New Mexico Workers’ Compensation Benefits Process

New Mexico workers' compensation benefits process

Every workers’ compensation claim is processed at the state level. For injured employees in New Mexico, a good understanding of the workers’ compensation process can help save you time as well as confusion when you’re ready to file. Below, you’ll find a brief overview explaining what steps you need to take when applying for New Mexico workers’ compensation benefits, plus a chart showing the program’s five-year statistical history.

Understanding the New Mexico Workers’ Compensation Process

According to the New Mexico Workers’ Compensation Administration, all New Mexico employers who employ three or more workers or are licensed within any construction industry are required to provide workers’ compensation coverage. With regards to workers’ comp coverage, this employee requirement number also includes part-time and seasonal workers. Each employer must purchase a New Mexico workers’ compensation insurance plan from a private insurer or may apply with the state to become an approved self-insurer, which must be approved by the New Mexico Workers’ Compensation Administration. This coverage helps protect both the employee and the employer if a workplace injury or illness does occur. When it’s time to file your New Mexico workers’ compensation claim, you should follow these steps:

  1. Report your injury or illness to your supervisor in writing using a Notice of Accident form within 15 days of the incident. This form should be readily available to you in the workplace. If your injury or other issues beyond your control prevent you from submitting notice in writing within 15 days of your accident, your notification period may be extended to 60 days. This written notice requirement may be waived if your supervisor or foreman witnessed the accident.
  2. Upon receiving notice of your illness or injury, your employer must report the accident within 72 hours to their workers’ compensation insurance provider using an Employers’ First Report of Injury or Illness form. Your employer should provide you with a copy of this form for your own personal records.
  3. When it comes to treating your illness or injury, New Mexico state law lets your employer to choose which doctor you’ll see, or the employer may allow you to pick your own doctor. Either way, your employer should let you know immediately which option is available to you.
  4. If your employer initially picks your healthcare provider, you automatically have the right to see a doctor of your own choosing after 60 days of treatment. The opposite is also true: Should you pick your initial doctor, then your employer has the right to send you to a doctor of their choosing after 60 days. Any change in healthcare providers during treatment requires notifying the other party in writing using a Notice of Change of Healthcare Provider form.
  5. A claims representative is then assigned to your case who will review the circumstances that led to your illness or injury as well as medical bills and health records to determine whether you’re owed benefits and in what amount.
  6. If the insurance provider determines your employer is not liable for your claim or you receive a determination decision that you disagree with, you should contact a state Ombudsman to help you informally resolve your claims dispute. To contact your Ombudsman, call 1-866-967-5667.
  7. If you cannot come to a binding agreement with your employer within 30 days of disputing your claim, you must send the claims rejection back to the New Mexico Workers’ Compensation Administration. Once you’ve submitted your rejected claim, you may schedule a formal trial and plead your case before a WCA judge.
  8. If you choose to retain legal representation for your claims dispute hearing, your Ombudsman may not speak with you about your claim any further.

Keep in mind that every workers’ compensation claim is different, meaning your own claims process may vary slightly from the above outlined steps. To get a more comprehensive understanding of how the claims process works, review the New Mexico Workers’ Compensation Administration FAQs.

New Mexico Workers’ Compensation Statistics

The Bureau of Labor Statistics (BLS) releases a statistical report each year on the workers’ compensation program in most states. In this report, you’ll find detailed information about how many total cases were filed state-wide, how many employees missed work, transferred jobs, or received restrictions, and workers’ comp claims reported within the service-providing industry. Below is a closer look at how the New Mexico workers’ compensation program statistics changed from 2011-2015.

Like most other U.S. states, the New Mexico workers’ compensation program has stayed relatively stable over prior five years. The biggest documented change happened from 2012 to 2013, when the total number of recordable cases fell. During this time the program saw a drop of 4,800 claims, quite a difference year-over-year. Despite no indication as to why these claims fell so drastically, new and future beneficiaries may find it beneficial. Fewer claims may mean shorter wait times and faster approval for current applicants.

Do You Need A Workers’ Compensation Attorney?

Before you file your New Mexico workers’ compensation claim, it may be beneficial to seek legal representation. This is especially true if yours happens to be a complicated case or you may need to file an appeal. Our network of workers’ compensation attorneys can help you collect required documentation, communicate and negotiate with your employers’ insurance company, and represent your claim in court if needed. Best of all, most attorneys work on a contingency basis, meaning they only get paid if you win compensation. If you need legal assistance but don’t have the money to pay up front, this can be extremely helpful.

To see if you may qualify for legal assistance from an attorney in your area, please complete your free workers’ compensation evaluation below.

Get Your Free Benefits Evaluation