In the busy environments of modern workspaces, from construction sites to corporate offices, accidents are inevitable. Workers comp laws are the way in which New Mexico, like other states, recognizes the need to protect both employees and employers when these accidents occur.
In New Mexico, private industry employers reported over 13,000 nonfatal work-related injuries and illnesses in 2021. This constitutes an incidence rate of 2.8 cases per 100 full-time equivalent workers, which is close to the 2020 rate of 2.6, according to the U.S. Bureau of Labor Statistics.
Workers’ compensation is an insurance system that provides employees with the necessary medical care and financial assistance after a job-related accident. New Mexico workers’ compensation laws follow the “no-fault system.” Under this framework, workers are entitled to immediate benefits after suffering a job-related injury, regardless of fault. As for employers, they are given “exclusive remedy” protection, safeguarding them against potential lawsuits from workers.
New Mexico Workers’ Compensation Insurance Requirements
Under New Mexico law, businesses employing three or more part-time or full-time workers are required to obtain workers’ compensation insurance. In the construction sector, even with just one employee, a business must carry workers’ compensation insurance. In other sectors, even if they are not legally required, many enterprises opt for coverage to protect their business and workforce. This voluntary act of acquiring insurance is known as “electing” coverage.
The following workers are exempt from workers’ compensation insurance requirements in New Mexico:
Individuals employed in private households, such as maids or nannies.
Workers on farms and ranches.
Real estate sales professionals.
These workers, however, may opt to be covered by the Workers’ Compensation Act by:
Submitting a sworn declaration to the director’s office expressing their commitment to the Act’s regulations.
Providing evidence of insurance or security as a commitment to workers’ compensation.
Sources of Workers' Compensation Insurance in New Mexico
Workers’ compensation insurance is available in New Mexico from insurance companies offering commercial lines. Most of these providers include employer liability in their workers’ compensation policies.
Employers that are required to have coverage can also opt for self-insurance through individual, group, or pooled plans. Self-insurance has strict financial requirements. Businesses that self-insure include large enterprises, higher learning institutions, and government organizations. They require the approval of the Workers’ Compensation Administration.
Businesses must display the Workers’ Compensation Act poster and Notice of Accident forms in areas where employees can see them. These resources are provided free of charge by the Worker’s Compensation Administration and can be accessed online or directly from any WCA office.
Employers must decide whether they will choose the initial healthcare provider or whether they will let the worker make the choice. Employers must notify employees in writing about their decision.
Businesses and employees covered by the Workers’ Compensation Act contribute to the WCA fund. On the last day of the quarter, employers are billed $2.30 for each covered worker, while employees are assessed a fee of $2.00.
A yearly safety inspection is mandatory for employers covered by New Mexico’s workers’ compensation law. These include businesses whose annual compensation premium is $15,000 or more and those who qualify as self-insurers. Companies without self-insurance can ask for safety assessments and guidance on how to make their workplaces safer. This service is available from any workers’ compensation insurance provider in New Mexico. Noncompliant employers may be fined up to $5,000.
Employers and safety consultants must work together to develop an accident-prevention strategy addressing recognized hazards. If an employer neglects to create, enact, or adhere to this plan, they risk a penalty of up to $5,000.
Penalties for Noncompliance
Employers who violate the Workers’ Compensation Act face a potential injunction on their business operations until they comply.
New Mexico Workers’ Compensation Benefits
These benefits pay healthcare providers directly for all necessary medical expenses. It’s crucial to remember that medical care received from unauthorized health practitioners is not covered.
These benefits act as a safety net, covering lost wages when employees fall ill or get injured due to workplace accidents. Indemnity payments are classified into three categories:
Temporary Total Disability
Paid when an employee can’t return to work due to a job-related injury.
Received by employees after a waiting period of seven days
Covers two-thirds of the worker’s average weekly wage but must not exceed the state’s annual maximum compensation rate
Temporary Partial Disability
This applies when an injured worker gets back to work but doesn’t earn as much as they did before the injury.
