Free INDEMNITY PAY ISSUES - New Mexico


File Size: 257.1 kB
Pages: 30
File Format: PDF
State: New Mexico
Category: Workers Compensation
Author: Robert V. Cravens
Word Count: 12,486 Words, 79,630 Characters
Page Size: Letter (8 1/2" x 11")
URL

http://workerscomp.state.nm.us/pdf/booklets/B2.pdf

Download INDEMNITY PAY ISSUES ( 257.1 kB)


Preview INDEMNITY PAY ISSUES
The Workers' Compensation Handbook For New Mexico

Booklet B2:

Benefits for Workers While They Cannot Work
What's your future?................................................................................................2 Indemnity Benefits during the Disability Period ........................................................4
If you cannot return to your job .................................................................................... 3 Waiting period before first payment ............................................................................... 4 Temporary Total Disability (TTD)................................................................................... 5 Your compensation rate could be affected by: ................................................................ 5 Safety device penalty (§52-1-10 NMSA) ......................................................................... 5 Drug and alcohol penalty (§52-1-12 and §52-1-12.1 NMSA)............................................. 6

Benefits could be terminated if -- (§52-1-51)-- .........................................................6 Maximum Medical Improvement (MMI) (§52-1-24.1 NMSA) ......................................6

Indemnity Benefits for Injury to Specific Body Parts (Scheduled Injuries, §52-1-43 NMSA).................................................................................................................10 Injuries to the whole body ....................................................................................10 The Permanent Partial Disability (PPD) Formula .....................................................11 Permanent total disability (§52-1-25 NMSA)...........................................................13 Benefits for specific conditions ..............................................................................13 Other issues related to workers' compensation benefits .......................................... 14
Mental impairment

Returning to work before MMI....................................................................................... 9 Reaching MMI with no impairment............................................................................... 10

Impairment Rating ..................................................................................................... 11 If you are back at work............................................................................................... 11 Number of weeks of PPD ............................................................................................ 12

(§52-1-24 and §52-1-42 NMSA).................................................... 13

Does the employer have to keep you employed? .................................................... 16 Lump Sum Settlements (§52-5-12 NMSA) ..............................................................17 Survivor Benefits for Death (§52-1-46 NMSA) ........................................................20

Unemployment .......................................................................................................... 14 Creditors and child support (§52-1-52 NMSA) ............................................................... 15 Third party lawsuits (§52-5-17 NMSA).......................................................................... 15

Partial Lump Sum Settlement for Debt ......................................................................... 18 Return to Work Lump Sum.......................................................................................... 18 Guardians for minors (§52-5-11 NMSA) ....................................................................... 20

The Workers' Compensation Handbook for New Mexico Booklet B2. Indemnity benefits for long-term or serious injuries

2007 Edition page 2

TERMS TO UNDERSTAND: .................................................................................... 22 Permanent Partial Disability Chart ......................................................................... 25 Property Tax Relief for PTD Workers ..................................................................... 27
The Schedule of Injuries to Specific Body Members ....................................................... 26 Workers' Compensation Handbook List of Booklets........................................................ 28 Help from the Workers' Compensation Administration ................................................... 29

Sometimes the worker cannot go back to work right after an injury ­ either because the doctor says the worker must take time off to recover, or because the worker temporarily cannot do his regular job and the employer has no work available that the worker can do. This booklet describes the special concerns for these workers. Most of this booklet is addressed directly to the worker. The booklet explains indemnity benefits (money payments to the injured worker) and the rights and responsibilities of injured workers and employers. Some injured workers recover completely from their injuries. For these workers, there may be a period when the worker is unable to work, and after this period the worker is fully recovered and able to do the same work as before. In other cases, the injury may cause a permanent physical change that will affect the worker's ability to work in the future. Workers' compensation indemnity benefits are paid for a temporary period of months or years in most cases. Most workers will be able to go back to work, at the same job or at a different job. In most cases workers are better off by going back to work as soon as they are ready than they would be by relying on workers' compensation payments.

What's your future?
Will you be able to return to your old job? What about returning to an even better job? In many cases, as an injured worker you can make good use of the recovery time out of work by going to school. This might be especially valuable if you know, due to your injury, that you will not be able to return to your old job and will need new skills. Talk to your doctor and your claims representative so you understand both the physical and legal limitations. (For example, this will not apply if your employer offers you a job while you are recovering.) Workers' compensation will not pay for your schooling, but you may find programs in your community that are free or low-cost. Contact your local high school,
__________________________________________________________ Published by the New Mexico Workers' Compensation Administration, a state agency. Laws can change. Check for new information by calling 1-866-WORKOMP or 1-866-967-5667 or look on the Internet at www.workerscomp.state.nm.us.

The Workers' Compensation Handbook for New Mexico Booklet B2. Indemnity benefits for long-term or serious injuries

2007 Edition page 3

community college, or Department of Labor One-Stop Center. Also see Booklet B3, "Going Back to Work."

If you cannot return to your job
This chart describes indemnity benefits (money to the worker). Medical care benefits are in Booklet B4. See the next section for explanation of these terms.

If you cannot work at all:

Health care provider decides you cannot work now, or employer has no work available that you can do based on medical restrictions Pre-injury Temporary total disability benefits two-thirds of your pre-injury average weekly wage up to "state cap." This amount is also called your "compensation rate."

If you can do a different job, at lower pay or part time
Temporary partial disability benefits two-thirds of the difference between pre-injury and post-injury wage. This option provides more money than staying at home receiving full workers' compensation benefits.

MAXIMUM MEDICAL IMPROVEMENT

Health care provider decides you have recovered as much as you can. After Maximum Medical Improvement, benefits will change to one of these types: Permanent partial Scheduled injury No benefits; Permanent partial disability benefits benefits claim is finished disability benefits with modifiers without modifiers Whole body injury Whole body injury Injury to a body You are back to with permanent with permanent part (such as arm normal. Fully impairment: impairment: or leg) only. recovered with no Not back to work Back to work Benefits are the impairment. OR working earning same or same, whether earning lower higher wages working or not wages

MAXIMUM TOTAL TIME FOR ALL BENEFITS

For most injuries, all indemnity benefits end at 500 weeks. For some very serious injuries (80% disability rating), benefits end at 700 weeks. You are still entitled to medical care for the injury if you need it. (See section below for Permanent Total Disability, which is limited to certain extremely serious injuries.)

__________________________________________________________ Published by the New Mexico Workers' Compensation Administration, a state agency. Laws can change. Check for new information by calling 1-866-WORKOMP or 1-866-967-5667 or look on the Internet at www.workerscomp.state.nm.us.

The Workers' Compensation Handbook for New Mexico Booklet B2. Indemnity benefits for long-term or serious injuries

2007 Edition page 4

Indemnity Benefits during the Disability Period
In most workers' compensation cases involving a period of disability, you may be under a doctor's care and unable to work for a period of time. Then, after the doctor has determined that you have reached a certain point in recovery, if your injury will have a permanent effect, you may be eligible for continued indemnity benefits at a reduced rate. This booklet contains a number of words and terms in boldface letters. These words and terms are explained in this booklet under "Terms to Understand." The word "doctor" is used here as a general reference to several types of health care provider who may be authorized to treat you.

Waiting period before first payment
After you first report your injury: No indemnity benefits are paid for the first 7 days off work. This is called the "waiting period" (§52-1-40 NMSA) 1. If you cannot work for more than 4 weeks, indemnity benefits must be paid for the missed first week. The insurer or self-insurance program is required to send the first indemnity benefit check not later than 14 days after you have missed 7 days from work, and must continue to send benefit checks twice a month (§52-1-30 NMSA). In some cases, a worker might be unable to work starting right after the accident. In these cases, the 7 days are counted as one week. In other cases, the lost time does not happen all at once. A worker might have an accident and then try to go back to work, but then later cannot continue working ­ or the worker loses work time because of the time involved in medical care for the injury. In these cases, the 7 days are counted one by one. In a case where the worker is required to miss partial days of work (for physical therapy, for example) the time might be counted in hours rather than full days. If you think you are entitled to indemnity benefits but you are not receiving them, or if your checks are late, talk to your claim representative or contact an ombudsman.

