New Mexico's system of workers' compensation is compulsory, meaning that employers are required to provide workers' compensation insurance to their employees. Workers' compensation insurance may be provided through private insurance carriers, a competitive state fund, or self-insurance. Waivers may be permitted to exclude certain employees from coverage, including corporate officers and sole proprietors.
Exemptions from coverage may apply to certain employees, including employees of very small businesses, farm and ranch laborers, casual labor, and real estate agents.
Medical Benefits are provided to employees entitled to workers' compensation benefits, including coverage for necessary medical care.
The employer may choose the treating physician for the first sixty days of treatment, or may allow the employee to choose a doctor. If the employer chooses the physician, the employee may change physicians after the initial sixty day period ends. If the employee makes the initial choice of physician, the workers' compensation claims representative may require the employee to change to a different doctor at the end of the initial sixty days of treatment.
Indemnity benefits are payable to injured workers to help make up for lost income. There is a waiting period of 7 days before a worker is eligible for indemnity benefits, but if the worker's disability lasts more than four weeks indemnity benefits become retroactive to the date of the injury.
Benefits available to injured workers include the following:
Temporary Total Disability (TTD)
Temporary total disability (TTD) benefits are paid to workers who are unable to work due to injury, but who are expected to make full or partial recovery such that they may return to work. Benefits are based upon 2/3 of the injured worker's average pre-injury weekly wage, subject to a cap, and continue for up to 700 weeks. Offsets may apply for unemployment insurance, or benefits from disability insurance paid for by the employer.
Permanent Total Disability (PTD)
When a worker is not expected to recover from a total disability caused by a work-related injury, and as a result suffers a total loss of earning capacity, the worker becomes eligible for permanent total disability (PTD) benefits. In New Mexico PTD benefits are calculated based upon 2/3 of the injured worker's pre-injury weekly wage, subject to a cap, and may continue for the duration of the disability. Offsets may apply for employer-provided disability insurance benefits and unemployment insurance.
Permanent Partial Disability (PPD)
Once an injured worker has recovered to the maximum possible extent, the worker may be able to return to employment but nonetheless remain partially disabled, and may potentially qualify for permanent partial disability (PPD) benefits. In New Mexico PPD benefits are determined based on a statutory schedule. Benefits are calculated based upon 2/3 of the injured worker's average weekly wage, subject to a cap. Benefits for unscheduled injuries are based upon a whole body impairment rating, with modifiers for the worker’s age, education, specific vocational preparation, training, and residual physical capacity, and are payable for a maximum of 500 weeks if the worker's injury rating is less than 80%, or for up to 700 weeks if rating is equal to or greater than 80%. For a primary mental impairment benefits are payable for a maximum of 100 weeks.
Temporary Partial Disability (TPD)
When a worker suffers an injury that limits his ability to return to work, resulting in a reduction of income as a result of reduced hours or wages, the injured worker may be eligible to receive a benefit based on the difference between the worker's pre-injury earnings and their reduced, post-injury earnings. In New Mexico, TPD benefits are paid based upon 2/3 of the difference between the injured worker's pre-injury and post-injury wage, subject to a cap. Benefits may be payable for up to 350 weeks.
For some, more serious injuries, workers' compensation indemnity benefits may be paid according to a statutory schedule, instead of following the standard model of the weekly benefit based on the duration of the disability. Scheduled injuries include such injuries as the amputation of an arm, the loss of a dominant hand, the loss of a leg, the loss of a foot, the loss of an eye, or loss of hearing in an ear.
Coverage may be available for cumulative trauma, disfigurement, mental stress and occupational hearing loss.
When a worker dies as the result of a work-related injury, workers' compensation pays additional benefits, including a burial allowance, and benefits for a surviving spouse and dependents. Survivor benefits are calculated based on 2/3 of the worker's average weekly wage, subject to a cap in amount and duration. Benefits may continue for minors until the age of 18, the age of 23 if the dependent is a student, or indefinitely in the event of disability that renders the dependent incapable of self-support. Spousal benefits end upon remarriage.
Attorney fees are not subject to special limits, and may be determined by agreement of the parties or by the judge assigned to the case. Attorney fees are ordinarily split between the employee and the employer or worker's compensation insurer.
This article provides a quick overview of the benefits available to injured workers, but the full formulas used for assessment of benefits, coordination of different types of benefits, and assessment of injuries and disability ratings can quickly complicate the determination of benefits. Also, states frequently revise their workers' compensation laws. Most workers who suffer a significant injury or wage loss as the result of a workplace injury will benefit from consulting a workers' compensation lawyer.
The state agency responsible for workers' compensation is:
New Mexico Workers' Compensation Administration
2410 Centre Avenue, SE
P. O. Box 27198
Albuquerque, NM 87125-7198
(505) 841-6000 or 1-800-255-7965