COMMIT WORKERS COMPENSATION FRAUD? NO WAY! IT S NOT WORTH IT!

Transcripción

1 COMMIT WORKERS COMPENSATION FRAUD? NO WAY! IT S NOT WORTH IT! Special prosecutors from the Workers Compensation Administration, the Insurance Fraud Bureau and law enforcement departments will prosecute any party who commits workers compensation fraud. Acusadores especiales de la Administración de Compensación para los Trabajadores, la Oficina de Fraude del Seguro y departamentos de aplicación de ley procesarán cualquier partido que comete fraude de compensación para los trabajodores. To Report Fraud: Call or visit our website at

2 State of New Mexico Workers Compensation Administration WORKERS COMPENSATION ACT If You Are Injured At Work Si Se Lastima En El Trabajo 1) Notice -- In most cases you must tell your employer about the accident within 15 days, using the Notice of Accident Form. 1) Aviso. -- En la mayoría de los casos usted debe de avisarle a su empleador del accidente dentro de los primeros 15 días usando las formas de Aviso de Accidente. 2) You have the right to information and assistance from an information specialist known as an Ombudsman at the Workers Compensation Administration. 3) Claims information -- Contact your employer s Claims Representative. 2) Usted tiene el derecho a información y ayuda contactándose con un especialista en información conocido como Ombudsman en la Administración para la Compensación a los Trabajadores. 3) Información acerca de Reclamaciones. -- Contáctese con el representante de reclamaciones de su compañía. Employer s Insurer / Claims Representative: Name: Phone #: Address: Note: Employer must fill in this insurer / claims representative information. WCA POSTER (TOP) PART 1 OF 2 ATTACH BOTTOM OF POSTER HERE

3 YOUR RIGHTS If you are injured in a work-related accident: Your employer / insurer must pay all reasonable and necessary medical costs. You may or may not have the right to choose your health care provider. If your employer / insurer has not given you written instructions about who chooses first, call an ombudsman. In an emergency, get emergency medical care first. If you are off work for more than 7 days, your employer / insurer must pay wage benefits to partially offset your lost wages. If you suffer permanent impairment, you may have the right to receive partial wage benefits for a longer period of time. SUS DERECHOS Si se lastima en el trabajo: ATTACH TOP OF POSTER HERE WCA POSTER (BOTTOM) PART 2 OF 2 Su empleador / asegurador debe de pagar por los gastos médicos necesarios y razonables. Es posible que usted tenga, o no tenga, el derecho de escoger el proveedor de servicios para la salud. Si su empleador / asegurador no le ha dado instrucciones por escrito de quien es él que selecciona primero, pregúntele o llame a un ombudsman. En una emergencia, obtenga asistencia médica de emergencia primero. Si usted está fuera del trabajo por más de siete días, su empleador / asegurador debe de hacerle un pago compensatorio de prestaciones para compensar parcialmente la pérdida de su salario. Si usted sufre daño permanente, usted puede tener el derecho a recibir prestaciones parciales de salario por un periodo de tiempo más largo. Ombudsmen are located at the following offices: Albuquerque: Farmington: Las Cruces: Las Vegas: Lovington: Roswell: Santa Fe: If You Need HELP Call: Ask for an Ombudsman Si Usted Necesita Ayuda Llame Al: W O R K O M P ( ) Visit our website at: For FREE copies of this poster and Notice of Accident Forms call: USE A NOTICE OF ACCIDENT FORM TO REPORT YOUR ACCIDENT TO YOUR SUPERVISOR EMPLOYER: You are required by law to post this poster where your employees can read it and to post Notice of Accident forms with it. This poster without Notice of Accident forms does not comply with law. You have other rights and duties under the law. New Mexico Workers Compensation Administration 2410 Centre Avenue, Albuquerque, New Mexico P.O. Box 27198, Albuquerque, New Mexico Pregunte por un Ombudsman POST FORMS HERE This poster published 3/15/07. It remains valid until reissued and supersedes all prior versions except 3/15/03.