In this booklet are references to specific paragraphs of the workers' compensation law. These references are in a standard form. §52-5-40 NMSA means Chapter 52, Article 5, Section 40 of the New Mexico Statutes Annotated (NMSA).
__________________________________________________________ Published by the New Mexico Workers' Compensation Administration, a state agency. Laws can change. Check for new information by calling 1-866-WORKOMP or 1-866-967-5667 or look on the Internet at www.workerscomp.state.nm.us.

1

The Workers' Compensation Handbook for New Mexico Booklet B2. Indemnity benefits for long-term or serious injuries

2007 Edition page 5

Temporary Total Disability (TTD)
While you are recovering from your injury, and not ready to return to work according to the authorized doctor who is treating you, you receive temporary total disability indemnity benefits (§52-1-25.1 NMSA). This is money paid to you from the insurance company or self-insurance program. The amount, according to the formula in the law, is two-thirds of the average weekly wage that you were earning before your injury, up to a maximum set by the state. This is also called your compensation rate. The maximum compensation rate for any New Mexico injured worker is based on the average weekly wage for all New Mexico workers, established each year by the New Mexico Department of Labor, called the State Average Weekly Wage or SAWW (§52-141(A) NMSA). Beginning in 2000, the maximum has been 100 percent of the SAWW. You can find out the current maximum compensation rate from a WCA ombudsman or by looking on the WCA web site, www.workerscomp.state.nm.us, under "Workers." Your average weekly wage is the average for the 26 weeks of wages just before your injury. If there is a question about your average weekly wage, payroll information may be reviewed. If you were working at more than one job, the wages are counted both from the job where you were injured and your other job. Some forms of non-cash compensation, such as housing provided in connection with a job, may be included in figuring your average weekly wage. If your average weekly wage was less than $36, your compensation rate is your full weekly wage (§52-1-41(D) NMSA).

Your compensation rate could be affected by:
These are things that could have been a factor in your accident.

Safety device penalty (§52-1-10 NMSA)
Penalty against worker: If your employer provided a safety device that is required by law or in general use in your industry and you did not use it, and that contributed to the accident, your compensation rate can be decreased by 10 percent. You will still be entitled to your full medical benefits. Penalty against employer: If your employer failed to provide a safety device that is required by law or in general use in your industry, your compensation rate can be increased by 10 percent. If you want help claiming this extra benefit, contact an ombudsman. Penalty in case of death: If a worker died as a result of the accident, the safety device penalty can affect the benefits to the worker's dependents. See the section "Death Benefits." The family members might have to investigate the accident in order to make this claim.
__________________________________________________________ Published by the New Mexico Workers' Compensation Administration, a state agency. Laws can change. Check for new information by calling 1-866-WORKOMP or 1-866-967-5667 or look on the Internet at www.workerscomp.state.nm.us.

The Workers' Compensation Handbook for New Mexico Booklet B2. Indemnity benefits for long-term or serious injuries

2007 Edition page 6

Drug and alcohol penalty (§52-1-12 and §52-1-12.1 NMSA)
If you were under the influence of alcohol or illegal drugs, and that contributed to your accident, your compensation rate can be reduced by 10 percent. You will still be entitled to your full medical benefits. If your drug or alcohol use caused the accident, your claim can be denied completely. You will not be entitled to any indemnity or medical benefits.

Benefits could be terminated if --

(§52-1-51)--

Later on in your claim, your benefits could be affected by your actions while you are on workers' compensation. You are required to participate in your own recovery process. Your benefits could be reduced or suspended if: ˇ you engage in unhealthful or unsafe practices; for example, if you do physically dangerous activities that are against your doctor's orders and likely to prevent your injury from healing; you refuse to undergo or cooperate with reasonable medical treatment. you refuse to go to a court-ordered independent medical examination when one has been scheduled for you.

ˇ ˇ

If you think the treatment being prescribed by your authorized health care provider is not right for you, is not adequate to help your condition or might be harmful, call an ombudsman for guidance. If you simply stop following the treatment, your claim could be terminated.

Maximum Medical Improvement (MMI)
NMSA)

(§52-1-24.1

You are usually eligible to receive temporary total disability indemnity benefits until the doctor determines that you are ready to go back to work or that you have recovered as much as you can be expected to recover. This point is called maximum medical improvement or MMI. Maximum Medical Improvement is defined in the law as "the date after which further recovery from or lasting improvement to an injury can no longer be reasonably anticipated based upon reasonable medical probability as determined by a health care provider." The time when you reach MMI is decided by the health care provider. If your doctor releases you to go back to work before you have reached MMI, and your employer offers you a job that you are able to do, your temporary total disability indemnity benefits will be adjusted to temporary partial disability benefits. If the job you are offered pays the same or a higher wage than before your injury, your temporary
__________________________________________________________ Published by the New Mexico Workers' Compensation Administration, a state agency. Laws can change. Check for new information by calling 1-866-WORKOMP or 1-866-967-5667 or look on the Internet at www.workerscomp.state.nm.us.

The Workers' Compensation Handbook for New Mexico Booklet B2. Indemnity benefits for long-term or serious injuries

2007 Edition page 7

total disability benefits will be ended. You might still be eligible for permanent partial disability benefits after MMI. If your doctor releases you to go back to work before MMI, and you find a job with a different employer at the same or higher wage than you were earning before your injury, your temporary total disability benefits will be ended. You might still be eligible for permanent partial disability benefits after MMI. You will still be eligible for medical care after MMI. Benefits after MMI are usually much less money than temporary total disability benefits. Be prepared for a big change.

Late adjustments for MMI
In some claims, after the health care provider has decided that you have reached MMI, it might take a few weeks for the health care provider's report to get to your claim representative. Meanwhile, you are still receiving benefits checks for TTD. In such a case, the claim representative could claim that you have been paid too much, because your benefits should have changed as soon as you reach MMI. If you have questions about this, call an ombudsman.

QUESTION:

Q. The doctor says I am at MMI but I don't agree. I don't think I am ready to go back to work. What can I do? A. Disagreements like this sometimes happen. Your first step should be to call an ombudsman, unless you have a lawyer. The best solution for you will depend on other factors in the progress of your claim. Q. I am being treated by a doctor selected by the claim representative. I don't like this doctor. The doctor says I have to have surgery and I think that is wrong. What happens if I refuse to have the surgery? A. If you refuse surgery, the doctor might decide that you are now recovered as much as you are going to, and declare that you are at maximum medical improvement. This will affect your workers' compensation indemnity benefits. Call an ombudsman (unless you already have a lawyer). You might have to file a formal complaint to resolve this disagreement. An ombudsman can help you get started.

__________________________________________________________ Published by the New Mexico Workers' Compensation Administration, a state agency. Laws can change. Check for new information by calling 1-866-WORKOMP or 1-866-967-5667 or look on the Internet at www.workerscomp.state.nm.us.

The Workers' Compensation Handbook for New Mexico Booklet B2. Indemnity benefits for long-term or serious injuries

2007 Edition page 8

Return to work before MMI
This chart applies if the worker comes back to work at any time before the doctor has found that the worker has reached "maximum medical improvement."
THE WORKER may also be entitled, later, to permanent partial or scheduled injury benefits if there has been a permanent injury.

If the worker is not able to return to work (§52-1-41 NMSA)
TEMPORARY TOTAL DISABILITY (TTD) BENEFITS two-thirds of worker's average weekly wage up to "state cap." This amount is also called the "compensation rate" for this worker. (The cap is $595.67 for 2007 injuries. To find the cap for a different year, call an ombudsman or look on the WCA web site.)

Or if the pre-injury employer makes a legitimate offer of work and the health care provider approves
NO (TTD) WORKERS' COMPENSATION BENEFITS "back to normal"
Full pay is higher than workers' compensation TTD benefits.

