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Workers' compensation benefits either stop or are reduced. Be ready.

Posted by Robert Scott | Aug 11, 2020 | 0 Comments

New Mexico Workers' Compensation Basics #4: Your benefits will stop or be reduced. Start planning now for that.

Why the old cars? Well I like old cars, and I saw these recently in the Sandias on a Sunday morning. Second, old cars can be like a workers' compensation case, something always goes wrong eventually. The fuel pump stops working; the insurer … for some reason … refuses to authorize your medication after approving it fifty times before. It's inevitable.

So, you've read my prior posts and have done all the right things and you're getting your workers' compensation benefits. These include money (also called indemnity) benefits and medical benefits.

Your life is is not normal because you're hurt and you're probably not working. But you and your family are persevering. You're focusing on your medical treatment, maybe you are back at work, probably light duty, and you're doing your best to get better.

This is the time to start thinking about what can go wrong and try to be prepared for them. What are you going to do if you can't get your medications for a few days? What are you going to do if your check is late? Sometimes, there isn't a good answer, but it's always worthwhile to try to do some planning.

The best thing you, as an injured worker, can do is to realize that your money benefits will be reduced (for some workers they will stop) sometime in the near future. That could be six months or three years depending on how badly you've been injured. Depending on how quickly you recover from your injury, money benefits will be reduced or stop once you reach maximum medical improvement (MMI). I will go into MMI in a later post. However, for now we'll define it as the time when there is no further treatment available for the worker.

So, at MMI, money and medical benefits will decrease and, in some cases, stop.

Depending on the facts of your case, you can expect MMI beginning as soon as six months after the work injury. The more serious the injury, the longer it takes to get to MMI.

Here is why I'm writing this post: INJURED WORKERS MUST PLAN FOR THE DAY WORKERS' COMPENSATION BENEFITS ARE REDUCED OR STOP!!!. Just like you've got to prepare for something to go wrong on your old car.

The sooner you start planning the better. The last thing an injured worker wants is for the money benefits to stop without warning (and that does happen unfortunately).

Each case is different, but here are some things you should start looking at soon after the work injury:

  1. What are the realistic chances that you will be able to return to the job you were doing when you were hurt? If it's not realistic, you need to start planning on how to get a different job you will be able to do once you're done with your treatment. If you need to training for a new job, start planning on how to get that training.
  2. Is this a good time to retire? If you're close to retirement age and the chances of returning to work are low, then maybe it's the time to retire. If so, do you have enough money to retire? If not, what is the plan to bridge the financial gap?
  3. If the chances of returning to work is good, do you have enough money to make it through your treatment and then return to work?
  4. If the chances of returning to work are not good and you're not able to retire, what is your plan? Can you go back to school? Can you borrow money until you're able to find a job? Can you qualify for unemployment? Can your spouse or significant other support you and your family in the interim?
  5. If you can't return to work, how will you get medical insurance for you and your family? Medicaid and Obamacare are probably the most likely sources. In either case, you need to start planning on applying for and, perhaps, paying for medical insurance until you can find another job.

In many cases, workers' compensation medical benefits become an issue and there can be lengthy delays and even complete denials of continued medical treatment. Often, there is only so much a worker's lawyer can do and the medical treatment stops.

The New Mexico Workers' Compensation Act provides for “lifetime” medical benefits. Injured workers have to understand, however, that in most cases medical benefits and medical treatment stops. If that happens and you want continued treatment, you will most likely have to find another way to get that treatment.

Injured workers must understand that workers' compensation benefits in New Mexico are in most cases TEMPORARY even though your injuries may not be. Therefore, the sooner you start planning for the day they are reduced or stop, the better.

On another note, unfortunately, COVID-19 is here to stay, and we must keep our physical distance from others and also wear our masks. We can only beat the virus if we work together and take care of each other.

At least the bees seem to be doing well.

If you have a legal question, please call me at 505 292-8836 or email me at [email protected]

About the Author

Robert Scott

“One of the most experienced workers' compensation attorneys in New Mexico.” After graduating from high school in New York, I attended the College of William & Mary on an ROTC scholarship and earned a degree in Spanish. I served four years in the United States Army as an infantry lieutenant.


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Attorney Robert Scott is committed to answering your questions about workers' compensation, employment law, wage theft, personal injury, and wrongful death law issues in Albuquerque.

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