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Workers’ Compensation FAQ

Workers’ Compensation Overview

What is Workers' Compensation?

Workers’ Compensation is a benefit overseen by the State of New Mexico. If you are injured at work, the employer or their insurance company must provide:

  • Health care for the injury or illness.
  • Indemnity benefits (money) as a partial substitute for lost wages if you are unable to work due to the injury or illness.
  • Workers’ compensation benefits do not include payments for pain and suffering

What should I do if I have a work accident?

  • If it is an emergency, get help and emergency care first.
  • Tell your supervisor that you were in an accident, no matter how minor you think the accident was or even if you think you may not be injured.
  • Fill out a Notice of Accident form. Forms should be provided by your employer and posted where you work. Notice of Accident form can be downloaded here.  You must fill out the form (or give notice) within 15 days of the accident.
  • Seek medical care. Ask your employer which doctor you should see (if you need emergency care, go directly to the hospital). Your employer has the right to choose a doctor for you at this time or to allow you to choose. Tell all doctors this was a work-related injury.

Is my injury covered by Workers’ Compensation?

An injury covered by Workers’ Compensation must “arise out of and occur in the course and scope of employment.”

If your injury occurred at work, it is usually covered. If your injury develops over time, such as carpal tunnel syndrome, or as a result of continued exposure to environmental conditions, it may be covered if the eventual injury or disease was caused by work. Injuries occurring while commuting to or from the employer’s location (place of employment) often are not covered, but injuries that occur while you are traveling for work purposes usually are covered.

Indemnity (money) benefits

What indemnity (money) benefits should I be receiving?

If you miss more than seven days of work, you may be eligible for wage replacement benefits of two-thirds of your pre-injury wages while you are medically recovering.

After you reach “maximum medical improvement” (the point at which continued medical improvement is not expected), your benefits will be changed based on the impairment rating provided by your doctor and your ability to return to your pre-injury job. Seek legal advice when your doctor starts discussing “maximum medical improvement” to ensure that you are receiving the maximum amount of indemnity (money) benefits available to you.

Do I have to accept a “light duty” job offer from my Employer?

If your Employer offers work within your medical restrictions, failure to accept the position will usually result in a forfeiture of benefits. Call our office if you have questions as to whether you must accept a job offer.

Can I receive Unemployment and Workers’ Compensation benefits at the same time?

Yes, you can receive both at the same time. However, your Workers’ Compensation benefits or Unemployment benefits may be reduced to offset the total amount of benefits you are receiving.

Applying for Unemployment benefits does not prevent you from receiving Workers’ Compensation benefits.

How do I get my benefits in one lump sum?

New Mexico law allows you to get your benefits in one lump sum check under limited circumstances. You are allowed to get a “lump sum” payment in these two ways:

  • to help pay for debts that you have accumulated since your injury;
  • if you have returned to work earning at least 80% of your pre-injury wage for more than six months; or
  • you want to settle your claim

Accepting a lump sum payment can result in you giving up future benefits or forfeiting large amounts of money that may be owed to you. Do not agree to a lump sum payment without consulting an attorney or calling our firm.

Medical Benefits

Which doctor should I see first?

The Employer or their Insurer have to pay 100% of your authorized medical expenses. Before you go to the doctor, ask your Employer if a specific doctor is authorized, or if they will pay the medical expenses for the doctor of your choice. If you go to a doctor other than the doctor chosen by the Employer, you may be responsible for your own medical bills and the medical records may not be admissible as evidence in a Workers’ Compensation trial.

Do I have to go to the doctor?

Yes. Failure to attend medical appointments can result in a suspension of your Workers’ Compensation benefits and could eventually result in a forfeiture of benefits.

What if I want to change doctors?

If the employer selects the doctor that you must see, you have to treat with that doctor for 60 days. After the initial 60 days, you have the right to change your doctor one time. To change doctors, you must submit a Notice of Change of Health Care Provider form to your insurance adjuster.

What if the Employer tries to change my doctor?

The Employer/ Insurer may have the right to change your doctor. If you receive a Notice of Change of Health Care Provider from the Employer or Insurer, or they give you directions to go to a new doctor, call an attorney immediately to determine whether the Employer or their Insurer have the right to change your doctor. You only have three days to complete the Objection to Change of Health Care Provider form and file it with the Workers’ Compensation Administration.

Do I have to submit to an Independent Medical Examination?

No, not unless you are ordered to go to the independent medical examination (“IME”) by a Workers’ Compensation Judge. If the adjuster tells you that you have to go to an IME without a judge’s order, you have the right to withhold consent.

Enforcing your rights

What can I do?

If you are having difficulties with your Employer, Adjuster, or feel like you are not receiving all of the benefits you deserve, you have options. To enforce your rights, you generally must take legal action. The first step is filing Complaint form with the Worker’s Compensation Administration, which starts your lawsuit. Call our firm for assistance.

How do I file a Complaint with the Workers’ Compensation Administration?

You must file a Complaint, Summons and sign a HIPAA compliant medical records release. The New Mexico Workers’ Compensation Administration has resources to assist you in filing a Complaint yourself. Information is available at http://www.workerscomp.state.nm.us or 1-800-255-7965.

If you are considering filing a complaint, you should call our firm. Our firm will prepare and file all required paperwork, represent you throughout your claim against the attorneys hired by the Employer and their insurance company, stay by your side during the entire process, and work to provide you the maximum benefits available to you.

When do I have to file a Complaint with Workers’ Compensation Administration?

Generally, you must file a Complaint with the Workers’ Compensation Administration within one year that your benefits were denied or incorrectly paid. Failure to file a Complaint within this time period can result in a forfeiture of benefits.

What happens after I file a Complaint with the Workers’ Compensation Administration?

Filing a Complaint is the first step in enforcing your rights. After you file your Complaint, you will be referred to a mediation conference, where you (and your attorney if you have one)  will have a conference with an Employer representative, an insurance adjuster and and attorney representing the insurance company. A mediator (an attorney with no affiliation to either party) will assist the parties in trying to negotiate a resolution before the claim is sent to a Workers’ Compensation Judge.

If the parties do not come to an agreement, the mediator will write a recommendation. If either party ‘rejects’ the mediator’s recommendation within 30 days, the Complaint will be referred to a Workers’ Compensation Judge. You will receive a trial date, where you will be required to present evidence to a Workers’ Compensation Judge to prove your claim.