If the worker returns to work at full pay for any employer (§52-1-25.1(B) NMSA)

Or if the employer makes a legitimate offer of work at reduced pay and the health care provider approves

If the worker returns to work for pre-injury employer at reduced pay (temporary assignment to different job or part time) (§52-1-25.1(C) NMSA)

TEMPORARY PARTIAL (TPD) WORKERS' COMPENSATION BENEFITS two-thirds of the difference between pre-injury and post-injury wage

Partial pay plus temporary partial benefits is higher than workers' compensation TTD benefits.

__________________________________________________________ Published by the New Mexico Workers' Compensation Administration, a state agency. Laws can change. Check for new information by calling 1-866-WORKOMP or 1-866-967-5667 or look on the Internet at www.workerscomp.state.nm.us.

The Workers' Compensation Handbook for New Mexico Booklet B2. Indemnity benefits for long-term or serious injuries

2007 Edition page 9

After MMI, your continuing indemnity benefits depend on two things: ˇ the medical severity of your condition (impairment rating); ˇ if you are not back to work, or if you are working at a reduced wage, a formula based on the likelihood that new job opportunities will be available to you (disability modifiers). As a general rule, before or after MMI, you will make more money by going back to work at whatever work you are able to do. After your temporary total disability period is over, if you have a condition that could be permanent, you may be eligible for permanent partial disability indemnity benefits. According to the formulas in the law, you will continue to receive indemnity checks for a certain number of weeks. Permanent partial disability is generally a much smaller amount of money than temporary total disability and will probably not be enough to support you. It will be time for you to look for work, possibly doing a different type of job.

Returning to work before MMI
Here are possibilities for a few different situations. One of these might fit with your circumstances. See Booklet B1 and the chart called entitled "Return to Work Before MMI."

Going back to work for your previous employer, before maximum medical improvement (MMI), at light duty or lower wage
You do not have to wait for MMI to go back to work. If you can go back to work for your employer at a job that you are physically able to do, and the authorized doctor agrees, you can go ahead and take the job. If your new wage is lower than your old wage, you will receive temporary partial disability indemnity benefits at the rate of two-thirds of the difference between your old wage and your new wage (§52-1-25.1(C) NMSA). You will make more in total money by going back to work. This indemnity benefit will continue until you reach MMI. If you have a continuing disability after MMI you may be eligible for permanent partial disability or scheduled injury benefits for an additional period of weeks, based on factors discussed in the section below. If you refuse to accept a light duty job from your employer when the doctor has approved you to take the job, you could lose your temporary total disability indemnity benefits. TEMPORARY PARTIAL DISABILITY BENEFIT is OLD WAGE minus NEW WAGE times TWO-THIRDS

__________________________________________________________ Published by the New Mexico Workers' Compensation Administration, a state agency. Laws can change. Check for new information by calling 1-866-WORKOMP or 1-866-967-5667 or look on the Internet at www.workerscomp.state.nm.us.

The Workers' Compensation Handbook for New Mexico Booklet B2. Indemnity benefits for long-term or serious injuries

2007 Edition page 10

Going back to work for any employer, before MMI, at full duty or same or higher wage as before injury
Since you are not suffering any loss of wages, you will not receive any more temporary total disability indemnity benefits. Continuing medical care for your injury is still covered (§52-1-25.1(D) NMSA). If you have a continuing impairment after MMI you may be eligible for continuing indemnity benefits for an additional period of weeks, based on factors explained in the section below.

Reaching MMI with no impairment
If, after you reach maximum medical improvement, the health care provider says you have no continuing physical impairment, your claim is probably finished. You will not receive any more workers' compensation indemnity benefits. Your workers' compensation period is over and it is time for you to go back to work, either by returning to your old job or by looking for a new one. See Booklet B3, "Going Back to Work." You might still be eligible for medical care in the future if you have future medical problems that are clearly based on this injury.

Indemnity Benefits for Injury to Specific Body Parts
(Scheduled Injuries, §52-1-43 NMSA)
If your injury has resulted in permanent loss (or long-term loss of use) of a specific body member, such as a finger, hand, arm, foot, leg, eye or ear, then your long-term indemnity benefit will probably be based on the schedule in the workers' compensation law. This is called a scheduled injury. You may continue to receive indemnity benefits based on a percentage of your compensation rate for a certain number of weeks. The percentage is based on your loss of ability to use the injured body part (the legal term is "loss of use"). The weeks of scheduled injury benefits start at MMI. (As of 2007, the method of deciding this is under study and could be changing.) Scheduled indemnity benefits are due regardless of the amount of wages you may earn at a new job. The complete schedule is in the statute at §52-1-43 NMSA and is copied in the back of this booklet.

Injuries to the whole body
If your injury was to the "body as a whole" -- that is, not limited to scheduled body parts -- and as a result of your injury you have an impairment from which you may never fully recover, such as a limitation in your ability to move or lift, then you may be eligible for permanent partial disability indemnity benefits. The words disability and impairment have specific legal meanings in workers' compensation. Impairment refers to an alteration in normal physical or psychological
__________________________________________________________ Published by the New Mexico Workers' Compensation Administration, a state agency. Laws can change. Check for new information by calling 1-866-WORKOMP or 1-866-967-5667 or look on the Internet at www.workerscomp.state.nm.us.

The Workers' Compensation Handbook for New Mexico Booklet B2. Indemnity benefits for long-term or serious injuries

2007 Edition page 11

function. Disability refers to the effect of the injury on the worker's future ability to work. It includes impairment as well as other factors.

Impairment Rating
The impairment rating is a number assigned by a doctor to express the limitation in the use of your body that you have suffered as a result of your injury. It is expressed as a percentage -- for example, an impairment rating of 10 percent or 20 percent. The method of calculating an impairment rating is based on a standard medical document published by the American Medical Association, called the AMA Guides. Your impairment rating can be established only by an authorized treating doctor or by an independent medical examiner selected for your case.

If you are back at work
If you have reached maximum medical improvement, are back at work earning your pre-injury wage or more, and have a permanent impairment, then you may receive continuing indemnity benefits equal to your compensation rate times your impairment rating (§52-1-26(D) NMSA) .

The Permanent Partial Disability (PPD) Formula
This is a general explanation of the PPD formula. This information is not intended to enable anyone to arrive at a PPD rating. It is provided to help you understand how your PPD has been calculated and to ask informed questions. This formula does not apply to you if you are back at work. The formula is applied when a worker has reached MMI, has received an impairment rating, and has not yet gone back to work or been offered a job. The formula is in the workers' compensation statute beginning at §52-1-26 NMSA. A chart that could be used to calculate a benefit based on the formula is in the back of this booklet. For more information about a particular case, ask your claims representative or call an ombudsman at the WCA (see telephone numbers in the back of this booklet).

__________________________________________________________ Published by the New Mexico Workers' Compensation Administration, a state agency. Laws can change. Check for new information by calling 1-866-WORKOMP or 1-866-967-5667 or look on the Internet at www.workerscomp.state.nm.us.

The Workers' Compensation Handbook for New Mexico Booklet B2. Indemnity benefits for long-term or serious injuries

2007 Edition page 12

The formula for determining your percentage of permanent partial disability is: "Age and education factors" times residual physical capacity plus impairment rating (§52-1-26(C) NMSA). The "age and education factors" are also a formula, based on your age, number of years of formal education and the specific vocational preparation (SVP) necessary for your pre-injury job. ˇ ˇ ˇ For your age, you get a certain number of points, from 1 to 5. Older workers get more points (§52-1-26.1 NMSA). For your education, you get a number of points from 0 to 3. Workers with less education get more points (§52-1-26.2(B) NMSA). For "specific vocational preparation," you get a number of points from 1 to 4. The number of points is based on a reference book produced by the U.S. government, called the Dictionary of Occupational Titles (§52-1-26.2(C) NMSA). An additional point is added for a worker who is unable to return to any work for which he is vocationally prepared (§52-1-26.2(D) NMSA).

