NM workers’ compensation is a type of insurance that provides benefits to employees who are injured or become ill because of their jobs. Coverage for workers includes medical expenses, lost wages, and death benefits.
It’s important to understand your key rights and protections under the NM workers’ compensation law. You can contact an experienced attorney to help you file a claim and get the benefits you deserve.
In this blog, we highlight some of the most important features of the law, including:
- What is workers’ compensation?
- What are the key rights of injured workers?
- What are the responsibilities of injured workers?
- What are the key protections of NM workers’ compensation?
- What is the process of filing a workers’ compensation claim?
- What are the penalties for non-compliance?
What is workers’ compensation?
Worker’s compensation is a type of insurance that provides protection to employees who suffer work-related injuries and illnesses
. In New Mexico, workers’ compensation laws provide the framework that guarantees certain rights for workers and responsibilities for employers.
These safeguards defend you from retaliation by your employer, discrimination based on injuries or illnesses, and ensure the privacy and confidentiality of your medical records.
Understanding your rights and responsibilities helps you navigate the complexities of the process if you ever need it.
What are the key rights of injured workers?
Under the New Mexico Workers’ Compensation law, injured or ill workers have several key rights designed to protect their well-being. The law provides the necessary support needed during the recovery process and prevents retaliation from employers.
NM workers’ compensation laws provide the right to:
- Choose a healthcare provider. You have the option to select your healthcare provider for treatment of your illness or injuries. Some restrictions and requirements apply. For instance, the healthcare provider must be licensed and authorized by the state’s worker’s compensation administration.
- File a claim and seek legal representation. You can file a claim to seek benefits for your work-related injury or illness. You also have the responsibility to report your injury or illness to your employer. You must submit the necessary paperwork and provide supporting documentation to substantiate your claim.
- Medical treatment and rehabilitation. If you’re injured on the job, you have a right to receive the necessary medical treatment to help you recover. Doctor visits, hospital stays, medications, physical therapy, and surgeries fall under this right.
- Wage replacement benefits. Known as temporary disability benefits, these wages partially compensation for lost wages if your illness or injury prevent you from working for a period.
Make sure you understand and exercise your rights if you’re injured or become ill due to working conditions. The law is in place to ensure you receive the medical care, financial support, and legal assistance you need to recover.
What are the responsibilities of injured workers?
Employers aren’t the only ones who have responsibilities under the New Mexico Workers’ Compensation law. As an employee, you have obligations you must fulfill to be eligible for your benefits.
Make sure you’re meeting all 5 of these requirements.
- Reporting an illness or injury
Ill or injured workers must promptly report their work-related condition to their employer. Reporting the incident as soon as possible ensures your employer is aware of the situation and can initiate the necessary steps to report the incident to the workers’ compensation administration.
- Seeking prompt medical attention
You must seek immediate medical attention for your work-related illness or injury. Additionally, you’re required to follow the prescribed treatment plans and attend all medical appointments, rehabilitation sessions, and therapies recommended by your healthcare provider. If you fail to do any of these things, you may disqualify yourself for workers’ compensation coverage.
- Cooperating with the workers’ compensation process
Providing accurate and truthful information about your injury or illness, medical history, and other relevant details is one of your responsibilities. You may need to provide documentation such as medical records and statements from coworkers to support your claim.
- Reporting changes in medical condition or work status
It’s your responsibility to report any changes in your medical condition or status to your employer and the workers’ compensation insurance carrier. Updates on your recovery process, your ability to return to work, and any other significant changes fall under this responsibility.
- Returning to work when medically cleared
You must return to work once medically cleared. The responsibility to inform your employer and make a good-faith effort to resume your job duties falls squarely on your shoulders. Failure to do these things makes you ineligible to receive benefits.
What are the key protections of NM workers’ compensation?
New Mexico’s workers’ compensation law provides 5 key protections to injured or ill workers. These safeguards ensure fair treatment throughout the claims process.
The 5 benefits include:
- Protection against retaliation from your employer for filing a workers’ compensation claim. It’s illegal for employers to fire, demote, or otherwise discriminate against you solely based on you exercising your right to file a workers’ compensation claim.
- Protection against discrimination from your employer based on your work-related injury or illness. You’re entitled to the same treatment, benefits, and opportunities as your coworkers in similar positions.
- Protection of privacy and confidentiality for your medical records and other personal information required for processing a workers’ compensation claim. Employers, insurance carriers, and other parties involved in the claims process must maintain your privacy and confidentiality, ensuring sensitive information is not disclosed without proper authorization.
