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.

NMSIF Board of Trustees

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 to the Self Insurers’ Fund, please use the following fax number: (505) 820-0670. If you are faxing information concerning finance or underwriting, please use (505) 984-1392.

Safety Counselling Inc.

Notice of Tort Claim Form

IRS Form W-9

Workers’ Compensation Glossary

Workers’ Compensation Policy

Liability Policy

2009 Annual Safety Training Log (Microsoft Excel format)

Experience Modifier FAQ

Sample Safety Training Matrices (Microsoft Excel format)

Worker’s Comp Premium Allocation

Workman’s Compensation Average Weekly Wage Worksheet

NEW NMSIF FAX REQUEST FORMS

Equipment Addition/Deletion Form

Auto Addition/Deletion Form

Certificate of Insurance Request Form

Employer’s First Report of Injury or Illness (e-1)

HIPAA Complaint Medical Release Form