New Mexico Administrative Code
Title 11 - LABOR AND WORKERS' COMPENSATION
Chapter 4 - WORKERS' COMPENSATION
Part 11 - PROOF OF COVERAGE
Section 11.4.11.8 - PROOF OF COVERAGE
Universal Citation: 11 NM Admin Code 11.4.11.8
Current through Register Vol. 35, No. 18, September 24, 2024
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
policy.
(2) Every insurer shall, in
the event of a policy cancellation, file a notice of cancellation with the
workers' compensation administration within 10 days of such
cancellation.
(3) Vendor
certification
(a) In order to be certified as
a vendor for submission of POC data with the workers' compensation
administration, an entity must receive certification from the workers'
compensation administration.
(b) In
order to maintain certified vendor status, the vendor must maintain
certification with the workers' compensation administration, which includes
continuous compliance with the workers' compensation administration POC
business plan.
B. POC submission procedures and requirements
(1) POC data must be submitted in the IAIABC
POC flat file format.
(2) A vendor
must provide optional ways for insurers to submit POC data to the vendor such
as hard copy, mag tape, web page form or IAIABC flat file.
(3) Once certified, vendors must notify the
workers' compensation administration of any changes they make in hardware or
software and complete re-certification with the workers' compensation
administration prior to using such changed or new hardware or software to
submit POC data. Vendors must also comply with IAIABC requirements pertaining
to hardware and software changes.
(4) A current information form and
sender/vendor information form must be on file with the workers' compensation
administration before electronic filings will be accepted.
(5) All POC data is the property of the New
Mexico workers' compensation administration and such data cannot be used for
any purpose other than that designated by the workers' compensation
administration.
(6) Failure to file
POC data in accordance with the act and these rules will subject the insurer to
penalties and fines permitted by the act and the rules.
(7) After notice and opportunity to be heard,
the director may decertify a vendor for good cause shown.
C. Exempt entities:
(1) The legislatively mandated pools governed
by 11.4.10 NMAC are required to provide membership information to the workers'
compensation administration through the self-insurance bureau and may exempt
themselves from the electronic filing requirements at their option.
(2) Self-insurance groups, authorized to
provide workers' compensation insurance to their members based upon a valid and
active certificate of self-insurance issued by the director of the workers'
compensation administration and whose membership roster does not exceed 75
members are required to provide membership information to the workers'
compensation administration through the self-insurance bureau and may exempt
themselves from the electronic filing requirements at their option.
(3) Individual self-insurers in possession of
a valid and active certificate of self-insurance issued by the director of the
workers' compensation administration and those subsidiaries listed on such
certificate are exempt from the filing requirements.
D. Affirmative election forms: Affirmative election forms for executive employees shall be deemed filed with the director pursuant to Section 52-1-7 NMSA 1978 by filing the form with the insurance carrier that is issuing or will be issuing the workers' compensation insurance policy to the employer. Election forms for executive employees need not be submitted to the WCA.
E. Referral to enforcement bureau: If proof of coverage is not provided within the deadlines given by the WCA to obtain coverage, the potential violation may be referred for investigation and prosecution in accordance with 11.4.5 NMAC.
Disclaimer: These regulations may not be the most recent version. New Mexico may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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