46th legislature - STATE OF NEW MEXICO - first session, 2003

RELATING TO WORKERS' COMPENSATION; CHANGING HOW HEALTH CARE PROVIDERS ARE SELECTED.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO:

Section 1. Section 52-1-49 NMSA 1978 (being Laws 1959, Chapter 67, Section 27, as amended) is amended to read:

"52-1-49. MEDICAL AND RELATED BENEFITS--SELECTION OF HEALTH CARE PROVIDER--ARTIFICIAL MEMBERS.--

A. After an injury to a worker and subject to the requirements of the Workers' Compensation Act, and continuing as long as medical or related treatment is reasonably necessary, the employer shall, subject to the provisions of this section, provide the worker in a timely manner reasonable and necessary health care services from a health care provider.

B. The employer shall initially [either] select the health care provider for the injured worker [or permit]. The employer shall serve upon the injured worker [to make the selection] a notice in writing of the name and address of the employer's choice of the initial health care provider within ten days of the date the injured worker notified the employer of the work-related accident pursuant to Section 52-1-29 NMSA 1978. The director shall adopt rules governing forms to enable this notice to be promptly and efficiently provided. Subject to the provisions of this section, that selection shall be in effect during the first sixty days from the date the [worker receives treatment from] employer notifies the worker in writing of the name and address of the employer's choice of the initially selected health care provider.

C. After the expiration of the initial sixty-day period set forth in Subsection B of this section, the [party who did not make the initial selection] injured worker may select a health care provider of his choice. Unless the worker and employer otherwise agree, the [party seeking such a change] injured worker shall file a notice of the name and address of his choice of health care provider with the [other party] employer at least ten days before treatment from that health care provider begins. The director shall adopt rules [and regulations] governing forms, which employers shall post in conspicuous places, to enable this notice to be promptly and efficiently provided. This notice may be filed on or after the fiftieth day of the sixty-day period set forth in Subsection B of this section.

D. If [a party] the employer objects to the choice of health care provider made pursuant to Subsection C of this section, then he shall file an objection to that choice pursuant to Subsection E of this section with a workers' compensation judge within three days from receiving the notice. He shall also provide notice of that objection to the other party. If the employer does not file his objection within the three-day period, then he shall be liable for the cost of treatment provided by the worker's health care provider until the employer does file his objection and the workers' compensation judge has rendered his decision as set forth in Subsection F of this section. [If the worker does not file his objection within the three-day period, then the employer shall only be liable for the cost of treatment from the health care provider selected by the employer, subject to the provisions of Subsections E, F and G of this section.] Nothing in this section shall remove the employer's obligation to provide reasonable and necessary health care services to the worker so long as the worker complies with the provisions of this section.

E. If the worker or employer disagrees with the choice of the health care provider of the other party at any time, including the initial sixty-day period, and they cannot otherwise agree, then he shall submit a request for a change of health care provider to a workers' compensation judge. The director shall adopt rules [and regulations] governing forms, which employers shall post in conspicuous places, to submit to a workers' compensation judge a request for change of a health care provider.

F. The request shall state the reasons for the request and may state the applicant's choice for a different health care provider. The applicant shall bear the burden of proving to the workers' compensation judge that the care being received is not reasonable. The workers' compensation judge shall render his decision within seven days from the date the request was submitted. If the workers' compensation judge grants the request, he shall designate either the applicant's choice of health care provider or a different health care provider.

G. If the worker continues to receive treatment or services from a health care provider rejected by the employer and not in compliance with the workers' compensation judge's ruling, then the employer is not required to pay for any of the additional treatment or services provided to that worker by that health care provider.

H. In all cases where the injury is such as to permit the use of artificial members, including teeth and eyes, the employer shall pay for the artificial members."