Current through Register No. 40, October 3, 2024
(a) If upon investigation it is determined
that the claim is compensable, the carrier or employer within 21 days of
notification of claim or period of disability shall:
(1) Pay compensation to the injured
employee;
(2) Complete and file a
"Memo of Payment", form 9WCA (6/1994), contained in Appendix II with the
department with a copy to the employee; and
(3) Complete and file the "Memo of Payment",
form 9WCA (6/1994) contained in Appendix II to indicate any payment or change
in benefits paid to an employee, as follows:
a. Box "1" shall be completed if:
1. A payment of compensation is definitive
either as a first payment of compensation, or is an adjustment of provisional
payment;
2. A change in the
compensation rate such as temporary partial benefits;
3. A first payment resulting from a
departmental hearing decision or is a payment of adjusted total disability
under RSA
281-A:29; or
4. The average weekly wage is a result of
combined earnings;
b. Box
"2" shall be completed when first payment is made provisionally because of the
absence of wage information;
c.
Box "3" shall be completed when a final payment of compensation is made due to
the claimant returning to work or because of benefit limitation under the law,
RSA
281-A:26,
RSA
281-A:31, or a "lump sum settlement" under
RSA
281-A:37;
d. Box 2 shall not be completed if box 1 is
completed:
e. Failure of a carrier
to file an accurately and fully completed "Memo of Payment", form 9WCA
(6/1994). contained in Appendix II shall constitute non compliance shall
subject the carrier to the civil penalty as prescribed by
RSA
281-A:42 and
Lab
508.02(e).
f. Defect as to format or contents may render
the filing invalid and subject the carrier to the civil penalty in e. above as
explained in Lab
508.02.
(b) The carrier shall attach to the "Memo of
Payment", form 9WCA (6/1994), contained in Appendix II the department's copy of
the "Wage Schedule", form 76WCA (9/2014), contained in Appendix II when
definitive payment of compensation is made for the first time. No wage schedule
shall be necessary if the disability period is 14 days or less or payroll
records are submitted that clearly show the gross earnings of the employee per
pay period for 52 weeks prior to the date of injury if available.
(c) In addition to the method set out in RSA
281-A: 15 the average weekly wage shall be computed as follows:
(1) Wages shall include vacation pay,
commission and bonuses for the periods to which such payments apply, and all
other considerations required by
RSA
281-A:2, XV,
RSA
281-A:15, III and
Lab
504.02(k) and (l);
(2) In computing the average weekly wage for
the 26 weeks prior to the injury, weeks with reduced earnings which occurred
during the week of injury or the week of hire shall be eliminated;
(3) If this method does not yield a figure
reflective of the claimant's true average weekly earnings, wages earned during
additional preceding consecutive weeks, up to a total of 52 weeks prior to the
injury, shall be used to compute an average;
(4) An employer shall submit a 52 week record
of gross earnings upon request of the employee or the labor department;
and
(5) In the event that the
employee's compensation rate is determined by utilizing the after tax earnings
rate as defined by RSA 281-A:15, IV, the carrier
shall complete and submit a "Supplemental Wage Schedule", form 76WCA1 (4/2014),
contained in Appendix II completed in its entirety, with any and all
documentation used to support the calculation of the after tax earning
indemnity rate as follows.
a. Documentation
shall include, but not be limited to, a copy of the applicable "Federal Income
Tax Withholding" table contained within Circular E of the Employer's Tax Guide,
used to determine the amount of the income tax withheld; and
b. The Federal Withholding Schedule and
Federal Insurance Contribution Act rate factor used to calculate these
deductions shall be based on the rates that are in effect at the time of the
injury, contained within Circular E of the Employers Tax Guide published by the
Internal Revenue Service.