4 State of New Mexico Workers Compensation Administration WORKERS COMPENSATION ACT If You Are Injured At Work Si Se Lastima En El Trabajo 1) Notice -- In most cases you must tell your employer about the accident within 15 days, using the Notice of Accident Form. 1) Aviso. -- En la mayoría de los casos usted debe de avisarle a su empleador del accidente dentro de los primeros 15 días usando las formas de Aviso de Accidente. 2) You have the right to information and assistance from an information specialist known as an Ombudsman at the Workers Compensation Administration. 3) Claims information -- Contact your employer s Claims Representative. YOUR RIGHTS If you are injured in a work-related accident: Your employer / insurer must pay all reasonable and necessary medical costs. You may or may not have the right to choose your health care provider. If your employer / insurer has not given you written instructions about who chooses first, call an ombudsman. In an emergency, get emergency medical care first. If you are off work for more than 7 days, your employer / insurer must pay wage benefits to partially offset your lost wages. If you suffer permanent impairment, you may have the right to receive partial wage benefits for a longer period of time. 2) Usted tiene el derecho a información y ayuda contactándose con un especialista en información conocido como Ombudsman en la Administración para la Compensación a los Trabajadores. 3) Información acerca de Reclamaciones. -- Contáctese con el representante de reclamaciones de su compañía. SUS DERECHOS Si se lastima en el trabajo: Su empleador / asegurador debe de pagar por los gastos médicos necesarios y razonables. Es posible que usted tenga, o no tenga, el derecho de escoger el proveedor de servicios para la salud. Si su empleador / asegurador no le ha dado instrucciones por escrito de quien es él que selecciona primero, pregúntele o llame a un ombudsman. En una emergencia, obtenga asistencia médica de emergencia primero. Si usted está fuera del trabajo por más de siete días, su empleador / asegurador debe de hacerle un pago compensatorio de prestaciones para compensar parcialmente la pérdida de su salario. Si usted sufre daño permanente, usted puede tener el derecho a recibir prestaciones parciales de salario por un periodo de tiempo más largo. For FREE copies of this poster and Notice of Accident Forms call: USE A NOTICE OF ACCIDENT FORM TO REPORT YOUR ACCIDENT TO YOUR SUPERVISOR New Mexico Workers Compensation Administration 2410 Centre Avenue, Albuquerque, New Mexico P.O. Box 27198, Albuquerque, New Mexico Employer s Insurer / Claims Representative: Name: Phone #: Address: Note: Employer must fill in this insurer / claims representative information. Ombudsmen are located at the following offices: Albuquerque: Farmington: Las Cruces: Las Vegas: Lovington: Roswell: Santa Fe: If You Need HELP Call: Ask for an Ombudsman Si Usted Necesita Ayuda Llame Al: Pregunte por un Ombudsman W O R K O M P ( ) Visit our website at: EMPLOYER: You are required by law to post this poster where your employees can read it and to post Notice of Accident forms with it. This poster without Notice of Accident forms does not comply with law. You have other rights and duties under the law. POST FORMS HERE This poster published 3/15/07. It remains valid until reissued and supersedes all prior versions except 3/15/03.

5 Employers and insurers who get the best SAW/RTW results and have the lowest costs: Take charge of the process from the start, making employment decisions with the worker and the doctor. Inform treating doctors that the employer has a temporary transitional work program and that most workers are expected to recover on the job. Make it clear that they can provide safe work within a wide range of functional abilities and will be careful to abide by any guidelines set by the doctor. Ask the doctors to provide functional capacities, restrictions and limitations instead of return to work dates. Measure work days lost per injury / illness to track the effectiveness of your programs. Source: Preventing Needless Work Disability by Helping People Stay Employed, American College of Occupational and Environmental Medicine, September, The sooner an injured employee can be safely back to work, the better; even if the tasks are reduced or the duties are restricted. This enhances the worker s self-esteem, promotes healing and reduces costs to the employer and the overall workers compensation system. An effective SAW/RTW program saves money by: Improving morale among all employees Increases control and potential for a positive resolution of the claim Reduces or avoids permanent disability Discourages fraudulent claims Retains the services of valuable trained employees Avoids the replacement and training costs of hiring a new employee Identifies cross-training opportunities that enhance employees abilities in their jobs Increases awareness of safe work practices and injury prevention WCA HELPLINE - HOTLINE: (toll free in New Mexico) WORKOMP Stay at Work / Return to Work Stay at Work is a process that allows an injured worker to stay at work as he recovers from an on the job injury. The prime objective of Stay at Work / Return to Work (SAW/RTW) is to minimize as much as possible the disruption caused when an accident occurs on the job. New Mexico Workers Compensation Administration

6 Always promote safety and accident prevention and ensure a safe working environment for workers. When an accident occurs, provide immediate, reasonable and necessary medical care. Then report the claim to the workers compensation insurance carrier or self-insurance claims personnel within 72 hours. The interests of the worker and employer are best served by early return to safe and appropriate working conditions. Although it is not always medically possible, in many cases workers are capable of returning to work soon, if not immediately after the accident, to the same job or modified work duties. There are times when an injured worker can stay at work without having to miss time after medical treatment has been started. Continuous early return to work practices result in an abundance of rewards for employers and workers. Early return to work practices help the employer by limiting work related accident costs, thereby reducing workers compensation insurance premiums. Early return to work also benefits the worker by substantially decreasing the adverse effects commonly linked to an injured worker s physical and/or emotional condition. Published by the Public Information Office of the New Mexico Workers Compensation Administration 5/2009 When a worker is given early return to work opportunities, accident related expenses are dramatically reduced and a worker s productive work routine becomes part of his therapy, allowing a faster, healthier recovery. Communication among the worker, employer, adjuster and health care provider (HCP), particularly during the initial period after injury, should be fostered, consistent with safeguards to prevent misuse or improper release of medical information and attempts to interfere with medical treatment. Studies show that workers who are out of work for 12 weeks reduce their chances of returning to work by 50%. The longer a worker stays out of work, the greater the chances of never returning to work. Workers need to be educated on the benefits of returning to work as early as possible after an accident. The worker should also be informed and involved in his medical decisions concerning return to work in an environment that is free from intimidation and coercion. RTW and the Americans with Disabilities Act (ADA) Under the ADA, an employer may have a legal responsibility to provide reasonable accommodation to a qualified employee with a disability if the employee requests it. Qualified individuals include persons who have a physical or mental impairment that limits one or more major activities, and who can perform essential job functions. The employer is required to engage in a timely, good-faith, interactive process with the employee or applicant to determine effective, reasonable accommodations, if any. However, a reasonable accommodation is not required if it would impose an undue hardship on the employer. A reasonable accommodation may include providing part-time or modified work schedules, reassigning to a vacant position, providing or modifying equipment or devices or making other employment adjustments.