Fill Out Your New Mexico Report Form

1. What is the purpose of the New Mexico Workers' Compensation Administration Employers' First Report of Injury or Illness form?

   This form is used to report all alleged work-related injuries or illnesses that result in more than seven days of lost work, or in the death of the worker. It serves as a mechanism for the employer, or the employer's representative, to document and notify the necessary parties about the incident. It's important to clarify that completing this form does not admit responsibility for the claim under the Workers’ Compensation Act.

2. When must the Employers' First Report of Injury or Illness form be filed?

   Employers must file this form within 10 days of becoming aware of any alleged work-related injury or illness that leads to more than seven days of lost work. The obligation to file exists regardless of any disputes over the worker's claim of a work-related injury or illness.

3. Where should the form be sent?

   The original form should be mailed to the New Mexico Workers' Compensation Administration, specifically to the Statistics department at the address provided on the form. Additionally, copies of the form must be provided to both the worker involved and the employer's workers' compensation insurer.

4. Are there any penalties for not filing the form on time?

   Yes, each instance of failing to file the form as required can result in a fine of up to $1,000.00.

5. What sections of the form are optional to fill out?

   Filling in the shaded areas of the form is optional, although some employers may choose to use these sections for their own records, such as listing witnesses. The intention behind making these sections optional is to provide flexibility for employers while ensuring essential details are reported.

6. How should the form be completed?

   The form should be completed either by printing in black ink or by typing to ensure legibility. It's critical to make sure that all entries are clear because an illegible or incomplete form may be returned for correction.

7. What is the NAIC code and where should it be included?

   The NAIC code represents the nature of the employer's business at the location where the worker was employed at the time of the injury or illness exposure. It is derived from the North American Industry Classification System Manual. If known, this code should be included on the form to provide clarity on the type of business where the incident occurred.

8. What should be done if the worker was not injured on the employer's premises?

   If the accident or illness did not occur on the employer's premises, it's necessary to specify the exact address or location of where it happened, such as a client's office. For incidents occurring in New having to include to include Mexico, the ZIP or COUNTY should also be provided if possible.

9. Where can additional information or assistance be sought?

   Employers or workers seeking more information or needing assistance with the form or the process can contact an ombudsman at any Workers' Compensation Administration regional office. A list of phone numbers is provided on the form for convenience, with services available Monday through Friday, 8 a.m. to 5 p.m.

1. Failing to use black ink or type when filling out the form can lead to legibility issues, making it difficult for the processing team to accurately interpret the information provided.

2. Omitting the employer's or carrier's Federal Identification Number (FEIN) can lead to confusion and delays, as these numbers are crucial for identifying the correct entities involved in the claim.

3. Incorrectly or incompletely listing the type of injury or illness, as well as the part of the body affected, can result in inappropriate handling of the claim. Specific and detailed descriptions are vital for a thorough understanding and evaluation of the injury or illness.

4. Not specifying whether the injury or illness occurred on the employer's premises leads to a lack of context for the claim, affecting its processing and outcome.

5. Leaving the section about whether salary continued post-injury blank can create uncertainties in the compensation calculation, potentially affecting the benefits the worker is entitled to.

6. Overlooking the signature and date areas at the end of the form invalidates the submission, as these are required to verify the accuracy of the information and the identity of the preparer.

It is crucial for individuals completing the New Mexico Employers' First Report of Injury or Illness form to avoid these common mistakes to ensure the timely and accurate processing of their claims. Attention to detail and thoroughness in completion can significantly impact the outcome and efficiency of the claim's processing.

When navigating through the complexities of reporting an injury or illness under the New Mexico Workers' Compensation system, having the right documents and forms ready can streamline the process, ensuring all parties are well-informed and compliant. The New Mexico Employer's First Report of Injury or Illness form is a crucial starting point for this process. However, to fully support a workers' compensation claim, several other documents may also come into play. Understanding these documents can be incredibly helpful for employers, employees, and insurance carriers alike.

