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How to use or fill out New Mexico Worker Compensation Claims Form
- Click ‘Get Form’ to open it in the editor.
- Begin by filling in the employer's name and address, including ZIP code. Ensure this information is accurate as it identifies the reporting entity.
- Next, provide the claims administrator's details, including their name, address, and phone number. This section is crucial for communication regarding the claim.
- Fill in the employee's information: name, date of birth, social security number, and occupation. Be precise to avoid any delays in processing.
- Indicate the date of injury or illness and describe its nature. Use clear language to detail how the incident occurred and what part of the body was affected.
- Complete sections on employment status and whether salary continued during the employee's absence. This helps clarify financial responsibilities.
- Finally, review all entries for legibility before submission. An illegible form may be returned for correction.
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How long do you have to file a workers comp claim in New Mexico?
Formal claim filing: You generally have one year from the date of the accident or one year of the employer or insurer refusing to provide compensation to file a formal workers compensation claim with the New Mexico Workers Compensation Administration.
What are the three main requirements to obtain workers compensation?
You must be an employee. Your employer must carry workers comp insurance. You must have a work-related injury or illness.
How does workers comp work in NM?
: If you are unable to work following your injury, workers compensation insurance may pay up to 66 2/3% of your average weekly wage, called Temporary Total Disability (TTD) Benefits. These benefits go into effect on the 8th day of non-work status, which do not have to occur consecutively.
What is a 5020 form for workers compensation?
The Employers Report of Occupational Injury or Illness (Form 5020).
How much is the workers comp fee in New Mexico?
The workers compensation fee, unchanged since 2004, will rise from $2.30 to $2.55 for employers and from $2 to $2.25 for employees. Additional increases are scheduled for July 2028 and July 2033. For more information see . gov/businesses/other-all-nm-taxes/
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People also ask
How to file a workers comp claim in New Mexico?
Other ways to file: Email: Complete the Employers First Report of Injury or Illness form (NM WCA FORM E1. 2) (link to form) and email it to NMMclaims@newmexicomutual.com. Fax: Complete the Employers First Report of Injury or Illness form (NM WCA FORM E1. 2) (link to form) and fax it to 505-345-0656.
How do I file a workers comp claim in New Mexico?
Other ways to file. By Phone: (505) 343-7777. Email: Complete the Employers First Report of Injury or Illness form and email it to NMMclaims@newmexicomutual.com. Fax: Complete the Employers First Report of Injury or Illness form and fax it to 505-345-0656.