SENATE BILL 275
51st legislature - STATE OF NEW MEXICO - first session, 2013
INTRODUCED BY
Pat Woods
AN ACT
RELATING TO WORKERS' COMPENSATION; DEFINING "EXTRA-HAZARDOUS EMPLOYER" IN THE WORKERS' COMPENSATION ACT; RAISING THE MINIMUM THRESHOLD FOR A MANDATORY SAFETY VISIT; CLARIFYING COMPENSATION BENEFITS TO BENEFICIARIES; ALLOWING ALL PARTIES TO OBTAIN A PERIODIC EXAMINATION OF THE WORKER FROM A HEALTH CARE PROVIDER OF CHOICE; REPLACING THE SAFETY AND FRAUD DIVISION IN THE WORKERS' COMPENSATION ADMINISTRATION WITH AN ENFORCEMENT BUREAU; ALLOWING A PERSON EMPLOYED AS AN OMBUDSMAN PURSUANT TO THE WORKERS' COMPENSATION ADMINISTRATION ACT TO HOLD ANOTHER POSITION IN THE ADMINISTRATION UPON LEAVING THE POSITION OF OMBUDSMAN; ALLOWING THE WORKERS' COMPENSATION ADMINISTRATION TO SERVE PARTIES IN FORMATS IN ADDITION TO CERTIFIED MAIL; REMOVING THE REQUIREMENT THAT HEARINGS ON WORKERS' COMPENSATION CLAIMS BE HELD IN THE COUNTY IN WHICH THE INJURY OCCURRED; PROVIDING PENALTIES; RECONCILING MULTIPLE AMENDMENTS TO THE SAME SECTION OF LAW IN LAWS 2003.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO:
SECTION 1. Section 52-1-1.1 NMSA 1978 (being Laws 1986, Chapter 22, Section 26, as amended by Laws 2003, Chapter 259, Section 1 and by Laws 2003, Chapter 263, Section 1) is amended to read:
"52-1-1.1. DEFINITIONS.--As used in Chapter 52, Articles 1 through 6 NMSA 1978:
A. "controlled insurance plan" means a plan of insurance coverage that is established by an owner or principal contractor that requires participation by contractors or subcontractors who are engaged in the construction project, including coverage plans that are for a fixed term of coverage on a single construction site;
B. "director" means the director of the workers' compensation administration;
C. "division" means the workers' compensation administration;
D. "extra-hazardous employer" means an employer whose injury frequencies substantially exceed those that may reasonably be expected in that employer's business or industry;
[D.] E. "rolling wrap-up or consolidated insurance plan" means coverage for an ongoing project or series of projects in which the common insurance program remains in place indefinitely and contracted work is simply added as it occurs under the control of one owner or principal contractor;
[E.] F. "workers' compensation judge" means an individual appointed by the director to act as a workers' compensation judge in the administration of the Workers' Compensation Act or the New Mexico Occupational Disease Disablement Law;
[F.] G. "workman" or "workmen" means worker or workers;
[G.] H. "Workmen's Compensation Act" means the Workers' Compensation Act; and
[H.] I. "workmen's compensation administration" or "administration" means the workers' compensation administration."
SECTION 2. Section 52-1-6.2 NMSA 1978 (being Laws 1989, Chapter 263, Section 92, as amended) is amended to read:
"52-1-6.2. SAFETY PROGRAMS--INSPECTIONS--PENALTIES--BONUSES.--
A. [Effective July l, l991] Every employer subject to the provisions of the Workers' Compensation Act who has an annual workers' compensation premium liability of [five thousand dollars ($5,000)] fifteen thousand dollars ($15,000) or more or who is a certified self-insurer shall receive an annual safety inspection. The director shall determine the adequacy and structure of the safety inspection, including establishing procedures for appropriate self-inspection. For any employer who is not self-insured, inspections and recommendations for creating a safer workplace shall be provided upon request by every insurer providing workers' compensation insurance in this state to [their] its workers' compensation insurance policyholders. To enforce this provision, the director may assess a penalty not to exceed five thousand dollars ($5,000) against any employer.
B. The [advisory council on workers' compensation and occupational disease disablement] administration shall develop safety programs for employers with an annual workers' compensation premium liability of less than [five thousand dollars ($5,000)] fifteen thousand dollars ($15,000).
C. The superintendent of insurance may assess a penalty against an insurer that refuses to provide annual safety inspections and recommendations. The penalty shall not exceed five thousand dollars ($5,000) per insurer per violation.
