New Mexico Administrative Code
Title 6 - PRIMARY AND SECONDARY EDUCATION
Chapter 50 - INSURANCE
Part 16 - ADMINISTRATIVE APPEAL OF AUTHORITY COVERAGE DETERMINATIONS
Section 6.50.16.7 - DEFINITIONS
Current through Register Vol. 35, No. 18, September 24, 2024
As used in this rule:
A. "Authority" means the New Mexico public school insurance authority or its authorized representatives.
B. "Authority board" or "board" means the board of directors of the New Mexico public school insurance authority.
C. "Appellant" means any party who complains that a coverage determination may be in violation of any law, rule, regulation, or order administered or promulgated by the authority and who initiates a proceeding under this rule by filing a petition for review with the authority.
D. "Coverage determination" and "determination" mean any decision, order or disposition by the authority denying coverage, limiting the scope of coverage or limiting the amount of payment of a claim of a member or employee, except for workman's compensation claims.
E. "Document" means, except as otherwise used in the provisions of this rule governing discovery, any written submission in a formal proceeding which is not a pleading or which is required to be filed by authority rule or order outside a formal pleading; this includes items such as reports, exhibits, and studies; at the option of the party or staff making a filing, any document may additionally be presented in a form the hearing officer so orders.
F. "Employee" means a person employed by a member school district, charter school or other educational entity, or an employee's representatives in the event of legal incapacity, and includes volunteers or officials entitled to authority liability coverage pursuant to the Tort Claims Act, Subsection F of Section 41-4-3 NMSA 1978.
G. "Final coverage determination by the authority" with respect to a member means a coverage letter from the authority's contracted general counsel or contracted claims adjuster or with respect to an employee means a coverage letter from the authority's contracted third party benefits administrator or authorized authority staff member.
H. "Hearing" means any proceeding that is noticed for "hearing" by the authority or hearing officer and shall include an opportunity for the parties to present such evidence, argument, or other appropriate matters as the presiding officer shall deem relevant and material to the issues; hearings may be conducted by telephone conference call at the discretion of the presiding officer.
I. "Hearing officer" means a person appointed by the authority as a hearing examiner, who is designated by the authority to conduct any hearing or investigation which the authority is authorized to conduct, to take testimony in respect to the subject under investigation, report such testimony and provide to the authority a proposed decision with regard to the issues.
J. "Member school districts, charter schools and other participating entities" herein referred to collectively as "members" means all public school districts and charter schools mandated by the act to be members of the authority and all other educational entities voluntarily participating in the authority.
K. "Party" means any person or entity that initiates or responds to an authority proceeding by filing a petition for review with the authority and includes the authority; unless the context indicates otherwise, the term "party" may also refer to counsel of record for the party.