(d) If at the time of an injury an employee
is employed by 2 or more employers subject to
RSA
281-A:55 and
RSA
281-A:55-a, the employee shall be eligible
for wages based on combined earnings pursuant to
RSA
281-A:15, III, with eligibility determined
for combined earnings as follows:
(1) Carriers
and self-insured employers shall notify the claimant in writing of possible
eligibility for additional weekly disability benefits payable under the
combined earnings provisions of the statute. Notice shall be issued in all
cases of injury pursuant to
RSA
281-A:15, III where the disability exceeds
the waiting period;
(2) Notice, for
the purposes of (1) above shall consist of the following statement: "If you
worked for more than one New Hampshire employer at the time you were injured,
you may be entitled to additional weekly disability benefits under the combined
earnings provision of the law. Upon your request, your employers are required
to complete a Wage Schedule, form 76WCA (9/2015) contained in Appendix II or
payroll records as described in
Lab
506.02(b) and to submit it to the
claims representative handling your claim. Contact your insurance carrier or
the New Hampshire department of labor for further information";
(3) The combined earnings shall be calculated
as follows:
a. Allowable sources of wages
shall be limited to concurrent employment subject to the New Hampshire workers'
compensation law;
b. Sources of
income that shall not be considered for concurrent employment include:
1. Unreported earnings;
2. Uninsured self-employment;
3. Federal; or
4. Other employment not subject to New
Hampshire workers' compensation law;
c. The claimant's wages from all allowable
sources shall be added for each week; and
d. The average weekly wage shall be the
result of adding the weekly totals and dividing by the number of
weeks.
(e) In
no case, including calculation of average weekly wage on the basis of combined
earnings, shall the resulting compensation rate for any type of indemnity
exceed the maximum set forth in
RSA
281-A:28, II.
(f) Upon the injured worker's return to work,
the carrier shall notify the worker in writing that if based on his or her
injury, he or she is earning less than his or her average weekly wage prior to
the injury, he or she shall submit or cause to be submitted a record of his or
her earnings.
(g) Carriers shall
begin payment of temporary partial disability benefits under
RSA
281-A:31 and
Lab
506.02(a) (3) when:
(1) Upon return to work, a partially disabled
claimant's earnings due to the work injury are less than the average weekly
wages prior to the injury; and
(2)
In the case of concurrent employment, pursuant to
RSA
281-A:15, III, upon return to any
employment(s), the partially disabled claimant's earnings are less due to the
work injury than the average weekly wages prior to the
injury.
(h) When an
employee dies from an occupational injury or disease the carrier shall pay
compensation to dependents in accordance with the provision of
RSA
281-A:26 as follows:
(1) Weekly payment shall begin as soon as
possible after death occurs, but no later than 21 days after dependency is
established;
(2) The carrier shall
file with the department the "Memo of Payment", form 9WCA (6/1994), contained
in Appendix II with an appropriate wage schedule or payroll records, birth and
marriage certificate if applicable;
(3) Allocation adjustments shall be made as
soon as possible after receiving from the department the "Authorization for
Compensation for Death", form 14WCA (10/2001), contained in Appendix II giving
the dependency allocation, but no later than 7 days thereafter; and
(4) Funeral expenses, as provided by statute,
shall be paid as soon as possible after presentation of an invoice or
statement.
(i) Carriers
shall notify an injured worker that he or she is entitled to medical care,
choice of doctor and mileage reimbursement costs to medical appointments as
follows:
(1) The injured workers' choice of
doctor may be limited if the employer is within a managed care
program;
(2) Carriers shall pay the
cost of medical, hospital, remedial and health support services, and devices
and appliances related to occupational injuries or diseases in accordance with
RSA
281-A:23 as soon as possible after
presentation of invoice or statement, but no later than 30 days thereafter:
and
(3) Payable costs under
RSA
281-A:23 and
Lab
506.02 shall include the related reasonable and
documented expenses of the claimant for all necessary travel and meals and
lodging, including the use of a personal vehicle at the rate established for
state employees.
(j)
Carriers shall notify an injured worker that they may be entitled to a
permanent impairment award for the loss of specified members or parts of the
body or for loss of the use thereof under
RSA
281-A:32.
(k) In order to determine and pay a permanent
impairment award, the carrier shall:
(1)
Contact the injured employee and the employee's treating physician to advise
him or her of the need of a permanent impairment evaluation which shall:
a. Be based on the
5th edition of the Guides to the
Evaluation of Permanent Impairment, published by the American
Medical Association; available as noted in appendix III;
b. Contain an affirmation from the submitting
physician that the findings for permanent bodily loss were determined from the
Guides to the Evaluation of Permanent Impairment, the
5th edition; available as noted in appendix III;
and
c. Contain medical evidence
that the injured worker has reached maximum medical
improvement.
