Section Lab 506.02 - Acceptance or Denial of Claims and Filing of Reports and Payment of Benefits(a) If upon investigation it is determined that the claim is compensable, the carrier or employer within 21 days of notification of claim or period of disability shall: (1) Pay compensation to the injured employee;(2) Complete and file a "Memo of Payment", form 9WCA (6/1994), contained in Appendix II with the department with a copy to the employee; and(3) Complete and file the "Memo of Payment", form 9WCA (6/1994) contained in Appendix II to indicate any payment or change in benefits paid to an employee, as follows: a. Box "1" shall be completed if: 1. A payment of compensation is definitive either as a first payment of compensation, or is an adjustment of provisional payment;2. A change in the compensation rate such as temporary partial benefits;3. A first payment resulting from a departmental hearing decision or is a payment of adjusted total disability under RSA 281-A:29; or4. The average weekly wage is a result of combined earnings;b. Box "2" shall be completed when first payment is made provisionally because of the absence of wage information; c. Box "3" shall be completed when a final payment of compensation is made due to the claimant returning to work or because of benefit limitation under the law, RSA 281-A:26, RSA 281-A:31, or a "lump sum settlement" under RSA 281-A:37;d. Box 2 shall not be completed if box 1 is completed:e. Failure of a carrier to file an accurately and fully completed "Memo of Payment", form 9WCA (6/1994). contained in Appendix II shall constitute non compliance shall subject the carrier to the civil penalty as prescribed by RSA 281-A:42 and Lab 508.02(e).f. Defect as to format or contents may render the filing invalid and subject the carrier to the civil penalty in e. above as explained in Lab 508.02.(b) The carrier shall attach to the "Memo of Payment", form 9WCA (6/1994), contained in Appendix II the department's copy of the "Wage Schedule", form 76WCA (9/2014), contained in Appendix II when definitive payment of compensation is made for the first time. No wage schedule shall be necessary if the disability period is 14 days or less or payroll records are submitted that clearly show the gross earnings of the employee per pay period for 52 weeks prior to the date of injury if available.(c) In addition to the method set out in RSA 281-A: 15 the average weekly wage shall be computed as follows: (1) Wages shall include vacation pay, commission and bonuses for the periods to which such payments apply, and all other considerations required by RSA 281-A:2, XV, RSA 281-A:15, III and Lab 504.02(k) and (l);(2) In computing the average weekly wage for the 26 weeks prior to the injury, weeks with reduced earnings which occurred during the week of injury or the week of hire shall be eliminated;(3) If this method does not yield a figure reflective of the claimant's true average weekly earnings, wages earned during additional preceding consecutive weeks, up to a total of 52 weeks prior to the injury, shall be used to compute an average;(4) An employer shall submit a 52 week record of gross earnings upon request of the employee or the labor department; and(5) In the event that the employee's compensation rate is determined by utilizing the after tax earnings rate as defined by RSA 281-A:15, IV, the carrier shall complete and submit a "Supplemental Wage Schedule", form 76WCA1 (4/2014), contained in Appendix II completed in its entirety, with any and all documentation used to support the calculation of the after tax earning indemnity rate as follows. a. Documentation shall include, but not be limited to, a copy of the applicable "Federal Income Tax Withholding" table contained within Circular E of the Employer's Tax Guide, used to determine the amount of the income tax withheld; andb. The Federal Withholding Schedule and Federal Insurance Contribution Act rate factor used to calculate these deductions shall be based on the rates that are in effect at the time of the injury, contained within Circular E of the Employers Tax Guide published by the Internal Revenue Service.