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GSD/RMD Workers’ Compensation Bureau

GSD/RMD Workers’ Compensation Bureau. Workers’ Compensation Insurance for all State Employees and State Universities. Approximately 52,000 Employees Approximately 150 State Agencies Eight Adjusters Santa Fe/LC. 1991 WC Statutes (new Law).

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GSD/RMD Workers’ Compensation Bureau

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  1. GSD/RMDWorkers’ Compensation Bureau Workers’ Compensation Insurance for all State Employees and State Universities. Approximately 52,000 Employees Approximately 150 State Agencies Eight Adjusters Santa Fe/LC

  2. 1991 WC Statutes (new Law) • Posters with information have to be posted at all employees work site to advise right to file an injury. • Future medical treatment for reasonable and necessary treatment to THAT injury stay open. • Medical impairments to the injured body parts are set by statute. • First choice of Health Care Provider, first 60 days.

  3. Ins. Premiums • Insurance Premiums are based on 5 yr. Experience/Exposure. • ERTW Modified duty saves money on premiums, since WC benefits are not being paid out, only medical coverage.

  4. Process of filing a Claim • When an employee gets injured or thinks they come in contact with an illness at work due to “COURSE & SCOPE OF THEIR EMPLOYMENT”, file a Notice Of Accident (NOA). • Employer should have on-going training for employees on this process. • Notice to Employer/Supervisor is sufficient. Once Employer has knowledge then it is Employers responsibility to file the paper work. • Not up to Employer or Supervisor to deny the claim.

  5. Medical Care • In an Emergency an Injured worker should be directed to Hospital ER nearest to the place of employment. • ER is no one’s first choice of Health Care. • If not an Emergency an Employer can direct injured worker to a Medical provider OR can Permit injured worker to choose a medical provider of their choice for the first 60 days. We do not have a Contract Medical Provider any where in the State.

  6. Continued • If the doctor that the injured worker chooses, does not accept workers comp insurance let them know they can find a doctor that does accept WC Insurance, direct them to the WCA for information as to what doctors accept workers compensation insurance. • WCA Offices 1 800 841-6000 Albuquerque, Farmington, Las Cruces, Las Vegas, Lovington, Roswell and Santa Fe

  7. EMPLOYERS’ REPORT

  8. Doctor Query Form • This form should be sent with an injured worker to Dr. every time they have an appt. • Can they work? • Can they work with restrictions? • Can they work Part Time? • Can employer accommodate restrictions?

  9. Investigation of a Claim Adjuster assigned the claim will determine if claim is compensable based on information given, medical evidence, WC Statutes, and Case Law If Adjuster denies claim, injured worker has a right to file a complaint with WCA, goes to Mediation, if not agreed by both parties, goes into hearing with WCA Judge, and can go into Trial.

  10. Benefit payment • If a doctor states NO Work, WC will start benefits on the 8th day of lost time. Temp. Total Disability (TTD) at 66 2/3 of injured workers Average weekly wage. This is calculated by the gross income for 26 weeks prior to the date of injury. There is a Max Comp Rate and that changes every January. • January 1, 2014 = $759.89 Max Rate • Minimum Rate = $ 36.00 a week • Continue payment until released back to work or can come back to modified duty with medical restrictions.

  11. If Claim Is Accepted • Medical get paid to that injury for reasonable and necessary treatment till resolved or on-going treatment is needed. • All medical bills and referrals are paid for reasonable and necessary treatment (PT,OT, MRI, x-rays, second opinions, IME). • If doctor determines injured worker can not work, Temporary Total Disability (TTD) is calculated after the 7 day waiting period and paid as WC Benefit. • Temporary Partial Disability (TPD).

  12. Average Weekly Wage Form (AWW) We will ask to fill this form from HR , we need to get average weekly wage according to NMWC Statute 5.21.20. Includes Gross income, Overtime, Shift Differential to include other part time work also. Impairment are also calculated according to the COMP Rate (66 2/3 % of AWW, taken from the AWW. For instance if an IW is at MMI, suffered a 10% impairment, the AWW wage is 500 the Comp rate is 333.33 x 10 % = $33.33 per week for 300 weeks or 500 weeks whole person. Scheduled injury, (knee, arm, leg) is so many weeks according to the ACT.

  13. ADJUSTERS • AKEMI ROBLES (575) 521-6257 LAS CRUCES • SILVA, RAY (575) 521-5919 LAS CRUCES • ANDREA ARMENTA (505) 476-3762 • TODD WILSON (505) 827-0451 • CINDY CARRILLO (505) 476-3871 • CHARLENE URBAN (505) 827-0338 • RICKY KITCH (505) 827-0272 • MARCEA DARK (505) 827-0347 • ANDREA CHAVEZ (505) 476-2174 CLAIMS INFORMATION • CARL SANDOVAL (505) 476-3874 SCANNER • CHERYL HUTTO (505) 827-2711 CLAIMS INFORMATION • PATRICIA ZENDEL (505) 827-0253 BILLING • MARTIN SANDOVAL (575) 476-3787 BILLING • Bureau Chief, IDA SPENCE (505) 827-0299

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