• Notice of Accident Form: To be completed by the injured employee, this form officially notifies the employer of a work-related injury or illness. It's a critical document that should be filled out and submitted to the employer as soon as possible after the incident occurs.
• Wage Verification Form: Used to verify the injured employee's wages, this document is essential for calculating compensation benefits correctly. It requires detailed information about earnings, including tips, bonuses, and any other compensation received prior to the injury or illness.
• Medical Release Form: This form authorizes the release of medical records related to the injury or illness to the employer or insurance carrier. It's an essential document for substantiating the claims made in the Workers' Compensation claim process.
• Agreement of Compensation: Once a claim is examined and accepted, this form outlines the terms of workers' compensation benefits that the injured employee will receive. Both the employer and the employee must sign this agreement, highlighting the importance of mutual understanding regarding compensation.
• Notice of Compensation Payable: Issued by the employer or insurance carrier, this document officially acknowledges that a claim has been accepted and that compensation payments will be made. It details the amount of benefits and the duration for which they will be provided.
• Final Receipt: Used to indicate the conclusion of workers' compensation benefits, this document is filed when the injured employee returns to work or has otherwise recovered from the injury or illness. It is a formal acknowledgment that compensation is no longer being paid.

Together, these documents form a comprehensive framework that supports the initial report of injury or illness. By ensuring timely and accurate completion of each form, all parties can contribute to a smoother and more effective claims process. Remember, the goal of workers' compensation is not just to provide financial assistance but also to ensure a safe and swift return to work for the injured employee. Knowledge of these documents empowers all involved parties to navigate the system with confidence and clarity.

The New Mexico Report form, officially known as the Employer's First Report of Injury or Illness, shares considerable similarities with various other documents used across the United States for reporting and managing workers' compensation claims. These documents serve as essential tools for employers, insurance carriers, and regulatory bodies to document and process incidents of workplace injuries or illnesses. Among these, two particular forms stand out for their relevance and comparability: the OSHA Form 301 and the IAIABC Form IA-1.

The OSHA Form 301 is one such document that bears a resemblance to the New Mexico Report form. Developed by the Occupational Safety and Health Administration (OSHA), Form 301 is an Injury and Illness Incident Report that employers must fill out to detail the specifics of an occupational injury or illness. Similar to the New Mexico Report form, it requires information about the employee, the nature of the injury or illness, how it occurred, and the outcome (such as time away from work). Both forms are designed to capture a comprehensive account of work-related injuries or illnesses, enabling employers to report these incidents accurately. They play a crucial role in maintaining workplace safety and health standards, facilitating the monitoring and prevention of future incidents.

The IAIABC Form IA-1, another document akin to the New Mexico Report form, is provided by the International Association of Industrial Accident Boards and Commissions. This form, also intended for reporting injuries or illnesses that occur in the workplace, collects similar kinds of information: details about the employee (including name, Social Security number, and job title), specifics about the injury or illness (such as date of occurrence, type, and body parts affected), and treatment information. Both the New Mexico Report form and the IAIABC Form IA-1 serve the same fundamental purpose: to ensure that workers' compensation claims are appropriately documented and processed. They support the effective management of workplace injuries and illnesses, helping to ensure that affected employees receive the benefits and care they are entitled to under respective workers' compensation laws.

Filling out the New Mexico Employers' First Report of Injury or Illness forms accurately is crucial for ensuring the prompt and effective handling of workers' compensation claims. Below are several important dos and don'ts to consider when completing this form:

• Do print in black ink or type the information to ensure legibility.
• Do provide detailed and specific information regarding the type of injury or illness and the part of body affected.
• Do ensure all required fields are completed to avoid delays; an incomplete form may be returned, further delaying the process.
• Do describe the sequence of events leading to the injury or illness in detail, including any objects or substances that directly contributed to the event.
• Don't leave the witness information section blank if there were any witnesses to the incident. Their accounts may be crucial to the investigation of the claim.
• Don't forget to list all equipment, materials, or chemicals the employee was using, applying, handling, or operating when the injury or illness occurred. This information is critical for understanding the circumstances of the incident.
• Don't provide vague descriptions of the injury, illness, or how it occurred. Specificity is key in understanding the nature of the incident and determining compensability.
• Don't wait longer than 10 days from gaining knowledge of the alleged work-related injury or illness that results in more than 7 days of lost work to file the form. Timely filing is crucial for compliance with state regulations.

