If injured at work or if you develop a workplace related sickness you should be able to obtain compensation by taking advantage of your employer’s workers’ compensation insurance. Most employers in New Mexico should have this type of insurance to cover their employees in the event of an accident at work. You normally have to stick to certain time limits when filing a claim for compensation. Workers’ Compensation generally covers any medical treatment you receive as well as a percentage of lost wages. Any claim denial can be appealed, although this can be a lengthy process and may take months or years to resolve. Workers Compensation Law in New Mexico In New Mexico, the Workers’ Compensation Administration (WCA) is responsible for overseeing workers’ comp. arrangements in the state and will also administer any appeals if there is dissatisfaction with a claim. Most employers in the state must take out workers’ compensation insurance, with limited exceptions. Agricultural and domestic workers and independent contractors, for example, are not covered. If your employer has WC insurance and you do have a genuine workplace injury or illness you should let your employer know by filling in the correct form as soon as you can. Compensation payments in New Mexico are limited to reasonable medical bills as well as replacement of lost earnings. There are different calculations for temporary and permanent disability as well as death compensation for relatives if an employee dies at work. Why Your WC Claim Could be Denied in New Mexico Insurers are never very happy to release compensation payments and have all sorts of reasons why they deny your claim. If your claim is denied because you were not at work, but you know you were, it might be a simple mistake in communication between your employer and the insurer which you should be able to resolve quite quickly. There are more serious reasons why the insurer denies a claim. These are the ones that might need an appeal to be reversed if you contest the reason. For example, they might say that you: did not file your claim on time or inform your employer properly on time; were not injured at work but outside work, even during your lunch break; did not take any notice of safety equipment or safety rules at work; acted in an ill-disciplined manner which contributed to your injury; were intoxicated or affected by drugs; did not provide sufficient evidence of medical costs. The New Mexico WC Appeals Process If you are dissatisfied with the decision but the insurer, either because it has been completely denied or because the amount of compensation is too low, you can make an appeal through the state’s Workers’ Compensation Administration. If you do decide to go down this route, it is advised that you obtain legal help from an attorney. The WCA operates a two step appeals process within its jurisdiction. Beyond that you have the option of appealing to the state’s Appellate Court. Normally the WCA will arrange a mediation meeting between you, the insurer’s representative and an independent third party. The idea will be to seek a resolute without having to go to a formal hearing. You will need to bring along with you as much evidence as possible which backs up your side of the claim. The mediator will not make a binding decision but suggest a resolution. If you are not satisfied with this, you will need to file a petition for a formal hearing. The formal hearing may take several months before it takes place. A WCA judge will review the dispute, listen to evidence, ask questions and make a final decision. Why a WC Attorney May be of Help If you feel that your claim has been unjustifiably denied you do have the chance to appeal the decision but this is not an easy process. You are advised to contact a workers’ compensation attorney to provide you with advice about your appeal and represent you at any informal and formal hearings.