D. Any employer who is subject to the provisions of the Workers' Compensation Act may implement a safety program, as approved by the superintendent of insurance, that provides for bonuses of up to ten percent of a worker's wage to be paid to a worker who fulfills criteria established by the employer for eligibility for the bonus. The criteria shall incorporate the concept of bonuses based upon a stated number of accident-free work days completed by the worker. Any bonus paid under a program authorized by this section shall not be included in computing a worker's average wage for establishing workers' compensation insurance premiums or benefits.
E. The administration shall develop a program to identify extra-hazardous employers. The administration shall notify each identified extra-hazardous employer and the insurance carrier for that employer that the employer has been identified as an extra-hazardous employer.
F. An employer that receives notification under Subsection E of this section shall obtain a safety consultation within thirty days from the administration's safety consultants, the employer's insurer or another professional source approved by the director for that purpose. The safety consultant shall file a written report with the director and the employer setting out any hazardous conditions or practices identified by the safety consultation.
G. The employer, in consultation with the safety consultant, shall, within a reasonable time, formulate a specific accident-prevention plan that addresses the hazards identified by the consultant. An employer that fails to formulate, implement or otherwise comply with the accident-prevention plan shall be subject to a penalty not to exceed five thousand dollars ($5,000)."
SECTION 3. Section 52-1-46 NMSA 1978 (being Laws 1959, Chapter 67, Section 25, as amended) is amended to read:
"52-1-46. COMPENSATION BENEFITS FOR DEATH.--Subject to the limitation of compensation payable under Subsection G of this section, if an accidental injury sustained by a worker proximately results in [his] the worker's death within the period of two years following [his] the worker's accidental injury, compensation shall be paid in the amount and to the persons entitled thereto as follows:
A. if there are no eligible dependents, except as provided in Subsection C of Section 52-1-10 NMSA 1978 of the Workers' Compensation Act, the compensation shall be limited to the funeral expenses, not to exceed seven thousand five hundred dollars ($7,500), and the expenses provided for medical and hospital services for the deceased, together with all other sums [which] that the deceased should have been paid for compensation benefits up to the time of [his] the worker's death;
B. if there are eligible dependents at the time of the worker's death, payment shall consist of a sum not to exceed seven thousand five hundred dollars ($7,500) for funeral expenses and expenses provided for medical and hospital services for the deceased, together with such other sums as the deceased should have been paid for compensation benefits up to the time of [his] the worker's death and compensation benefits to the eligible dependents as hereinafter specified, subject to the limitations on maximum periods of recovery provided in Sections 52-1-41 through 52-1-43 and 52-1-47 NMSA 1978;
C. if there are eligible dependents entitled thereto, compensation shall be paid to the dependents or to the person authorized by the director or appointed by the court to receive the same for the benefit of the dependents in such portions and amounts, to be computed and distributed as follows:
(1) [to the child or children] if there is no widow or widower entitled to compensation, sixty-six and two-thirds percent of the average weekly wage of the deceased to the child or children;
(2) [to the widow or widower] if there are no children, sixty-six and two-thirds percent of the average weekly wage of the deceased to the widow or widower, until remarriage; or
[(3) to the widow or widower, if there is a child or children living with the widow or widower, forty-five percent of the average weekly wage of the deceased, or forty percent if such child is not or all such children are not living with a widow or widower and, in addition thereto, compensation benefits for the child or children which shall make the total benefits for the widow or widower and child or children sixty-six and two-thirds percent of the average weekly wage of the deceased. When there are two or more children, the compensation benefits payable on account of such children shall be divided among such children, share and share alike]
(3) if there is a widow or widower and children:
(a) if all the children are living with the widow or widower, forty-five percent of the weekly compensation benefits as provided in Sections 52-1-41 through 52-1-43 and 52-1-47 NMSA 1978 to the widow or widower and fifty-five percent divided equally to the children; or
(b) if no child is living with a widow or widower, forty percent of the weekly compensation benefits as provided in Sections 52-1-41 through 52-1-43 and 52-1-47 NMSA 1978 to the widow or widower and sixty percent divided equally to the children; and
(4) two years' compensation benefits in one lump sum shall be payable to a widow or widower upon remarriage; however, the total benefits shall not exceed the maximum compensation benefit as provided in Subsection B of this section;
D. if there is neither widow, widower nor children, compensation may be paid to the father and mother or the survivor of them, if dependent to any extent upon the worker for support at the time of the worker's death, twenty-five percent of the average weekly wage of the deceased, and in no event shall the maximum compensation to such dependents exceed the amounts contributed by the deceased worker for their care; provided that if the father and mother, or the survivor of them, was totally dependent upon such worker for support at the time of the worker's death, [he or] they shall be entitled to fifty percent of the average weekly wage of the deceased;
