New Mexico Administrative Code

The authority for this part derives from the director's powers under NMSA 1978, Sections 52-1-2, 52-1-4(A), 52-1-6 and 52-5-4.1.

Permanent.

November 29, 1997 unless a later date is cited at the end of a section.

The purpose of these rules is to provide criteria and procedures to apply to the issuance and maintenance of certificates of self-insurance for governmental entities insured through the organizations identified in 11.4.10.2 NMAC.

For the purposes of these rules: A. "workers' compensation" also means "workman's compensation"; B. "administrator" means an individual, partnership or corporation engaged by a pool's board of trustees to carry out the policies established by that board to provide day-by-day mana…

A. A governmental entity not insured by an insurance company in the voluntary market nor certified as an individually self-insured employer shall be deemed in compliance with NMSA 1978, Section 52-1-4 if the director has issued a certificate of pool self-insurance pursuant to the…

A. As a condition precedent to maintenance of a certificate of pool self-insurance, each pool shall compel its administrator and any service company to provide to the director the following information and access to records: (1) a copy of any reinsurance or excess insurance agree…

Workers' Compensation Administration

This rule applies to all insurers issuing workers' compensation coverage in the state of New Mexico, all self-insured groups issuing workers' compensation coverage in the state of New Mexico and all vendors submitting proof of coverage information either on behalf of themselves o…

Sections 52-1-4.1 and 52-5-4 NMSA 1978 (Repl. Pamp. 1991) and department of insurance regulation 17, rule 2.

Permanent

September 30, 2016 unless a later date is cited at the end of a section.

The purpose of this rule is to establish requirements governing workers' compensation insurance proof of coverage.

A. "Certified vendor" (also referred to as a "vendor") means a company or business which electronically transmits proof of coverage insurance information to the workers' compensation administration either for itself or for others and is certified by the WCA as being qualified to …

A. Filing requirements:(1) Every insurer shall file proof of coverage with the workers' compensation administration within 30 days of the effective date of any workers' compensation policy or within 30 days of the date of extension, renewal, reinstatement or amendment to such pol…

New Mexico Workers' Compensation Administration

The employer shall pay claims, costs, interest and penalties for which it becomes obligated under the New Mexico Workers' Compensation Act, the Occupational Disease Disablement Law, and Uninsured Employers' Fund (UEF) Act.

A. Notwithstanding the provisions of the Workers' Compensation Act and Occupational Disease Disablement Law, injured employees or an employee's beneficiaries who pursue a claim for benefits from the uninsured employers' fund (UEF) are not guaranteed payment for full workers' comp…

If the WCA director or workers' compensation judge determines that an employer was obligated to pay workers' compensation benefits to or on behalf of a worker and has not done so due to its failure to obtain and keep in force a policy of workers' compensation insurance that is va…

A. The fiscal year of the fund coincides with the fiscal year of the state. B. Beginning with the calendar quarter ending September 30, 2004, and for each calendar quarter thereafter, there is assessed against each employer who is required or elects to be covered by the Workers' …

A. The fund may purchase excess insurance from the fund corpus if, in the judgment of the director, it is fiscally prudent to do so. B. Auditing of the fund by the superintendent of insurance shall occur yearly, commencing thirty (30) days after the close of the fund's fiscal yea…

This rule applies to all employers in the state of New Mexico who are subject to the Workers' Compensation Act and Occupational Disease and Disablement Law.

Chapter 258, Laws of 2003 and NMSA 1978, Section 52-5-4, authorizes the director to adopt reasonable rules and regulations for implementing the purposes of the act.

Permanent

October 15, 2003 unless a later date is cited at the end of a section.

The purpose of this rule is to establish requirements governing the uninsured employers' fund and establishing penalties against uninsured employers pursuant to Chapter 258, Laws of 2003.

