N.M. Admin. Code § 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
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 its 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 health 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.
(2) Upon notice of an accident or
injury, the employer shall notify the injured worker in writing whether the
employer's policy directs that medical care shall be provided by health care
provider selected by the employer or whether the policy permits the worker to
initially select the health care provider. The party who did not select the
initial health care provider has the right to change to a different health care
provider 60 days from the date the worker receives treatment from the selected
provider.
E.
Workers' compensation benefits.
(1) Medical benefits include all medical,
surgical, and drug expenses that are reasonable, necessary and related to the
work injury.
(2) Lost wage benefits
are payments to a worker who is disabled from work in the opinion of an
authorized health care provider and cannot earn wages. Lost wage benefits are
based on a portion of its average weekly wage up to a maximum limit set by the
Workers' Compensation Act, Sections
52-1-1 et seq. NMSA 1978. The
first seven days (consecutive or non-consecutive) is the statutory waiting
period when no disability benefits are paid.
F.
Sick leave and insurance premium
payment options. Each employer shall determine as a matter of policy
whether it elects to allow an injured worker to use paid time off during the
initial seven days of the statutory waiting period and how insurance premiums
will be paid while disabled. There are only two options as follows:
(1) Employer Option #1:
(a) Use of sick leave: The initial seven day
period that a worker is absent due to a work-related occurrence is the
statutory waiting period in which no lost wage benefits are paid under the
workers' compensation claim. The initial seven day period can be consecutive or
non-consecutive days and must be charged to paid time off. If the worker
continues to be disabled after the seven day waiting period, they will be
entitled to lost wage benefits equal to sixty-six and two-thirds percent of
their average weekly wage up to the statutory maximum allowed at the time of
injury. The worker is not permitted to use paid time off leave after the seven
day waiting period. If the disability persists past 28 days, the worker will
then be paid the lost wage benefits for the initial seven day waiting period
and the worker is required to reimburse their paid time off bank;
(b) Payment of Insurance premiums: When an
absence is due to a work-related occurrence, the worker does not receive wages
from the employer. During the period of disability, the worker shall pay its
portion of any insurance premiums for employer provided insurance directly to
the employer. The employer will continue payment of its matching portion of the
insurance premiums until the employee returns to work from the qualifying
disability, through the end of the current fiscal year or for as long as the
worker continues to pay its portion of the premiums, whichever occurs
first.
(2) Employer
Option #2:
(a) Use of sick leave: The initial
seven day period that a worker is absent due to a work-related occurrence is
the statutory waiting period in which no lost wage benefits are paid under the
workers' compensation claim. The initial seven day period can be consecutive or
non-consecutive days and must be charged to paid time off. If the worker
continues to be disabled after the seven day waiting period, they will be
entitled to lost wage benefits equal to sixty-six and two-thirds percent of
their average weekly wage up to the statutory maximum allowed at the time of
their injury. In order to allow the worker to maintain other employment
benefits such as 401(k) contributions and health insurance premiums for family
members and dependents, the worker is permitted to use paid time off leave in
addition to workers' compensation benefits to equate to one hundred percent of
the worker's gross wage. The worker will not be paid in excess of one hundred
percent of his gross wages when both paid time off leave and compensation
benefits are combined. The worker will not be entitled to any advancement of
additional paid time off that the worker might potentially accrue during the
balance of the fiscal year. If the disability persists past 28 days, the worker
will then be paid the lost wage benefits for the initial seven day waiting
period and the worker is required notify the employer in writing for proper
reimbursement their paid time off bank;
(b) Payment of Insurance premiums: When an
absence is due to a work-related occurrence, the worker does not receive wages
from the employer. During the period of disability, the worker shall pay their
portion of any insurance premiums for employer provided insurance directly to
the employer or if the worker uses paid time off leave, the worker's portion of
the insurance premiums will continue to be deducted from the checks issued by
the employer. The employer will continue payment of its matching portion of the
insurance premiums until the employer returns to work from the qualifying
disability, through the end of the current fiscal year or for as long as the
worker continues to pay their portion of the premiums, whichever occurs
first.
G.
Family medical leave act. Family medical leave act benefits may
run concurrently with the worker's time off for a work-related
injury.
H.
Returning to
work. Employees returning to work from a work-related disability shall:
(1) submit a written medical statement from
the treating physician to the workers' compensation administrator that they are
physically able to return to perform the essential job functions of the
original position; and
(2) if
physically unable to return to performance of the essential job functions of
the original position, the worker shall submit a written medical statement from
the treating physician for review by their supervisor, human resources and the
workers' compensation administrator detailing which specific functions of the
original position that they are physically able to perform and which they
cannot; such written medical statement shall specify the employee's physical
capacity in the terms outlined in Section
52-1-26.4, NMSA 1978; within five
days of receiving this written notification, the employer shall advise the
worker in writing of the availability of accommodating work and the start date
on which the employee is expected to fill the accommodating position.
(3) If physically unable to perform even
marginal job duties, the worker shall submit a written medical statement from
the treating physician to the workers' compensation administrator to that
effect for review by their supervisor, human resources and the workers'
compensation administrator; and
(4)
present themselves for work within one working day after being released to
return to work by his treating physician or of being notified of accommodating
work by the employer.
I.
Workers' compensation assessment fee. Workers covered by workers'
compensation under the New Mexico Workers' Compensation Act, Sections
52-1-1 et seq., NMSA 1978 are
required to pay a quarterly fee. The worker's contribution is taken as a
quarterly payroll deduction.
Notes
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
No prior version found.