New Mexico Workers' Comp Claims: Eligibility, Filing, and Appeals
An overview of workers' compensation in New Mexico.
In New Mexico, private employers with three or more regular employees must carry workers’ compensation insurance. As in other states, the workers’ compensation system in New Mexico is a no-fault system that compensates injured workers for medical bills, lost wages, and permanent impairments resulting from their injuries. To take advantage of these benefits, injured workers must follow certain procedures required by New Mexico law.
Who Is Eligible for Workers’ Comp Benefits?
Most employees are covered by workers’ compensation in New Mexico. However, there are a few exceptions for employees engaged in certain types of work. For example, workers’ comp does not cover farm workers, domestic workers, casual employees, or real estate salespersons who are paid on commission.
Workers’ compensation covers all injuries or illnesses that happen in the course and scope of employment, including traumatic injuries and occupational illnesses. Traumatic injuries are those that result from a one-time accident at work, such as a broken bone from a slip and fall. Occupational diseases are injuries or illnesses that occur over a period of time, including injuries caused by repetitive movements at work (such as carpal tunnel syndrome) and illnesses developed from exposure to toxic substances at the workplace (such as cancer from exposure to asbestos).
What Should I Do if I’m Injured at Work?
To receive workers’ comp benefits, you must report your injury to your employer. You should do so as soon as possible, but no later than 15 days after your injury. Your claim for benefits may be denied if you fail to give notice and your employer does not already know about your injury. Once your employer has notice of your injury, it will notify its insurance company. The insurance company will then decide whether to accept or deny your claim.
How Do I Get Medical Treatment?
If you need emergency medical treatment, you can go to the nearest hospital or urgent care center. For non-emergency care, you will need to check with your employer first. In New Mexico, your employer can either select your treating doctor or allow you to see a doctor of your choosing. If your employer chooses the initial doctor, you can switch to your own doctor after 60 days. If you choose the initial doctor, your employer can select a new doctor after 60 days.
What Benefits Can I Receive?
All reasonable and necessary medical treatment related to your work injury will be covered through workers’ comp in New Mexico, including the cost of doctors’ visits, hospital bills, prescriptions, and prosthetic devices. You’ll also be reimbursed for the mileage you incur in traveling to and from medical appointments. In addition to medical benefits, you will also be eligible to receive disability benefits.
Temporary Disability Benefits
If you need time off from work while you are recovering from your injuries, you can receive temporary total disability benefits. These benefits are two-thirds of your average weekly wages, up to a maximum set by state law each year. For 2016, the weekly maximum is $785.03. You will receive these benefits until you are able to return to work or until your doctor finds that your condition has improved as much as it is going to (this is called “maximum medical improvement”).
If you are able to work while recovering from your injury, but you’re earning less than you normally do, you can receive temporary partial disability benefits. These benefits are two-thirds of the difference between your wages, subject to the same maximum mentioned above.
Permanent Disability Benefits
Once you reach maximum medical improvement (MMI), your doctor will evaluate you to determine whether you have a permanent disability. If your injury has left you permanently and totally disabled, you can receive permanent total disability benefits. These benefits are available only for the most serious injuries, such as serious brain injuries or the loss of both hands, arms, feet, legs, eyes (or a combination of any of two of these body parts). Permanent total disability benefits are paid at the same rate as temporary total disability benefits for the rest of the worker’s life.
If you have a permanent impairment, but you are not totally disabled, you can receive permanent partial disability benefits. How much you will receive, and for how long, depends on whether your injury is listed in New Mexico’s schedule of injuries.
New Mexico’s schedule lists injuries to certain body parts—such as a hand, arm, leg, foot, finger, toe, eye, and ear—and designates a maximum number of weeks for which benefits are paid. For example, the schedule allows a worker to receive benefits for 160 weeks for the total loss of use of an arm at the elbow. If the worker has suffered only a 50% loss of use, he or she can receive benefits for 80 weeks. You will receive two-thirds of your average weekly wage during this time, subject to the same maximum as temporary disability benefits.
Injuries not listed on the schedule—such as those to the back or neck—are considered whole body impairments. Your benefit rate will depend on a number of factors, including your impairment rating, age, education, and the physical demands of your job. If your disability rating is 80% or higher, you will receive benefits for up to 700 weeks. If your disability rating is less than 80%, you will receive benefits for up to 500 weeks.
What If My Claim Is Denied?
If the insurance company denies your claim, you can file a petition to controvert with the New Mexico Workers’ Compensation Commission. A hearing will be held before a workers’ comp judge, who will issue a written decision. If you disagree with the judge’s decision, you will have an opportunity to appeal the decision. For more information on the appeals process, see our article on appealing a denial of your New Mexico workers’ comp claim.