A. "Claim" means any allegation of entitlement to benefits under Chapter 258, Laws of 2003, which has been communicated to the uninsured employer's fund or to the fund through the workers' compensation administration. B. "Eligible" and "eligibility" mean that the claim is properl…

A. All claims shall be submitted on the mandatory complaint form available on the WCA website for workers' compensation benefits naming the uninsured employers' fund. (1) The date of presentation to the fund shall be deemed to be the earliest date shown on the claim or complaint …

A. The WCA may contract with a an independent adjusting company for the adjusting of those claims that are determined to be eligible for payment by the fund, purchase a loss portfolio transfer covering some or all of the liabilities of the fund, or may purchase a policy of commer…

New Mexico Workers' Compensation Administration (WCA).

A. Criteria for approval. The following requirements must be met for initial approval of a safety plan and for final approval of an application for a controlled insurance plan. Failure to maintain continuous compliance with each of these requirements shall be considered a violati…

A waiver of any non-statutory requirement in this part may be sought by the applicant. No waiver of any requirement of this part shall be effective unless documented in writing, signed by the director. No waiver shall be granted under circumstances where the waiver has the effect…

A. All bid notices to contractors and subcontractors shall include specification of the single construction site proposed, and shall include a copy of the proposed controlled insurance safety plan. B. The bid procedure utilized by the applicant must include a mechanism for contra…

A. The controlled insurance plan shall submit a report on a quarterly basis or as otherwise determined by the director. B. The director may require an official visit to the controlled insurance plan site to keep apprised of the progress of the controlled insurance plan and its co…

A. All application materials, and safety plan materials shall be submitted to the director at least 30 days before the planned commencement of construction. B. Amendments to the application or safety plan, and any waivers of requirements, that are negotiated between the WCA and t…

The following acts are prohibited: A. The establishment of the controlled insurance plan for projects that do not have an aggregate construction value in excess of $150 million, including equipment and furnishings, expended within a five-year period as provided in NMSA 1978, Sect…

A. In the event of violation of any of these rules, or in the event of the occurrence of any prohibited acts specified in these rules, the WCA may seek any or all of the following penalties singly or in combination, against the applicant, any individual responsible for the perfor…

These rules cover all parties regulated pursuant to NMSA 1978, Section 52-1-4.2 and all parties seeking to establish a "controlled insurance plan" or a "wrap-up " insurance plan, as defined below, for the purpose of insuring workers' compensation liability.

The director is authorized by NMSA 1978, Section 52-5-4 to adopt reasonable rules and regulations to implement the legislative purposes of the Workers' Compensation Act (Act). The director is empowered to seek administrative penalties pursuant to NMSA 1978, Section 52-1-61. Regul…

Permanent.

November 15, 2004 unless a later date is cited at the end of a section.

This part sets forth the requirements and processes for application and regulation of controlled insurance plans, enumerates prohibited acts and sets forth enforcement procedures.

A. "Unit statistical data" means the detailed exposure, premium, and loss (claim) information at the classification code level. Data providers submit unit statistical data to the designated rate service organization for use in ratemaking and experience rating. B. "Single construc…

A. Any party proposing a controlled insurance plan pursuant to Section 52-1-4.2 NMSA 1978, shall submit an application for approval to the director on a form provided for that purpose not less than 30 days prior to the commencement of bidding procedures for the primary contractor…

The controlled insurance plan shall be considered a single employer for purposes of WCA regulations concerning extra-hazardous employers, promulgated pursuant to Subsection (E) of Section 52-1-6.2 NMSA 1978. The North American industrial classification system (NAICS) code applica…

Workers' Compensation Administration.

A. Every employer shall post and keep posted in conspicuous places on its business premises, in areas where notices to employees and applications for employment are customarily posted, an accident notice poster stating the requirement that workers notify employers of accidents. T…

These provisions govern all employers subject to the act.

The director is authorized by Section 52-5-4, NMSA 1978, to promulgate regulations to implement the act. The regulations implementing the safety program requirements are adopted pursuant to Section 52-1-6.2, NMSA 1978. The rules on gathering and reporting of statistical data are …

Permanent.