(d) If at the time of an injury an employee is employed by 2 or more employers subject to RSA 281-A:55 and RSA 281-A:55-a, the employee shall be eligible for wages based on combined earnings pursuant to RSA 281-A:15, III, with eligibility determined for combined earnings as follows:(1) Carriers and self-insured employers shall notify the claimant in writing of possible eligibility for additional weekly disability benefits payable under the combined earnings provisions of the statute. Notice shall be issued in all cases of injury pursuant to RSA 281-A:15, III where the disability exceeds the waiting period;(2) Notice, for the purposes of (1) above shall consist of the following statement: "If you worked for more than one New Hampshire employer at the time you were injured, you may be entitled to additional weekly disability benefits under the combined earnings provision of the law. Upon your request, your employers are required to complete a Wage Schedule, form 76WCA (9/2015) contained in Appendix II or payroll records as described in Lab 506.02(b) and to submit it to the claims representative handling your claim. Contact your insurance carrier or the New Hampshire department of labor for further information";(3) The combined earnings shall be calculated as follows:a. Allowable sources of wages shall be limited to concurrent employment subject to the New Hampshire workers' compensation law;b. Sources of income that shall not be considered for concurrent employment include: 2. Uninsured self-employment;4. Other employment not subject to New Hampshire workers' compensation law;c. The claimant's wages from all allowable sources shall be added for each week; andd. The average weekly wage shall be the result of adding the weekly totals and dividing by the number of weeks.(e) In no case, including calculation of average weekly wage on the basis of combined earnings, shall the resulting compensation rate for any type of indemnity exceed the maximum set forth in RSA 281-A:28, II.(f) Upon the injured worker's return to work, the carrier shall notify the worker in writing that if based on his or her injury, he or she is earning less than his or her average weekly wage prior to the injury, he or she shall submit or cause to be submitted a record of his or her earnings.(g) Carriers shall begin payment of temporary partial disability benefits under RSA 281-A:31 and Lab 506.02(a) (3) when: (1) Upon return to work, a partially disabled claimant's earnings due to the work injury are less than the average weekly wages prior to the injury; and(2) In the case of concurrent employment, pursuant to RSA 281-A:15, III, upon return to any employment(s), the partially disabled claimant's earnings are less due to the work injury than the average weekly wages prior to the injury.(h) When an employee dies from an occupational injury or disease the carrier shall pay compensation to dependents in accordance with the provision of RSA 281-A:26 as follows: (1) Weekly payment shall begin as soon as possible after death occurs, but no later than 21 days after dependency is established;(2) The carrier shall file with the department the "Memo of Payment", form 9WCA (6/1994), contained in Appendix II with an appropriate wage schedule or payroll records, birth and marriage certificate if applicable;(3) Allocation adjustments shall be made as soon as possible after receiving from the department the "Authorization for Compensation for Death", form 14WCA (10/2001), contained in Appendix II giving the dependency allocation, but no later than 7 days thereafter; and(4) Funeral expenses, as provided by statute, shall be paid as soon as possible after presentation of an invoice or statement.(i) Carriers shall notify an injured worker that he or she is entitled to medical care, choice of doctor and mileage reimbursement costs to medical appointments as follows: (1) The injured workers' choice of doctor may be limited if the employer is within a managed care program;(2) Carriers shall pay the cost of medical, hospital, remedial and health support services, and devices and appliances related to occupational injuries or diseases in accordance with RSA 281-A:23 as soon as possible after presentation of invoice or statement, but no later than 30 days thereafter: and(3) Payable costs under RSA 281-A:23 and Lab 506.02 shall include the related reasonable and documented expenses of the claimant for all necessary travel and meals and lodging, including the use of a personal vehicle at the rate established for state employees.(j) Carriers shall notify an injured worker that they may be entitled to a permanent impairment award for the loss of specified members or parts of the body or for loss of the use thereof under RSA 281-A:32.(k) In order to determine and pay a permanent impairment award, the carrier shall:(1) Contact the injured employee and the employee's treating physician to advise him or her of the need of a permanent impairment evaluation which shall: a. Be based on the 5th edition of the Guides to the Evaluation of Permanent Impairment, published by the American Medical Association; available as noted in appendix III;b. Contain an affirmation from the submitting physician that the findings for permanent bodily loss were determined from the Guides to the Evaluation of Permanent Impairment, the 5th edition; available as noted in appendix III; andc. Contain medical evidence that the injured worker has reached maximum medical improvement.