Healing starts here.
Helping the workers in our care to recover from their injuries is the first priority at New Mexico Mutual. So rest easy—you’ll soon be receiving the medical attention and services you need to get well and back to work. Please call us at 505-345-7260 to find out if you are also eligible to receive lost-wage benefits.
What Is Workers’ Compensation?
Workers’ compensation is the insurance that covers workers who have on-the-job accidents or who acquire a compensable occupational disease. Workers’ compensation benefits include medical care and attention and may also include lost-wage benefits. The goal of this coverage is to help workers make successful recoveries so that they can return to their jobs.
What Benefits are Available?
If you are injured in a work-related accident or diagnosed with an occupational illness, you are entitled to receive reasonable and necessary medical care, as prescribed by an authorized treating health care provider, for conditions related to the injury or illness. You may also qualify for temporary or permanent disability payments depending upon your pre-injury wages and the length of your recovery. Except in emergencies, you should check with your employer or New Mexico Mutual before receiving medical attention. That way, you can make sure that your treatment will be paid for by New Mexico Mutual.
To check your eligibility, contact your New Mexico Mutual claims representative after you miss more than 7 days of work.
You may be eligible for wage-replacement benefits if the doctor authorized to provide your care takes you off the job and you miss more than 7 days of work. You may also be eligible if your employer doesn’t have work available for you because of your work restrictions. The wage-replacement benefit pays eligible workers up to 66 2/3% of their average weekly wage in accordance with state law.
What Are My Responsibilities as an Injured Worker?
Your responsibilities include attending all medical appointments and following the instructions of your healthcare providers. In addition, you must stay in touch with your employer and your New Mexico Mutual claims representative throughout the recovery process. You’ll need to notify your claims representative if your case changes in any way – for example, if you return to work or experience another injury.
Contact an Ombudsman
You can also contact an ombudsman with the New Mexico Workers Compensation Administration. Ombudsmen provide information about the workers’ compensation system and can help if any disputes arise.
After an accident, where should I go to receive urgent care?
You Have Many Choices Available If You Need Urgent Care After A Work-Related Accident. You can choose an urgent care center from New Mexico Mutual’s Preferred Provider Network. This large network of authorized providers offers expert, reasonably priced care at locations across New Mexico. Or you can choose an urgent care facility on your own.
Please choose a provider you feel comfortable with—but don’t delay. It’s important for you to receive medical attention as soon as possible after the accident occurs.
Getting a Prescription Filled
On the day of the accident, you may fill your prescription at any pharmacy in New Mexico. Tell the pharmacist that you have workers’ compensation insurance through New Mexico Mutual. No out-of-pocket payment should be required.
Shortly after we receive notice of your accident, you will receive a prescription card in the mail from Alius Health, our pharmacy benefit provider. Be sure to use this card for any medications prescribed for your work injury. Prescriptions may be filled at any participating pharmacy within the Alius network.
Returning to Work
As a recovering employee insured by New Mexico Mutual, you have a full team of experts working on your behalf. Your doctor, your employer and our company will be helping you to return to work as soon as medically reasonable. But the team can’t do it alone. You will need to play an active role in the process.
Many employers use return-to-work programs to help their employees get back on track after an injury. The following Q and A explains return-to-work programs and the responsibilities of injured workers who are offered light modified-duty work.
What is a return-to-work program?
A return-to-work program allows injured employees to return to work with temporary physical restrictions assigned by the treating physician. Employees may return to their original job with modifications or to a completely different job, depending on which restrictions the employer can accommodate.
Why should I return to modified work, also known as “light duty”?
Workers’ Compensation lost-wage benefits only pay 66 2/3% of your pre-injury average weekly wage. You will be paid more by returning to work than by staying home, even if you work only part time during your recovery.
In addition, research shows that working is an important part of the recovery process. Keeping your work relationships going helps with self-esteem and allows you to maintain a more positive attitude.
Is my employer required to offer me a light-duty job?
No. An employer is not required to create a position to accommodate an employee who is injured while working.
Do I have to return to light-duty work if it is available?
Yes. If your employer offers a job that accommodates your light-duty restrictions, you are required to accept. Refusal will put you at risk of having your lost-wage benefits suspended or terminated.
How am I paid if I am on light duty?
You will be paid by your employer. If the light-duty job offered is not at your pre-injury wage, New Mexico Mutual will pay 66 2/3% of the difference.
How long can I stay on light duty?
You may stay on light duty for as long as your employer is able to accommodate your restrictions, or until your treating physician states that you have reached Maximum Medical Improvement.
What if I am asked by a coworker to do something outside of my restrictions?
It is very important not to exceed your restrictions, either at work or at home. If a coworker asks you to perform work that exceeds your restrictions, you must remind the coworker that you are unable to do the requested task. If the coworker persists, you should advise your supervisor and/or your claims representative immediately.
New Mexico Mutual has a “Zero Tolerance” policy for fraud, and aggressively pursues allegations of fraudulent activities by injured workers, medical providers, or employers. Any agent, customer, or employee may anonymously communicate or report any Code of Conduct matter through the Global Compliance Alert Line or call 1-877-874-8416.