N.M. Admin. Code § 1.6.4.14 - JOB-RELATED INJURY OR ILLNESS CLAIMS MANAGEMENT

A. The high incidence of this type loss in terms of productivity, quality of work, training, hiring, administrative costs and benefits attributed to job-related injury or illness claims warrants special mention and demands close managerial control.

B. Each agency head shall establish a workers' compensation claims management policy and implementing programs that comply with relevant laws and regulations, the mandates of this rule, executive orders, mandates from the workers' compensation administration, state safety and loss prevention and control initiatives and other appropriate requirements. Each agency shall have written policies regarding:

(1) workers' compensation claims management procedures;

(2) early return to work procedures for workers with job-related injuries or illnesses; and

(3) new employee orientation programs to include job safety, workers' compensation, and employment-related civil rights.

C. Each agency shall have individual and specific written policies providing for the following items, as they apply to job-related injury or illness claims:

(1) establishment of safety and loss prevention and control as line management responsibilities of high priority and evaluate on the execution of these responsibilities; standards shall be in writing at the agency level;

(2) training, appropriate to each supervisor, on the supervisor's role and what the supervisor is responsible for accomplishing;

(3) assignment of an individual or individuals, at the agency level, responsible for maintaining complete job-related injury and illness claim records for the purpose of upkeep, monitoring, and analysis and for providing management information data; sub-agencies are also required to maintain job-related injury and illness records; the names of these individuals are to be submitted to the state loss control manager of the RMD; these same persons will be the agency contacts for the RMD workers' compensation bureau;

(4) mandatory information: claims records retained by the agency or sub-agency and submitted to the RMD workers' compensation bureau shall contain the following mandatory documents:

(a) notice of accident (WCA form NOA-1, as may be amended);

(b) employer's first report of injury or illness (WCA form E1.2, as may be amended);

(c) authorization to release medical information (WCA mandatory form, per Subparagraph (c) of Paragraph (2) of Subsection R of 11.4.4.9 NMAC, as may be amended);

(5) other information: claims records retained by the agency or sub-agency and submitted to the RMD workers' compensation bureau may contain the following documents, if appropriate or applicable to the job-related injury or illness situation:

(a) doctor's visit form (or similar record of information);

(b) injured employee and witness statements;

(c) supervisor's investigation report;

(d) safety specialist or loss prevention and control coordinator investigation report;

(e) follow-up action documents;

(f) adjuster's and medical provider's documents; and

(g) photographs and sketches, as appropriate.

D. In formulating the policies required by this rule Paragraphs (1), (2) and (3) of Subsection B of 1.6.4.14 NMAC, each agency shall ensure the policies address and include direction for the following items:

(1) injured employee responsibilities: this criterion shall include, at a minimum, injury reporting procedures, administration and documentation details, and compliance with medical treatment plan;

(2) employer responsibilities: this criterion shall include, at minimum, job-related injury or illness reactive procedures, contact protocol, employer involvement in all phases of job-related injury or illness claim management, and accountability measures;

(3) identification of jobs or the modification of jobs to accommodate the job-related injured or ill worker who is placed on restricted or modified work status; this criterion shall also include the procedures and authorities to implement such procedures;

(4) identification and analysis of root causes of job-related injury or illness and recommended corrective action or change to prevent recurrence of such job-related illness or injury.

E. Every effort shall be made to implement an early return to work program that includes, at a minimum, the requirements of Section 52-1-25.1 NMSA 1978. To ensure that sound claims management procedures have been accomplished and that reasonable accommodations and opportunities afforded by applicable legal mandates have been explored, no state employee shall be terminated from employment because of a job-related injury or illness or physical circumstances resulting from a job-related injury or illness unless the state agency has provided advance notice to the state risk management division, attention: workers' compensation claims specialist.

F. Except as provided in Paragraphs (1) and (2) of this subsection, vacant positions resulting from job related injuries or illnesses shall not be filled, except by temporary employment.

(1) A position may be permanently filled if there is documented medical diagnosis or evidence that an employee with a job-related injury or illness has reached maximum medical improvement or that the employee's impairment or condition is permanent and that the employee cannot perform the essential functions of the particular job.

(2) A position may be permanently filled if there is a critical need and that need cannot be satisfied with temporary employment, and the agency has made a "good faith" effort to do so, and the provisions of Subsection E of this section have been satisfied.

G. The state loss control manager and the workers' compensation claims specialist of the RMD, or their designees, shall provide "model" programs, policies and supplemental materials that may be used by each agency as guidance in creating programs and drafting policies.

Notes

N.M. Admin. Code § 1.6.4.14

1.6.4.14 NMAC - Rp, 1.6.4.14 NMAC, 7/1/2007