Cover two-thirds of the difference between the worker’s wage before and after the injury but must not exceed the TTD amount
Permanent Partial Disability
Compensate workers who have reached Maximum Medical Improvement but still have lasting impairments
The amount depends on the severity of the impairment, the specific body parts affected, and other considerations
Travel Benefits for Medical Care
Travel expenses from an employee’s home to a healthcare facility are reimbursed if the total mileage reaches 15 miles. Employees must keep receipts and keep track of travel costs.
Workers’ compensation travel benefits include the following:
Mileage driven by employees using their vehicles.
Ticket fares for airplanes, buses, and trains.
Accommodation expenses for required overnight stays.
For information regarding current mileage and per diem rates, employees can contact an ombudsman or visit the WCA website and refer to Rule 3 on the Rules and Statutes link.
How to File a Workers’ Compensation Claim in New Mexico
When an accident occurs at work in New Mexico, employers and workers have their share of responsibilities. Employees must follow specific procedures per New Mexico workers’ compensation laws to ensure they receive the benefits they are entitled to. Employers should take immediate action and ensure injured workers are taken good care of.
It may be challenging to keep up with the deadlines and the necessary forms when filing a claim. To make sure that both employees and employers fulfill and submit the correct forms as well as adhere to the timelines, it is ideal to retain a workers’ comp lawyer.
When Is the Deadline for Workers’ Compensation Claims in New Mexico?
Following a workers’ compensation denial, employees have one year to file a claim. However, if they remain with the same employer, this deadline can be extended to another year. According to Section 52-1-29 NMSA 1978, a worker permanently forfeits their right to seek compensation for their injuries if they miss the notice or claim deadlines.
Step-By-Step Guide on Filing a Workers’ Compensation Claim in New Mexico
Following a workplace accident, the first thing an injured worker should do is go to the nearest healthcare facility to seek prompt medical care. If they have a non-emergency case, workers should first determine if their employer has a preference for a particular healthcare provider. Once medical attention is received, following the step-by-step process below increases the likelihood of a successful workers’ compensation claim.
1. The Employee Notifies the Employer About the Injury
Employees must notify their employers in writing within 15 days of becoming aware of a job-related injury. They have up to 60 days if they are incapacitated or dealing with other issues beyond their control. No formal notification is required if the employer or a supervisor is already aware of the injury.
Once the employer has been notified, they are required to provide a Notice of Accident form, which the employee will use to document the incident properly. Both the employee and employer should sign and date the form. Employers are prohibited from discouraging a worker from using the NOA form. They should also refrain from ordering supervisors to refuse to sign the form or refusing to sign it themselves.
2. The Employer or Employee Selects the Healthcare Provider
Following a workplace accident, the Workers’ Compensation Act requires employers to promptly provide the injured worker with all the necessary medical care from a qualified healthcare provider, as long as such treatment is medically necessary or relevant.
The employer must first choose the healthcare provider, or the employee must be given the opportunity to do so. This choice remains for the first 60 days from the time the employee obtains medical attention from the initially chosen healthcare provider. After those 60 days have passed, the party that did not make the first selection may choose their preferred healthcare provider.
3. Employer Notifies the Insurance Company
After becoming aware of the injury, employers have 72 hours to notify the insurance company. They are required to submit every workers’ compensation claim, even if there are questions about its validity.
Companies must provide all the necessary information to ensure the claim is handled efficiently. They should never make it more difficult for employees to file a claim. Should problems arise, they must inform the insurance company right away. Regular communication with the insurance adjuster is crucial for a smooth claims process.
4. The Employer or Insurer Files the First Report of Injury with the WCA
Employers or their insurance providers must promptly report work-related injuries or illnesses that cause an employee to miss over seven days of work. They have 10 days to submit a detailed account of the incident to the state director using the FROI form. The injured worker must also receive a copy of this report. Failure to act within the given time frame can lead to legal consequences.
