Section Lab 507.01 - Changes in Medical or Employment Status(a) An employee receiving workers' compensation benefits shall report to the carrier, self-insured employer, or third party administrator: (1) Any changes in his or her medical condition; and(2) Any changes in his or her employment status or earnings or both.(b) An employee eligible for temporary partial benefits under RSA 281-A:31 shall: (1) Provide or cause to be provided pay stubs or records of their earnings to the carrier on a weekly basis; and(2) Promptly notify the carrier if the temporary partial employment ceases so a determination of benefits may be calculated.(c) Pursuant to RSA 281-A:53-a, every carrier, self-insurer, employer or third party administrator shall notify any employee receiving workers' compensation benefits of the duty to report changes in earnings or employment status by completing and filing "Employee's Statement of Employment Status", form 53 WC (12/2000), contained in Appendix II.(d) The notice required by (c) above shall be sent by first class mail and may be included with the employee's regular indemnity payment.(e) The notice required by (c) above shall require a report of any change in employment status or earnings that has occurred only in the 3 month period prior to the date listed on the notice.(f) The carrier, self-insured, or third party administrator shall provide a self-addressed stamped envelope along with a completed "Employee Statement of Employment Status", form 53 WC (12/2000), contained in Appendix II.(g) The notice required by (c) above shall be copied to the claimant's counsel of record if applicable.(h) Form "Employee Statement of Employment Status", form 53 WC (12/2000), shall indicate that: (1) Failure by the employee to report any change in employment status or earnings might subject the employee to civil or criminal penalties; and(2) Failure to complete and return the form within 30 days of the request might result in suspension of the employee's compensation benefits.(i) The carrier, self-insured employer, or third party administrator shall not request the employee to fill out and return "Employee Statement of Employment Status" form 53 WC (12/2000) contained in Appendix II more than once every 3 months.(j) If an employee fails to complete and return "Employee Statement of Employment Status", Form 53 WC (12/2000), contained in Appendix II as requested, the carrier, self-insured employer, or third party administrator shall:(1) Send a notice to the commissioner, employee and claimant's counsel of record if applicable of its intent to suspend benefits by completing and filing "Notice of Intention to Suspend Payment of Workers' Compensation Benefits" form 53-A WC (12/2000), contained in Appendix II;(2) Notify the commissioner in writing if the completed "Employee Statement of Employment Status" form 53 WC (12/2000) contained in Appendix II has not been received within 15 days of the notice of intent to suspend benefits and request permission to suspend benefits until such time as that form is filed; and(3) Send a copy of the request for permission to suspend benefits to the injured employee and claimant's counsel of record if applicable.(k) Upon receipt of a request to suspend benefits, the commissioner shall within 10 working days issue an order suspending the employee's benefits until "Employee Statement of Employment Status", form 53 WC (12/2000), contained in Appendix II is filed.(l) Upon receipt of "Employee Statement of Employment Status", form 53 WC (12/2000), contained in Appendix II the carrier, self-insured, third party administrator, or employer shall within 5 working days resume making payment of benefits and shall include in the first check all the benefits unpaid during the period of suspension.N.H. Admin. Code § Lab 507.01
#2264, eff 1-6-83; ss by #2935, eff 12-27-84; amd by #4854, eff 6-29-90; amd by #5041, eff 1-9-91; ss by #5235, eff 9-27-91, EXPIRED: 9-27-97
New. #6631, INTERIM, eff 11-16-97, EXPIRED: 3-16-98
New. #6806, eff 7-18-98 (formerly Lab 513.01); ss by#7585, eff 10-30-01; ss by #9019, eff 11-1-07
Amended by, Volume XXXVI Number 14, Filed April 7, 2016, Proposed by #11067, Effective 4/1/2016, Expires 4/1/2026.