Frequently Asked Questions About Injury and Disability
- Page 9
Should I Use My Personal Health Insurance After an Accident in New Mexico?
After an accident, you should seek immediate medical attention. The most important thing is to get the treatment you need and do not let issues of insurance and payment prevent you from getting the proper treatment. Your safety and health will always be top priority!
If given the option, you should insist on using your own personal health insurance for all of your medical treatment, even if the accident was caused by another person.
Understandably, many people are hesitant to use their own health insurance to pay since their injuries were caused by someone else—shouldn’t the responsible party’s insurance have to pay? The answer is yes, they should!
Important Reasons to Use Your Personal Health Insurance After an Accident
One of the most common questions that I get asked in my personal injury practice is whether I should use my personal health insurance to pay for medical treatment after I've been in an accident that was caused by someone else.
The answer is, yes, every time. and here's why.
Anytime you've been in an accident, one of the main goals is going to ensure you don't have any lingering bills or ongoing debts after the accident. Using your personal health insurance is the best way to do that.
#1 – There could be a dispute as to who was at fault.
After an accident. you may think the other person was at fault. But you never quite know if there is going to be a dispute as to who caused the accident. It is not uncommon for there to be an argument as to who actually caused the accident. And since most of your medical treatment is going to take place soon after the accident. You should never assume that there's going to be that insurance to cover you because that may not be determined until a much later time. If you use your personal health insurance you eliminate the risk that that bill could go unpaid.
#2 - The other driver could be uninsured or underinsured.
You don't know if the accident was caused by an uninsured or underinsured driver. This is true even if the police report shows the other driver has insurance. Often times those listed policies have expired, so you can’t rely on the insurance provided to the police at the scene. Even if the other driver caused the accident, they may not actually carry the minimum insurance required because in New Mexico we have a very high rate of uninsured drivers – in fact, the third-highest in the United States. So you never quite know if there is insurance to cover your injuries, even if the other person was clearly at fault. You also don't know if they're going to have enough insurance to cover all of your bills. So again, use your personal health insurance to completely eliminate that as a possibility.
#3 - Health insurers pay discounted rates.
Your personal health insurance company – for instance, Blue Cross Blue Shield, Medicaid, Medicare, and virtually all health insurers—have contracts with medical providers that allow them to pay a reduced rate, called a “contract rate” for your medical treatment. This means it is in your best interest for your health insurer to pay those bills at a reduced contract rate, as opposed to the other drivers auto insurance company paying your medical bills, because the auto insurer will pay the full amount of those charged bills. This will help put more in your pocket when your claim is finished.
#4 – You can negotiate with your health insurer.
If you do ultimately receive a settlement and your health insurance has paid out on your behalf, you will have a legal obligation to pay them back. That's part of your contract agreement with them. But there are also some benefits under the law that allow you to negotiate down what you potentially have to reimburse to your health insurance company. Therefore, it will be in your best interest to negotiate the reimbursement owed to your health insurance company versus getting stuck with an unpaid medical bill.
IMPORTANT BONUS TIP - Don’t be surprised if the medical provider does not want to bill your personal health insurer and they instead want to bill the auto insurance for the person that hit you. This has to do with the economics of how much they make off of that medical treatment. My advice is to be persistent and insist the provider bill your health insurer—it may be the single most important step you can take to maximize your take-home pay from a settlement.
A Note of Caution: Do Not Delay Medical Treatment
Since medical treatment is typically required immediately after an accident, you do not want to delay medical treatment while the legal issues of the accident are sorted out. This is where New Mexico law provides the appropriate remedy.
Medical Payments Paid By Your Insurance Must Be Reimbursed
Keep in mind: New Mexico law provides reimbursement rights to your health insurer for benefits paid out on your behalf that were caused by another person’s negligence. That means if your health insurer pays for your medical expenses for treatment caused by someone else’s negligence, and you ultimately recover monetary damages from that negligent person, your health insurer has a right to be reimbursed (these are called rights of subrogation) from you out of the accident money you received.Quick Example:
You are driving and a negligent driver runs a stop sign and hits you. An ambulance arrives and transports you to the hospital. You remember reading something from The Injury and Disability Law Center that said to use your personal health insurance if you are in an accident. The hospital bills your personal health insurance for payment for your treatment. It is later determined that the other driver was at fault for causing the accident, and carried auto insurance. The negligent driver’s insurance company then pays you for your bodily injury damages from the accident, which include your medical bills. Your receipt of payment from the responsible party’s insurance for your damages triggers the legal right of your health insurance company to be reimbursed what they paid out for your treatment caused by the negligent driver.