ˇ

Physical capacity, also called residual physical capacity, is a rating based on the physical demands of the pre-injury job compared to your ability to do physical work now (§52-1-26.4 NMSA). The age and education factor is multiplied by the physical capacity rating, and then that number is added to the impairment rating. The PPD formula produces a number, known as your PPD rating, which is then used as a percentage to calculate your indemnity benefits. For example, if your PPD rating was 40, then you would be eligible for payments of 40 percent of your compensation rate.

Number of weeks of PPD
Most injured workers who receive PPD indemnity benefits may be paid for a maximum of 500 weeks (roughly 9˝ years), counting the weeks they received temporary total indemnity benefits (§52-1-42(A)(2) NMSA). The formula is structured so that whenever you return to work, whether you are able to earn your old wage or a lower wage, you will earn more by working than by not working. A worker who receives a disability rating of 80 or higher may receive benefits for 700 weeks (roughly 13 ˝ years) (§52-1-42(A)(1) NMSA). This worker is likely to have a serious continuing disability or a low likelihood of being able to work at a job similar to the pre-injury job.

__________________________________________________________ Published by the New Mexico Workers' Compensation Administration, a state agency. Laws can change. Check for new information by calling 1-866-WORKOMP or 1-866-967-5667 or look on the Internet at www.workerscomp.state.nm.us.

The Workers' Compensation Handbook for New Mexico Booklet B2. Indemnity benefits for long-term or serious injuries

2007 Edition page 13

If you go back to work and earn a wage lower than your pre-injury wage:
As long as you are making less money than your pre-injury wage, you will be eligible for continuing PPD, as determined by the PPD formula. In most cases the indemnity benefits will continue until the total number of weeks receiving workers' compensation (TTD plus PPD) equals 500 weeks. If your wages increase during this period to your pre-injury wage or higher, your PPD may be reduced to your compensation rate multiplied by your percentage of impairment.

If you go back to work and earn the same or higher wage than before your injury:
You will receive permanent partial indemnity benefits based on your compensation rate multiplied by the percentage of impairment. In most cases this will continue until the total number of weeks receiving workers' compensation benefits (TTD plus PPD) equals 500 weeks. If your impairment rating was 80 or higher, the total number of weeks is 700 weeks.

Permanent total disability

(§52-1-25 NMSA)

A few workers who have been very seriously injured may receive indemnity benefits at their compensation rate for life. This is called permanent total disability or PTD. Permanent total disability is paid only if: ˇ the worker has lost, or lost the use of, both hands, both arms, both feet, both legs, both eyes or any two of them; or ˇ the worker has suffered a brain injury, in which a single traumatic injury results in a 30 percent or higher brain impairment according to the AMA Guides. A worker who qualifies for permanent total disability benefits may also qualify for a special exemption on New Mexico property tax. See the section on property tax near the end of this booklet.

Benefits for specific conditions
Mental impairment (§52-1-24 and §52-1-42 NMSA)
A mental condition may be covered by workers' compensation under certain conditions. If a mental problem occurs as a result of a work-related trauma, it is probably covered even if there was no physical injury. For example, if a worker witnessed a horrifying event at work and suffered severe emotional stress as a result, that could be covered. The law calls this condition primary mental impairment. A disabling mental or emotional condition is also covered if it is the result of a workrelated physical injury. For example, if a worker becomes emotionally depressed as a
__________________________________________________________ Published by the New Mexico Workers' Compensation Administration, a state agency. Laws can change. Check for new information by calling 1-866-WORKOMP or 1-866-967-5667 or look on the Internet at www.workerscomp.state.nm.us.

The Workers' Compensation Handbook for New Mexico Booklet B2. Indemnity benefits for long-term or serious injuries

2007 Edition page 14

result of a permanently disabling injury, the emotional condition would probably be covered. This is called secondary mental impairment. To qualify for mental impairment benefits, the condition must fit the description of primary or secondary mental impairment and also must be diagnosed by a qualified health care provider as a mental illness. A decision of the New Mexico Supreme Court now governs the payment of benefits for mental impairment. According to this decision (Breen and Carrasco v. Carlsbad Municipal Schools and NMPSIA, 2005), workers suffering from a mental impairment have the same rights as workers with a physical impairment and therefore could be entitled to TTD and PPD benefits on the same basis. Previously, these benefits were limited by §52-1-42 NMSA. If a worker suffers a physical injury and as a result develops a secondary mental impairment, the worker may be entitled to TTD benefits as long as he has not reached MMI for either the physical or mental condition. Mental impairment benefits may not be included in any lump sum settlement. They must continue to be paid periodically (§52-5-12 (F) NMSA). Ordinary emotional stress is not recognized as a cause for a workers' compensation claim in most cases. A stressful job that causes emotional problems is not covered.

Other issues related to workers' compensation benefits
Unemployment
Can a worker receive workers' compensation and unemployment benefits at the same time? In most cases, no. You cannot receive the full amount of temporary total disability benefits and unemployment benefits at the same time (§52-1-70 NMSA). The workers' compensation insurer will reduce your workers' compensation benefit by the amount you are receiving in unemployment benefits. Workers' compensation and unemployment contradict each other. To receive workers' compensation TTD benefits, you must generally be unable to work, according to the health care provider. To receive unemployment benefits, you must be actively looking for a job. If you are receiving PPD (permanent partial disability) benefits, you could continue to receive those benefits and also receive unemployment benefits while you are looking for work. However, according to the New Mexico Department of Labor (recently renamed the Department of Workforce Solutions), your unemployment benefits will be
__________________________________________________________ Published by the New Mexico Workers' Compensation Administration, a state agency. Laws can change. Check for new information by calling 1-866-WORKOMP or 1-866-967-5667 or look on the Internet at www.workerscomp.state.nm.us.

The Workers' Compensation Handbook for New Mexico Booklet B2. Indemnity benefits for long-term or serious injuries

2007 Edition page 15

reduced by the amount you are receiving in workers' compensation. (Unemployment benefits are provided by the New Mexico Department of Labor and not regulated by the WCA.) A worker whose workers' compensation claim has been denied, but who is not working, might apply for unemployment benefits with the New Mexico Department of Labor while going through the workers' compensation legal system contesting the denial of the claim.

Creditors and child support (§52-1-52 NMSA)
Workers' compensation benefits are exempt from creditors, except for child support. No one may attach or garnish your benefits. That means that no one may force the insurer or self-insurance program to send your money to someone other than you to pay off a debt (§52-1-52(A) NMSA). However, if you owe child support, you can be required to use a portion of your benefit to pay the child support (§52-1-52(B) NMSA). The WCA sends a list of all workers receiving workers' compensation benefits to the New Mexico Child Support Enforcement Division of the Human Services Department four times each year (§52-160(B) NMSA).

Third party lawsuits (§52-5-17 NMSA)
If your injury resulted from negligent action by someone outside your company, you have the right to sue or collect damages from that person or business in a separate lawsuit outside of workers' compensation. A portion of the money you collect will be required to be returned (or reimbursed) to your workers' compensation insurer or selfinsurance program. In these situations, workers' compensation comes first and provides indemnity and medical benefits for you just the same as in any other work-related injury or disability. Later, after you have received an award of damages from the third party, a determination will be made of the amount of money that has to be returned to the workers' compensation insurer. It is a portion of the total damage award, determined by a formula. You will probably need a lawyer to help you with this process. For example, if you were injured while working on the property of another business, and the cause of your injury was the negligence of the other business, you could sue that other business.

QUESTION:

Q. I was injured because of the careless action of another employee of my company. Can I file a third party lawsuit? A. No ­ not if the injury happened while you were both at work. Injuries caused by other employees of your company are usually covered by your employer's workers' compensation policy.
__________________________________________________________ Published by the New Mexico Workers' Compensation Administration, a state agency. Laws can change. Check for new information by calling 1-866-WORKOMP or 1-866-967-5667 or look on the Internet at www.workerscomp.state.nm.us.

