The New Mexico Workers' Compensation Administration has created this glossary for general use. Please see the New Mexico Statutes Annotated if an exact definition of a workers' compensation term is needed.
Spanish glossary/Glosario en Español
A B C D E F G H I J K L M N O P Q R S T U V W X Y Z
A
Adjuster
A person licensed by the New Mexico Office of the Superintendent of Insurance to adjust claims while working for an insurance company, a self-insurance program or a third-party administrator. Adjusters make decisions about benefit payments and authorize medical treatment. Also known as a claims representative.
AMA Guides to the Evaluation of Permanent Impairment
A book published by the American Medical Association for health care providers that describes how to rate the impairments of injured workers. The AMA Guides is the official standard for the impairment ratings for workers' compensation injuries in New Mexico.
Average Weekly Wage (AWW)
The weekly wage a worker earned before the injury or illness occurred, which includes wages for all jobs worked 26 weeks before the injury, even those earned with a second job. It is an average of wages used to determine the compensation rate. The AWW may include some forms of non-monetary compensation, such as the value of living quarters if that is part of payment for the job. See the AWW table, which is updated annually.
B
Bad Faith
Unreasonable, intentional or malicious denial or refusal to pay a claim without any reasonable basis. Also, intentional conduct in the handling of a claim by any person, including the worker, that amounts to fraud, malice, oppression or willful or reckless disregard of the rights of any party.
Benefit
Any payment to an injured worker or on behalf of an injured or deceased worker, for compensation, medical treatment, legal expenses, funeral or travel costs resulting from a work-related injury, illness or death.
Burden of Proof
In legal disputes, the necessity of proving a fact or facts on an issue raised between parties.
C
Claim
A legal demand from the worker to the employer for workers' compensation benefits. Learn about the claims process.
Compensable
A loss or hardship for which compensation is due. A claim for workers' compensation can be compensated if a worker sustains an injury or illness during the course of employment and the disability is a natural and direct result of the accident.
Compensaton Rate
See Temporary Total Disability benefits.
Complaint
A legal document filed in a workers' compensation case to initiate the review of a dispute.
D
Dependents
Children or other family members who qualify to receive workers' compensation benefits in the case of a worker's death.
Dictionary of Occupational Titles (DOT)
A publication containing job titles and descriptions which is used in calculating the PPD rating and sets forth the physical abilities required to perform a job and the time and repetitiveness of a job's physical actions.
Disability Rating
A percentage value determined by calculating an injured worker's impairment as modified by the worker's age, education and physical capacity. A disability rating is used to determine benefits for an injured worker with a permanent disability.
E
Employer's First Report of Injury (FROI)
The form that an insurer or self-insurance program is required to file electronically with the WCA to provide a record of a workers' compensation claim. The employer or insurer is required to provide the worker with a copy of the FROI.
Exclusive Remedy
A legal term that means workers injured on the job are not allowed to sue their employers in the regular court system when the injury is covered by the workers' compensation system.
Ex Parte Communication
Improper contact with the judge or health care provider (HCP) to a case without proper presence or knowledge of other parties involved.
Executive Employee
The chairman of the board, president, vice-president, secretary, treasurer or other executive officer who owns 10 percent or more of the outstanding stock of the professional business or corporation, or a 10 percent ownership interest in the limited liability company.
F
Form Letter to Health Care Provider
A letter containing questions to be answered by the health care provider (HCP) in a disputed case. The Form Letter to Health Care Provider is provided to the complaining party by the WCA either online or via the WCA Court Clerk. The form letter should be completed and brought to the mediation conference by the worker. A copy should also be sent to the insurer or TPA.
H
Health Care Provider (HCP)
A person or organization that provides health care services. By law, the health care provider may be any person licensed in New Mexico in one of these professions: medical doctors, optometrists, chiropractors, dentists, podiatrists, osteopaths, physician assistants, certified nurse practitioners, physical therapists, occupational therapists, acupuncture practitioners, psychologists, athletic trainers and certified nurse-midwives.
Hearing
A courtroom proceeding where both sides involved in a workers' compensation dispute present their cases to a workers' compensation judge for resolution. This may include a trial.
I
Impairment Rating
Describes the degree of permanent damage to the body as a whole. This rating can only be given by the treating health care provider or independent medical examiner and must be based on a reference book called the AMA Guides.
Indemnity Payment
A payment to the injured or ill worker or dependents to make up for (compensate) wage loss, permanent impairment or death. This may also be known as compensation benefits.
Independent Medical Examination (IME)
When parties dispute a worker's medical treatment, either party may petition a workers' compensation judge for the worker to be examined by an independent physician who has not previously treated the worker. IMEs can also occur by agreement of the parties. The judge then considers the opinion of that examination in determining the case. IME providers must be approved by a committee appointed by the WCA Advisory Council.
L
Loss of Use
Loss of or decrease of function of a specific body part in a work-related accident. This could include total amputation of a specific body part or a lower degree of loss of function (§52-1-43).
Lump Sum Payment
A single workers' compensation payment, usually in place of the recurring medical or indemnity payments that would otherwise be received over a period of time. Lump-sum payments must be approved by a workers' compensation judge.