Financial Burden is on the Wrongdoer
As you can see in the example, the law ultimately is designed to place the financial burden on the wrongdoer. In this example, the negligent driver. Even though your health insurance paid out initially, the wrongdoer paid for those damages through a settlement with you, and you are then able (and required) to pay your health insurer back. This process ensures there is no improper shifting of the financial burden unfairly to your health insurer, while at the same time allowing you to receive the timely medical treatment you need.
Contact Our Roswell Injury Law Office for Help
Our team would be happy to talk with you if you have additional questions about using your personal health insurance, ensuring your medical bills get paid, or any other questions you may have following a car wreck or other accident in New Mexico. Give us a call at (575) 300-4000 or fill out our contact form so we can discuss the details of your specific situation in a free consultation.
I don't like my workers' compensation treating doctor, can I change?
One of the most common questions we receive about worker’s compensation has to deal with changing doctors. To help explain the law on this issue I will use three examples:
Worker is injured on the job, and he/she goes to the Emergency Department for treatment, and then requires follow up medical care. Who gets to pick the doctor the worker must see for the follow-up treatment?
Answer – Employer. But do not lose hope just yet… Worker is not without rights and options.
What Does New Mexico Law Say?
New Mexico law allows the employer to initially (I repeat, initially) select which doctor you must see. The employer has two options. First, they can select the doctor and the injured worker is required to present for follow up treatment to that doctor. Alternatively, the employer can allow the injured worker to select which doctor to follow up with.
*Important Rule – An injured worker should first check with their employer about who is to select the doctor before continuing treatment. If the employer does not give direction about which doctor to see, the injured worker can select the doctor of their choice.
Let’s assume Employer instructed Worker to see a specific doctor who we’ll call “Employer Doctor”. Is Worker stuck with Employer Doctor permanently? Answer - No.
*Important Rule - If the employer selects the initial doctor, then worker has the automatic right to change to a doctor of worker’s choosing after 60 days of treatment.
After 60 days of treatment, Worker has the automatic right (no filing a motion or court hearing required) to change doctors. Worker must notify Employer by simply completing and sending to Employer a form called the “Notice of Change of Healthcare Provider” which can be found on the New Mexico Workers Compensation Administration's website.
Let’s now change the facts again and assume Employer did not instruct Worker to see Employer Doctor, and instead allowed Worker to choose the doctor either by expressly telling Worker to choose or by failing to give Worker direction on who to see. Worker then chooses to see “Worker Doctor”. Does Worker get to keep seeing Worker Doctor? Answer - Maybe.
*Important Rule – The same 60-day rule applies equally to both parties. If Worker makes the initial doctor selection, Employer has an automatic right to change doctors simply by completing and sending a Notice of Change of Healthcare Provider to Worker.
Let’s now change the facts again. This time, Worker chose Worker Doctor and treated for 60 days before Employer exercised the right to change Worker Doctor to Employer Doctor. Employer Doctor has been treating Worker for 60 days. Can Worker change back to his/her preferred doctor, Worker Doctor? Answer - Maybe.
*Important Lesson - Any further changes in doctor selection must happen through one of two ways: 1) Agreement of both parties; or 2) By filing a motion with the court and getting a judge to approve the change.
Understand Your Rights
It is impossible to know what a workers’ compensation judge may approve on an issue like that, but it is unlikely a judge will allow Worker or Employer to continue the carousel of changing doctors without a compelling reason to do so. Examples of compelling reasons could be mistreatment, lack of physician qualification, length of treatment, or any other reason that the Worker or Employer could demonstrate to justify another change in treating physician.
In summary, New Mexico law grants Workers important rights and remedies when it comes to selecting the Worker’s health care provider.