The Workers' Compensation Handbook for New Mexico Booklet B2. Indemnity benefits for long-term or serious injuries

2007 Edition page 16

Does the employer have to keep you employed?
The workers' compensation and occupational disease disablement law does not require the employer to retain you as an employee while you are recovering, if you cannot do your job, or if there is a serious risk that you might hurt yourself or someone else due to your condition. However, the law does require the employer to give you a chance to go back to work later, if you are medically ready and if you apply for a suitable job for which there is an opening. See Booklet B3, "Going Back to Work." It is against the law for the employer to fire a worker in retaliation for making a workers' compensation claim. If the employer does keep you employed, the employer's policy determines how other benefits are covered. Large businesses and public agencies may have formal policies for these decisions. The WCA encourages employers to keep workers employed if it is possible. See the "Stay at Work/Return to Work Program Guide."

Employer:
When a worker is injured and unable to work, the workers' compensation law does not require you to keep the worker employed. You can make decisions based on your judgment of the best interest of your company, including this worker and other workers. You may also wish to consider other laws, including federal employment laws such as the Family and Medical Leave Act and the Americans with Disabilities Act, in your decision. You will have a legal obligation to the injured worker when the worker is ready to go back to work and you have the worker's pre-injury job, or other work the worker can do, available. See Booklet B3. Many employers find that in the long run it is most cost-effective to keep an injured worker employed, even if the worker is temporarily unable to do his regular job. The company's long-range best interest may be the strongest argument why you should maintain as supportive a relationship as possible with the injured worker during recovery. The worker who is welcomed back to work will bring increased company loyalty as well as his prior knowledge and experience of your business. The message will not be lost on fellow employees, who may see that they work for an employer who cares about their well-being and values their ability to make productive contributions.

__________________________________________________________ Published by the New Mexico Workers' Compensation Administration, a state agency. Laws can change. Check for new information by calling 1-866-WORKOMP or 1-866-967-5667 or look on the Internet at www.workerscomp.state.nm.us.

The Workers' Compensation Handbook for New Mexico Booklet B2. Indemnity benefits for long-term or serious injuries

2007 Edition page 17

Worker:
Be businesslike in managing your affairs and in your relationship with your employer during this period. You may have a number of decisions to make -- such as arranging to continue health insurance coverage for your family if you were covered under the employer's group policy. Make decisions based on your long-range best interest and the needs of your family. If you (and your family) were covered under your employer's group health plan, you may be eligible to continue coverage under the federal Family and Medical Leave Act or another federal law called COBRA. Under COBRA, you would have to pay the whole amount yourself, including any portion that was a contribution from the employer. You will have to ask for this if you want it. Contact the U.S. Department of Labor for more information or talk to your employer's employee benefits administrator.

QUESTION:

Q: My employer said I can continue my group health policy while I am out of work, but I have to pay the whole cost, not just my regular share. I said to take it out of the check from workers' compensation, but the employer said I have to write a separate check to the health insurance company. A: The workers' compensation insurer or self-insurance program is not allowed to deduct your group health insurance contributions from the check before sending it to you. An indemnity benefit check is an insurance payment. It is not like a payroll check. You will have to make a separate arrangement with your employer.

Lump Sum Settlements

(§52-5-12 NMSA)

A "lump sum settlement" is the term used when an insurance claim is paid off in a single large payment. In some other kinds of insurance, a lump sum settlement means that the claim is completely closed. In New Mexico workers' compensation, the claim is usually not completely closed. Lump sum settlements are deliberately restricted under the New Mexico workers' compensation law. The law permits lump sum settlements only under certain circumstances and requires the approval of a workers' compensation judge. As long as the worker is still unable to go back to work and receiving indemnity benefits, the claim remains open. Checks must be paid twice a month, and the insurance company or self-insurance program must continue to pay for medical expenses resulting from the injury. The law permits two types of lump sum settlements. See the chart titled "Two Types of Lump Sum Settlements."

__________________________________________________________ Published by the New Mexico Workers' Compensation Administration, a state agency. Laws can change. Check for new information by calling 1-866-WORKOMP or 1-866-967-5667 or look on the Internet at www.workerscomp.state.nm.us.

The Workers' Compensation Handbook for New Mexico Booklet B2. Indemnity benefits for long-term or serious injuries

2007 Edition page 18

Partial Lump Sum Settlement for Debt
A partial lump sum payment may be approved by a judge to pay debts that the worker has accumulated since the injury. This type of settlement is only permitted after the worker has reached maximum medical improvement. This is sometimes called a lump sum for debt. For a partial lump sum settlement to be approved, the worker must appear before a workers' compensation judge and show evidence of the debts ­ for example, documents from a mortgage or loan company. If a partial lump sum is approved, and the worker is represented by a lawyer, the worker might be required to pay some or all of the attorney fees owed to the lawyer out of the lump sum.

Return to Work Lump Sum
If the worker is entitled to continuing indemnity benefits after going back to work, a lump sum settlement of the indemnity benefits is permitted, only if: ˇ the worker has been back at work for at least 6 months, and; ˇ the worker is earning at least 80 percent of his former wage. The amount of the settlement is based on the impairment level of indemnity benefits. A workers' compensation judge must approve the settlement. This is sometimes called a lump sum for return to work. A "return to work" lump sum settlement pays off all indemnity benefits that would be owed to the worker in future, except for a "discount rate." "Discount rate" is a financial term, which means that the worker will be paid less money because the money is being paid earlier than if it were continued as periodic payments. With this type of lump sum, the worker will probably be expected to pay all of his attorney fees out of the lump sum, and that will be part of the judge's order. If the worker owes child support through the New Mexico Child Support Enforcement Division (CSED), CSED can file a court order to stop any lump sum settlement from being completed until an arrangement has been worked out to pay the child support debt. A workers' compensation judge can excuse this requirement in cases of extreme hardship (§52-1-60(C) NMSA). The insurance company or self-insurance program is generally not allowed to close the medical portion of the claim in a lump sum settlement. Insurer responsibility for medical payments continues as long as continued treatment is needed for the workrelated condition (§52-5-12(A)). This type of lump sum has one result that may be very important to the worker. When a worker accepts this type of lump sum, in some cases the worker can no longer claim any indemnity benefits. There are some types of injury where the worker's condition might get worse over time. When this lump sum is accepted, even if the worker is entitled to coverage of the medical expenses, the worker may not be entitled to
__________________________________________________________ Published by the New Mexico Workers' Compensation Administration, a state agency. Laws can change. Check for new information by calling 1-866-WORKOMP or 1-866-967-5667 or look on the Internet at www.workerscomp.state.nm.us.

The Workers' Compensation Handbook for New Mexico Booklet B2. Indemnity benefits for long-term or serious injuries

2007 Edition page 19

any more indemnity benefits. Workers considering this type of lump sum might want to ask a health care provider about the possibility of such a concern.

Two Types of Lump Sum Settlements
PARTIAL LUMP SUM for debt (§52-5-12(C) NMSA)
Must be approved by a workers' compensation judge. To qualify, you must: have reached maximum medical improvement; have debts that are documented (such as unpaid bills), which you can show the judge. This settlement is ONLY to pay off debts that have accumulated since you were injured. The judge may examine documents to make sure these are legitimate debts. After this settlement, you will still be entitled to receive the rest of your indemnity benefits in periodic payments. Your claim remains open. You will still be entitled to "reasonable and necessary" medical care that is related to the injury, if you need it. If you are represented by a lawyer, you may be required to pay all or part of your attorney fees as part of this lump sum. If you owe child support through the New Mexico Child Support Enforcement Division, that must be resolved before your settlement can be approved. Must be approved by a workers' compensation judge. To qualify, you must be: back to work for at least 6 months; earning at least 80 percent of your pre-injury wage. After this settlement, you will not be entitled to any more indemnity benefits for this claim in the future. The indemnity part of the claim is closed. If in the future you are unable to work because of this injury, you will not be able to claim any more benefits. You will still be entitled to "reasonable and necessary" medical care that is related to the injury, if you need it. The amount of money is determined by: the amount that would be due to you in future payments, based on your impairment rating; a "discount rate" which reduces the amount of payment because you are receiving it sooner. If you are represented by a lawyer, you will probably be required to pay all the attorney fees you owe as part of this lump sum. If you owe child support through the New Mexico Child Support Enforcement Division, that must be resolved before your settlement can be approved.