M
Maximum Medical Improvement
The date after which further recovery from or lasting improvement to an injury can no longer be reasonably anticipated as a result of further medical treatment., based upon reasonable medical probability as determined by a health care provider.
Medical Benefits
Payment by the insurer to a health care provider for an injured worker's reasonable, necessary and related medical care.
Mediation
An informal meeting involving both sides (parties) involved in a workers' compensation dispute. Both sides meet with a WCA mediator to try to resolve the dispute.
Mediator
A dispute resolution specialist from the WCA who meets with the disputing parties out of court to try to reach an agreement.
Mental Impairment
A permanent mental illness that is the result of a workplace accident or injury. The impairment can be primary or secondary (§52-1-24 (B)(C)).
Mileage Reimbursement
A monetary payment for every mile approved for travel to get medical treatment that is required by the workers' compensation claim, paid only if the worker has to travel 15 miles or more each way.
Modified Work
A change to normal work duties that allows an injured worker to return to employment. Modifier Formula
Once at maximum medical improvement, a modifier formula may be used to calculate in specific indemnity cases where the worker is unable to return to work or has returned to work but earns less than the pre-injury wage. Modifiers may result in additional benefits. Statute specifies the modifier points to be assigned, based on factors such as age, education, job skills and physical capacity.
N
No Fault
A concept in the law that says the claim will generally be covered no matter who caused the accident.
Notice of Accident (NOA) and NOA Form
A formal notification by an injured worker to the employer that there has been a work-related accident. This can be done through a written statement or by oral notice to let the employer know an accident occurred. An accident witnessed by a supervisor or employer can also count as notice. Employers are required to post WCA Notice of Accident forms for employee use. An adequate supply of WCA Notice of Accident forms must be kept attached to the required WCA poster.
O
Occupational Disease
A disease that is caused or partly caused by the specific job a worker does.
Occupational Injury
An injury that is caused or partly caused by the specific job a worker does.
Ombudsman
A specialist who investigates and attempts to fairly resolve disputes, problems or concerns. An ombudsman provides information on workers' compensation for all parties at no charge. An ombudsman does not provide legal advice.
P
Party
Typically, the worker or the employer and insurer or self-insurance program. Parties may also include health care providers, the Uninsured Employers' Fund or the estate of a deceased worker.
Per Diem
An amount of money to cover daily cost of living when the worker is away from home for medical treatment related to the injury.
Permanent Partial Disability (PPD)
Permanent partial disability (PPD) benefits are paid to workers after they have reached maximum medical improvement (MMI). Benefits are based on the worker's disability rate and other factors. Permanent disability is compensated differently depending on the nature of the injury and the body part(s) affected.
Permanent Total Disability (PTD)
A category of indemnity benefit payable when a worker has been left with the permanent and total loss or loss of use of both hands or both arms or both feet or both legs or both eyes or any two of them, or a disabling brain injury.
Pre-Existing Condition
A physical condition or illness that the worker had before the work-related accident.
Pro Se
When people represent themselves in a legal proceeding without any representation from a lawyer.
R
Recommended Resolution
A written evaluation by a mediator on how best to resolve a formal complaint. Parties can decide to accept or reject the recommended resolution.
Residual Physical Capacity (RPC)
A rating given to an injured worker's ability to perform physical tasks after an injury compared to before the injury (§52-1-26.4)
Retaliation
Any adverse action an employer takes against workers because they reported a workplace injury or illness. Adverse actions can include termination, giving negative evaluations, disciplining or demoting, reassigning or reducing pay.
Rules
Laws instituted by administrative agencies such as the Workers' Compensation Administration, usually clarifying statutory language or defining internal processes and procedures. The WCA director is authorized by §52-5-4 NMSA 1978 to adopt reasonable rules and regulations in order to implement the legislative purposes of the Workers' Compensation Act.
S
Scheduled Injury
An injury to a specific body part listed in a schedule in the statute (§52-1-43). Benefits for scheduled injuries are based on loss of use rather than the permanent partial disability benefit formula, and are paid for a specific number of weeks, depending on the affected body part.
Sole Proprietor
A single individual who owns all the assets of a business, is solely liable for its debts and employs in the business no person other than him/herself.
Specific Vocational Preparation (SVP)
A component of the modifier formula, used to determine how much time and training is needed for a disabled worker to prepare for another job. Vocational preparation training can include education, apprenticeship, job training and essential experience in other jobs.
Statute
A written law passed by a legislative body. Laws pertaining to New Mexico workers' compensation can be found in Chapter 52 of the New Mexico Statutes Annotated (NMSA).
T
Temporary Partial Disability (TPD)
Indemnity payments made to workers who remain employed but at a reduced wage or with reduced hours during the period of temporary disability. Payments are calculated using a set formula.
Temporary Total Disability (TTD)
Indemnity payments made to workers based on their inability t perform duties by reason of accidental injury arising out of and in the course of employment, up to the date of maximum medical improvement. The temporary total disability amount is also known as the compensation rate for the worker.
Third Party Administrator (TPA)
A representative hired by an insurance company or self-insurance program to handle workers' compensation claims.
Tort Liability
In a civil lawsuit for damages, being responsible for damages caused by wrongful conduct or omission.
W
Whole Body Injury
All other injuries not listed in the scheduled injuries statute, commonly to the back, shoulders and hips.