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The Workers' Compensation Handbook For New Mexico

Setting Up a Workers' Compensation Program
Your insurance company ........................................................................................3 The workers' compensation posting requirement......................................................4
Understanding the posting requirement.......................................................................... 5 If your employees don't go to your office ....................................................................... 6 Required government posters are free and downloadable ................................................ 7 Federal, State and Local Required Posters ...................................................................... 8 EMPLOYER'S CHECKLIST (Do as soon as you can): ......................................................... 2

Booklet A2:

OSHA Reporting Requirements................................................................................9 Setting up a procedure to respond to an accident .................................................. 10 Emergency medical care....................................................................................... 11 Selection of health care provider ........................................................................... 11
Health care provider selection summary ....................................................................... 12

Safety and Accident Prevention ............................................................................. 12
Safety Device Penalty (§52-1-10 NMSA) ....................................................................... 13 Safety Incentive Bonus Programs ................................................................................ 13 Job Application Forms and Interviews .......................................................................... 14 Drug and Alcohol Use ................................................................................................. 15 Drug and Alcohol Testing ............................................................................................ 15 Best practice: training topics checklist ......................................................................... 16 Training for all employees ........................................................................................... 16 Safety training ........................................................................................................... 16

OPTIONAL FORMS: .............................................................................................. 17 Notification of health care provider selection.......................................................... 17
Help from the Workers' Compensation Administration.................................................... 19 Workers' Compensation Handbook List of Booklets........................................................ 20 NMWCA Offices and phone numbers ................................ Error! Bookmark not defined.

The Workers' Compensation Handbook for New Mexico Booklet A2: Setting up a workers' compensation program

2007 Edition page 2

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Many business owners buy an insurance policy and file the envelope in a drawer without much thought. Workers' compensation requires you to do more. The employer should take a number of steps NOW, including training and informing supervisors and all workers. Workers should be aware of certain basic information NOW.
This booklet is addressed to employers. The booklet outlines specific actions for employers in preparation for using the New Mexico workers' compensation system. If you are a new employer, or if your business is covered by the New Mexico workers' compensation system for the first time, this booklet is for you. This booklet is also for supervisory employees and for all employees who want to understand how to be prepared in case someone has to make a workers' compensation claim.

EMPLOYER'S CHECKLIST (Do as soon as you can):
Review your insurer's policy packet; see what the insurer has provided for you in forms, instructions, postings, fliers, etc. Post the workers' compensation mandatory poster. Fill out the center portion with the name and contact information of your insurer. If your insurer did not provide a poster, you can get it from the WCA or download it from the WCA web site. Post Notice of Accident forms near the poster. If your insurer did not provide Notice of Accident forms, you can get them from the WCA. See below. Review the basics of your responsibilities when an accident occurs (from this booklet, from Booklet B1, "What to Do After an Accident," and from the insurer's policy packet). Set up a health care provider selection policy and put it in writing to your employees. See the optional forms in the back of this booklet. Review your job application forms. See recommendations in this booklet. Develop a file of emergency contact information (immediately family or closest friends) for all employees and update it annually. Train your supervisory staff. Develop a Return to Work policy. See the WCA booklet "Stay at Work / Return to Work Program Guide" for ideas and a model policy. If you need help, consider contacting the WCA for a training session, free of charge. Call the WCA office nearest you. See the list of addresses at the back of this booklet.
Published by the New Mexico Workers' Compensation Administration, a state agency. Laws can change. Check for new information by calling 1-866-WORKOMP or 1-866-967-5667or look on the Internet at www.workerscomp.state.nm.us.

The Workers' Compensation Handbook for New Mexico Booklet A2: Setting up a workers' compensation program

2007 Edition page 3

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Your insurance company
Employer:
If you are a private business, you probably bought your insurance policy from an insurance agency. The insurance agency is in the business of selling insurance policies and providing certain kinds of customer service. It is not the same as the company that carries your insurance policy, called an insurance "carrier." Or you might be covered through a group self-insurance program operated through an industry association (Workers' compensation law, Chapter 52, Article 6). If you are with a very large company, your company might be individually self-insured (§52-5-4.1 NMSA). 1 Both group and individual self-insurance require WCA approval and are regulated by the WCA. You need to know the name of the company with which you have your policy. Some insurance carriers and self-insurance programs contract with specialized companies to process their claims. These are called claims adjusters or third-party administrators. If your insurer or self-insurance program has that type of arrangement, you need to know the name of that company and its contact information (telephone number). If you are in state or local government or public schools, your organization may be independently self-insured or part of a governmental pool. Some governmental pools also contract with third party administrators to manage their claims. You need this information to fill in the blanks on the WCA mandatory poster, described below. The information should have been provided in an insurance packet from your insurer or self-insurance program. Federal government agencies do not come under the New Mexico workers' compensation law. They are covered by a federal workers' compensation program through the U.S. Department of Labor. Find information online at www.dol.gov, or call 1-866-4-USA-DOL. If you have difficulty reaching the federal workers' compensation office, it is sometimes helpful to ask for assistance from the constituent services staff of your Congressional representative.

