N.M. Admin. Code § 13.17.5.7

Current through Register Vol. 35, No. 22, November 19, 2024

Section 13.17.5.7 - DEFINITIONS

A."Assigned risk pool or pool" means the workers' compensation insurance assigned risk facility established by Chapter 59A, Article 33 NMSA 1978.

B."Client" means an employer which obtains workers through an employee leasing arrangement.

C."Employee leasing arrangement" means any arrangement whereby an employer contracts with a leasing contractor to provide all or some of the employer's workers; provided, that the term does not include the provision of temporary workers.

D."Employer" means any person or entity, including a leasing contractor and a client, as defined in, or having the right to control workers within the meaning of case precedents applicable to, the Workers' Compensation Act (Chapter 52, Article 1 NMSA 1978) or the New Mexico Occupational Disease Disablement Law (Chapter 52, Article 3 NMSA 1978).

E."Leased worker" means a worker provided to a client through an employee leasing arrangement; provided that, if a worker has been previously employed by the client prior to working for a leasing contractor, it shall be presumed that the worker is a leased worker, not a temporary worker; and further provided that, if a worker works and should be classified in any construction class, or in any oil and gas well-service or drilling class, the worker shall be presumed to be a leased worker.

F."Leasing contractor" means any person or entity which provides all or any part of a client's New Mexico workers through an employee leasing arrangement.

G."Premium subject to dispute" means premium for a workers' compensation policy as to which the insured has provided a written notice of dispute to the insurer or servicing carrier, and has filed a written request for pending administrative review or has initiated pending litigation. To qualify as premium subject to dispute, the insured must have identified and detailed specific areas of dispute, have provided a reasonable estimate of the premium believed to be correct, and have paid the amount of such undisputed premium in full.

H."Rating based upon experience" includes any workers' compensation premium rating plan which provides for premium adjustments based upon an insured's loss experience under a workers' compensation insurance policy, including but not limited to any approved experience rating plan and the assigned risk adjustment program (ARAP).

I."Subterfuge" means any artifice, trick, device, misrepresentation or concealment, whether committed knowingly or negligently, including but not limited to:

(1) providing false or misleading information to an insurer, its agent, a rating bureau or the assigned risk pool;

(2) failing or refusing to make full disclosure to an insurer, its agent, a rating bureau or the pool of an employer's, client's or leasing contractor's true ownership, change of ownership, or current or previous employee leasing arrangements;

(3) failing or refusing to make full disclosure of any employer's, client's or leasing contractor's operations, location, payrolls, worker's compensation loss experience, experience modifiers, worker classifications or other necessary rating information;

(4) failing or refusing to disclose the existence of more than one policy covering an employer's, client's or leasing contractor's workers; or

(5) failing or refusing to disclose the identity of all former insurers and self-insurance plans providing workers compensation coverage to an employer's, client's or leasing contractor's workers, including but not limited to workers provided to any client through an employee leasing arrangement.

J."Temporary worker" means a worker hired and employed by an employer to support or supplement another's work force in special work situations such as employee absences, temporary skill shortages, seasonal workloads and special temporary assignments such as temporary work for the production of a motion picture; and

K."Worker" includes "worker" or "workman" as defined pursuant to the Workers' Compensation Act and employee as defined pursuant to the New Mexico Occupational Disease Disablement Law.

N.M. Admin. Code § 13.17.5.7

9/6/91; Recompiled 11/30/01