Frequently Asked Questions
What is the difference between a medical only claim and a lost time claim?
Claims resulting from a work-related injury fall into two groups: medical only claims and lost time claims. A lost time claim occurs when a worker misses more than seven calendar days (one week) of work due to the injury. Although most work-related injuries are not serious enough for a worker to lose more than three workdays, it is still important that workers report the injury to their employer immediately.
What do I do if I am injured while working?
It is very important that any time you are injured on the job you report the incident to your employer immediately. Although the law requires that injuries be reported to the employer within 15 days, all accidents should be reported, regardless if an injury occurred or not.
Seek medical care. If it is an emergency, go to the nearest hospital emergency room and then contact your employer.
Will I receive a W2?
No, workers’ compensation benefits are not taxable.
Do I have a co-pay for my medical care?
No, you will have no out of pocket costs for medical care.
I am missing time from work. When can I expect to receive a check?
Lost time benefits are generally paid every 14 days. If the authorized doctor takes you off work, the first 7 days missed from work is a waiting period and is not paid unless the doctor keeps you off work for a full 28 days. So, your first check should be issued 14 days from the first day you began missing work, and will likely be for one week. Your adjuster can provide more specific information.
Do I have to accept a modified duty position from my employer?
If your employer is able to make a job offer that accommodates the restrictions the authorized treating health care provider has placed, you should accept the job, or face losing wage benefits. If the light duty position pays less than your regular pay, sixty-six and two thirds of the difference will be paid to you, see Temporary Total/Temporary Partial Disability.
What should I do if I receive a bill for medical care?
Please send a copy of the bill to your claims adjuster. It is also wise to contact the provider and remind them that the care you are receiving is covered by workers’ compensation and all bills should be sent to the adjuster, at P.O. Box 27810 Albuquerque, NM 87125.
What about prescription medication?
We use a prescription benefit manager company for billing of all prescriptions, called EHIM. A prescription card will be sent to you. The first time you fill a prescription take the EHIM information to your pharmacy.
As an employer, what are my return to work and rehiring obligations following a job accident?
You are not required to hold a worker’s job position open following a job accident if worker is unable to return to work. You can replace the worker. However, once the worker reaches Maximum Medical Improvement and is released to return to work by the doctor, you are required by law to rehire worker, if:
- The worker requests re-employment.
- You are hiring,
- The treating doctor certifies the worker is fit to perform the pre-injury job or a modified duty job without significant risk of re-injury,
- The job is available.
If you are hiring, you shall also offer to rehire the worker who applies for any job paying less than the pre-injury job – provided the worker is qualified for the job, and the doctor certifies that the worker is fit to perform the job offered without risk of re-injury.
Who selects my doctor if I’m injured?
The law allows your employer to initially select which doctor you are to see, or the employer can allow you to pick your own doctor. If the employer picks the doctor, then you have the automatic right to change to a doctor of your own choosing after 60 days of treatment.
Likewise, if you initially pick the doctor, the employer can send you to their doctor after 60 days of treatment. Whoever is allowed to change doctors, must notify the other of the change by completing and sending to the other a form called “NOTICE OF CHANGE OF HEALTHCARE PROVIDER.”
Whether your employer picks the doctor or you initially pick the doctor, if you are not happy with the doctor you are seeing, you may be able to see another doctor, but only with the permission of the employer’s insurance adjuster. If you are initially treated in an “emergency room” and referred to a certain doctor, you should first check with your employer about who is to select the doctor before continuing treatment.
What is the amount and duration of Wage Loss Benefits?
If you are taken off work duty by an “authorized health provider,” workers’ compensation insurance pays 66 2/3 percent of your average weekly wage, called Temporary Total Disability (TTD) Benefits. These benefits go into effect on the 8th day of non-work status. The first 7 days of non-work status are not payable unless you are off work up to 4 weeks. The first payment of benefits will be mailed to you 21 days after you are off work. Thereafter, benefits will be mailed to you every 2 weeks.
TTD Benefits will stop either when the doctor releases you to full work duty or when you reach Maximum Medical Improvement (MMI), which is that point in time the doctor feels you are as good as you are going to get from medical treatment. If the doctor believes you have some remaining disability after you reach MMI, you may then be eligible for Permanent Partial Disability (PPD) Benefits for a specified period of time, depending on the type of your injury.