1 In this booklet are references to specific paragraphs of the workers' compensation law. These references

are in a standard form. §52-5-4.1 NMSA means Chapter 52, Article 5, Paragraph 4.1 of the New Mexico Statutes Annotated (NMSA).
Published by the New Mexico Workers' Compensation Administration, a state agency. Laws can change. Check for new information by calling 1-866-WORKOMP or 1-866-967-5667or look on the Internet at www.workerscomp.state.nm.us.

The Workers' Compensation Handbook for New Mexico Booklet A2: Setting up a workers' compensation program

2007 Edition page 4

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The workers' compensation posting requirement
The Workers' Compensation Act poster is published by the WCA. It gives basic information to workers about the procedures to follow if they have an accident, it describes the use of the Notice of Accident form (NOA), and it lists the locations and telephone numbers of the offices of the WCA. The posting requirement is described in Paragraph §52-1-29(B) NMSA of the workers' compensation law. The employer is required to post the WCA poster in a location where workers will have easy access to it. The most common places for this poster are in an employee lunch room or break room or near the time clock, along with other labor-law related posters. The Notice of Accident form is a two-part carbonless form for a worker to fill out when the worker has a work-related accident, whether or not the worker is aware of any injury. This form is printed by the WCA. The law specifies that the employer must attach blank Notice of Accident forms to the Workers' Compensation Act poster at the place of work, where workers can see them and reach them easily. Forms may be hung directly over the bottom of the poster in the space shown on the poster. If the poster is posted but no forms are posted, the employer is not complying with the law.

Where to find WCA posters and NOA Forms:
· · Look in the information packet sent to you by the insurance carrier or selfinsurance program. Posters and NOA forms can also be obtained from WCA offices free of charge on request. Telephone any office or go in person.

The poster is downloadable from the WCA web site at www.workerscomp.state.nm.us. Notice of Accident forms are not downloadable because by law they must be printed in duplicate. As of the date of this publication in 2007, all employers should be using the 20022003 edition of the Workers' Compensation Act poster. The publication date is in small print in the lower right hand corner.

Employer:
On the 2002-2003 poster, you are required to fill in the blank space with the correct name and telephone number of your insurance company or other claims representative -- the party that should be contacted if one of your employees has a workers' compensation claim. You can get that information from the materials sent to you by your insurer or self-insurance program. The telephone number must be a New Mexico telephone number.
Published by the New Mexico Workers' Compensation Administration, a state agency. Laws can change. Check for new information by calling 1-866-WORKOMP or 1-866-967-5667or look on the Internet at www.workerscomp.state.nm.us.

The Workers' Compensation Handbook for New Mexico Booklet A2: Setting up a workers' compensation program

2007 Edition page 5

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Best Practice

Take the time NOW to find the required insurance contact information in the materials that your insurer or self-insurance program sent to you. Write it on the poster, or use a stick-on label. The insurance packet probably contains forms and instructions you will need if you ever have to file a claim. While you have these materials handy, set up a file folder for this material and let several people know where to find it. The packet may also contain forms for you to post or information to distribute to your employees. Some of this may be recommendations on health care provider selection, explained below. Your insurer or self-insurance program may also have provided instructions for what to do after an accident. Don't wait for an accident to find out what instructions you are supposed to follow. Take a minute NOW to look at these instructions. Then share the information with everyone in management who needs to know.

Understanding the posting requirement
The purpose of the workers' compensation poster and NOA forms is: · · to inform workers that their employer has workers' compensation coverage, and that they have certain rights if they are injured; to provide a way for workers to notify their employers in writing if they have an accident, with a copy that the worker may keep for his or her own records as evidence that he reported the accident.

By law, employers must allow their employees to report accidents in writing using NOA forms. It is not legal for employers to require employees to report by another method, unless the employer has received written approval from the Director of the WCA (Rules of the WCA, NMAC 11.4.2.10 2 ). Employers are also required to notify their employees about the WCA Ombudsman program (§52-5-1.4 NMSA). That information is on the poster. The intention of the posting requirement is for workers to have free access to the forms. Keeping the forms stored in a supervisor's desk, or any place where the worker has to ask the supervisor for a copy of the form, does not comply with the law's requirement that the poster and NOA forms be posted in a conspicuous place.

2

In this booklet are references to the Rules of the Workers' Compensation Administration. These references are in a standard form based on the numbering system of the New Mexico Administrative Code (NMAC); for example, NMAC 11.4.2.10. This stands for Title 11, Labor and Workers' Compensation; Chapter 4, Workers' Compensation; and then the number of the section and exact paragraph.
Published by the New Mexico Workers' Compensation Administration, a state agency. Laws can change. Check for new information by calling 1-866-WORKOMP or 1-866-967-5667or look on the Internet at www.workerscomp.state.nm.us.