- Protection from unfair settlements gives you the assurance you can’t be coerced or pressured into accepting less than desirable settlement terms. You have the right to consult an attorney before accepting any offers to prevent your employer from taking advantage of your situation.
- Protection of benefits entitlements ensures you receive the benefits and entitlements to which you’re entitled under the law. Medical treatment, wage replacement benefits, and vocational rehabilitation are included.
These key protections under New Mexico’s workers’ compensation law ensure you’re treated fairly if you’re injured or become ill due to working conditions.
What is the process of filing a workers’ compensation claim?
Eight steps comprise the workers’ compensation claims filing process. You’re obligated to follow each of these steps under the NM workers’ compensation law.
Step 1 – Report the injury or illness
You must promptly report your injury or illness to your employer. In the case of work-related accidents that cause an injury, you must follow additional protocol.
Informing your employer as soon as possible that you’ve been hurt or become ill due to working conditions ensures your eligibility for workers’ compensation.
Put the notice in writing when possible. Include the date, time and nature of the illness or injury, plus any additional details relating to your case.
Step 2 – Seek medical attention
Seeking immediate medical attention bolsters your case if your employer tries to challenge your workers’ compensation claim. You have the right to visit the healthcare provider of your choice. Verify the medical professional treating you is authorized by the NN Workers’ Compensation Administration (WCA).
Step 3 – Complete and submit claim forms
You or your attorney must complete the necessary forms for receiving workers’ compensation. Among the forms you must file include the First Report of Injury (Form C-4).
Additional documents may be required by the state workers’ compensation administration. Information typically collected on the forms includes information about your injury or illness, your employer, and any medical attention received.
Step 4 – Notify the insurance carrier
Your completed claims form should be submitted to the workers’ compensation insurance carrier for your employer. Information about the carrier is provided by your employer directly or through the NM WCA.
Step 5 – Investigation and review
Once your claim is received by the insurance carrier, they begin to investigate it. The process can involve reviewing your medical records, statements, and other relevant documentation.
Sometimes insurance companies request you visit a medical provider of their choosing to provide a second opinion. If this happens, you have a right to seek legal advice before agreeing.
Step 6 – Claim acceptance or denial
Based on their investigation and review, the insurance company either accepts or denies your claim. If your claim is accepted, you’ll receive notification and benefits begin.
If your claim is denied, you have a right to file an appeal. Before doing so, consult with an attorney experienced in NM workers’ compensation law to improve your chances of success.
Step 7 – Mediation and dispute resolution
If there’s a disagreement or dispute between you and your employer’s insurance carrier about your claim, mediation or alternative dispute resolution methods may be used to resolve the issue.
Mediation is a voluntary process. A neutral third party acts as a mediator to help you reach a mutually-beneficial agreement.
Step 8 – Appeal process
Should mediation fail, the final step is the appeal process. You must submit an appeal to the NM WCA. There, an administrative law judge reviews the evidence from both sides and makes a ruling.
The appeals process isn’t the final step. If you’re still dissatisfied, you have the right to seek legal counsel to explore filing a workers’ compensation lawsuit.
What are the penalties for non-compliance?
Failure to comply with NM workers’ compensation laws has consequences for employers and employees. The penalties were designed to encourage both parties to comply with the law to ensure the protection of workers.
Penalties for employers include:
- Failure to provide coverage results in penalties and fines from the NM WCA. The WCA can initiate legal action against employers under certain circumstances.
- Increased liability for employers who fail to comply with state workers’ compensation laws. Under this provision, employers can be held personally liable for your medical expenses, wage replacement benefits, and other costs.
- Stop-work orders are issued by the WCA against employers who fail to comply with the law. Stop-work orders prevent employers from conducting business operations until they provide the necessary workers’ compensation coverage.
Penalties for employees include:
- Fraudulent claims charges are possible against employees who knowingly file a false claim for benefits. You can face fines, be ordered to repay any benefits, and potentially face criminal charges.
- Non-cooperation from workers includes the failure to provide requested information, refusing to undergo medical exams, or intentionally obstructing the investigation of a workers’ compensation claim. If you engage in this behavior, you can face denial of benefits or other penalties.
Get NM workers’ compensation help
Understanding the key rights and responsibilities under NM’s workers’ compensation system is crucial for employers and employees.
As an injured worker, you have the right to medical treatment, wage replacement benefits, and the freedom to choose your healthcare provider. If you fulfill your obligations and are still denied benefits, seek the expertise of an attorney skilled in workers’ compensation benefits law. They can help you get