Speak To a Roswell New Mexico Workers' Comp Lawyer
Our workers' compensation attorneys are here to answer your questions and explain how workers’ compensation works in New Mexico. Call our office or fill out our contact form to schedule a free consultation.
Related Workers Compensation Information:
How do I know if my employer carries workers’ compensation insurance in New Mexico?
In New Mexico, almost all employers are required to carry workers’ compensation insurance in the event of an injury on the job. An employer who has personnel in the construction industry must provide workers' comp benefits. Other employers are also required to carry this insurance as long as it has three or more staff members. The owner and family members working in the business are considered employees under this requirement, making the law apply to more workers.
Although New Mexico requires employers to purchase workers’ compensation insurance, not all employees will do so.
Ways to Determine If Your Employer Provides Workers’ Comp
There are several things to check if your employer offers workers’ compensation benefits. These include the following:
- Poster. Under New Mexico law, employers are required to post a workers’ compensation poster in a conspicuous space where all staff members can see it. An employer is supposed to fill in the information regarding the workers’ compensation insurance company’s name and contact information on the poster. A Notice of Accident form must be attached to the poster for it to comply with state law.
- Online search. You can search online at the State of New Mexico Worker Compensation Administration to see if your employer is registered as having workers’ compensation insurance.
- Employer. If you cannot determine whether or not an employer carries workers’ compensation insurance, simply ask. An employer hopefully won't have any problem telling you this if complying with this New Mexico law.
- Experienced workers’ compensation attorney. You should consult with an experienced workers’ compensation attorney who can assist you in determining if your employer provides injury benefits. He can also explain your rights under workers’ compensation laws, file your claim, and negotiate your settlement so that you receive the benefits you deserve.
Do you have questions regarding your rights to workers’ compensation? Even if your employer complies with New Mexico law regarding this insurance, it doesn't mean you won't have to fight to receive what you're entitled to if injured on the job. We're here to answer your questions and explain how workers’ compensation works in New Mexico. Call our office or fill out our contact form to schedule a free consultation with one of our workers compensation attorneys.
Who is eligible for workers’ compensation benefits in New Mexico?
If you were injured on the job or suffered an occupational illness, you may be entitled to workers’ compensation benefits to pay medical bills and replace lost wages. Like many other states’ laws, New Mexico’s workers’ compensation program is a no-fault law that provides benefits to injured workers regardless of who was at fault in causing the accident.
Are You Eligible for Workers’ Compensation Benefits?
Almost all employers in our state are required to have workers' compensation insurance. Employers who staff three or more workers must provide workers’ comp benefits to injured workers. An employer and members of his or her family who work at the business are also considered employees. Part-time staff, temporary and seasonal workers, and many agricultural laborers are also considered employees under this rule.
In addition, an employer who has personnel in the construction industry—even if it's less than three employees—is required to have workers’ compensation insurance.
Assuming that your employer is required to provide workers’ compensation, you could be entitled to benefits if you can demonstrate the following:
- You are an employee with active standing.
- Your injury or illness was caused during the course of your employment.
Exceptions to Providing Workers’ Compensation Benefits
In limited situations, an employer isn't required to provide workers’ compensation to injured personnel. You wouldn't be eligible for benefits if you're of the following:
- Independent contractor
- Domestic worker
- Real estate salesperson who receives a commission
- Federal employee covered under federal workers’ compensation laws
- Executive who meets certain requirements and has elected not to receive workers’ comp benefits
- Sole proprietor
Contact Our Roswell Office for Help
Even if you're clearly eligible for workers’ compensation and suffered an injury on the job, your employer’s insurance company could deny your claim for benefits. Call our Roswell workers' comp lawyers today to schedule a free case evaluation to learn about your rights to workers’ compensation benefits and how our legal team can help.
How much is my personal injury case worth?
When you must make the difficult decision to file a claim for compensation after suffering an injury in a car, slip and fall, or other personal injury accident, it's important to know whether or not it's worth your time to file a claim. To start this assessment, you first have to know the damages for which you can receive a settlement.
Types of Compensation You're Entitled to in Personal Injury Cases
Although each personal injury claim is unique, most people report the same type of damages in order to regain financial stability after suffering an injury. You may be awarded compensation for the following:
- Medical bills. You're entitled to reimbursement for the cost of doctor visits, hospitalizations, surgery, prescription medications, physical therapy, and any other expenses associated with treatment for your injuries.