The Workers' Compensation Handbook for New Mexico Booklet A2: Setting up a workers' compensation program

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Q. I am an employer. I don't want to hang Notice of Accident forms on the wall. I require my employees to use a different method to notify me when they have an accident. What's wrong with that? A. By law, employers must allow employees to report accidents in writing using the Notice of Accident forms. If you don't, you are probably exposing yourself to additional liability. You can ask your employees to fill out an additional form, if you wish, but you cannot deny an employee workers' compensation benefits for failing to use your additional form. Q. What happens if an employer does not post the poster?

A. If the poster is not available, the right of the worker to report an accident to the employer and make a claim is extended from 15 days to 60 days (§52-1-29(A) NMSA). Normally, in most cases, a worker has 15 days from the date of the accident to report the accident in writing. If the worker does not report the accident within this period, the insurer or self-insurance program may be entitled by law to deny the claim (this does not apply if the employer had other knowledge of the accident or if the worker is prevented from giving notice by circumstances beyond the worker's control). However, if the poster and Notice of Accident forms were not available to the worker, the time for notice is extended to 60 days.

If your employees don't go to your office
Some businesses have employees who never or rarely report to a central location or main office. Such businesses may include some construction companies, trucking companies, janitorial services, home health care services, and others. Any business can have this concern if you are based in another state and your employees (such as sales representatives) work out of their own homes or are regularly on the road. The law specifically requires you to post the poster and forms in a location on your premises where employees will have access to them. However, if posting the poster and forms will not give your employees effective access to them, it is your responsibility to do more, to safeguard your employees' rights and protect yourself from additional liability. It is your responsibility to figure out what method will work to ensure that your employees understand what to do and have access to the information on the poster and to NOA forms.

Best practice:
To ensure that you are providing adequate information to workers who never or rarely go to any central location, consider doing the following: · Provide a copy of the poster, at least one NOA form, and a notice of your health care provider selection policy (see the section "Selection of Health Care Provider"), together in an envelope to each employee or in each company vehicle. (You can get copies from the WCA or download the poster from the WCA web site and print it on ordinary paper.)

Published by the New Mexico Workers' Compensation Administration, a state agency. Laws can change. Check for new information by calling 1-866-WORKOMP or 1-866-967-5667or look on the Internet at www.workerscomp.state.nm.us.

The Workers' Compensation Handbook for New Mexico Booklet A2: Setting up a workers' compensation program

2007 Edition page 7

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·

Send out periodic reminders to each employee, such as a quarterly notice sent with paychecks, about employees' rights under workers' compensation and the availability of these materials.

Follow this procedure only if this fits your circumstances. If it doesn't, develop your own method to ensure that your employees are informed.

Required government posters are free and downloadable
You never have to pay for mandatory posters. Most businesses have received advertisements from companies that sell their own versions of the federal and state mandatory posters. Some of these advertisements are confusing, so you might think they are from a government agency rather than a private business trying to sell you a product. If you receive any mailing from any source demanding money for mandatory posters, the source of that mailing IS NOT A GOVERNMENT AGENCY but a private, for-profit business. No private vendors provide NOA forms. If you have posted the poster without the NOA forms, you are not in compliance with the workers' compensation posting requirement. Until recently, all mandatory posters were available from offices of the New Mexico Department of Labor. The posters may still be available from some local offices, but for most businesses it is easier to download and print them from government web sites.

Published by the New Mexico Workers' Compensation Administration, a state agency. Laws can change. Check for new information by calling 1-866-WORKOMP or 1-866-967-5667or look on the Internet at www.workerscomp.state.nm.us.

The Workers' Compensation Handbook for New Mexico Booklet A2: Setting up a workers' compensation program

2007 Edition page 8

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Federal, State and Local Required Posters
Federal and state posting requirements vary for different businesses, depending on the nature of your business, the number of employees and other factors. The U.S. Department of Labor has helpful information on its web site. As of 2007, the posting requirements affecting all or most New Mexico employers are the following: U.S. Dept. of Labor postings; downloadable in sections from USDOL at http://www.dol.gov/osbp/sbrefa/poster/matrix.htm; Employers should read this web site for more information. Posters requirements for most businesses include:
· · · · · Equal Employment Opportunity is the Law Federal Minimum Wage Job Safety and Health Protection Employee Polygraph Protection Act Uniformed Service Employment and Reemployment Rights Act (USERRA - NEW IN 2005-6) Family Medical Leave Act of 1993 (for employers with 50 or more employees)

·

NM Dept. of Labor minimum wage poster; downloadable from http://www.dws.state.nm.us/dws-posters.html Job Health and Safety; available from Occupational Health and Safety Bureau of the New Mexico Environment Dept.; downloadable from http://www.nmenv.state.nm.us/OHSB_Website/ohsb_home.htm Contact state OHSB at 476-8700. Workers' Compensation Administration poster and Notice of Accident forms (for covered employers only); · may be provided in your insurance policy packet; · available from NM Workers' Compensation Administration; · NOA forms are NOT downloadable; Poster is downloadable at http://workerscomp.state.nm.us/partners/poster.php IF YOU DO BUSINESS WITH THE FEDERAL GOVERNMENT there are additional requirements, shown at http://www.dol.gov/osbp/sbrefa/poster/matrix.htm CITY OR COUNTY MINIMUM WAGE FLIERS are required in Albuquerque, Bernalillo County and Santa Fe, which have their own minimum wage ordinances; they are downloadable from the city or county web sites.

