New Mexico Register / Volume XXXV,
Issue 23 / December 10, 2024
This is an
amendment to 6.50.14 NMAC, Sections 9 and 11, effective 12/10/2024.
6.50.14.9 WORKERS’ COMPENSATION FORM POLICY
FOR SCHOOL DISTRICTS, CHARTER SCHOOLS, OTHER EDUCATIONAL ENTITIES AND OTHER
ENTITIES PARTICIPATING IN AUTHORITY WORKERS’ COMPENSATION INSURANCE PROGRAM: 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] its
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] 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] 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] health
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] its average weekly wage up to a maximum limit
set by the Workers’ Compensation Act, Sections 52-1-1 et seq. NMSA 1978. The first seven 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 seven 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 seven day period that a worker is
absent due to a [work related] work-related
occurrence is the statutory waiting period in which no lost wage benefits are
paid under the workers’ compensation claim.
The initial seven 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 seven day waiting period, [he] they will be entitled to lost
wage benefits equal to sixty-six and two-thirds percent
of [his] their 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 seven day waiting period. If the disability persists
past 28 days, the worker will then be paid the lost wage benefits for the
initial seven 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]
work-related occurrence, the worker does not receive wages from the
employer. During the period of
disability, the worker shall pay [his] its 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]
its portion of the premiums, whichever occurs first.
(2) Employer Option #2:
(a) Use of sick leave: The initial seven day period that a worker is
absent due to a [work related] work-related
occurrence is the statutory waiting period in which no lost wage benefits are
paid under the workers’ compensation claim.
The initial seven 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 seven day waiting period, [he] they will be entitled to lost
wage benefits equal to sixty-six and two-thirds percent of [his] their
average weekly wage up to the statutory maximum allowed at the time of [his]
their 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 one hundred percent of the worker’s gross wage. The worker will not be paid in excess of one hundred percent 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 seven 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]
work-related occurrence, the worker does not receive wages from the
employer. During the period of
disability, the worker shall pay [his] their
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] their
portion of the premiums, whichever occurs first.
G. Family medical leave act.
Family medical leave act
benefits [will] may run concurrently with the worker’s time off
for a [work related] work-related injury.
H. Returning to work. Employees
returning to work from a [work related] 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]
their supervisor, human resources and the workers’ compensation
administrator detailing which specific functions of the original position that
[he is] they are physically able to perform and which [he]
they 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]
their supervisor, human resources and the workers’ compensation
administrator; and
(4) present [himself] themselves for work within
one 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.
[6.50.14.9 NMAC - Rp, 6
NMAC 50.14.9, 09/01/2014; A, 12/10/2024]
6.50.14.11 CLAIMS DETERMINATION: No school district, charter school or
educational entity has the authority to accept or acknowledge liability for any
workers' compensation claim. There is no
liability for a workers' compensation claim until liability is acknowledged in
writing by an authorized employee of the authority’s [third party] third-party
administrator.
[6.50.14.11 NMAC - Rp, 6
NMAC 50.14.11, 09/01/2014; A, 12/10/2024]