If you have a work-related injury
Give notice of the accident/injury to your employer
Section 52-1-29 of New Mexico Workers’ Compensation Statute states that a worker must give written notice, to his employer of an accident within 15 days (this is 15 calendar days including weekends and holidays) from the point worker knew or should have known of the accident/injuries occurrence. Employers are required to have a poster informing employees of their duty to give notice of injuries within 15 days. If the employer fails to hang this poster in a public area, the notice period is increased to 60 days. If there are circumstances beyond the worker’s control, notice must be given no later than 60 days.
Verbal notice may constitute actual notice, but only if it puts the employer on notice regarding the time, place and circumstances of a work accident. An employers’ knowledge of a injury, without relation to a work accident is insufficient notice. For example, the statement, “My neck hurts,” would not constitute notice of an accident. The statement, “My neck hurts since I lifted an engine block yesterday,” would be sufficient as notice.
Written notice is not required if the employer or supervisor has actual knowledge of the accident. Notice must be given to the employer or supervisor. Notice to a co-worker is not considered valid notice.
Seek medical care
In an emergency, medical care should be sought immediately wherever it is available. If it is not an emergency, please contact your employer to discuss the selection of a health care provider.
Selection of health care provider rules and regulations
Section 52-1-49 (A) requires the employer to provide reasonable and necessary medical and related treatment in a timely manner.
Section 52-1-49 (B) gives the employer the right to either initially select an authorized health care provider or give that right to first selection to the injured worker. The initial selection is in effect for at least the first 60 days.
Rule 18.104.22.168 (C) states that the employer must notify the employee in writing of its decision to select the initial healthcare provider or to give that selection to the worker. If written notice is not given to the worker, the selection of the worker will be considered the selection of the employer as well.
WCA rule 12.1.2 (A) states that Emergency Medical Care is not to be considered a choice of treating health care provider by the Employer or Worker.
Section 52-1-49 (C) allows the party that did not make the initial selection the right of second selection. Thus allowing, after at least 60 days, a redirection of medical care to another health care provider, who will remain the authorized treating health care provider for the remainder of the injury. This redirection requires the completion of a NOTICE OF CHANGE OF HEALTH CARE PROVIDER. The first appointment with the new health care provider can be no sooner than 10 days from the receipt by the other party the notice of change.
Section 52-1-49 (D) allows the party receiving the Notice of Change of Health Care Provider to file an objection with the Workers’ Compensation Administration. The Administration will set a hearing before a Judge within 7 days. A NOTICE OF HEALTH CARE PROVIDER DISAGREEMENT can be filed by either party at any time if there is a disagreement on the choice of health care provider. Again the Administration will set a hearing before a Judge within 7 days. The party filing the disagreement will bear the burden showing that the change in healthcare provider is not reasonable or necessary.
Keep your employer informed
The goal after any injury is a successful return to work. This is most likely to occur if the lines of communication are kept open. WCA rule 12.1.2 requires an injured worker to notify the employer/insurer within (15) days of any return to work release. If you are working (even part time) you are required to notify the insurance company.
Keep your adjuster informed
Adjusters are responsible for determining what, if any, benefits are owed after a work-related injury. This determination is made based on an investigation of the incident. If information is not being provided to the adjuster, benefits that may be owed could be missed. If you are missing time from work, it is very important that you contact your adjuster after every doctor visit.