In New Mexico, the agency responsible for occupational health and safety is not federal OSHA but state OHSB, the Occupational Health and Safety Bureau of the New Mexico Environment Department.
Published by the New Mexico Workers' Compensation Administration, a state agency. Laws can change. Check for new information by calling 1-866-WORKOMP or 1-866-967-5667or look on the Internet at www.workerscomp.state.nm.us.

The Workers' Compensation Handbook for New Mexico Booklet A2: Setting up a workers' compensation program

2007 Edition page 9

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Posting requirements do not automatically change each year. To find out whether you need to update your posters, you can check the web sites of the WCA or DOL. WCA posters are available free from every office of the WCA. You may also receive posters from your insurer or self-insurance program. Look in the packet sent to you with your policy. The poster can be downloaded and printed from the WCA web site at www.workerscomp.state.nm.us. You can print it on two regular size 8 ½ by 11 pages.

Best Practice
Buy a plain bulletin board. Post the Workers' Compensation Act poster and a small supply of NOA forms on the bulletin board. You can also use the bulletin board for other federal, state and local mandatory posters. Most mandatory posters are now downloadable from federal, state and local government web sites and can be printed in small sections on regular-size 8 ½ by 11 paper with an ordinary printer. A bulletin board will enable you to organize the posters neatly.

OSHA Reporting Requirements
When accidents occur, most employers are required to keep records under the federal Occupational Safety and Health Act. The Workers' Compensation Administration does not administer the OSHA law but is providing this information to help you comply with related requirements. This law is administered in New Mexico by the state Occupational Health and Safety Bureau (OHSB), which is a bureau of the Environment Department. The bureau is located in Santa Fe and can be reached at 476-8700 or, toll free, 1-877-610-6742.

Best Practice (Employer):
If you are required to keep an OSHA 300 log, download the forms and set up a file now, so that it will be readily available if you need it. Also keep the OHSB telephone numbers in that file in case you have a catastrophic accident and need to notify OHSB. Store your OSHA file near your workers' compensation file. Note that the E1 form used for workers' compensation reporting is accepted as a substitute for the OSHA 301 form. The forms required by New Mexico OHSB are federally mandated. You can find OSHA forms online from the U.S. Department of Labor at www.osha.gov. You can choose downloadable forms that you can print out and fill out by hand; or Excel spreadsheets that you can save and fill out on your computer. For information about New Mexico OHSB and the state OHSB poster, go to the web site of the New Mexico Environment Department. Navigate from the New Mexico state home page at www.state.nm.us.
Published by the New Mexico Workers' Compensation Administration, a state agency. Laws can change. Check for new information by calling 1-866-WORKOMP or 1-866-967-5667or look on the Internet at www.workerscomp.state.nm.us.

The Workers' Compensation Handbook for New Mexico Booklet A2: Setting up a workers' compensation program

2007 Edition page 10

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If a catastrophic event has happened, you must notify OHSB within 8 hours. A catastrophic event is an accident that results either in a fatality or at least three employees hospitalized. Call OHSB at 476-8700 or, toll free, 1-877-610-6742. You can leave a recorded message if it is after the normal business day. Employers who are required to keep OSHA 300 logs and reports are generally: those with more than 10 employees. If your entire company had more than 10 employees at any time during the year, you are covered; AND those in higher risk industries. Lower-risk industries such as office and retail are generally not covered. Call the OHSB if you are not certain. OHSB can require any employer to comply with the reporting requirements. The requirement to notify OHSB about a catastrophic event applies to all employers. Commercial software products for accident reporting exist. Employers may want to investigate these to simplify reporting and record-keeping.

Setting up a procedure to respond to an accident
Accidents can happen. Employers should have procedures and provide training so that workers and supervisors know what to do.

Employer:
Develop accident response procedures. Provide training sessions so that workers know the procedures. Make sure that you know, and your workers know, where emergency first-aid supplies and emergency medical facilities are located. Show workers where to find the Notice of Accident forms. Instruct them to fill out a form if any accident happens, even if there is no injury. The forms will become your record of safety problems that need your attention. Instruct supervisors that they must sign a Notice of Accident form when asked by a worker. Explain that their signature indicates only that they have received the notice. It is not an admission of liability. Communicate to your employees that you care about their safety.

