New Mexico Administrative Code
Title 11 - LABOR AND WORKERS' COMPENSATION
Chapter 4 - WORKERS' COMPENSATION
Part 2 - DATA REPORTING AND SAFETY REQUIREMENTS
Section 11.4.2.8 - DATA COLLECTION

Universal Citation: 11 NM Admin Code 11.4.2.8

Current through Register Vol. 35, No. 6, March 26, 2024

A. General provisions:

(1) Paper copies of FROI and SROI will not be accepted by the WCA as of January 1, 2017. Beginning January 1, 2017, FROI and SROI data shall only be submitted through EDI or the WCA website.

(2) It is the claims administrator's or an uninsured employer's responsibility to timely submit all data required under the data collection rules.

(3) Time frames for submission of reports are not waived when the WCA acknowledges and returns an erroneous submission that needs correction.

(4) It is the responsibility of the claims administrator to report to the WCA required financial, legal and medical claims activity for the insured including reporting of the first dollar of indemnity benefits paid by, or on behalf of, an employer who has a deductible policy.

(5) It is the responsibility of the claims administrator to provide a loss run to the WCA upon request for reconciliation of a noted discrepancy.

(6) Claims administrators that file any required report at the time of the mediation conference, either with the mediator or at the clerk of the courts office, have not met their filing obligation with the WCA and must electronically file all required FROI and SROI data. The date of actual filing is the date of acceptance by the WCA, which will be used to determine compliance with filing requirements.

(7) Electronic filing
(a) A claims administrator shall file electronically with the WCA.

(b) EDI trading partner profile must be on record with the WCA before electronic filings can be accepted. A sample EDI trading partner profile is available on the WCA website.

(c) The transmission format is the international association of industrial accident boards and commissions (IAIABC) 148 and A49 record scheme. Transmission header and trailer records are also required under this format. The transmission record formats are also available on the WCA website.

(d) Electronic transmissions must be in the ASCII format. The file may be transmitted by electronic transmission via the internet.

(e) Electronic mailboxes must be registered with the management information systems (MIS) bureau of the WCA.

(f) Receipts for all TA, TE, and TR transmissions will be returned electronically.

(g) TR codes must be corrected within 30 days.

B. FROI:

(1) FROI data must be submitted, within 10 days of notification, for all injuries or occupational diseases that result in more than seven cumulative days of lost time.

(2) FROI data must be timely submitted even if the claim is disputed.

(3) The claims administrator must furnish a copy of the FROI data to the worker and the employer at the time of electronic submission to the WCA. If the employer is uninsured, the employer must furnish a copy of the FROI data to the worker.

(4) When an employer has notice of an accident and receives a complaint, FROI data must be submitted immediately after receiving an initial pleading involving an injury or illness that is not otherwise already supported by FROI data.

C. SROI must be submitted:

(1) within 10 days of the date of initial payment of the indemnity portion of any claim;

(2) within 50 days of the filing of an order of the WCA, or of the date upon which a recommended resolution became a compensation order for payment made to or on behalf of an injured worker, unless an order staying enforcement of a compensation order is filed with the clerk; and

(3) within 30 days of the date of the closing payment of the indemnity portion of the claim; and

(4) within 30 days of any change in benefits; and

(5) within 90 days of the date of the initial payment of a medical-only claim with cumulative payments over $300, provided, however, that a E-6 closing report shall be submitted with respect to all claims for which expenses have been previously reported;

(6) for medical-only claims with cumulative payments over $300, the initial and closing E-6 may be submitted on one form.

D. Annual expenditure report: Claims administrators shall file an annual expenditure report with the economic research and policy bureau of the WCA. The annual expenditure report must:

(1) be submitted electronically using the WCA website;

(2) identify the carrier(s), groups, pools or self-insured employer(s), by the name and the federal employers identification number (FEIN);

(3) be submitted for all expenditures reported in a calendar year (January 1-December 31); and

(4) be received by the WCA no later than February 15th of the year following the reporting period.

E. Failure to file. Any failure to timely file a statistical report as required by 11.4.2 NMAC shall be considered a violation of these rules and may be penalized pursuant to Section 52-1 -61 NMSA 1978.

F. Waiver: Any provision of 11.4.2.8 NMAC may be waived, either permanently or temporarily, by written order of the director upon good cause shown.

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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