Can worker injured in New Mexico get treatment outside of New Mexico? This question often comes up in workers' compensation cases in New Mexico. The answer, unfortunately, is it depends.
Going to a doctor or provider outside of New Mexico usually comes up in the following situations:
- The injured worker leaves New Mexico to live permanently or long term in another state.
- The injured worker needs specialized treatment and there are no doctors or providers in New Mexico who can provide the specialized treatment. Therefore, the injured worker has to go to a doctor or provider in another state.
- There may be doctors or providers in New Mexico who can provide the specialized treatment and are willing to accept the injured worker as a patient, but the injured worker's main doctors feels that an out of state doctor or provider would give the worker better treatment.
For each of these scenarios, the main challenge is convincing the workers' compensation insurer to approve the out of state treatment. If the workers' compensation insurer won't approve the out of state treatment, the injured worker can file a complaint or another pleading to try and convince a workers' compensation judge to order the workers' compensation insurer to approve the out of state treatment. Sometimes this works, sometimes it doesn't.
Even if a workers' compensation judge orders the insurer to pay for the out of state treatment, it can be extremely difficult to find a doctor or provider outside of New Mexico who will accept New Mexico workers' compensation insurance as payment for treating the injured worker. This is less of a problem for injured workers with very severe injuries that require very specialized treatment, such as amputations or paraplegia because the out of state specialists often understand they are the only option for treating the very severely injured worker.
For less severely injured workers, the chances an out of state doctor or provider will accept New Mexico workers' compensation is much lower, especially if it's for ongoing, maintenance type care. When this happens, the injured worker usually has to accept treatment by New Mexico doctors or providers or find a way to pay for out of state treatment some other way.
If an injured worker leaves New Mexico and cannot find a doctor or provider in the state where they will be living to treat them, they can travel back to New Mexico for ongoing treatment. If that is the case, the injured worker should request travel costs from the workers' compensation insurer for travelling back to New Mexico. Alternatively, they can try to find a way to pay the out of state doctor or provider some other way than by the New Mexico workers' compensation insurer. This can involve "closing out the workers' compensation claim" which I have covered before here: "Settling a WC claim"
I hope this helps. If this comes up in your case, please call me at 505 292-8836.
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