Emergency contact information
Make sure you have emergency contact information on file (such as family members' phone numbers) for all your employees, and that all the necessary staff
Published by the New Mexico Workers' Compensation Administration, a state agency. Laws can change. Check for new information by calling 1-866-WORKOMP or 1-866-967-5667or look on the Internet at www.workerscomp.state.nm.us.

The Workers' Compensation Handbook for New Mexico Booklet A2: Setting up a workers' compensation program

2007 Edition page 11

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members know where that information is kept and have access to it. Update the information once a year.

Emergency medical care
Emergency medical care comes first, for a work-related injury as well as any other medical emergency. Employees should be instructed on the locations of emergency medical facilities. Employees should know that in a work-related injury, emergency medical care comes first, and they should use their best judgment. However, "emergency" medical care should be used only when the situation is clearly an emergency. Emergency care is limited to the initial visit or hospital stay. If follow up care is needed, a selection of health care provider is necessary. If you do not specify whether you are going to direct the care or allow the worker to select, then the follow up care will be deemed to be the employer's selection.

Selection of health care provider
Employer:
The workers' compensation law has special provisions for the selection of health care providers to treat covered injuries. These provisions DO NOT apply to emergencies. Emergency medical care is covered in the Rules of the WCA, NMAC 11.4.4.11 (C)(1). Look in your insurance packet or consult with your insurance carrier now for instructions or recommendations on the selection of a health care provider for your employees, should they be injured. Your insurer or self-insurance program may advise you to give written instructions to employees now. The law (§52-1-49 NMSA) provides that the employer may select the health care provider who will treat an injured worker for the first 60 days after the injury, or may permit the worker to choose. If the employer makes the first selection, the worker will be permitted to change doctors after 60 days. If the employer does not choose a health care provider, the worker may choose one. If the worker selects first, the employer may change the provider after 60 days, if medical care is still needed. A claims representative will be managing the claim at this point. Give clear written instructions to your employees. Don't wait for an accident. Either you should tell your employees that you will select the health care provider (or provide the name of a particular doctor or health care facility); or you should tell them to choose their own doctor. By doing this, you may prevent a dispute in the future.

Published by the New Mexico Workers' Compensation Administration, a state agency. Laws can change. Check for new information by calling 1-866-WORKOMP or 1-866-967-5667or look on the Internet at www.workerscomp.state.nm.us.

The Workers' Compensation Handbook for New Mexico Booklet A2: Setting up a workers' compensation program

2007 Edition page 12

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First, find out whether your insurance carrier or self-insurance program has a recommended policy on health care provider selection. Then make a decision and inform your employees in writing by posting a notice on bulletin boards, issuing wallet cards with the necessary information, or informing your employees in some other manner. The requirement to use a method that will notify workers in writing of your policy is in the Rules of the WCA, NMAC 11.4.4.11 (C)(2).

Health care provider selection summary
§52-1-49 NMSA and NMAC 11.4.4.11 (C)(2)
1. The employer is responsible for communicating with workers.

2. Employer should provide instructions IN ADVANCE in writing by establishing a policy that applies to all employees. Either the employer tells workers that employer is selecting the health care provider, or the employer tells workers to select their own health care provider. 3. If employer has not provided any instruction in advance, employer should provide an instruction as soon as possible, BEFORE any non-emergency health care.

IF EMPLOYER SELECTS FIRST
Employer instructs worker to use a specific health care provider. Worker must be treated by this health care provider (and other providers referred by the treating provider) for 60 days. 4. After the initial 60-day period, the worker will have the right to change to a different health care provider.

IF WORKER SELECTS FIRST
Employer instructs worker to select a health care provider of the worker's own choosing. Worker will be treated by this health care provider (and other providers referred by the treating provider) for 60 days.

4. After the initial 60-day period, the claims representative will be managing the claim at that time, and will have the right to require the worker to change to a different health care provider. See Booklet B4, "Medical Care in Workers' Compensation," for the procedure regarding the change of health care provider.

Safety and Accident Prevention
There is no replacement for good health and a whole, strong body. Safety at work is everybody's responsibility. It is an important part of the workers' compensation system. See Booklets D1 and D2 for more information about safety in the workplace and the safety requirements of the workers' compensation law. The WCA offers safety consulting services free of charge to employers on request.
Published by the New Mexico Workers' Compensation Administration, a state agency. Laws can change. Check for new information by calling 1-866-WORKOMP or 1-866-967-5667or look on the Internet at www.workerscomp.state.nm.us.

The Workers' Compensation Handbook for New Mexico Booklet A2: Setting up a workers' compensation program

2007 Edition page 13

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Safety Device Penalty (§52-1-10 NMSA)
The workers' compensation law provides a direct financial incentive for employers to provide workers with safety devices appropriate to the work they are doing, and also provides incentives for workers to use the safety devices provided. The law states: · If the employer provides a safety device and the worker fails to use it, and that contributes to the accident, the indemnity benefits to the worker can be decreased by 10 percent. · If the employer fails to provide a safety device that is required by law or in general use in the industry, the indemnity benefits to the worker can be increased by 10 percent. The 10 percent extra benefit required by this provision of law must be paid directly by the employer, not the insurer.