"RETURN TO WORK" lump sum settlement (§52-5-12(B) NMSA)

__________________________________________________________ Published by the New Mexico Workers' Compensation Administration, a state agency. Laws can change. Check for new information by calling 1-866-WORKOMP or 1-866-967-5667 or look on the Internet at www.workerscomp.state.nm.us.

The Workers' Compensation Handbook for New Mexico Booklet B2. Indemnity benefits for long-term or serious injuries

2007 Edition page 20

Survivor Benefits for Death

(§52-1-46 NMSA)

The dependent family members of a worker killed by an on-the-job injury or illness are entitled to indemnity benefits. The beneficiaries may include spouse, dependent children, or other immediate family members if they were financially dependent on the worker. The family is eligible only if the worker has died as a result of the work-related accident within two years after the accident. The death benefit includes all the worker's medical expenses. Benefits to survivors include any indemnity benefits that were due to the worker at the time of death. The indemnity benefits will continue for the spouse or children of the worker, for as long as the worker would have been entitled to the benefits, or for as long as the beneficiaries remain qualified. For example, when children reach age 18, or age 23 if full-time students, they are no longer entitled to benefits. Dependent sisters, brothers or parents of the worker may be eligible for a smaller amount of benefits if there is no eligible spouse or child. A formula in the law determines the amount permitted for each person. The death benefit also includes actual funeral expenses up to $7,500 (for claims beginning June 20, 1999). If a spouse of the deceased worker remarries while receiving indemnity benefits, the spouse can receive up to two years' benefits in a lump sum.

QUESTION:

Q. My former husband was killed in a work-related accident. He was paying child support to me for our child. He also had married again and had a child with his new wife. How do I get a share of the benefits for my child? A. Under the law, a specific proportion of the death benefit goes to the widow. If no other family members are involved, the rest of the benefit is divided equally among all the worker's children. Your child has a right to the same amount of money as the worker's other child. You must make sure that the insurance company knows about your child! Contact the employer and the claims representative as soon as possible. If you need help, call an ombudsman at the WCA.

Guardians for minors (§52-5-11 NMSA)
If benefits are payable to a minor child or to an adult person who is legally incompetent, the Director of the WCA is responsible for ensuring that the benefits are managed properly for the benefit of the minor or incompetent person. A hearing may be held to decide the correct person to receive the benefits on behalf of the minor or incompetent. The Director may also require the person who receives the money to provide periodic accounts of the money to the WCA.

__________________________________________________________ Published by the New Mexico Workers' Compensation Administration, a state agency. Laws can change. Check for new information by calling 1-866-WORKOMP or 1-866-967-5667 or look on the Internet at www.workerscomp.state.nm.us.

The Workers' Compensation Handbook for New Mexico Booklet B2. Indemnity benefits for long-term or serious injuries

2007 Edition page 21

Death Benefits (§52-1-46 NMSA)
Benefits are payable when: Medical costs Funeral expenses INDEMNITY BENEFIT MAXIMUM Worker's indemnity benefit prior to death Survivor benefits the worker dies as a result of a work-related accident, either immediately or within two years of the date of the accident; or, resulting from an occupational disease. all medical and hospital bills for services related to the accident or disease, up to the time of worker's death up to $7,500 for actual funeral expenses The maximum amount of benefits due before and after the worker's death is limited to 700 weeks of temporary total disability benefits at the weekly compensation rate for this worker. If the worker lives for a period of time following the accident, temporary total disability benefits are due to the worker. If any of these are unpaid when the worker dies, these unpaid benefits become part of the death benefit. The maximum amount of benefits to be paid is the "indemnity benefit maximum." If indemnity benefits are paid prior to death, the amount paid prior to death is subtracted from the maximum. Benefits are paid ONLY to the eligible dependents according to a formula in the law. The death was not work-related, or was caused by worker's use of drugs or alcohol. The worker had no eligible dependents as defined in the workers' compensation law, EXCEPT that if there are unpaid indemnity benefits that should have been paid to the worker while still living, those benefits go to the worker's estate. if, at time of worker's death, ˇ living with the worker, or ˇ entitled to be supported by the worker, or ˇ divorced and entitled to alimony spouse may receive 2 years of benefits in a lump sum including: ˇ a child under age 18; ˇ a child under age 23 if full-time student; ˇ an adult child who is incapable of self-support The definition includes (§52-1-18): ˇ stepchildren ˇ adopted children ˇ children born after worker's death ˇ acknowledged illegitimate children benefits may be paid to the family members below this line, limited to maximum of $7500 each only if financially dependent on the worker if, at the time of worker's death: ˇ under age 18, or; ˇ incapable of self-support, and; ˇ financially dependent on the worker.

NO BENEFITS are paid if: NO INDEMNITY BENEFITS are paid if:

Dependents include (§52-1-17 NMSA)
The worker's spouse

If spouse remarries while receiving benefits The worker's children

IF THERE ARE NO DEPENDENT CHILDREN AND NO SPOUSE The worker's parent The worker's grandchild, brother or sister

Special benefit for safety device (§52-1-10(C) NMSA)
If the worker died as a result of failure of employer to provide a safety device, a compensation benefit of $5,000 may be paid to the worker's surviving father and/or mother, if the following conditions are met: ˇ the parents did not qualify as eligible dependents; ˇ there were no eligible dependents, so no other indemnity benefits were paid; ˇ notice of the accident was given timely (§52-1-29 (A) NMSA); ˇ the parents claim the $5,000 benefit within one year of the death.

__________________________________________________________ Published by the New Mexico Workers' Compensation Administration, a state agency. Laws can change. Check for new information by calling 1-866-WORKOMP or 1-866-967-5667 or look on the Internet at www.workerscomp.state.nm.us.

The Workers' Compensation Handbook for New Mexico Booklet B2. Indemnity benefits for long-term or serious injuries

2007 Edition page 22

TERMS TO UNDERSTAND:
AMA Guides A book published by the American Medical Association describing standard methods that doctors must use to test injured persons to calculate impairment ratings. Average weekly wage The weekly wage that the worker was earning before the injury occurred, averaged out based on the last 26 weeks before the injury, used to determine the worker's compensation rate. The wage may include some forms on non-monetary compensation, such as the value of living quarters, if that is part of the payment for the job. Compensation rate The weekly amount of money due to the worker during the temporary total disability period. The formula for the compensation rate, according to the law, is: ˇ for injuries through 1999, two thirds of the worker's average weekly wage up to a maximum of 85 percent of the average weekly wage for New Mexico as determined by the New Mexico Department of Labor; ˇ for injuries beginning Jan. 1, 2000, two thirds of the worker's average weekly wage up to 100 percent of the state average weekly wage. The compensation rate is discussed as a number of dollars per week. In most cases injured workers receive checks every two weeks rather than every week. Dictionary of Occupational Titles (DOT) A reference book that describes several thousand occupations and the physical activities that may be performed by a person having this type of job. Information from the DOT is used in calculating the injured worker's SVP (specific vocational preparation) by evaluating how much the injury affects the worker's ability to do his old job. Disability As used in the workers' compensation law: "Date of disability" means the first day that the worker was unable to work due to a work-related injury or occupational disease. "Disability rating" means the worker's impairment rating multiplied by the modifiers in the permanent partial disability formula. Impairment An alteration from normal physical or psychological functioning, which is expected to be permanent. Also called "residual impairment" or "impairment rating." This is a medical determination. It is expressed as a percentage. (Example: 10% impairment) Maximum Compensation Rate A dollar amount set by the state each year. The maximum compensation rate is the highest amount of money per week that may be paid in temporary total disability benefits to a worker injured in that year. If two-thirds of the worker's average weekly
__________________________________________________________ Published by the New Mexico Workers' Compensation Administration, a state agency. Laws can change. Check for new information by calling 1-866-WORKOMP or 1-866-967-5667 or look on the Internet at www.workerscomp.state.nm.us.

