New Mexico Workers Comp Claims: Eligibility, Filing and Appeals

Workers Compensation insurance protects employees who have been injured in the workplace by paying medical expenses and lost wages due to disability. In New Mexico, all employers with three or more employees must have insurance, with the exception of domestic servants, real estate salespersons and farm or ranch workers. Employers in Construction related fields must have insurance even if they have only one employee. An Uninsured Employers' Fund also exists to protect employees working for employers without the required coverage. The New Mexico Workers Compensation Administration oversees the specific Workers Compensation laws in the state.

Common Covered Work Related Injuries

Injuries or diseases must have a direct connection to work in order to be covered. If an injury is sustained at work but is not work related, such as injuries sustained through horseplay or due to drug or alcohol use, these injuries will probably not be covered. Injuries sustained while traveling for work purposes are covered, though not while commuting to and from work. Occupational diseases that are the result of work are also covered. Certain mental impairments, hernias, and disfigurements may also be covered.

How to File a Claim

An employee should fill out a Notice of Accident form within 15 days of an injury and submit it to their employer. Employees should also ask their employer if they are required to see a specific health care provider. The employer will then submit an Employer’s First Report of Injury or Illness form to their insurance company and to the Workers Compensation Administration. A claims representative will then contact the employer to begin the claims process.

Workers Compensation Claim Denials

Workers Compensation is generally a “no fault” system, though denials do sometimes occur. A claim may be denied if the injury or illness is found to be caused by activities not related to an employee's work. Insufficient evidence of injury or incomplete or incorrect paperwork may also lead to a denial.

Appealing a New Mexico Workers Comp Denial

An employee who has been denied benefits should first contact an ombudsman with the Workers Compensation Administration, who will offer advice and solutions. Another option is to file a complaint with the Workers Compensation Court. A mediation conference will then be scheduled around three to seven weeks after filing the complaint. An employee may represent themselves in mediation or have an attorney represent their interests. If mediation doesn't work, an employee may request a formal trial in Workers’ Compensation court in front of a judge. Judge's decisions can be further appealed with the New Mexico Court of Appeals.

Collecting New Mexico Workers Comp Benefits

For wage loss benefits, employees should get their first check within 14 days after missing more than seven work days. The amount of benefits depends on the type of injury as well as an employee’s average wage. For Total Disability, benefits will amount to two-thirds of an employee's average weekly wage. Partial disability rates will be lower, depending on the severity of the injury. All benefits are subject to maximum caps, and workers who earn more than the state's average wage will not receive more than the maximum allowed amount. As of 2009, the maximum weekly benefit rate is $669.21.

Hiring a Workers Compensation Lawyer

Though lawyers are not mandatory in mediation hearings, consulting an experienced attorney who understands the complex legal issues of Workers Compensation law can be beneficial to employees with claim disputes. A lawyer should almost certainly be hired in the event of a formal trial.

New Mexico Workers Compensation Office Locations

New Mexico Workers Compensation Administration
Mailing Address:
Post Office Box 27198
Albuquerque, New Mexico 87125-7198
Street Address:
2410 Centre Avenue SE
Albuquerque, New Mexico 87125
(800) 255-7965

Farmington Office
3535 East 30th Street
Farmington, NM 87402
505-599-9746

Las Cruces Office
1120 Commerce Dr., Suite B-1
Las Cruces, NM 88011
575-524-6246

Las Vegas Office
32 N.M. 65
Las Vegas, NM 87701
505-454-9251

Lovington Office
100 West Central, Suite A
Lovington, NM 88260
575-396-3437

Roswell Office
Penn Plaza Building
400 N. Pennsylvania Ave., Ste. 425
Roswell, NM 88201
575-623-3781

Santa Fe Office
810 West San Mateo, Suite A2
Santa Fe, NM 87505
505-476-7381