·

This provision of law provides a direct financial consequence to the employer for failure to provide necessary safety devices. You can avoid this penalty by making sure you are providing necessary safety devices and complying with safety laws. See booklets D1 and D2, "Annual Safety Inspections" and "How to Develop a Safety Program," or call the WCA for free safety consultation services.

Safety Incentive Bonus Programs
If you establish a safety bonus program, any bonuses paid to workers are not counted as pay for computing their compensable average weekly wage or your workers' compensation insurance premiums. This is covered in paragraph §52-1-6.2 (D) NMSA of the law. The New Mexico Insurance Division establishes guidelines for qualifying programs. You must register your program with this division. For details, contact the workers' compensation bureau of the Insurance Division, which is part of the Public Regulation Commission.

PRC Insurance Bureau contact information, as of 2007
Web site: http://www.nmprc.state.nm.us/ Toll free telephone: 1-800-947-4722 Insurance Division switchboard: (505) 827-4601 Workers' Compensation Bureau: 827-4652

Employer:
Safety incentive bonus programs should not be used to discourage workers from filing workers' compensation claims when an injury has occurred.

Published by the New Mexico Workers' Compensation Administration, a state agency. Laws can change. Check for new information by calling 1-866-WORKOMP or 1-866-967-5667or look on the Internet at www.workerscomp.state.nm.us.

The Workers' Compensation Handbook for New Mexico Booklet A2: Setting up a workers' compensation program

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Job Application Forms and Interviews
Some employers try to protect themselves from future workers' compensation problems by asking job applicants such questions as whether they have any medical conditions or whether they have previously filed any workers' compensation claims. Questions of this nature can potentially result in future liability problems for the employer, under a federal law called the Americans with Disabilities Act. The New Mexico workers' compensation law specifically prohibits the WCA from giving out any information about a worker's history of prior claims, unless the worker has filed a workers' compensation claim and the person asking for the information is a party to that claim (§52-5-21 NMSA). The suggestions in this section are based on the Americans with Disabilities Act, NOT the workers' compensation law. These are generally regarded as standard recommendations by human resource professionals.

Employer:
You can protect yourself from potential problems in the future by your job applications and interview questions. You may ask a general question, such as whether the applicant is capable of doing all the tasks required by the job, "with or without reasonable accommodations." To do this, it helps to have a detailed written job description with a list of the "essential job functions," which might include lifting, reaching, sitting, driving, etc. Ask the same questions of all applicants for the job. Suggested statements to include on job application forms: · Include a statement, clearly visible on your job application forms, advising applicants that the information they provide may be investigated, and that they can be terminated or denied workers' compensation benefits if they knowingly provide false information. · If you have a drug and alcohol testing policy, especially if you test employees prior to hire, state that on the application (see "Drug and Alcohol Testing" below). Design the form so that the applicant signs the form below this section. You may ask for some more detailed information and even require a medical examination (at your expense) after you have made a "conditional offer of hire." Human resource professionals recommend that all employers use written job application forms. You may need more in-depth information about job applications and interviews. Consult with a lawyer who specializes in employment law, take a seminar, or contact a
Published by the New Mexico Workers' Compensation Administration, a state agency. Laws can change. Check for new information by calling 1-866-WORKOMP or 1-866-967-5667or look on the Internet at www.workerscomp.state.nm.us.

The Workers' Compensation Handbook for New Mexico Booklet A2: Setting up a workers' compensation program

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reliable information source such as the New Mexico Small Business Development Centers for model job application forms that are compliant with federal and New Mexico law. Small Business Development Centers are attached to most of the state's community colleges. The locations can be found online at www.nmsbdc.org.

Drug and Alcohol Use
Educate your employees about the dangers of drugs and alcohol. A worker abusing drugs or alcohol is a danger not only to himself but also to other workers, your customers, and others around you.

Drug and Alcohol Testing
Consider adopting a drug and alcohol testing program and policy. It is recommended that you: · have a written policy; · make sure every employee is informed of the policy by having employees sign a copy of the policy; · provide a copy of the policy to each employee; · enforce the policy fairly and consistently; · if you require pre-employment drug testing as a condition of hire, inform applicants of that in advance by stating it on the job application; · use a testing laboratory that is certified by the U.S. Department of Transportation (§52-1-12.1). For help with developing a policy, contact your insurer or self-insurance program. Or contact the DWI Resource Center in Albuquerque, a nonprofit organization that provides free and low-cost services to employers to support drug-free workplaces and other drug and alcohol related programs (telephone 881-1084 or www.dwiresourcecenter.org). Consider drug and alcohol education as part of your workplace safety education program. A worker who is under the influence of alcohol or any drug (except prescription medication) at the time of an accident could lose the right to some benefits or all benefits, depending on the circumstances. See Booklet B1, "What to Do After an Accident." The provisions of the workers' compensation law related to drug and alcohol involvement in work-related injuries are at paragraphs §52-1-11, §52-1-12 and §52-1-12.1 NMSA.

