New Mexico Administrative Code › Title 11 - LABOR AND WORKERS' COMPENSATION › Chapter 4 - WORKERS' COMPENSATION › Part 1 - GENERAL PROVISIONS › Section 11.4.1.7 - DEFINITIONS

Current through Register Vol. 35, No. 13, July 16, 2024
The definitions adopted below shall apply to all WCA rules
				  unless expressly indicated otherwise in a specific part of these rules.
A.
"Act"
means collectively: the
				Workers' Compensation Act, the Workers' Compensation Administration Act, and
				the Occupational Disease Disablement Law, Sections
				52-4-1 to
				52-4-5 NMSA 1978. This definition
				includes prior law applicable to the particular facts of the claim.
B.
"Administration"
means the
				workers' compensation administration (WCA).
C.
"Bad faith"
means conduct in
				the handling of a claim by any person that amounts to fraud, malice, oppression
				or willful, wanton or reckless disregard of the rights of any party.
D.
"Cause"
means any and all
				proceedings before the WCA pertaining to the same disease or accidental injury
				and assigned the same file number by the clerk of the administrative
				court.
E.
"Claim"
means any allegation of entitlement to benefits or relief under the act, which
				has been communicated to the employer by the giving of notice as required by
				the act.
F.
"Clerk"
(also referred to as clerk of the administrative court or clerk of the WCA)
				means any individual assigned by the director to oversee the filing of claims
				and records with the WCA.
G.
"Complaint"
means a written request for workers' compensation
				benefits or any relief under the Act, filed on a mandatory form with the clerk
				of the WCA by a worker, employer, insurance carrier or the uninsured employers'
				fund.
H.
"Director"
means the director of the WCA.
I.
"Employer"
means, collectively, unless otherwise stated: an
				employer subject to the act; a self-insured entity, group or pool; a workers'
				compensation insurance carrier or its representative; or any authorized agent
				of an employer or insurance carrier, including any individual owner, chief
				executive officer or proprietor of any entity employing workers.
J.
"Health care provider"
(also
				referred to in the rules as "HCP") means any person, entity or facility
				authorized to furnish health care to an injured worker pursuant to Section
				52-4-1 NMSA 1978, including any
				provider designated pursuant to Sections
				52-1-49 or -51 NMSA 1978 and may
				include a provider licensed in another state if approved by the director, as
				required by the act.
K.
"IME"
, or independent medical examination, means a medical
				examination of a worker, by a provider other than a previously designated
				health care provider, upon whom the parties have agreed or the judge has
				appointed according to the act.
L.
"Judge"
means a workers' compensation judge appointed by the
				director pursuant to Section
				52-5-2 NMSA 1978.
M.
"Mediation conference"
means
				a mandatory conference at which all parties named in the complaint shall appear
				and present their positions to the mediator.
N.
"Mediator"
means a director's
				designee, who will evaluate and attempt to resolve a complaint by holding a
				mediation conference and issuing a recommendation for resolution of the
				complaint.
O.
"Medical
				records"
means:
(1) all records,
				reports, letters, and bills produced or prepared by a HCP relating to the care
				and treatment rendered the worker;
(2) all other documents generally kept by the
				HCP in the normal course of business relating to the worker, including, but not
				limited to, clinical, nurses' and intake notes, notes evidencing the patient's
				history of injury, subjective and objective complaints, diagnosis, prognosis
				and/or restrictions, reports of diagnostic testing, hospital records, logs and
				bills, physical therapy records and bills for services
				rendered.