NEW MEXICO MUTUAL New Mexico’s Experts in Workers’ Compensation Insurance 1

FALL 2010

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A sEMIANNUAL NEWsLETTEr prEsENTEd by NEW MEXICO MUTUAL

New Mexico Mutual works in partnership with policyholders and regulators to detect, prevent and prosecute fraud. Policyholders are encouraged to report any reasonable suspicion of fraud to New Mexico Mutual and provide supporting documentation to assist the investigation. New Mexico Mutual will investigate the report to determine if a fraud has occurred.

The New Mexico Insurance Code requires all insurers to report any reasonable belief that insurance fraud has been or will be committed. Our internal investigators work closely with the Insurance Fraud Bureau and the Workers’ Compensation Administration (WCA) Enforcement Unit to prosecute fraud.

In 2009, New Mexico Mutual invested more than $200,000 to investigate fraud. Of this amount, 159 investigative assignments were made to licensed private investigators for surveillance, background checks and investigation on 127 different claims.

Fraud can occur in many ways. Checks can be washed or medical claims may be filed for services that did not take place. Workers may report that they are unable to work while actually working in another job. Workers may also file a claim for an alleged on–the-job injury, when they were actually injured at home. Likewise, employers may say that an injured worker of one business is covered under the coverage of another business. In all these examples, insurance fraud occurs that increase costs to the industry.

New Mexico Mutual takes fraud very seriously. Fraud hurts everyone. It hurts the business

owner, the insurance company and the industry in general. Fraud can negatively impact an

individual business owner’s loss ratio to increase rates. Insurers run the risk of paying illegitimate

claims which could drive up expenses. Finally, the whole industry is harmed in that claims get

reported to the National Council on Compensation Insurance impacting the data used to make

rate recommendations to the Division of Insurance.

Workers’ Compensation Fraud -

It’s a Costly Crime

Call the New Mexico Mutual AlertLine at:

877-874-8416 or

File a report online at:

nmmfraud.alertline.com/gcs/welcomeAnyone reporting can remain anonymous and all reports are confidential. You can report reasonable suspicions of fraud online or by phone 24 hours a day, seven days a week.

? Did you know?Investigating Fraud Did you know that the Workers’ Compensation Administration (WCA) Enforcement Bureau has two full time investigators investigating fraud reports related to workers’ compensation? Did you know that the WCA has the authority to criminally prosecute fraudsters? New Mexico Mutual works closely with the WCA Enforcement Bureau investigators to provide all the necessary information to prosecute fraud arising out of workers’ compensation claims.

What should you do if you suspect fraud?

Proud of Twenty YearsIn March of 2011, New Mexico Mutual will celebrate its 20th year in business. In 1991, the State Legislature appropriated funding to establish New Mexico Mutual Casualty Company, which was fully repaid to the State by 1996.

State lawmakers and the industry brought New Mexico Mutual into existence to assure competitive workers’ compensation coverage in New Mexico for all New Mexico businesses. New Mexico Mutual was also tasked to stabilize rates in New Mexico that had fluctuated significantly in the late 80’s and early 90’s. During that time, workers’ compensation coverage costs were exorbitant and the Assigned Risk Pool had grown to more than 40 times the size it is today. Many national carriers abandoned the workers’ compensation market in New Mexico.

The following graph shows how rates have changed collectively over the past 20 years:

NEW MEXICO MUTUAL

Each year New Mexico Mutual partners with the Independent Insurance Agents of New Mexico to sponsor the Annual Scholarship Fund Golf Tournament that provides college scholarships for injured workers or their dependents. With rising education costs, this scholarship can substantially assist the New Mexico families by providing an injured worker or a dependent with the opportunity to obtain an education.

This year will be the 16th Annual Scholarship Fund Golf Tournament. Since its inception, New Mexico Mutual and the Independent Insurance Agents of New Mexico have awarded more than $150,000 in scholarship monies.

