Current through Register Vol. 35, No. 18, September 24, 2024
All entities participating in the authority workers'
compensation coverage shall adopt a policy substantially in the following form,
selecting one of two options available for the selection of health care
providers, for use of sick leave and for payment of insurance premiums while an
employee is disabled from work.
A.
Workers' compensation eligibility. In accordance with applicable
workers' compensation statutes, all employees of (insert name of participating
entity) who have a work-related injury are eligible for coverage.
B.
Reporting accidents. An
injured worker must report all work-related accidents or injuries immediately
to his immediate supervisor by completing and submitting the notice of accident
form, whether or not medical care is needed. The worker's supervisor must then
complete the supervisor's accident investigation report form. Both documents
must be submitted to the employer's designated workers' compensation
administrator within 24 hours from the time the supervisor is informed of the
accident. The workers' compensation administrator then must complete the
employer's first report of accident form and forward all three forms to the
third party administrator within 72 hours from the employer's first knowledge
of the accident. The forms are available to download on the authority's website
at: https://nmpsia.com.
C.
Emergency medical treatment. When an injury or illness is life
threatening in nature, the injured worker shall seek emergency treatment at the
nearest emergency facility or by calling 911. After the emergency has abated,
the injured worker will notify the employer in writing of the work related
injury and present any disability or return to work notices.
D.
Selection of health care provider
policy options.
(1) Each employer shall
determine as a matter of policy whether it elects to initially select the heath
care provider or whether the injured worker is permitted to make the initial
selection. Each employer shall also provide at the time of hiring or during
employee orientation the following information in writing:
(a) Option 1 for selection of health care
provider: (name of participating entity) elects to have injured workers treated
at (insert name and location of facility); or
(b) Option 2 for selection of health care
provider: (name of participating entity) permits the injured worker to
initially select the health care provided as provided by Subsection B of
Section
52-1-49
NMSA 1978.
(2) Upon
notice of an accident or injury, the employer shall notify the injured worker
in writing whether the employer's policy directs that medical care shall be
provided by health care provider selected by the employer or whether the policy
permits the worker to initially select the health care provider. The party who
did not select the initial health care provider has the right to change to a
different health care provider 60 days from the date the worker receives
treatment from the selected provider.
E.
Workers' compensation
benefits.
(1) Medical benefits include
all medical, surgical, and drug expenses that are reasonable, necessary and
related to the work injury.
(2)
Lost wage benefits are payments to a worker who is disabled from work in the
opinion of an authorized health care provider and cannot earn wages. Lost wage
benefits are based on a portion of his average weekly wage up to a maximum
limit set by the Workers' Compensation Act, Sections
52-1-1 et
seq. NMSA 1978. The first 7 days (consecutive or non-consecutive) is the
statutory waiting period when no disability benefits are paid.
F.
Sick leave and insurance
premium payment options. Each employer shall determine as a matter of
policy whether it elects to allow an injured worker to use paid time off during
the initial 7 days of the statutory waiting period and how his insurance
premiums will be paid while he is disabled. There are only two options as
follows:
(1) Employer Option #1:
(a) Use of sick leave: The initial 7 day
period that a worker is absent due to a work related occurrence is the
statutory waiting period in which no lost wage benefits are paid under the
workers' compensation claim. The initial 7 day period can be consecutive or
non-consecutive days and must be charged to paid time off. If the worker
continues to be disabled after the 7 day waiting period, he will be entitled to
lost wage benefits equal to 66 2/3% of his average weekly wage up to the
statutory maximum allowed at the time of his injury. The worker is not
permitted to use paid time off leave after the 7 day waiting period. If the
disability persists past 28 days, the worker will then be paid the lost wage
benefits for the initial 7 day waiting period and the worker is required to
reimburse their paid time off bank;
(b) Payment of Insurance premiums: When an
absence is due to a work related occurrence, the worker does not receive wages
from the employer. During the period of disability, the worker shall pay his
portion of any insurance premiums for employer provided insurance directly to
the employer. The employer will continue payment of its matching portion of the
insurance premiums until the employee returns to work from the qualifying
disability, through the end of the current fiscal year or for as long as the
worker continues to pay his portion of the premiums, whichever occurs
first.
(2) Employer
Option #2:
(a) Use of sick leave: The initial
7 day period that a worker is absent due to a work related occurrence is the
statutory waiting period in which no lost wage benefits are paid under the
workers' compensation claim. The initial 7 day period can be consecutive or
non-consecutive days and must be charged to paid time off. If the worker
continues to be disabled after the 7 day waiting period, he will be entitled to
lost wage benefits equal to 66 2/3% of his average weekly wage up to the
statutory maximum allowed at the time of his injury. In order to allow the
worker to maintain other employment benefits such as 401(k) contributions and
health insurance premiums for family members and dependents, the worker is
permitted to use paid time off leave in addition to workers' compensation
benefits to equate to 100% of the worker's gross wage. The worker will not be
paid in excess of 100% of his gross wages when both paid time off leave and
compensation benefits are combined. The worker will not be entitled to any
advancement of additional paid time off that the worker might potentially
accrue during the balance of the fiscal year. If the disability persists past
28 days, the worker will then be paid the lost wage benefits for the initial 7
day waiting period and the worker is required notify the employer in writing
for proper reimbursement their paid time off bank;
(b) Payment of Insurance premiums: When an
absence is due to a work related occurrence, the worker does not receive wages
from the employer. During the period of disability, the worker shall pay his
portion of any insurance premiums for employer provided insurance directly to
the employer or if the worker uses paid time off leave, the worker's portion of
the insurance premiums will continue to be deducted from the checks issued by
the employer. The employer will continue payment of its matching portion of the
insurance premiums until the employer returns to work from the qualifying
disability, through the end of the current fiscal year or for as long as the
worker continues to pay his portion of the premiums, whichever occurs
first.
G.
Family medical leave act. Family medical leave act benefits will
run concurrently with the worker's time off for a work related
injury.
H.
Returning to
work. Employees returning to work from a work related disability shall:
(1) submit a written medical statement from
the treating physician to the workers' compensation administrator that they are
physically able to return to perform the essential job functions of the
original position; and
(2) if
physically unable to return to performance of the essential job functions of
the original position, the worker shall submit a written medical statement from
the treating physician for review by his supervisor, human resources and the
workers' compensation administrator detailing which specific functions of the
original position that he is physically able to perform and which he cannot;
such written medical statement shall specify the employee's physical capacity
in the terms outlined in Section
52-1-26.4,
NMSA 1978; within five days of receiving this written notification, the
employer shall advise the worker in writing of the availability of
accommodating work and the start date on which the employee is expected to fill
the accommodating position.
(3) If
physically unable to perform even marginal job duties, the worker shall submit
a written medical statement from the treating physician to the workers'
compensation administrator to that effect for review by his supervisor, human
resources and the workers' compensation administrator; and
(4) present himself for work within 1 working
day after being released to return to work by his treating physician or of
being notified of accommodating work by the employer.
I.
Workers' compensation assessment
fee. Workers covered by workers' compensation under the New Mexico
Workers' Compensation Act, Sections
52-1-1 et
seq., NMSA 1978 are required to pay a quarterly fee. The worker's contribution
is taken as a quarterly payroll deduction.
