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Work-Comp Pay/Benefit Change??

Latest post Thu, Oct 13 2011 1:24 PM by Just the Facts. 2 replies.
  • Thu, Oct 13 2011 2:59 AM

    • Jon88240
    • Not Ranked
    • Joined on Mon, Aug 8 2011
    • NM
    • Posts 17

    Question [=?] Work-Comp Pay/Benefit Change??

    I had an Independent Medical Exam a month ago *IME*, and I expect an imparement rating to be given. Last week my pulmonologist told me ive reached my MMI and he would not be releasing me to work.

    The question is: After recieving the Imparement Rating, how long does it take for any changes to occur? Is there a system to either Reducing a person's cash benefits; such as some sort of court..or could work comp immediately change benefits as soon as the Imp. Rating is recieved? On the other hand, If the IME panel decides that I am permanently disabled, will that be the end of the fight, or will i also have to go through a process? It gets frustrating trying to get expenses from w/c when you cant talk to your adjuster.


    In case it matters, the state is New Mexico.

    Thank You VERY MUCH for your time!


    If you have time, I also have a secondary question as well...

    If you settle a work-comp claim, and you or the insurance provider decided they wanted to settle your entire benefits (medical, expenses, Rx, and Cash), how do they Calculate how much to settle the medical part? I've been hospitalized 4 times this year for a total of nearly 5 weeks time, and have incured over $200,000 in Hospital Bills alone...and to consciously settle medical, etc.... there would need to be a pretty significant amount of money needed obviously. And I take ALOT of medications, that I will always have to take. The most expensive is over $800/mo. I dont think I would ever consider settling medical, because you never know what can happen,..but im just curious on how they determine the amount to be settled for in medical, etc.


    If you really have time....

    New Mexico is Changing a 6 or 7 different rules and regulations (including some paperwork changes) being voted on October 27th by whoever, will my claim have to abide by those new statutes or will I be held in the old statutes that were in place when I became disabled? Asking, for obvious reasons...the law is wierd sometimes...people are in prison still for things that are either no longer illegal, or arent fellony crimes, or have lesser sentences and/or consequences but they still have to abide by the ruling according to the rules, laws, and statutes of the time of the crime/trial. 

    If you happened to answer all three, Thank you 3 times as much. Thank You Thank You Thank You.

    Even when winning seems illogical, losing is still far from optional.

    When we stop questioning and asking how, and why,...That is when we loose our Humanity...

  • Thu, Oct 13 2011 8:11 AM In reply to

    • Neice
    • Top 500 Contributor
    • Joined on Fri, May 13 2011
    • CO
    • Posts 67

    Re: Work-Comp Pay/Benefit Change??

    When you sign a settlement, you are signing your medical benefits away and you won't be able to use your own health insurance.  Be careful about signing a settlement. 

  • Thu, Oct 13 2011 1:24 PM In reply to

    Re: Work-Comp Pay/Benefit Change??

    1) Do you still have an atty? If NOT, you NEED ONE, NOW. You are asking very BASIC questions that should have been addressed by your atty.

    Once your IR is received by the Ins Co., your benefits typically will change as soon as they receive the report from your IME.  Do you know your rating?  

     "Benefits after MMI are usually much less money than temporary total disability benefits. Be prepared for a big change."

    2)  Apparently, (according to the NM WC website,) you CAN'T BUY OUT your future med. However, even if you can cash out in NM, if you are receiving Medicare or on SS you MUST take steps to protect medicare's interests, in the form of a Medicare Set Aside trust. (WCMSA) If your atty is NOT aware of this, ask for their malpractice insurance info.

    This is from a the New Mexico Work Comp Board re: Lump Sum Buyout of Future Medical:

    Right to lifetime medical care 

    The injured worker is entitled to medical care for the injury for the rest of his life, if required by the medical condition that resulted from the injury. The insurer or self-insurance program will be responsible for paying the authorized health care provider for reasonable and necessary medical care as long as that care is needed.

    The right to lifetime medical care is found in §52-5-12(A), which is the section of the law regulating lump sum payments. Under this section of the law, the insurer or self-insurance program may not close out the worker's right to future medical benefits with a lump sum payment.

     As far as your question regarding the new laws, you have to read the statutes. In CA., for example, we had a major overhaul of WC in 2004. Some of the news laws applied to all cases, all dates of injury. Others, were only for new injuries. So, it is specific to the statute.


    Disclaimer: I do not represent Injured Workers in New Mexico. This is not a solicitation for representation. I only represent Injured workers in the State of CA. Therefore, the information that I provide may not apply to your claim,  as most claims are state specific. I do try to provide you with my sources of information that are state specific to your inquiry.   

    Benefits after MMI are usually much less money than temporary total

    disability benefits. Be prepared for a big change.


    Benefits after MMI are usually much less money than temporary total

    disability benefits. Be prepared for a big change.

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