The Workers' Compensation Handbook for New Mexico Booklet B2. Indemnity benefits for long-term or serious injuries

2007 Edition page 23

wage before the injury was higher than the maximum compensation rate, the worker's TTD benefit will be set at the maximum compensation rate. The maximum compensation rate is equal to the State Average Weekly Wage. The rate for each year since 1975 is posted on the WCA web site at www.workerscomp.state.nm.us. Maximum Medical Improvement (MMI) The determination that the worker has recovered from his injury as much as he is likely to recover, so that any injured condition that remains is likely to be permanent. It does not mean that the worker is fully recovered from all symptoms. MMI is a medical determination that can only be made by the authorized treating doctor or an independent medical examiner. It is possible for doctors to disagree about when MMI is reached. In some medically complicated cases, it is possible for a worker to reach MMI status more than once. Permanent partial disability (PPD) The rating that is used to determine the continuation of indemnity benefits after the worker has reached maximum medical improvement. This rating is based on a formula that considers the worker's age, education, job experience and residual physical capacity as well as the impairment rating. Permanent total disability (PTD) Disability entitling the injured worker to lifetime indemnity benefits. Permanent total disability is defined in the law as: ˇ the permanent and total loss, or the loss of use, of both hands, both arms, both feet, both legs, both eyes or any two of them; ˇ or a brain injury, in which a single traumatic injury results in a 30 percent or higher brain impairment according to the AMA Guides. The brain injury qualification applies only to injuries that occurred in 2003 or later. (§52-1-25 NMSA). Lifetime indemnity benefits may be awarded only for injuries meeting this definition. Physical capacity (PC) A rating of the injured worker's ability to perform physical tasks compared to the demands of the worker's usual and customary work. Also sometimes called "residual capacity." Scheduled injury An injury to a body part that is listed specifically in the law. The schedule list includes arms and legs, parts of arms and legs, eyes and ears. When a worker has an injury to a body part listed in the schedule, indemnity benefits are paid according to the schedule and not according to the PPD formula. Specific vocational preparation (SVP) A rating of the amount of training necessary for the type of work that the injured worker did before the injury.
__________________________________________________________ Published by the New Mexico Workers' Compensation Administration, a state agency. Laws can change. Check for new information by calling 1-866-WORKOMP or 1-866-967-5667 or look on the Internet at www.workerscomp.state.nm.us.

The Workers' Compensation Handbook for New Mexico Booklet B2. Indemnity benefits for long-term or serious injuries

2007 Edition page 24

State Average Weekly Wage (SAWW) The average wage paid to all New Mexico workers in the previous year, set by the New Mexico Department of Labor based on information collected from employers. The State Average Weekly Wage is the maximum compensation rate payable to injured workers for that year (§52-1-41(E) NMSA). Temporary total disability (TTD) Indemnity benefits paid to the worker during the recovery period while the worker is not yet able to return to work and has not reached maximum medical improvement, according to the authorized doctor. The amount to be paid is the worker's compensation rate, according to the formula in the law. Waiting period The number of days that the worker cannot work (certified by the health care provider) before worker is entitled to indemnity benefits (§52-1-40 NMSA). The New Mexico waiting period is 7 days. If the injury requires the worker to be out of work for more than four weeks, benefits must be paid for the waiting period.

__________________________________________________________ Published by the New Mexico Workers' Compensation Administration, a state agency. Laws can change. Check for new information by calling 1-866-WORKOMP or 1-866-967-5667 or look on the Internet at www.workerscomp.state.nm.us.

The Workers' Compensation Handbook for New Mexico Booklet B2. Indemnity benefits for long-term or serious injuries

2007 Edition page 25

Permanent Partial Disability Chart
The terms in this chart are explained in the section titled, "The Permanent Partial Disability (PPD) Formula."
(This chart shows the formula values as amended in 2001 and 2003.)

Impairment rating (From Doctor) Age
at time of disability rating

0 - 44 45 - 49 50 - 54 55 - 59 60 +

=1 =2 =3 =4 =5

Education
school highest grade completed

SVP
(specific vocational preparation)

training

0-5= 6 - 11 = 12/GED = College grad = 1-2=4 3-4=3 5-6=2 7-9=1 can do = 0 can't do = 1

3 2 1 0

Education subtotal Group subtotal Physical Capacities present SLMH 1 1 1 1 3 1 1 1 5 3 1 1 8 5 3 1

ADD ADD

S = sedentary L = light M = medium H = heavy

p a s t

S L M H

MULTIPL Y ADD

DISABILITY

__________________________________________________________ Published by the New Mexico Workers' Compensation Administration, a state agency. Laws can change. Check for new information by calling 1-866-WORKOMP or 1-866-967-5667 or look on the Internet at www.workerscomp.state.nm.us.

The Workers' Compensation Handbook for New Mexico Booklet B2. Indemnity benefits for long-term or serious injuries

2007 Edition page 26

The Schedule of Injuries to Specific Body Members (§52-1-43)
Compensation Benefits Number of Weeks (1) one arm at or near shoulder, dextrous member ....... 200 weeks (2) one arm at elbow, dextrous member .................. 160 weeks (3) one arm between wrist at elbow, dextrous member .... 150 weeks (4) one arm at or near shoulder, nondextrous member .... 175 weeks (5) one arm at elbow, nondextrous member ............... 155 weeks (6) one arm between wrist and elbow, nondextrous member 140 weeks (7) one hand, dextrous member .......................... 125 weeks (8) one hand, nondextrous member ....................... 110 weeks (9) one thumb and the metacarpal bone thereof .......... 55 weeks (10) one thumb at the proximal joint ................... 34 weeks (11) one thumb at the second distal joint .............. 22 weeks (12) one first finger and the metacarpal bone thereof .. 28 weeks (13) one first finger at the proximal joint ............ 22 weeks (14) one first finger at the second joint .............. 17 weeks 12 weeks (15) one first finger at the distal joint .............. (16) one second finger and the metacarpal bone thereof . 22 weeks (17) one second finger at the proximal joint ........... 17 weeks (18) one second finger at the second joint ............. 12 weeks 10 weeks (19) one second finger at the distal joint ............. (20) one third finger and the metacarpal bone thereof .. 17 weeks (21) one third finger at the proximal joint ............ 12 weeks (22) one third finger at the second joint .............. 10 weeks (23) one third finger at the distal joint .............. 10 weeks (24) one fourth finger and the metacarpal bone thereof . 14 weeks (25) one fourth finger at the proximal joint ........... 14 weeks (26) one fourth finger at the second joint ............. 10 weeks (27) one fourth finger at the distal joint ............. 7 weeks (28) loss of all fingers on one hand where thumb and palm remain 70 weeks (29) one leg at or near hip joint, so as to preclude the use of an artificial limb 200 weeks (30) one leg at or above the knee, where stump remains sufficient to permit the use of an artificial limb 150 weeks (31) one leg between knee and ankle .................... 130 weeks (32) one foot at the ankle ............................. 115 weeks (33) one great toe with the metatarsal bone thereof .... 35 weeks 17 weeks (34) one great toe at the proximal joint ............... (35) one great toe at the second joint ................. 12 weeks (36) one toe other than the great toe with the metatarsal bone thereof 14 weeks (37) one toe other than the great toe at the proximal joint 10 weeks (38) one toe other than the great toe at second or distal joint 8 weeks (39) loss of all toes on one foot at proximal joint .... 40 weeks (40) eye by enucleation ................................ 130 weeks (41) total blindness of one eye ........................ 120 weeks (42) total deafness in one ear ......................... 40 weeks (43) total deafness in both ears ....................... 150 weeks Injury

__________________________________________________________ Published by the New Mexico Workers' Compensation Administration, a state agency. Laws can change. Check for new information by calling 1-866-WORKOMP or 1-866-967-5667 or look on the Internet at www.workerscomp.state.nm.us.