(2) Once an injured worker has achieved maximum medical improvement, advise the injured worker that if the treating physician does not perform permanent impairment evaluations, the physician may refer the employee to a physician that does perform permanent impairment evaluations;(3) Pay the cost of the initial permanent impairment evaluation by the treating or referring physician;(4) Complete and submit "Memo of Permanent Impairment Award", form 10WCA (10/1998), contained in Appendix II together with the medical reports that support the impairment rating within 15 days of receipt of the physicians report if no objection is filed;(5) Pay the permanent impairment award within 5 days of receipt of the approved "Memo of Permanent Impairment Award", form 10WCA (10/1998), contained in Appendix II.(6) Pay the permanent impairment award based on the physicians report that used the 5th Edition Guides to the Evaluation of Permanent Impairment published by the American Medical Association except where RSA 281-A:32 II is more favorable to the injured worker;(7) Pay the award in a single payment based on the average weekly wage of the employee at the time of the injury;(l) If upon receipt of the permanent impairment award evaluation, the carrier, self-insurer, employer, or third party administrator objects to the percentage of loss given by the treating or referred physician, they shall: (1) Notify the department of labor within 15 days of receipt of the permanent impairment evaluation;(2) Arrange for an independent medical examination in accordance with RSA 281-A:32, XI and RSA 281-A:38 within 30 days of their objection to the treating or referring physicians report; and(3) Request a hearing on the matter.(m) If upon receipt of the permanent impairment award evaluation, an objection is not filed with the department of labor pursuant to 506.02(l) above, the carrier shall: (1) Accept the rating filed by the treating or referred physician;(2) Complete and file the "Memo of Permanent Impairment Award", form 10WCA (10/1998), contained in Appendix II; and(3) Pay the award in accordance with RSA 281-A:32, XI.(n) If the carrier, self-insurer, employer, or third party administrator fails to pay the permanent impairment award and comply with (m) (1-3) above, the commissioner shall order payments of the award in accordance with RSA 281-A:43, II.(o) If the employer or carrier determines that the case is not compensable: (1) The employer or carrier shall complete and file a "Memo of Denial of Workers Compensation Benefits", form 9WCA-1(9/2015), contained in Appendix II with the department and send a copy to the claimant within 21 days of notification of a claim or subsequent period of disability; and(2) The denial shall: a. State the reason for the denial;b. Advise the employee of their right to request a hearing within 18 months of the date of the denial if the employee disagrees with the denial;c. Provide the employee with the name, phone number and email address of the adjuster; andd. Provide a narrative explanation for the denial.(p) If disability benefits have been paid within the first 21 days of the receipt of notice of disability, and the employer, carrier, self-insured or third party administrator determines that payment should not have been made, they may cease weekly payments of compensation as follows: (1) If payments have been made for no longer than 21 days, compensation may cease;(2) A letter shall be written to the injured worker setting forth the reason for denial of the claim and the cessation of benefits;(3) The injured employee shall be notified of his or her right to a hearing if the denial is contested;(4) The injured employee shall be advised that the request for a hearing must be made within 18 months of the date of denial; and(5) Copies of all such correspondence shall be sent to all parties including the department simultaneously.(q) If disability benefits have been paid after 21 days following the carrier's receipt of the notice of disability the carrier shall request permission of the department prior to terminating benefits as provided in RSA 281-A:48 and Lab 510.02, subject to the following: (1) Failure to obtain permission shall subject the employer or carrier to fines under RSA 281-A:42; and(2) Failure to make timely payments shall subject the employer or carrier to make payment of interest to the employee in accordance with RSA 281-A:42, V and subject the employer, carrier, self-insured or third party administrator to fines under RSA 281-A:42.