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Handling a denied workers’ comp claim in New Mexico

On Behalf of | Jun 1, 2023 | Workers' Compensation, Workers' Compensation Appeals |

Workers’ compensation serves as a safety net for employees who suffer injuries on the job. It helps cover medical bills and lost wages.

However, sometimes, workers’ comp claims in New Mexico may face denial. It can be a frustrating and confusing situation, but understanding the reasons and knowing the next steps can be helpful.

Reasons for denied workers’ comp claims

Various reasons can lead to the denial of a workers’ comp claim. They include late reporting of the injury, lack of medical evidence supporting the claim or the employer disputing the claim stating the injury did not happen at work. Understanding the reason for denial can provide a clearer path for the next steps.

Responses to a denied claim

Upon receiving a denial, workers should review the explanation carefully. They should gather all relevant documents, medical reports and any evidence that can support their claim. This collected information will be vital for the appeal process.

Navigation of the appeal process

The Workers’ Compensation Administration in New Mexico oversees the appeal process for denied claims. This process requires submitting a formal appeal, attending a mediation conference, and if needed, proceeding to a formal hearing before a judge. The goal is to present a strong case backed by evidence to reverse the denial.

Engagement in mediation

The first step in the appeal process is mediation. A mediation conference provides an opportunity to resolve the dispute with the employer or the insurance company. It involves presenting the collected evidence and discussing the case with a neutral mediator.

The formal hearing

If mediation does not resolve the issue, the next step is a formal hearing before a judge. Here, all parties present their case and the judge makes a determination. You can appeal the decisions further to the Court of Appeals and the Supreme Court if necessary.

The importance of personal health

While navigating the appeal process, it is important to continue medical treatments as advised by the doctor. Staying focused on recovery is crucial during this challenging period.

Having a workers’ comp claim denied can seem like a setback, but it is not the end of the road. By understanding all the reasons for denial, and the steps to take, it is possible to challenge the decision effectively.