The Workers' Compensation Handbook for New Mexico Booklet B2. Indemnity benefits for long-term or serious injuries

2007 Edition page 27

Property Tax Relief for PTD Workers
Some relief from increases in New Mexico property tax is available to individuals who have permanent total disability as a result of a work-related injury, if they also meet criteria for low income. This tax break is not a reduction in current tax, but a limitation on how much their property value for tax purposes can increase in any year. In addition to workers permanently disabled under workers' compensation, the provision also applies to a person who is blind or who is permanently disabled under Social Security. This law is Section §7-36-21.3 NMSA, in the New Mexico tax code. The worker must also qualify as low income, based on a formula in the tax law. The qualifying income limit changes from year to year (for example, the limit for 2005 was about $19,400). The Property Tax Division annually computes the qualifying income and sends that information to county assessors. The disabling injury could have occurred at any time. The person must have been found to be permanently totally disabled under law. Since the definition of permanent total disability has changed from time to time, this will be determined by the law in effect at the time of the injury. The WCA has a procedure to certify that an individual qualifies as permanently totally disabled. The disabled worker should contact the General Counsel's office of the WCA and send copies of any documentation they possess. The worker may ask the insurer for a letter supporting the claim. If necessary, the WCA Court Clerk will help the worker to research any documentation that may have been filed with the Clerk. The General Counsel's office will examine the documentation and will arrange for a hearing, if necessary, to make the determination so that a certificate can be issued. At the same time, the worker should check with the local county assessor to determine if he or she is qualified under the current income limit. When the worker has obtained a certificate from the WCA, the worker should take that certificate to the local county assessor. The worker will also have to provide the assessor with documentation of income, such as a copy of their federal or New Mexico Personal Income Tax return. The certificate of disability, once filed, will be permanently attached to the worker's property tax record. However, because of the income qualification, the worker will have to apply for the tax benefit each year, by providing new evidence of low income.

__________________________________________________________ Published by the New Mexico Workers' Compensation Administration, a state agency. Laws can change. Check for new information by calling 1-866-WORKOMP or 1-866-967-5667 or look on the Internet at www.workerscomp.state.nm.us.

The Workers' Compensation Handbook for New Mexico Booklet B2. Indemnity benefits for long-term or serious injuries

2007 Edition page 28

Workers' Compensation Handbook List of Booklets
This list shows new titles and numbering system that will be in effect when the 2007 revision is completed. Some booklets are eliminated and others are renumbered. There are some changes from the pre-2007 editions of the booklets.
To get the information you need: Contact any office of the Workers' Compensation Administration for printed copies OR All booklets can be downloaded from the Workers' Compensation Administration web site at www.workerscomp.state.nm.us
Booklet Booklet Booklet Booklet Booklet Booklet A1(E) A1(S) A2 A3 A4 A5 Workers' Compensation Quick Facts- English Compensación A Los Trabajadores Informes Básicos ( Spanish) Setting Up a Workers' Compensation Program The Workers' Compensation Coverage Guide for Employers and Insurance Agents Uninsured Employers' Fund Workers' Compensation Personnel Assessment Fee (WC-1)

Booklet B1 What to Do after an Accident Booklet B2 Benefits for Workers While They Cannot Work Booklet B3 Going Back to Work Booklet B4 Medical Care in Workers' Compensation (B5 and B6 will be discontinued) Booklet B7 Información del sistema compensativo para los empleados (Spanish) Booklet B8 Quick Facts for Health Care Providers Booklet C1 When you need help with a workers' compensation claim Booklet C2 What to Do In Response to "Bad Acts" (C3 through 5 will be discontinued) Booklet D1 Booklet D2 Annual Safety Inspections How to Develop a Safety Program (published by the Advisory Council on Workers' Compensation and Occupational Disease Disablement)

(On the web site, look under Employers)
E3 E4

Guide to Completing and Filing Paper Copy for Employers' First Report of Injury or Illness (Form E1.2) and Notice of Benefit Payment (Form E6.2) EDI Guide to Completing the Employers' First Report of Injury or Illness (Form E1.2) and Notice of Benefit Payment (Form E6.2) -- limited to certified electronic filers

Other publications

Health Care Provider Guide to New Mexico Workers' Compensation Guidebook for Employers in New Mexico (English and Spanish) Workbook for Injured Workers (English and Spanish) The Stay at Work/Return to Work Program Guide
Wcamjd 9/07

__________________________________________________________ Published by the New Mexico Workers' Compensation Administration, a state agency. Laws can change. Check for new information by calling 1-866-WORKOMP or 1-866-967-5667 or look on the Internet at www.workerscomp.state.nm.us.

The Workers' Compensation Handbook for New Mexico Booklet B2. Indemnity benefits for long-term or serious injuries

2007 Edition page 29

Help from the Workers' Compensation Administration
(See the list of offices and telephone numbers at the end of this booklet) For questions and concerns about CLAIMS Personal contact Contact an ombudsman. You can telephone or come in person to any WCA office around the state. (If you want to come in person, it's best to make an appointment.) Some ombudsmen speak Spanish. Use a local phone number or a FREE toll-free phone number. An ombudsman will talk to you informally and give you information about your rights. WCA publications You can get publications from any office of the WCA. Go to an office or telephone to request publications by mail. The booklets in this series are also available on the WCA web site at www.workerscomp.state.nm.us. Workbook for Injured Workers is a book written just for workers. It explains the claims process in a relatively simple, easy to understand way, telling you your rights and responsibilities. It contains forms that you can use to keep track of your claim.

The Workers' Compensation Handbook for New Mexico (the booklets in this series) are more detailed, containing more information than the Workbook for Injured Workers.
Several publications are available in Spanish. WCA web site www.workerscomp.state.nm.us

Look under Booklets for copies of the booklets you can read, download and print. Look under Workers for other information that might be useful for you. You can print out copies of the forms from the Workbook for Injured Workers so you will have extra copies. Look under News and Announcements for any new changes that might affect you.

__________________________________________________________ Published by the New Mexico Workers' Compensation Administration, a state agency. Laws can change. Check for new information by calling 1-866-WORKOMP or 1-866-967-5667 or look on the Internet at www.workerscomp.state.nm.us.

The Workers' Compensation Handbook for New Mexico Booklet B2. Indemnity benefits for long-term or serious injuries

2007 Edition page 30

NEW MEXICO WORKERS' COMPENSATION ADMINISTRATION
STATE HEADQUARTERS Mailing Address: Workers' Compensation Administration PO Box 27198, Albuquerque NM 87125 Location: 2410 Centre Avenue SE (near Yale-Gibson intersection) In-state toll-free phone: 1-800-255-7965 Local phone 841-6000 REGIONAL OFFICES: Southeastern regional office at Lovington: 100 West Central, Lovington, NM 88260 Telephone: 575-396-3437 In-state toll-free phone: 1-800-934-2450 Southwestern regional office at Las Cruces: 1120 Commerce Drive, Suite B-1, Las Cruces, NM 88011 Telephone: 575-524-6246 In-state toll-free phone: 1-800-870-6826 Northwestern regional office at Farmington: 3535 East 30th Street, Farmington, NM 87401 Telephone: 505-599-9746 In-state toll-free phone: 1-800-568-7310 Northeastern regional office at Las Vegas : 2515-2 Ridge Runner Road, Las Vegas NM 87701 Moving in 2008 to: 32 New Mexico 65, Las Vegas NM 87701 Telephone: 505-454-9251 In-state toll-free phone: 1-800-281-7889 Roswell Office: Penn Plaza Bldg., 400 N. Pennsylvania Ave., Ste. 425, Roswell NM 88201 Telephone: 575-623-3781 In-state toll-free phone: 1-866-311-8587 Santa Fe Office: 810 West San Mateo, Suite A-2, Santa Fe, NM 87505 Telephone: 505-476-7381 Internet web site address: http://www.workerscomp.state.nm.us/ HELP & HOTLINE: 1-866-WORKOMP / 1-866-967-5667

mjdwca 1/08

__________________________________________________________ Published by the New Mexico Workers' Compensation Administration, a state agency. Laws can change. Check for new information by calling 1-866-WORKOMP or 1-866-967-5667 or look on the Internet at www.workerscomp.state.nm.us.