(r) If payment of the bill under RSA 281-A:23 is denied, the carrier shall: (1) Write the employee on carrier letterhead and copy the provider and the labor department, providing explanation of the denial, which shall:a. Be issued within 30 days of the receipt of the bill or invoice;c. Advise the employee of the reason for the denial;d. Advise the employee of the identity of the entity issuing the denial; ande. Advise the employee of their right to request a hearing within 18 months of the date of denial if the employee disagrees with the denial; and(2) Failure to follow procedures in Lab 506.02(r) (1) shall subject the carrier to fines under RSA 281-A:23, V (e), as explained in Lab 508.02.(s) When a dispute arises as to the reasonable value of medical hospital and remedial services, the employer or its insurance carrier shall pay, in the first instance, what they feel reasonable within 30 days from presentation of invoice or statement. They shall state in writing to the party providing such services, copy to the labor department, reasons for contesting the unpaid balance. The parties shall make an effort to resolve any dispute. If the parties cannot resolve the differences concerning invoices with dates of service of 9/4/15 and after, a hearing may be requested pursuant to RSA 281-A:24 at which the provider shall have the burden of proof.(t) Payment of any net benefit made directly to the claimant shall be made promptly in a form that allows the claimant easy accessibility to it.(u) In order to be in substantial compliance with RSA 281-A:42 for making payment of compensation, and in substantial compliance with Lab 501.02 for paying benefits in amounts, manner and when due, the carrier or employer shall establish a payment system that meets the following criteria:(1) Payment of compensation for disability shall be made:a. For partial disability where a statement of earnings is needed to compute the benefits, within 5 days from the date of receipt of such documentation; andb. For all other benefits, weekly on a day designated at the onset of payment of the claim. If the designated day falls on a holiday, payment shall be made the day prior.(2) The normal standard payment procedure shall be by delivery of a paper check, made payable to the claimant, and delivered to the home address of the claimant. Alternatively, the employer may make a direct deposit to a claimant's financial account, if the claimant so authorizes. Also, at the claimant's option, the parties may agree in writing upon an alternate payment procedure, called here a "paycard", so long as it meets the criteria of this paragraph;(3) The paycard shall provide to the claimant at least one free means to withdraw up to and including the full amount of the claimant's account during each benefit payment period at a financial institution or other location within 20 miles from the claimant's home address;(4) The payment of the benefit to the claimant shall be verifiable by the claimant, either by delivery of a paper deposit receipt, or by the ability to view the transaction through a secure internet connection;(5) If the paycard offers options other than cash withdrawals, there shall be written disclosure in plain language of all the claimant's options. The written disclosure shall state the terms and conditions of the paycard, including, but not limited to, the requirements set forth in this section and a complete itemized list of all known fees that may be deducted from the paycard account by the employer or the card issuer. The disclosure shall also state whether third parties may assess transaction fees in addition to the fee assessed by the paycard issuer or issuers;(6) In no event shall the employer provide payment of benefits to a paycard that has an expiration date, unless the employer agrees to provide a replacement paycard before the expiration date at no cost to the employee;(7) The employer shall provide written notice of any change to any of the terms and conditions of the paycard account, including but not limited to an itemized list of all fees that may have changed; and(8) The employer shall provide the claimant the option to discontinue receipt of benefits by a paycard account at any time, without penalty to the claimant.N.H. Admin. Code § Lab 506.02
#2264, eff 1-6-83; ss by #2935, eff 12-27-84; amd by #4854, eff 6-29-90; amd by #5041, eff 1-9-91; ss by #5235, eff 9-27-91, EXPIRED: 9-27-97
New. #6631, INTERIM, eff 11-16-97, EXPIRED: 3-16-98
New. #6806, eff 7-18-98); ss by #8682, INTERIM, eff 7-15-06, EXPIRED: 1-11-07
New. #9019, eff 11-1-07; amd by #10038, eff 12-1-11
Amended by, Volume XXXVI Number 14, Filed April 7, 2016, Proposed by #11067, Effective 4/1/2016, Expires 4/1/2026.