- Wage losses. This includes income you'll lose while you're off work, vacation and sick time benefits, bonuses, and commissions. If you must make a career change or become disabled due to your injuries, you may also be entitled to lost earning capacity, which is the future income and job benefits you might lose as a result of those changes.
- Pain and suffering. You're entitled to be reimbursed for emotional trauma, pain, and suffering caused by your accident and injury. Since there isn't a set formula for calculating this amount, you'll need the assistance of an experienced personal injury attorney to value this part of your claim.
- Wrongful death. If a family member died as a result of his or her injuries, a wrongful death attorney can assist in seeking compensation for the financial losses you suffered as well as the support, companionship, and advice of your loved one.
- Punitive damages. When the at-fault party’s actions are grossly negligent, punitive damages may be awarded.
Factors That Affect the Value of Your Claim
The exact amount you receive in a settlement is based on a number of factors that affect the strength or weakness of your claim. Some of these factors include:
- Liability. If the liability of the negligent party is clear-cut, or he admits being at fault, this strengthens the claim and makes it more likely that you'll receive what you are owed. When there are issues about your fault in contributing to your injuries, you may have to accept less when settling the case.
- Severity of injuries. Your claim will be worth more if your injuries are more severe or cause some permanent injury than if you suffer a minor injury that you recover from quickly.
- Insurance coverage. The amount of insurance coverage for the negligent party affects the value of your settlement in a practical way. No matter how much the amount of damages, you can only receive the insurance liability coverage in settlement of your claim.
- Your attorney. Having an experienced personal injury attorney with a track record of successfully settling and trying cases similar to yours can increase the value of the case. He or she will be able to thoroughly investigate your accident, build a strong case against the negligent party, and negotiate a settlement that provides you with deserving compensation.
Contact a New Mexico Injury Attorney Today
If you were injured in a personal injury accident, call our office today to schedule a free consultation. We'll discuss the parties who could be responsible for compensating you and the value of your personal injury claim.
How long do I have to file a personal injury lawsuit in New Mexico?
If you or a family member suffered a serious injury in a motor vehicle, slip and fall, or personal injury accident, you may need to file a claim for compensation with the negligent party’s insurance company.
When you do this, it's important to understand the basic process, such as the types of compensation that you may be entitled to, how personal injury claims work, and the evidence that you will need to prove your case.
In addition, a crucial law to understand is the statute of limitations in New Mexico.
What Is the Statute of Limitations in New Mexico?
The statute of limitations is the New Mexico law that sets the time period for you to file a personal injury lawsuit against all negligent parties who caused your accident. If you fail to file a lawsuit within these time periods, you waive your right to do so, and the judge would most likely dismiss your case.
It is very important that you always consult an attorney to make sure you are filing your claim within the statute of limitations.
As a general guideline, the statute of limitations to file a personal injury case is:
- Two years from the date of the accident for a claim against a governmental entity, including a 90-day tort claim notice from the date of the accident
- Three years from the date of the accident for personal injuries suffered
- Three years from the date of the victim’s death if a loved one died from his or her injuries and you must file a wrongful death action
- Four years from the date of the accident for property damage suffered
Act Fast: Contact an Attorney Soon After Your Accident
One of the best ways to ensure you receive what you deserve in a settlement is to retain an experienced personal injury attorney immediately after your accident. Even if your accident happened recently and you have a long time to file a lawsuit, you might be making a big mistake that could weaken your claim for compensation.
If you wait to hire a personal injury lawyer, you limit his ability to promptly investigate the cause of your accident and interview witnesses. If too much time lapses between the incident and his investigation, scene evidence may disappear, or individuals may move or forget important details to help your claim. Your attorney can also handle all communications with the insurance adjuster and help you avoid mistakes, such as agreeing to give a recorded statement or signing the insurance company’s medical release, which could hurt your case.
Do you need to file a claim following a personal injury accident? Call our office today to schedule a free consultation to discuss your legal options, and how we can help you fight to hold the negligent parties accountable.
What's the Social Security Disability Sequential Evaluation Process?
