Current through Register Vol. 35, No. 18, September 24, 2024
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.
