Below is an outline of statutory and Primex3 requirements of Worker's Compensation members, employees and Primex3.
- The employer must post - in clear view of all employees - the State of New Hampshire Workers' Compensation Law Notice of Compliance WCP-1 with workers' compensation insurance coverage. You can download the WCP-1 form by clicking here. The insurance carrier's name and address shall be identified clearly. The employer shall prepare a current written safety program. You can download required workplace postings, by clicking here.
- The employer shall establish a Joint Loss Management Committee.
- The employer shall provide employees with a safe work environment.
- The employer shall complete and file the Employer's First Report of Injury 8WC within five days of receipt of notice of injury.
- The employer shall complete and file a Supplemental Report of Injury 13WCA for claims involving four days or more of disability. The supplemental report should also be filed whenever there is a change of employment status relative to a workers' compensation claim.
- The employer shall complete and file the Wage Schedule 76WCA to include twenty-six (26) weeks of gross wages on all claims involving disability of fourteen days or longer.
- The employer shall provide temporary alternate duty work for all employees suffering compensable injuries released to modified duty work. The employer shall reinstate all employees suffering compensable injuries to their former position within eighteen (18) months of the date of injury (DOI)
- The employer should comply with the NH Retirement System regulations when an employee is out of work as a result of a compensable injury.
- The employer is not legally obligated under the Workers' Compensation Statute to continue the employee's salary or benefits. Employees suffering compensable disabling injuries shall be paid 60% of their gross average weekly wage (AWW) by Primex3. If the employer does choose to supplement workers' compensation disability benefits, they must bear in mind that workers' compensation benefits are nontaxable. Taxation should only be on the supplemental portion paid by the employer.
In the event an employee suffers an injury while in the course of his or her employment, the following steps should be followed:
- The employee must report the injury to the employer or employer's representative, either verbally or in writing, using Notice of Accidental Injury or Occupational Disease 8aWCA.
- The employee has two years from the date he or she knew, or should have known, that an injury is work-related to report the injury.
- The employee has three years from the date of injury to seek medical attention.
- The longer the delay in reporting an injury, the more questions arise relative to the causal relationship between the medical condition and the reported injury.
- The employee may seek treatment with the health care provider of his or her choosing.
- The employee should notify the health care provider that he/she has filed a workers' compensation claim and request direct billing to NH Public Risk Management Exchange (Primex3). The employee should, however, also provide their health insurance information and comply with any managed care requirements in the event the claim is denied.
- The employee must notify the employer immediately after seeing his/her health care provider after each visit to advise them of his/her present work capacity.
- The employee must cooperate with the employer's efforts to accommodate the Temporary Alternate Duty restrictions placed upon them by their health care providers.
- Employees disabled from work will be contacted by a Primex3 representative, and should cooperate with the investigation.
- Employees must facilitate, as necessary, the transfer of medical information.
Upon receipt of the Employer's First Report of Injury (8WC), the NH Public Risk Management Exchange (Primex3) will:
- Review the First Report of Injury for loss prevention issues and employer relationship issues;
- Assign the case to a claims team based on the geographic location of the employer;
- Request relevant medical records; and
- Request wage documentation from primary employer and concurrent employer if applicable.
- If the employee is disabled from work over three days, the claims consultant will contact the employer and the employee to investigate the reported incident and injury.
- The claims consultant has twenty-one (21) days from the receipt of the claim to determine whether the medical and investigative evidence substantiates that the injury arose out of and in the course of employment.
- In order for an injury to be considered to arise out of the employment it must result from a risk or hazard created by the employment. In order for an injury to be considered in the course of employment it must occur within the boundaries of time and space created by the terms of the employment.
- If the injury does not meet these two criteria, it will be denied by Memo of Denial with an explanation.
- If within the first twenty-one days the adjuster has not received medical documentation, the claim will be denied using the Memo of Denial with the explanation that the claim is denied pending receipt of medical documentation.
- If the employee is disabled from work, the adjuster will pay 60% of the gross average weekly wage (AWW) for the period of disability, but not for the first three (3) days of disability unless the disability is over fourteen (14) days. If the employee returns to work temporary alternate duty (TAD) within five (5) days of the date of injury, the three-day waiting period is waived. If an employee is employed by more than one employer at the time of injury, all sources of allowable income shall be included when calculating the average weekly wage. In order for other sources of income to be included, they must be in New Hampshire and covered by a valid NH Workers' Compensation policy. Primex3 will issue separate checks at the request of the employer or employee.
- If the employee did not miss time from work and sought medical attention, the adjuster must either pay or deny medical bills within thirty days of receipt. If the medical records are not received within thirty days, the bills will be denied pending receipt of the necessary medical documentation. If the injury did not arise out of and in the course of employment, the medical bills will be denied by letter to the employee with copies to both the medical provider and employer.
- The adjuster may require the employee to attend no more than two independent medical examinations (IME's) per year. The location of the independent medical exam must be within fifty miles of the employee's home.
- Employees whose cases are denied may request a hearing within 18 months of the date of denial with the NH Department of Labor, 95 Pleasant St., Concord, NH 03301.
- Hearings are scheduled by the New Hampshire Department of Labor usually within four to six weeks.
- Either party may appeal within 30 days of the DOL decision to the Compensation Appeals Board.
- Appeal hearings are usually scheduled within six months. If the injured employee prevails, the insurance carrier is required to pay his or her attorney fees.
- The aggrieved party may appeal the CAB decision. The NH Supreme Court accepts appeals involving errors in law.
- An annual log of all workplace injuries and illnesses for which an employer's First Report of Injury is submitted to the Department of Labor shall be kept at the place of employment and made available to a safety inspector upon request.
- Claim Detail Reports are not accepted in lieu of the First Aid Log.
- To avoid citation, and to recreate your claims history, contact Primex3 for the needed information
- To open the First Aid Log file, click here.