E. if there is neither widow, widower nor children nor dependent parent, then to the brothers and sisters and grandchildren if actually dependent to any extent upon the deceased worker for support at the time of the worker's death, thirty-five percent of the average weekly wage of the deceased worker with fifteen percent additional for brothers and sisters and grandchildren in excess of two, with a maximum of sixty-six and two-thirds percent of the average weekly wage of the deceased, and in no event shall the maximum compensation to partial dependents exceed the respective amounts contributed by the deceased worker for their care;
F. in the event of the death or remarriage of the widow or widower entitled to compensation benefits as provided in this section, the surviving children shall then be entitled to compensation benefits computed and paid as provided in Paragraph (1) of Subsection C of this section for the remainder of the compensable period. In the event compensation benefits payable to children as provided in this section are terminated as provided in Subsection E of Section 52-1-17 NMSA 1978, a surviving widow or widower shall then be entitled to compensation benefits computed and paid as provided in Paragraphs (2) and (4) of Subsection C of this section for the remainder of the compensable period; and
G. no compensation benefits payable by reason of a worker's death shall exceed the maximum weekly compensation benefits as provided in Sections 52-1-41 through 52-1-43 and 52-1-47 NMSA l978, and no dependent or any class thereof, other than a widow, widower or children, shall in any event be paid total benefits in excess of seven thousand five hundred dollars ($7,500) exclusive of funeral expenses and the expenses provided for medical and hospital services for the deceased paid for by the employer."
SECTION 4. Section 52-1-51 NMSA 1978 (being Laws 1929, Chapter 113, Section 19, as amended) is amended to read:
"52-1-51. PHYSICAL EXAMINATIONS OF WORKER--INDEPENDENT MEDICAL EXAMINATION--UNSANITARY OR INJURIOUS PRACTICES BY WORKER--TESTIMONY OF HEALTH CARE PROVIDERS.--
A. In the event of a dispute between the parties concerning the reasonableness or necessity of medical or surgical treatment, the date upon which maximum medical improvement was reached, the correct impairment rating for the worker, the cause of an injury or any other medical issue, if the parties cannot agree upon the use of a specific independent medical examiner, either party may petition a workers' compensation judge for permission to have the worker undergo an independent medical examination. If a workers' compensation judge believes that an independent medical examination will assist the judge with the proper determination of any issue in the case, including the cause of the injury, the workers' compensation judge may order an independent medical examination upon the judge's own motion. The independent medical examination shall be performed immediately, pursuant to procedures adopted by the director, by a health care provider other than the designated health care provider, unless the employer and the worker otherwise agree.
B. In deciding who may conduct the independent medical examination, the workers' compensation judge shall not designate the health care provider initially chosen by the petitioner. The workers' compensation judge shall designate a health care provider on the approved list of persons authorized by the committee appointed by the advisory council on workers' compensation to create that list. The decision of the workers' compensation judge shall be final. The employer shall pay for any independent medical examination.
C. Only a health care provider who has treated the worker pursuant to Section 52-1-49 NMSA 1978 or the health care provider providing the independent medical examination pursuant to this section may offer testimony at any workers' compensation hearing concerning the particular injury in question.
D. If, pursuant to Subsection C of Section 52-1-49 NMSA 1978, either party selects a new health care provider, the other party shall be entitled to periodic examinations of the worker by the health care provider the [worker] other party previously selected. Examinations may not be required more frequently than at six-month intervals; except that upon application to the workers' compensation judge having jurisdiction of the claim and after reasonable cause therefor, examinations within six-month intervals may be ordered. In considering such applications, the workers' compensation judge shall exercise care to prevent harassment of the claimant.
E. If an independent medical examination or an examination pursuant to Subsection D of this section is requested, the worker shall travel to the place at which the examination shall be conducted. Within thirty days after the examination, the worker shall be compensated by the employer for all necessary and reasonable expenses incidental to submitting to the examination, including the cost of travel, meals, lodging, loss of pay or other like direct expense, but the amount to be compensated for meals and lodging shall not exceed that allowed for nonsalaried public officers under the Per Diem and Mileage Act.
F. No attorney shall be present at any examination authorized under this section.
G. Both the employer and the worker shall be given a copy of the report of the examination of the worker made by the independent health care provider pursuant to this section.
H. If a worker fails or refuses to submit to examination in accordance with this section, the worker shall forfeit all workers' compensation benefits that would accrue or become due to the worker except for that failure or refusal to submit to examination during the period that the worker persists in such failure and refusal unless the worker is by reason of disability unable to appear for examination.