Scholarships help families of injured workers

In partnership with the Independent Insurance Agents of New Mexico, New Mexico businesses immediately gained access to competitive and local workers’ compensation insurance coverage and services from New Mexico Mutual.

Today, New Mexico Mutual consists of six companies positioned throughout the workers’ compensation insurance market to serve all types and sizes of employers throughout New Mexico. By January of 2011, New Mexico Mutual plans to offer out-of-state coverage to serve those New Mexico employers with out-of-state business.

Created for New Mexico employers, New Mexico Mutual advocates state lawmakers and regulators for policy solutions that maintain a competitive and stable market in New Mexico to assure that the state is an affordable place to do business. We are a leader in providing superior claims management and loss prevention services in the best interests of injured workers and policyholders.

Many insurance carriers have come and gone over the past 20 years. New Mexico Mutual remains a financially strong company that provides quality and affordable workers’ compensation insurance products and services to New Mexico policyholders, claimants and independent agents.

New Mexico Mutual works with an extensive network of more than 186 authorized providers throughout New Mexico to offer quality and cost-effective medical treatment for injured workers. For a full list of acute care facilities and authorized providers or information about medical treatment referrals and pharmacies, visit the New Mexico Mutual website at newmexicomutual.com and click on the “Locate a Healthcare Provider” button.

Extensive ProviderService Network

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Driver Monitoring ServiceRunning motor

vehicle reports on

employees can

cost up to $10 per

employee. As motor

vehicle accidents represent a significant

risk to policyholders and employees, New

Mexico Mutual encourages policyholders to

monitor employee driving behaviors. To help,

New Mexico Mutual provides a Driver

Monitoring Service to policyholders* free of

charge that automatically checks driving

records for any new violations, convictions,

license suspensions, cancellations or

revocations as well as upcoming license

renewal dates. Every month, policyholders can

receive a concise report to identify any risks so

that management can take action before a

serious accident occurs. To request the “Driver

Monitoring Service,” please visit our website,

newmexicomutual.com and click

employer resources/download forms/Driver

Monitoring Service (SAMBA).

* Driver Monitoring Service is not available for

Assigned Risk policyholders.

Legally Required NoticesState law requires all employers to post notices

in clearly visible locations. New Mexico Mutual

can provide any policyholder the required New

Mexico workers’ compensation posters free of

charge. Call us at 1-800-788-8851 and request

your posters. Policyholders may also obtain the

required posters and more information by

going to the following websites:

workerscomp.state.nm.us/partners/ poster.php

dol.gov/oasam/programs/osdbu/sbrefa/poster/matrix.htm

you can nominate a candidate for this scholarship by simply completing the following information and sending it to:

New Mexico MutualScholarship Nominations3900 Singer Blvd. NEAlbuquerque, NM 87109

• Name of scholarship nominee• Nominee’s relationship to injured worker• Name of injured worker• Place of employment• Nominee’s address, day and evening phone number • Why do you recommend this nominee?• Person nominating, company and contact information

Ask the Expert

New Mexico Mutual Community GivingNew Mexico Mutual has always considered it vital to “give back” to New Mexico communities through in-kind service and charitable giving. This year, New Mexico Mutual will contribute nearly $250,000 to non-profits throughout New Mexico. Some of these organizations include:

• United Way of Central New Mexico

• Mack Chase Scholarship Foundation

• Youth Development, Inc.

• Roadrunner Food Bank

• ARCA

• Special Olympics

• Santa Fe Community Foundation

• Project Share

• Presbyterian Healthcare Foundation

• Carrie Tingley Hospital

• Goodwill

• American Cancer Society

• American Heart Association

• Golden Apple Foundation

• National Hispanic Cultural Center

• Team Builders

• Samaritan Counseling Center of Albuquerque

What do you do with a surveillance video?

In most cases, the worker has suffered a legitimate injury. Benefits are delivered promptly and professionally to those injured workers.