Remember, accurately completing the New Mexico Employers' First Report of Injury or Illness form is not only a legal requirement but also a critical step in ensuring workers receive the appropriate care and compensation following workplace injuries or illnesses.

When dealing with the New Mexico Workers' Compensation Administration's First Report of Injury or Illness form, there are several misconceptions that can lead to misunderstandings regarding its use and requirements. It's crucial to address these to ensure accurate and timely reporting of workplace injuries or illnesses.

• Misconception 1: Completing the form is optional.
• Misconception 2: Only injuries requiring immediate medical attention must be reported.
• Misconception 3: The form serves as an admission of liability by the employer.
• Misconception 4: The form must be completed in pen and mailed to the Workers' Compensation Administration.
• Misconception 5: All sections of the form must be filled out, regardless of relevance.
• Misconception 6: The form is only necessary for incidents that occur on the employer's premises.

To clarify:

1. The form is mandatory for reporting any alleged work-related injuries or illnesses that result in more than 7 days of lost work, or in death. It's not optional and must be filed within 10 days of knowledge of such injuries or illnesses.
2. Every alleged workplace injury or illness must be reported, not only those that seem severe at the onset. This includes injuries or illnesses that develop over time, such as repetitive stress injuries.
3. Filing the form is a procedural requirement and does not constitute an admission of liability or agreement that the injury or illness is compensable under the Workers’ Compensation Act.
4. Although the form must be completed accurately and legibly, it can be printed in black ink or typed. Moreover, submitting the form electronically may also be an option, depending on current administration processes.
5. Filling in shaded areas of the form is optional and primarily for the employer's records. These sections include areas for witnesses or additional notes that may not be directly relevant to the initial report filing.
6. Reportable injuries or illnesses include those that do not occur on the employer's premises if they are work-related. For instance, injuries that occur while traveling for work purposes or working remotely should also be reported.

Understanding these points is crucial for ensuring that injuries and illnesses are reported correctly and in compliance with New Mexico Workers' Compensation Administration requirements. Proper filing supports the well-being of employees and helps maintain a transparent and efficient workplace injury and illness reporting system.

Here are key takeaways about filling out and using the New Mexico Workers' Compensation Administration Employers' First Report of Injury or Illness:

1. The form must be used to report any alleged work-related injuries or illnesses that result in more than seven days of lost work, or in the death of a worker.
2. Employers or their representatives are required to complete the form, not an admission or denial of the worker's alleged injury or illness's compensability.
3. It's mandatory to file this form within 10 days of becoming aware of an alleged work-related injury or illness that results in more than seven days of lost work.
4. The original form should be mailed to the New Mexico Workers' Compensation Administration, with copies provided to the worker affected and the employer's workers' compensation insurer.
5. A failure to file the form as required can result in a fine of up to $1,000.00 per instance.
6. For clarity and record-keeping, filling out the form in black ink or typing is recommended to ensure legibility.
7. The form requires detailed information about the injury or illness, including the date of the injury/illness, type of injury or illness, part of body affected, and how the injury or illness occurred.
8. Identification of all equipment, materials, or chemicals the employee was using at the time of the injury or illness is necessary unless not applicable (noted as "NA").
9. Safeguards or safety equipment provided and whether they were used should be disclosed on the form.
10. Information about the worker's employment status, including occupation/job title, employment status, and whether full pay was provided for the day of injury, is required.
11. It's essential to include the date when the employer was notified of the injury or illness and when the disability began.

If workers believe benefits are due under the Workers' Compensation Act and those benefits have not been made available, they have the right to file a complaint with the New Mexico Workers' Compensation Administration. Employers and workers with questions about rights or responsibilities under the Act are advised to contact an ombudsman for assistance.