I. If any worker persists in any unsanitary or injurious practice that tends to imperil, retard or impair the worker's recovery or increase the worker's disability or refuses to submit to such medical or surgical treatment as is reasonably essential to promote the worker's recovery, the workers' compensation judge may in the judge's discretion reduce or suspend the workers' compensation benefits."
SECTION 5. Section 52-5-1.3 NMSA 1978 (being Laws 1990 (2nd S.S.), Chapter 2, Section 63) is amended to read:
"52-5-1.3. [SAFETY AND FRAUD DIVISION] ENFORCEMENT BUREAU.--
A. There is created in the workers' compensation administration [a "safety and fraud division"] an "enforcement bureau".
[B. The safety and fraud division shall develop a program to identify extra-hazardous employers. "Extra-hazardous employer" means an employer whose injury frequencies substantially exceed those that may reasonably be expected in that employer's business or industry. The safety and fraud division shall notify each identified extra-hazardous employer and the insurance carrier for that employer that the employer has been identified as an extra-hazardous employer.
C. An employer who receives notification under Subsection B of this section must obtain a safety consultation within thirty days from the safety and fraud division, the employer's insurer or another professional source approved by the director for that purpose. The safety consultant shall file a written report with the director and the employer setting out any hazardous conditions or practices identified by the safety consultation.
D. The employer in consultation with the safety consultant shall, within a reasonable time, formulate a specific accident prevention plan that addresses the hazards identified by the consultant. An employer who fails to formulate, implement or otherwise comply with the accident prevention plan shall be subject to a penalty not to exceed five thousand dollars ($5,000).
E.] B. The [safety and fraud division] enforcement bureau shall investigate to determine whether any fraudulent conduct relating to workers' compensation is being practiced. The [safety and fraud division] enforcement bureau shall refer to an appropriate law enforcement agency any finding of fraud. For any claim pending in the administration, the [safety and fraud division] enforcement bureau shall also bring its findings to the attention of the workers' compensation judge assigned to that claim.
[F.] C. For the purposes of this section, "fraud" includes the intentional misrepresentation of a material fact resulting in workers' compensation or occupational disablement coverage, the payment or withholding of benefits or an attempt to obtain or withhold benefits. The intentional misrepresentation of a material fact may occur through the conduct, practices, omissions or representations of any person. Any person found guilty of committing fraud shall be sentenced pursuant to the provisions of Section 30-16-6 NMSA 1978 and the provisions of the Criminal Sentencing Act."
SECTION 6. Section 52-5-1.4 NMSA 1978 (being Laws 1990 (2nd S.S.), Chapter 2, Section 64, as amended) is amended to read:
"52-5-1.4. OMBUDSMAN PROGRAM.--
A. The director shall establish an ombudsman program to assist injured or disabled workers, persons claiming death benefits, employers and other persons in protecting their rights and obtaining information available under workers' compensation and occupational disease disablement laws.
B. An ombudsman shall meet with or otherwise provide information to injured or disabled workers, investigate complaints and communicate with employers, insurance carriers and health care providers on behalf of injured or disabled workers. An ombudsman shall otherwise assist unrepresented claimants, employers and other parties to enable them to protect their rights in the workers' compensation and occupational disease disablement system. At least one specially qualified employee in each location that the administration has an office shall be designated by the director as an ombudsman, and duties described in this section shall be that person's primary responsibility. The director may designate additional ombudsmen and assign them as [he] the director deems appropriate.
C. An ombudsman need not be an attorney but shall demonstrate familiarity with workers' compensation and occupational disease disablement laws. [Any person employed as an ombudsman shall be ineligible to hold any other position in the administration for at least one year from the date of leaving the position of ombudsman.]
D. An ombudsman shall not be an advocate for any person and shall restrict [his] ombudsman's activities to providing information and facilitating communication. An ombudsman shall not assist a claimant, employer or any other person in any proceeding beyond the informal conference held pursuant to Section 52-5-5 NMSA 1978.
E. Each employer shall notify [his] the employer's employees of the ombudsman service in a manner prescribed by the director. The notice shall include the posting of a notice in one or more conspicuous places. The director shall also describe clearly the availability of the ombudsmen on the first report of accident form required under Section 52-1-58 NMSA l978, or the first report of disablement form required under Section 52-3-51 NMSA 1978."