When you must file a claim for Social Security Disability Insurance (SSDI), it's helpful to understand how the claims process works and the rules that apply to these cases. Knowing how the Social Security Administration (SSA) evaluates a person’s medical condition or illness to determine disability helps predict what might happen with your claim.
We explain the Social Security Sequential Evaluation Process that's used to evaluate whether or not you're entitled to benefits.
Questions Asked in the Social Security Disability Sequential Evaluation
In order to be eligible for SSDI benefits, your medical condition must meet the requirements of a disability. It's defined as the inability to engage in any gainful activity due to a medically-determinable physical or mental impairment which is expected to last for at least 12 months or results in death.
The Social Security Sequential Evaluation is a series of five steps in the process used to determine whether you're disabled. At each stage, the SSA worker assigned to your claim asks questions pertaining to eligibility.
Here are the questions in the process:
- Step 1. Are you working above the SGA level? SGA stands for Substantial Gainful Activity, which is working at a job. For example, in 2017, the SGA level income amount is $1,170 per month.
- Step 2. Is your physical or mental condition severe? Your medical condition or illness must be severe enough to meet the definition of a disability, as discussed above. To be severe, the condition must interfere with basic work-related activities.
- Step 3. Does your medical condition meet or equal the severity of the Listing of Impairment? The SSA lists many medical conditions and illnesses in its Listings of Impairments, which is also known as the Blue Book. If you can prove your condition is included in the Listing or is substantially as severe, you can establish a disability.
- Step 4. Can you perform any of your past relevant work? If the answer is no due to your condition, it furthers your claim.
- Step 5. Can you make an adjustment to any other work? The SSA has the burden of proving that work, other than what you performed in the past, exists in sufficient number; and that you can adjust to another form of employment given your age, educational level, work experience, and impairment.
Do you have questions about filing your application for SSDI benefits? Has your claim been denied? Our experienced Social Security disability lawyers are here to help you prove that you are disabled under Social Security Administration laws. We have more than two decades of experience guiding our clients through the process of obtaining the SSDI benefits they deserved. To discuss your situation and rights to benefits, call our office or fill out our online form to schedule a free, no-obligation consultation.
Who's eligible for Social Security Disability benefits?
If you're disabled and unable to work, this doesn't automatically mean that you qualify for Social Security Disability Insurance benefits (SSDI), or that you won't have to fight for the benefits you deserve. Your eligibility for disability income depends on both your work history and disability. Here, we discuss basic eligibility requirements that you need to meet.
What Are the Work History Eligibility Requirements for SSDI?
To meet the work eligibility requirements to qualify for SSDI, you must have worked long enough and recently enough to qualify. Eligibility is based on the number of work credits you have earned. For each quarter of work with income of a certain amount, you can earn one work credit.
The amount of work needed changes, but for example, in 2017, if you earn $1,700 per quarter or more in the year, you would earn four credits for the year.
How many credits you will need to qualify for benefits will depend on your age. These general rules apply:
- Generally, you must have earned 40 work credits with 20 of them having been earned in the last 10 years.
- If you're younger than 31 years old, you may qualify for SSDI benefits with fewer work credits.
Disability Requirements for Social Security Disability Benefits
You must also be considered disabled to be eligible for SSDI benefits. The Social Security Administration (SSA) determines disability by the following requirements:
- You can no longer perform your former job; and
- You cannot perform other work due to your medical condition; and
- Your disability has lasted or is expected to last for at least one year, or result in your death.
The SSA maintains a Medically Approved Listing of Impairments. If your medical condition is on the list, you may automatically qualify for benefits. However, if your disability isn't on the list, this doesn't mean you're not entitled to SSDI benefits.
If you don't qualify for SSDI benefits, you may be eligible for Supplement Security Income benefits (SSI). To be approved, you must be disabled and meet strict asset and income rules.
Let Us Help You With Your Social Security Disability Claim
Even if you clearly qualify for SSDI benefits, you shouldn't be surprised if your application for benefits is denied. Unfortunately, the SSA denies many legitimate claims. If you need help filling out your initial application for benefits or fighting for the benefits you deserve, our Roswell Social Security disability lawyers are here to help. Call our office today to schedule a free, no-obligation consultation.
Related Social Security Disability Information: