Workers’ compensation benefits are a hot topic of discussion in New Mexico. When it comes to workers’ compensation claims, New Mexico has a no-fault system. This means that the worker will get compensation benefits for their medical expenses, lost wages, and permanent impairments that resulted from the injury.
Many people aren’t entirely informed what a workers compensation settlement is and if they’re eligible.
Some professions such as construction workers or firefighters are eligible for compensation. Although most workers will get their claim, in some cases, there may be some challenges. This is why a New Mexico workers’ compensation attorney should be by your side when you file for the claim.
Who Is Eligible for Workers’ Compensation Benefits?
New Mexico private employees who have three or more regular employees must have workers’ compensation insurance. Most employees who work in covered businesses are covered by workers’ comp. There are a few exceptions for employees involved in certain types of work. Workers’ compensation benefits in New Mexico won’t cover injuries for domestic workers, casual employees, farmworkers, or real estate salespersons who get paid on commission.
The compensation will cover all injuries or illnesses that occur in the course and scope of employment (this includes slip and fall accidents and occupational illnesses).
What to Do if You’re Injured at Work?
First of all, you must report the injury to your employer. Do this as soon as possible, but not later than fifteen days after the injury. The claim for workers’ compensation benefits might be denied if you fail to report your injury after the deadline.
Once your employer is notified of your injury, they will notify the company’s insurance company. The insurers will then decide whether they will accept or deny your claim.
Although your injury might seem minor, don’t refuse medical treatment. In New Mexico, your employer can select your treating doctor or let you choose your doctor. If your employer chooses the doctor, you can later switch to your own doctor after 60 days. In case you choose the initial doctor, your employer can choose a new doctor after 60 days.
Workers’ Comp Benefits in New Mexico
Your compensation claim will cover all needed medical treatments, including hospital bills, costs of doctors’ visits, prosthetic devices, and prescriptions. You will get a settlement for the mileage you acquire in traveling to and from medical appointments. You will also be eligible to receive disability benefits.
Temporary and Permanent Disability Benefits
If your injuries require time off from work, you can receive temporary total disability benefits. These include two-thirds of your average weekly wages, up to a yearly maximum set by the state. You will get these benefits until you can return to work or until your doctor finds that your condition has improved (the so-called “maximum medical improvement”).
When you reach maximum medical improvement (MMI), your doctor will evaluate whether you have a permanent disability. If your injury has left you permanently and entirely disabled, you can get permanent total disability benefits. These benefits are available only for the most serious injuries (brain injuries or the loss of both limbs, eyes).
What If the Claim is Denied?
In some cases, the workers’ compensation benefits may be denied. In this case, you should seek legal help and guidance from a workers’ compensation attorney. You can also contact the New Mexico Ombudsman Program at the Workers’ Compensation Administration (WCA). The ombudsman is a representative of the workers’ compensation agency who will give answers to your questions and try to help you solve minor disputes with the insurance company.
If this doesn’t result in a settlement with the insurance company, you can file a complaint with the WCA Court Clerk. First, you should file a complaint form and summons with the clerk. Then, mail a copy to the insurance company. Make sure to file the complaint within one year of the insurance company’s refusal to pay your workers’ compensation benefits.
When filing a complaint, you’ll have to give a form to your doctor to fill out the Form Letter to Health Care Provider. They should complete the form (it has questions about your injury, treatment, and possible continuing limitations); then return the form to the WCA Court Clerk.
Some people may find this process to be complex; they may be still recovering and might not be able to do all of these steps.
If you need legal help, the FBD Law team is here to guide you. Get the help you need; we’re here for you.