Published by the New Mexico Workers' Compensation Administration, a state agency. Laws can change. Check for new information by calling 1-866-WORKOMP or 1-866-967-5667or look on the Internet at www.workerscomp.state.nm.us.

The Workers' Compensation Handbook for New Mexico Booklet A2: Setting up a workers' compensation program

2007 Edition page 16

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Best practice: training topics checklist
The following are recommended topics for training. The information for some of these topics can be found in other booklets of this Handbook series.

Training for supervisors
Location for emergency medical care (nearest hospital, urgent care center, etc.) Use of Notice of Accident forms Follow-up procedures for reporting accidents (Booklet B1) Your procedure for selection of health care provider (Booklet B1) What to do if there was an accident with no apparent injury (Booklet B1) Options for return to work (Booklets B1 and B3 and Stay at Work / Return to Work Program Guide) Worker's rights if time off is required (Booklets B1 and B2) Enforcement of your drug and alcohol policy

Training for all employees
Your company's accident response procedures Location of emergency first-aid supplies and emergency medical facilities Use of Notice of Accident forms Your drug and alcohol policy

Safety training
Your own safety program Training from WCA safety consultants (free from the WCA) See Booklets D1 and D2 The WCA can help provide additional training. Contact your nearest WCA office.

Published by the New Mexico Workers' Compensation Administration, a state agency. Laws can change. Check for new information by calling 1-866-WORKOMP or 1-866-967-5667or look on the Internet at www.workerscomp.state.nm.us.

The Workers' Compensation Handbook for New Mexico ­ Booklet #A2 -__________________________________________________________

FORMS

OPTIONAL FORMS: Notification of health care provider selection
Model forms for notification to all employees ­ flier or payroll stuffer version: These are models for the wording of fliers that the employer might wish to post at work, or enclose with workers' paychecks once or twice a year. Version 1 ­ Use this as a model if the employer has selected the health care provider

Version 1

TO EMPLOYEES OF _________________________________ (Name of company) IF YOU HAVE AN ACCIDENT AT WORK FIRST, get emergency medical care or first aid if you need it. If you need help, ask your supervisor or another employee. REPORT your accident to your supervisor. WITHIN 15 DAYS, fill out a Notice of Accident form. These forms are located: ________________________ Take the form to your supervisor. Sign and date the form. Ask your supervisor to sign and date the form. KEEP ONE COPY. BEFORE YOU GO TO THE DOCTOR: The policy of our company is to select the health care provider for your workrelated injury. We have selected: Name of health care provider _____________________ Address ______________________________________ Telephone number __________________ Call this medical office to make an appointment. If you have been to an emergency room, tell the doctor's office about this so they can obtain the emergency room records. Company policy, issue date: _________________

The Workers' Compensation Handbook for New Mexico ­ Booklet #A2 -__________________________________________________________

FORMS

OPTIONAL FORMS: Notification of Health Care Provider Selection
Version 2
Version 2 ­ Use this as a model if the employer is instructing employees to select their own health care provider.

TO EMPLOYEES OF _________________________________ (Name of company) IF YOU HAVE AN ACCIDENT AT WORK FIRST, get emergency medical care or first aid if you need it. If you need help, ask your supervisor or another employee. REPORT your accident to your supervisor. WITHIN 15 DAYS, fill out a Notice of Accident form. These forms are located: ________________________ Take the form to your supervisor. Sign and date the form. Ask your supervisor to sign and date the form. KEEP ONE COPY. BEFORE YOU GO TO THE DOCTOR: The policy of our company is to allow you to select the health care provider for your work-related injury. You may select any medical doctor, osteopathic physician or chiropractic physician whose medical specialty is suitable for your injury. After you have selected a doctor, notify the company of the name, address and phone number of the doctor you have selected.

Company policy, issue date: _________________

The Workers' Compensation Handbook for New Mexico ­ Booklet #A2 -__________________________________________________________

FORMS

Help from the Workers' Compensation Administration
Assistance and training opportunities for employers Personal contact WCA safety training videotapes

Safety programs, safety training, safety inspections. Provided free of charge by the WCA safety staff throughout the state, tailored to your company's needs and requests. The WCA has an extensive library of videotapes on safety topics. You can borrow these tapes, or a WCA safety consultant can show them for you. Seminars for employers, explaining workers' compensation general guidelines and claims management. Contact your nearest WCA office.

