The League organized and administers the New Mexico Self Insurers’ Fund, which offers Workers’ Compensation, general liability, law enforcement, civil rights, errors and omissions, auto liability, auto physical damage, and property and volunteer coverage to its members. The Fund also offers group health, medical and life insurance.
Included in this page are two forms commonly used by the Fund, a Notice of Tort Claim and IRS Form W-9, Request for Taxpayer Identification Number and Certification. Also included is a Class Code Glossary of Workers’ Compensation Terms, the Fund’s Liability Policy and the Fund’s Workers’ Compensation Policy. Each of these documents are in PDF format. These documents may be printed for your convenience.
PLEASE NOTE: If you are faxing any material concerning claims or underwriting to the Self Insurers’ Fund, please use the following fax number: (505) 820-0670.
MINIMIZING YOUR RISK
(Presentation by Risk Services Director Ed Zendel at the League’s 58th Annual Conference in Albuquerque)
Workers’ Compensation Glossary
Sample Safety Training Matrices (large file, may take time to load)
Workers’ Compensation Premium Allocation
Automobile/Mobile Equipment Loss Control Requirements
NMSIF FORMS
Equipment Addition/Deletion Form
Property Additon/Deletion Form
Certificate of Insurance Request Form
Employer’s First Report of Injury or Illness (E-1)
HIPAA Complaint Medical Release Form
Medical Travel Reimbursement Request Form
Notice of Tort Claim Form
(Notice of Tort Claim may be submitted by e-mail to: liabilityclaims@nmml.org)
Workers’ Compensation Average Weekly Wage Worksheet
Auto Physical Damage Loss Claim Fillable Form
Inland Marine Equipment Loss Claim Fillable Form
Property Loss Claim Fillable Form
Printable Forms
Auto Physical Damage Loss Claim Form
Inland Marine Equipment Loss Claim Form