5. The Claims Representative Contacts the Employee
After suffering an injury or illness due to their job, the affected worker should expect communication from the person managing their claim, also known as a claims representative. This individual could be an insurance adjuster, a member of a self-insurance group, or a representative from a third-party administrator.
A claim’s representative’s primary duties include reimbursing related expenses and assisting the injured employee during the claims process. Employees must take action if they don’t hear from a claims representative within 10 working days post-accident. They can either ask their employer about the process for contacting the claims representative or refer to the contact details provided on the employer’s official poster.
6. The Employee Returns to Work
The employee should let their former employer know if they are ready to return to work, even on a part-time basis. The employer is required to offer the worker their previous role if the following requirements are met:
The treating physician confirms the worker’s ability to carry out their previous role or similar but modified work.
The offered wage is the same or lower than the previous salary.
There are similar vacant positions within the company.
The returning worker submits a new job application.
What Should One Do If a Workers’ Compensation Claim in New Mexico Has Been Denied?
Contact an ombudsman: They can mediate discussions without taking sides. While they can’t provide legal advice, they can assist you with the necessary forms and procedures if you’re filing a claim with the WCA court without representation.
Hire an attorney: If you opt for legal representation, an ombudsman can’t communicate with you and only claims representatives should engage with your attorney.
Consider a full trial: If the issue can’t be resolved through mediation, a workers’ compensation judge will hear your case in court. At this point, hiring an attorney is advisable.
Negotiate personally: You can always try to resolve matters directly with the employer or insurer.
If the employer seeks reemployment but is turned down by the employer despite satisfying the above conditions, the worker can reach out to an ombudsman for guidance. While the healthcare provider has the last say regarding the employee’s ability to work, communicating with the employer to identify roles that accommodate medical restrictions is crucial. If an employee declines a job offer that aligns with their medical requirements, they risk potential benefits being permanently forfeited.
Legal Resources for Injured Workers in New Mexico
Nothing is more crucial than seeking legal counsel following a workplace accident. The state of New Mexico provides various legal resources to assist employees with their workers’ compensation concerns.
New Mexico State Bar General Referral Program
The New Mexico State Bar General Referral Program is a lawyer referral service that connects people facing legal challenges with private attorneys. It offers legal consultations lasting 30 minutes for a fee of $35. An intake representative will request information to determine the county and legal region needed for the referral. Program staff will then seek out an attorney in the relevant jurisdiction.
Individuals must communicate directly with the referral attorney to ask about representation costs and schedules. They can also negotiate with the attorney should they require more time outside the allotted 30-minute consultation. Those interested in the referral program can contact 505-797-6066 or 505-797-6000.
Albuquerque Bar General Referral Program
The Albuquerque Bar General Referral Program is another attorney referral service catering to the people of New Mexico. It is an initiative of the Albuquerque Bar Association, offering 30-minute legal consultations for $50. Individuals have the option to discuss their legal concerns with licensed attorneys at the office or over the phone.
The bar association is located at 201 3rd St. NW, #500, Albuquerque, NM 87102. Those who are interested in learning more about the program may call 505-243-2615. They can also visit the association’s official website.
Workers' Compensation Administration's Ombudsman Program
The Workers' Compensation Administration's Ombudsman program is a helpful resource for those requiring more information on how the workers' compensation system works. The WCA appoints an ombudsman to educate individuals on workers' compensation laws free of charge. These officials clarify rights, obligations, and options for employees and employers while assisting in dispute resolution. They are unable to help any party who has legal representation or a claim that is still subject to formal adjudication. Workers without justification to file a claim can call 1-866-967-5667 to speak to an ombudsman for guidance.
New Mexico District Court Self-Help Guide
Individuals in New Mexico who are dealing with workers’ compensation issues and want to know how to represent themselves in court effectively can use the New Mexico District Court Self-Help Guide. This manual provides information about referral programs and options for legal resources. Guides, worksheets, and online forms about various legal topics are available in English and Spanish. Users can download the resource guide in PDF format. They can also access the complete guide when they download individual substantive topics.
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