can only be sought as
				  provided by statute or by rules promulgated by the supreme court for appeal of
				  state agency decisions.
New Mexico Administrative Code › Title 6 - PRIMARY AND SECONDARY EDUCATION › Chapter 50 - INSURANCE › Part 16 - ADMINISTRATIVE APPEAL OF AUTHORITY COVERAGE DETERMINATIONS › Section 6.50.16.10 - PETITION FOR REVIEW

Current through Register Vol. 35, No. 13, July 16, 2024
Every appeal of a coverage determination of the authority
				  shall be initiated by mailing a petition for review, within 30 days of the
				  mailing date of the determination, to the executive director of the New Mexico
				  Public School Insurance authority by certified mail.
A. A petition for review must specify and
				include:
(1) the name of the employee or
				member appealing, and, for institutional parties, the name, position, address
				and phone number of a person who will be responsible for receiving
				communications from the authority;
(2) a full description of the coverage
				determination being appealed, including the date of the determination and,
				specifically, the substance of the determination that is being
				appealed;
(3) a short, concise
				statement of the grounds for the appeal;
(4) if the authority determination is in a
				writing, a copy of the writing must be attached to the notice;
(5) copies of all documents, photographs or
				other tangible evidence that appellant contends provides support for
				appellant's position; and
(6) a
				memorandum stating the complete argument for overturning the determination of
				the authority, including a statement of relevant facts, an outline of
				controlling law, and the appellant's argument.
New Mexico Administrative Code › Title 6 - PRIMARY AND SECONDARY EDUCATION › Chapter 50 - INSURANCE › Part 16 - ADMINISTRATIVE APPEAL OF AUTHORITY COVERAGE DETERMINATIONS › Section 6.50.16.11 - FINAL DECISION OF THE AUTHORITY BASED ON PETITION FOR REVIEW

Current through Register Vol. 35, No. 13, July 16, 2024
A. Within 30 days
				following receipt of the completed petition for review, including all
				supporting documents, the board shall either:
(1) issue a final decision vacating or
				modifying the coverage determination of the authority consistent with
				appellant's argument; or
(2) issue
				a notice of hearing setting, such hearing to be held no less than 30 days and
				no more than 45 days after the date the notice of setting is mailed to
				appellant.
New Mexico Administrative Code › Title 6 - PRIMARY AND SECONDARY EDUCATION › Chapter 50 - INSURANCE › Part 16 - ADMINISTRATIVE APPEAL OF AUTHORITY COVERAGE DETERMINATIONS › Section 6.50.16.12 - SETTLEMENT OF APPEAL

Current through Register Vol. 35, No. 13, July 16, 2024
The appellant and the authority may, at any time, either
				  prior to or during a proceeding under this rule, informally settle a dispute by
				  the consent of the parties.
New Mexico Administrative Code › Title 6 - PRIMARY AND SECONDARY EDUCATION › Chapter 50 - INSURANCE › Part 16 - ADMINISTRATIVE APPEAL OF AUTHORITY COVERAGE DETERMINATIONS › Section 6.50.16.13 - PRE-HEARING PROCEDURE

Current through Register Vol. 35, No. 13, July 16, 2024
A. Hearing
				officer. The board shall appoint a hearing officer for an appeal within 7 days
				after mailing the notice of setting. The board shall provide appropriate
				clerical support and space for any hearings conducted. Venue for any hearings
				shall be Santa Fe county unless the hearing officer in view of convenience to
				parties and witnesses orders that another location is more appropriate. The
				hearing officer shall oversee all proceedings after the hearing is set. The
				hearing officer will also provide written findings of fact and a disposition
				recommendation to the board within 14 days after completion of a hearing. The
				board shall make a final decision, after review of the recommendations of the
				hearing officer, and mail a notice of final decision to appellant within 30
				days of receipt of the hearing officer's recommendations.
B. Representation of parties:
(1) The authority shall be represented in
				proceedings under this rule by its general counsel or a staff member of the
				authority appointed by the executive director for this purpose.
(2) The appellant may appear pro se, if
				appellant is an individual, or by an administrator of an institutional
				appellant who has been appointed for that purpose by the governing body of the
				institution. Any appellant may be represented by legal counsel licensed to
				practice law in the state of New Mexico.