(2) Once an
injured worker has achieved maximum medical improvement, advise the injured
worker that if the treating physician does not perform permanent impairment
evaluations, the physician may refer the employee to a physician that does
perform permanent impairment evaluations;
(3) Pay the cost of the initial permanent
impairment evaluation by the treating or referring physician;
(4) Complete and submit "Memo of Permanent
Impairment Award", form 10WCA (10/1998), contained in Appendix II together with
the medical reports that support the impairment rating within 15 days of
receipt of the physicians report if no objection is filed;
(5) Pay the permanent impairment award within
5 days of receipt of the approved "Memo of Permanent Impairment Award", form
10WCA (10/1998), contained in Appendix II.
(6) Pay the permanent impairment award based
on the physicians report that used the 5th Edition
Guides to the Evaluation of Permanent Impairment
published by the American Medical Association except where
RSA
281-A:32 II is more favorable to the injured
worker;
(7) Pay the award in a
single payment based on the average weekly wage of the employee at the time of
the injury;
(l) If upon
receipt of the permanent impairment award evaluation, the carrier,
self-insurer, employer, or third party administrator objects to the percentage
of loss given by the treating or referred physician, they shall:
(1) Notify the department of labor within 15
days of receipt of the permanent impairment evaluation;
(2) Arrange for an independent medical
examination in accordance with
RSA
281-A:32, XI and
RSA
281-A:38 within 30 days of their objection to
the treating or referring physicians report; and
(3) Request a hearing on the
matter.
(m) If upon
receipt of the permanent impairment award evaluation, an objection is not filed
with the department of labor pursuant to 506.02(l) above, the carrier shall:
(1) Accept the rating filed by the treating
or referred physician;
(2) Complete
and file the "Memo of Permanent Impairment Award", form 10WCA (10/1998),
contained in Appendix II; and
(3)
Pay the award in accordance with
RSA
281-A:32, XI.
(n) If the carrier, self-insurer, employer,
or third party administrator fails to pay the permanent impairment award and
comply with (m) (1-3) above, the commissioner shall order payments of the award
in accordance with RSA 281-A:43, II.
(o) If the employer or carrier determines
that the case is not compensable:
(1) The
employer or carrier shall complete and file a "Memo of Denial of Workers
Compensation Benefits", form 9WCA-1(9/2015), contained in Appendix II with the
department and send a copy to the claimant within 21 days of notification of a
claim or subsequent period of disability; and
(2) The denial shall:
a. State the reason for the denial;
b. Advise the employee of their right to
request a hearing within 18 months of the date of the denial if the employee
disagrees with the denial;
c.
Provide the employee with the name, phone number and email address of the
adjuster; and
d. Provide a
narrative explanation for the denial.
(p) If disability benefits have been paid
within the first 21 days of the receipt of notice of disability, and the
employer, carrier, self-insured or third party administrator determines that
payment should not have been made, they may cease weekly payments of
compensation as follows:
(1) If payments have
been made for no longer than 21 days, compensation may cease;
(2) A letter shall be written to the injured
worker setting forth the reason for denial of the claim and the cessation of
benefits;
(3) The injured employee
shall be notified of his or her right to a hearing if the denial is
contested;
(4) The injured employee
shall be advised that the request for a hearing must be made within 18 months
of the date of denial; and
(5)
Copies of all such correspondence shall be sent to all parties including the
department simultaneously.
(q) If disability benefits have been paid
after 21 days following the carrier's receipt of the notice of disability the
carrier shall request permission of the department prior to terminating
benefits as provided in
RSA
281-A:48 and
Lab
510.02, subject to the following:
(1) Failure to obtain permission shall
subject the employer or carrier to fines under
RSA
281-A:42; and
(2) Failure to make timely payments shall
subject the employer or carrier to make payment of interest to the employee in
accordance with RSA
281-A:42, V and subject the employer,
carrier, self-insured or third party administrator to fines under
RSA
281-A:42.