SECTION 7. Section 52-5-5 NMSA 1978 (being Laws 1986, Chapter 22, Section 31, as amended) is amended to read:
"52-5-5. CLAIMS--INFORMAL CONFERENCES.--
A. When a dispute arises under the Workers' Compensation Act or the New Mexico Occupational Disease Disablement Law, any party may file a claim with the director no sooner than thirty-one days from the date of injury or the occurrence of the disabling disease. The director shall assist workers and employees not represented by counsel in the preparation of the claim document.
B. The director shall prepare a form of claim, which shall be available to all parties. The claim shall state concisely in numbered paragraphs the questions at issue or in dispute [which] that the claimant expects to be determined with sufficient particularity that the responding or opposing party may be notified adequately of the claim and its basis, including, if applicable, the specific benefit [which] that is due and not paid.
C. Upon receipt, every claim shall be evaluated by the director or [his] the director's designee, who shall then contact all parties and attempt to informally resolve the dispute. Within sixty days after receipt of the claim, the director shall issue [his] recommendations for resolution and [provide] serve the parties with a copy [by certified mail, return receipt requested]. Within thirty days of receipt of the recommendation of the director, each party shall notify the director on a form provided by [him] the director of the acceptance or rejection of the recommendation. A party failing to notify the director waives any right to reject the recommendation and is bound conclusively by the director's recommendation unless, upon application made to the director within thirty days after the foregoing deadline, the director finds that the party's failure to notify was the result of excusable neglect. If either party makes a timely rejection of the director's recommendation, the claim shall be assigned to a workers' compensation judge for hearing.
D. Each party to a dispute shall have a peremptory right to disqualify one workers' compensation judge; provided that:
(1) the employer and [his] the employer's insurer shall constitute a single party for purposes of this subsection;
(2) this peremptory right to disqualify one worker's compensation judge shall not apply to the judge appointed pursuant to Section 52-1-49 NMSA 1978 to render a decision within seven days on a request for a different health care provider; and
(3) no party shall be required to disqualify a workers' compensation judge until a judge has been assigned to a case."
SECTION 8. Section 52-5-6 NMSA 1978 (being Laws 1986, Chapter 22, Section 32, as amended) is amended to read:
"52-5-6. AUTHORITY OF THE DIRECTOR TO CONDUCT HEARINGS.--
[A. Hearings shall be held in the county in which the injury or disablement occurred for which the claim is being made unless the parties agree otherwise. Upon motion of a party, or upon his own motion, if he finds that good cause exists, the workers' compensation judge may order the hearing to be held in the workers' compensation administration regional office located nearest to the county in which the injury or disablement occurred or in the county identified as being in the best interests of the parties, taking into consideration cost-effectiveness, judicial efficiency, the health and mobility of the employee and the convenience of parties and witnesses.]
A. Unless the parties agree otherwise, or it is ordered by the workers' compensation judge or the director in the case of a director's hearing, hearings shall be held at an office of the workers' compensation administration that is located nearest to the location of injury or disablement. In determining the site of hearing, the judge or the director shall consider cost-effectiveness, judicial efficiency, the health and mobility of the worker and the convenience of parties and witnesses. Hearings may be conducted by videoconferencing or by telephone at the discretion of the judge or the director.
B. The workers' compensation judge and the director shall have the power to preserve and enforce order during hearings; administer oaths; issue subpoenas to compel the attendance and testimony of witnesses, the production of books, papers, documents and other evidence or the taking of depositions before a designated individual competent to administer oaths; examine witnesses; enter noncriminal sanctions for misconduct; and do all things conformable to law [which] that may be necessary to enable [him] the judge or the director to discharge the duties of [his] the judge's or the director's office effectively.
C. In addition to the noncriminal sanctions that may be ordered by the workers' compensation judge or the director, any person committing any of the following acts in a proceeding before a workers' compensation judge or the director may be held accountable for [his] the person's conduct in accordance with the provisions of Subsection D of this section:
(1) disobedience of or resistance to any lawful order or process;
(2) misbehavior during a hearing or so near the place of the hearing as to obstruct it;
(3) failure to produce any pertinent book, paper or document after having been ordered to do so;
(4) refusal to appear after having been subpoenaed;
(5) refusal to take the oath or affirmation as a witness; or
(6) refusal to be examined according to law.
D. The director may certify to the district court of the district in which the acts were committed the facts constituting any of the acts specified in Paragraphs (1) through (6) of Subsection C of this section. The court shall hold a hearing and, if the evidence so warrants, may punish the offending person in the same manner and to the same extent as for contempt committed before the court, or it may commit the person upon the same conditions as if the doing of the forbidden act had occurred with reference to the process of or in the presence of the court."
SECTION 9. EFFECTIVE DATE.--The effective date of the provisions of this act is July 1, 2013.
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