WCA publications

You can get publications from any office of the WCA. Go to an office or telephone to request publications by mail. is a book written just for employers. It covers basic management issues for employers in a relatively simple, easy to understand way, explaining your rights and responsibilities. The Workers' Compensation Handbook for New Mexico (the booklets in this series) are more detailed, containing more information and best practice recommendations. Booklets on safety are included in the Handbook series (Booklets D1 and D2) plus additional separate booklets and pamphlets that may be distributed to your workforce; some in English and Spanish. The Stay at Work/ Return to Work Program Guide is a booklet that may be used to help you establish policies for minimizing your costs.

The Employer's Guide to New Mexico Workers' Compensation

WCA web site

www.workerscomp.state.nm.us

Look under Booklets for copies of the booklets in this Handbook series, which you can read, download and print. Look under Employers for other information that might be useful for you, including a link to the downloadable poster. Look under Annual Report for in-depth information, charts, trends and statistics about the workers' compensation system. Look under News and Announcements for any new changes that might affect you and announcements of upcoming seminars.

The Workers' Compensation Handbook for New Mexico ­ Booklet #A2 -__________________________________________________________

FORMS

Workers' Compensation Handbook List of Booklets
This list shows new titles and numbering system that will be in effect when the 2007 revision is completed. Some booklets are eliminated and others are renumbered. There are some changes from the pre-2007 editions of the booklets.
To get the information you need: Contact any office of the Workers' Compensation Administration for printed copies OR All booklets can be downloaded from the Workers' Compensation Administration web site at www.workerscomp.state.nm.us

Booklet Booklet Booklet Booklet Booklet Booklet

A1(E) A1(S) A2 A3 A4 A5

Workers' Compensation Quick Facts- English Compensación A Los Trabajadores Informes Básicos ( Spanish) Setting Up a Workers' Compensation Program The Workers' Compensation Coverage Guide for Employers and Insurance Agents Uninsured Employers' Fund Workers' Compensation Personnel Assessment Fee (WC-1)

Booklet B1 What to Do after an Accident Booklet B2 Benefits for Workers While They Cannot Work Booklet B3 Going Back to Work Booklet B4 Medical Care in Workers' Compensation (B5 and B6 will be discontinued) Booklet B7 Información del sistema compensativo para los empleados (Spanish) Booklet B8 Quick Facts for Health Care Providers Booklet C1 When you need help with a workers' compensation claim Booklet C2 What to Do In Response to "Bad Acts" (C3 through 5 will be discontinued) Booklet D1 Booklet D2 Annual Safety Inspections How to Develop a Safety Program (published by the Advisory Council on Workers' Compensation and Occupational Disease Disablement)

(On the web site, look under Employers)
E3 E4 Guide to Completing and Filing Paper Copy for Employers' First Report of Injury or Illness (Form E1.2) and Notice of Benefit Payment (Form E6.2) EDI Guide to Completing the Employers' First Report of Injury or Illness (Form E1.2) and Notice of Benefit Payment (Form E6.2) -- limited to certified electronic filers

Other publications

Health Care Provider Guide to New Mexico Workers' Compensation Guidebook for Employers in New Mexico (English and Spanish) Workbook for Injured Workers (English/ Spanish edition soon to be published) The Stay at Work/Return to Work Program Guide

NEW MEXICO WORKERS' COMPENSATION ADMINISTRATION

The Workers' Compensation Handbook for New Mexico ­ Booklet #A2 -__________________________________________________________

FORMS

STATE HEADQUARTERS Mailing Address: Workers' Compensation Administration PO Box 27198, Albuquerque NM 87125 Location: 2410 Centre Avenue SE (near Yale-Gibson intersection) In-state toll-free phone: 1-800-255-7965 Local phone 841-6000 REGIONAL OFFICES: Southeastern regional office at Lovington: 100 West Central, Lovington, NM 88260 Telephone: 575-396-3437 In-state toll-free phone: 1-800-934-2450 Southwestern regional office at Las Cruces: 1120 Commerce Drive, Suite B-1, Las Cruces, NM 88011 Telephone: 575-524-6246 In-state toll-free phone: 1-800-870-6826 Northwestern regional office at Farmington: 3535 East 30th Street, Farmington, NM 87401 Telephone: 505-599-9746 In-state toll-free phone: 1-800-568-7310 Northeastern regional office at Las Vegas : 2515-2 Ridge Runner Road, Las Vegas NM 87701 Moving in 2008 to: 32 New Mexico 65, Las Vegas NM 87701 Telephone: 505-454-9251 In-state toll-free phone: 1-800-281-7889 Roswell Office: Penn Plaza Bldg., 400 N. Pennsylvania Ave., Ste. 425, Roswell NM 88201 Telephone: 575-623-3781 In-state toll-free phone: 1-866-311-8587 Santa Fe Office: 810 West San Mateo, Suite A-2, Santa Fe, NM 87505 Telephone: 505-476-7381 Internet web site address: http://www.workerscomp.state.nm.us/ HELP & HOTLINE: 1-866-WORKOMP / 1-866-967-5667

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