(r) If payment of the bill under
RSA
281-A:23 is denied, the carrier shall:
(1) Write the employee on carrier letterhead
and copy the provider and the labor department, providing explanation of the
denial, which shall:
a. Be issued within 30
days of the receipt of the bill or invoice;
b. Be in narrative form;
c. Advise the employee of the reason for the
denial;
d. Advise the employee of
the identity of the entity issuing the denial; and
e. Advise the employee of their right to
request a hearing within 18 months of the date of denial if the employee
disagrees with the denial; and
(2) Failure to follow procedures in
Lab
506.02(r) (1) shall subject the
carrier to fines under
RSA
281-A:23, V (e), as explained in
Lab
508.02.
(s) When a dispute arises as to the
reasonable value of medical hospital and remedial services, the employer or its
insurance carrier shall pay, in the first instance, what they feel reasonable
within 30 days from presentation of invoice or statement. They shall state in
writing to the party providing such services, copy to the labor department,
reasons for contesting the unpaid balance. The parties shall make an effort to
resolve any dispute. If the parties cannot resolve the differences concerning
invoices with dates of service of 9/4/15 and after, a hearing may be requested
pursuant to RSA
281-A:24 at which the provider shall have the
burden of proof.
(t) Payment of any
net benefit made directly to the claimant shall be made promptly in a form that
allows the claimant easy accessibility to it.
(u) In order to be in substantial compliance
with RSA
281-A:42 for making payment of compensation,
and in substantial compliance with
Lab
501.02 for paying benefits in amounts, manner and when
due, the carrier or employer shall establish a payment system that meets the
following criteria:
(1) Payment of
compensation for disability shall be made:
a.
For partial disability where a statement of earnings is needed to compute the
benefits, within 5 days from the date of receipt of such documentation;
and
b. For all other benefits,
weekly on a day designated at the onset of payment of the claim. If the
designated day falls on a holiday, payment shall be made the day
prior.
(2) The normal
standard payment procedure shall be by delivery of a paper check, made payable
to the claimant, and delivered to the home address of the claimant.
Alternatively, the employer may make a direct deposit to a claimant's financial
account, if the claimant so authorizes. Also, at the claimant's option, the
parties may agree in writing upon an alternate payment procedure, called here a
"paycard", so long as it meets the criteria of this paragraph;
(3) The paycard shall provide to the claimant
at least one free means to withdraw up to and including the full amount of the
claimant's account during each benefit payment period at a financial
institution or other location within 20 miles from the claimant's home
address;
(4) The payment of the
benefit to the claimant shall be verifiable by the claimant, either by delivery
of a paper deposit receipt, or by the ability to view the transaction through a
secure internet connection;
(5) If
the paycard offers options other than cash withdrawals, there shall be written
disclosure in plain language of all the claimant's options. The written
disclosure shall state the terms and conditions of the paycard, including, but
not limited to, the requirements set forth in this section and a complete
itemized list of all known fees that may be deducted from the paycard account
by the employer or the card issuer. The disclosure shall also state whether
third parties may assess transaction fees in addition to the fee assessed by
the paycard issuer or issuers;
(6)
In no event shall the employer provide payment of benefits to a paycard that
has an expiration date, unless the employer agrees to provide a replacement
paycard before the expiration date at no cost to the employee;
(7) The employer shall provide written notice
of any change to any of the terms and conditions of the paycard account,
including but not limited to an itemized list of all fees that may have
changed; and
(8) The employer shall
provide the claimant the option to discontinue receipt of benefits by a paycard
account at any time, without penalty to the claimant.
#2264, eff 1-6-83; ss by #2935, eff 12-27-84; amd by #4854,
eff 6-29-90; amd by #5041, eff 1-9-91; ss by #5235, eff 9-27-91, EXPIRED:
9-27-97
New. #6631, INTERIM, eff 11-16-97,
EXPIRED: 3-16-98
New. #6806, eff 7-18-98); ss by
#8682, INTERIM, eff 7-15-06, EXPIRED: 1-11-07
New. #9019, eff 11-1-07; amd by
#10038, eff 12-1-11
