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NEW MEXICO WORKERS' COMPENSATION ADMINISTRATION
EMPLOYERS' FIRST REPORT OF INJURY OR ILLNESS
2410 Center. SE ? PO BOX 27198
ALBUQUERQUE, NM 87125-7198
OFFICIAL USE ONLY
PLEASE PRINT IN BLACK INK OR
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How to fill out new mexico workers39 compensation
How to fill out New Mexico workers' compensation:
01
Obtain the necessary forms: Start by requesting the appropriate forms from your employer or the New Mexico Workers' Compensation Administration. These may include the Employer's First Report of Injury, Employee's Notice of Accident, and any other required forms.
02
Provide accurate information: Fill out the forms accurately and completely. Include your personal information, such as name, address, and contact details. Make sure to include the date and details of the incident that led to your injury or illness.
03
Describe the incident: In the description section, provide a detailed account of how the accident occurred or how you developed your work-related illness. Be specific about the location, time, and any contributing factors.
04
Document medical treatment: Indicate the medical providers you have seen for your injuries or illness. Include the dates of your appointments and any treatments received. Attach any medical reports, test results, or bills related to your condition.
05
Provide employer information: Identify your current or former employer and provide their contact information. Include details about your job position, work responsibilities, and the date of hire.
06
Sign and date the forms: Once you have completed the necessary sections, sign and date the forms. Ensure that you have read the statements and declarations provided.
07
Keep a copy: Make a copy of the filled-out forms for your records before submitting them to the appropriate authority.
08
Submit the forms: Submit the completed forms to your employer and the New Mexico Workers' Compensation Administration within the specified time frame.
Who needs New Mexico workers' compensation?
01
Employees: All employees in New Mexico, whether part-time, full-time, or seasonal, may be eligible for workers' compensation benefits. This includes individuals working for private companies, state and local governments, and certain types of agricultural labor.
02
Dependents of deceased workers: If a worker dies as a result of a work-related injury, their dependents may be entitled to workers' compensation benefits.
03
Employers: Employers in New Mexico are required by law to provide workers' compensation coverage for their employees, in most cases. This coverage helps protect employers from legal actions resulting from workplace injuries and illnesses.
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