New Mexico employees who are injured at work or suffer from an employment-related illness are entitled to benefits under the state workers’ compensation system. The workers’ comp system in New Mexico covers medical bills related to your workplace injury and pays disability benefits while you are unable to work due to your illness or injury.
Almost all New Mexico employers with three or more employees are required to carry workers’ compensation insurance. The New Mexico workers’ comp system is overseen by the New Mexico Workers’ Compensation Administration. However, because most employers are insured through insurance companies, the insurance company typically reviews claims and pay benefits for accepted claims. In order to receive the maximum benefit from your employer’s insurance company, you will need to follow New Mexico’s workers’ comp rules for reporting your injury and getting medical treatment.
After a workplace injury, you will naturally be most concerned about getting immediate medical care. In an emergency, you should seek treatment at the nearest emergency room. In non-emergency situations, you must notify your employer of the injury first. If your employer has designated a physician or medical facility to treat work-related injuries, you must treat with that doctor for the first 60 days (unless your employer gives you permission to see your own doctor). New Mexico workers’ comp covers all reasonable medical bills associated with authorized treatment for your work injury. You will not be reimbursed for medical bills from unauthorized providers. (To learn more, see our overview article on getting medical treatment for a work-related injury.)
In New Mexico, you must report a workplace injury to your employer within 15 days. However, the best approach is to notify your employer of your injury immediately after it happens. Sometimes, this will be impossible because you need emergency care or because your supervisor is unavailable. In those cases, report the injury as soon as you can, but before the 15-day deadline.
Your notice must be written. Your employer should provide you with a Notice of Accident Form to fill out. You will need to explain when and where the injury occurred, how the injury occurred, and what type of injury you sustained. Both you and your supervisor should sign and date the form.
After it receives your notice, your employer will fill out an Employer’s First Report of Injury or Illness Form and notify its insurance company of your claim. This is the official start to your workers’ comp claim. At this point, the insurance company will review your claim and decide whether to pay benefits.
New Mexico workers’ comp pays temporary disability benefits, which replace part of your lost wages while you are recovering from your injury. These benefits are available once you miss more than seven days of work. You will receive two-thirds of your average weekly wage prior to the injury, but no more than a maximum amount set by the State of New Mexico each year. If you end up having a permanent disability due to your workplace injury, you are entitled to receive wage-replacement benefits for up to 700 weeks. The amount of your benefit is determined by the severity of your permanent disability. In some serious cases, you may be entitled to lifetime benefits. (To learn more, see our article on the different types of workers’ comp benefits.)
You do not need to file any additional paperwork unless you have a dispute with the insurance company over your claim. To start your appeal, you will need to file a Workers’ Compensation Complaint with the Workers’ Comp Administration. Your doctor will also need to fill out a Form Letter to Health Care Provider and return it to the Worker’s Comp Administration.
After you file the complaint, your case will be set for a formal workers’ compensation hearing. Before that, you and the insurance company will have an opportunity to negotiate a settlement agreement at an informal conference called “mediation.” If your case does not settle at mediation, the mediator will make his or her own recommendation for how your case should be resolved. The recommendation will go into effect if neither party objects to it within 30 days. If either party objects, the case will go on to a formal hearing before a workers’ comp judge.