Sometimes evidence appears in surveillance videos that may contradict a disability claim. On those occasions, claims adjusters take steps to mitigate benefits paid where a reasonable suspicion of fraud exists.

For example, surveillance results may challenge Temporary Total Disability benefit payments if a worker is working or participating in activity in a manner that shows the worker’s ability to work. An investigation may also bring about evidence that may prompt a judge to order an Independent Medical Exam to assess the level of disability by an independent physician. Permanent Partial Disability benefits may also be challenged if the surveillance shows that the worker is unable to perform activity at a higher level than presented to the doctor conducting a Functional Capacity Examination.

How does this save the employer money?

Fraud detection assures that New Mexico Mutual only pays claims for legitimate work-related injuries. Legitimate denials of coverage for a fictitious or fraudulent claim protects our policyholders whose loss ratio or experience modifier may be negatively impacted, meaning higher premiums down the road.

How can I help New Mexico Mutual claims adjusters combat fraud?

Communication is the key. If a policyholder or independent agent has any knowledge or information of insurance fraud related to a claim, they should contact the claims adjuster or make a report through New Mexico Mutual’s AlertLine. Prompt reporting and providing more information can assure that insurance fraud is detected, investigated and prosecuted. They may call the New Mexico Mutual claims department at 800-788-8851 or use the AlertLine at 877-874-8416 or online anmmfraud.alertline.com/gcs/welcome.

New Mexico’s Experts in Workers’ Compensation Insurance 3

Michael HamsingClaims Specialist

New Mexico Mutual ServicesNew Mexico Mutual has many online resources available to independent agents and policyholders on our website at newmexicomutual.com. Bookmark the link and log-on today to get information about safety programs, safety videos, independent agency locator, company directory and claims information in English and Spanish. Workplace injuries can also be reported to New Mexico Mutual on-line.

New Mexico Mutual’s claims professionals offer a bilingual help desk to serve Spanish-speaking policyholders and workers. Just call our main office at 505-345-7260 locally or toll-free statewide at 800-788-8851 to access these bilingual services or informational materials. Spanish materials about claims and workplace safety can be downloaded from our website under the ‘Español’ section. Other materials are available online in Spanish including information on how to file a workers’ compensation claim and on premium audit.

En EspañolEs

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Workers’ Compensation 101 Classes AvailableIf one of your employees had a work-related

accident, would you know what to do? Do

you know how to fill out the accident form?

Could you properly investigate the injury?

New Mexico Mutual’s Claims Department

offers a free training program, Work Comp

101, for employers who would like to learn

the basics of workers’ compensation claims

handling, law, and benefits.

Classes are taught by trained claims

professionals and can be offered to

individual businesses, groups, and trade

associations.

If you would like to schedule a Work Comp

101 training class for your business, please

contact Claims Manager Dawn Madden by

phone at 505-343-2819 or by email at

colleenm@newmexicomutual.com.

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Timeliness is always important when reporting a workers’ compensation claim. To make it as easy as possible, New Mexico Mutual policyholders can report their claims online.

Report your workers’ compensation claimon line at our website: NewMexicoMutual.com

• Go to the main page and select the tab Report an Injury.

• Click on Login as Guest.

• Then click on Start New Report.

• Fill in the requested information and send it to us over the internet.

• Our claims department will be in touch with you.

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Report Your Claims Online

Free Safety Materials OnlineNew Mexico Mutual has a library of free safety resources available to our policyholders, including videos, training manuals, publications, links to other safety websites, and a small business safety advisor. Simply visit newmexicomutual.com and click on Safety to access our resources.

Pay OnlineNew Mexico Mutual offers our policyholders the ability to pay their monthly bill online through VirtualCheck or Vcheck, an online check service. Please visit our web site and click on the Pay My Bill button on the home page. Payments received through VCheck before 3pm (MST) will be posted the same day. VCheck payments made after 3pm or on the weekend will be posted the next business day. Vcheck does not accept recurring payments. All credit card payments are posted immediately.

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