The Enforcement Bureau investigates violations of the Workers' Compensation Act and Agency Rules. The most frequently received allegations are Fraud, Bad Faith, and Unfair Claims Practice.

All reports to the Enforcement Bureau are fully investigated and tracked with an internal priority system. The Enforcement Bureau uses its best efforts to provide service to both Employers and Workers in New Mexico in a detailed, thorough and evenhanded manner. All reports are independently investigated and reviewed by the Bureau Supervisor and General Counsel for determination of action to be taken.

Some of the most common violations are listed below. This list is an example of prosecuted violations and is not intended to limit the scope of our bureau's responsibility.

CRIMINAL FRAUD The Agency takes these violations most seriously and prosecutes them to the fullest extent of the law.

• Falsely claiming an injury was work related
• Staging an accident
• Misrepresenting medical or work status
• Malingering in an attempt to prolong receipt of benefits
• Misclassification of class code or payroll
• Failure to report a work related injury to the carrier and instead paying bills/benefits out-of-pocket
• Misrepresenting benefits due or rights of the injured worker
• Misrepresentation of coverage when coverage does not exist

PAYMENT OF CLAIMS AND CONDUCT OF PARTIES - BAD FAITH/UNFAIR CLAIMS PROCESSING The Agency takes these violations seriously and even one violation or a pattern of conduct will result in full prosecution>

• Unreasonable denial or refusal to pay benefits
• Unreasonable conduct in handling the claim
• Failure to make a timely initial payment
• Prohibited Ex Parte communications with medical providers
• Use of out-of-state adjuster(s)
• Failure of a carrier to provide loss runs to an insured
• Intimidating injured worker to not report a work related accident
• Failure to communicate promptly with worker
• Failure to promptly affirm or deny coverage
• Failure to negotiate settlements in good faith
• Unreasonable delay in paying HCPs
• Inducing worker to forfeit benefits
• Any practice which delays or prolongs the payment of benefits not consistent with the Act
• Requiring unreasonable travel to obtain health care or receive benefits
• Failure to abide by Rules governing mileage and expense reimbursement
• Requiring worker to sign improper medical release or waiver of benefits
• Failure to properly sign or process a Notice of Accident Form
• Unprofessional/unethical conduct by attorney
• Attempt to gain access to confidential records

DATA REPORTING

• Failure to comply with data collection procedures and protocols
• Failure to properly submit E1.2
• Failure to properly submit E6
• Failure to properly submit Annual Expenditure Report

SAFETY

• Failure to conduct required annual inspections
• Failure to properly respond to "Extra-Hazardous" plan and protocol
• Failure to properly post Accident Notice Poster
• Failure to properly make available Notice of Accident Forms

The Enforcement Bureau is run by Robert Piñon, the Bureau Supervisor. The Bureau has a full time investigator, Justine Andrews. Investigator duties include full background checks on all parties involved in a complaint (E1 and E6 filings, reported income, state and federal taxes, MVD, criminal, social security, Department of Labor- unemployment records and wages, medical records, department of insurance records, state corporation commission filings, past WC violations, past WC complaints/benefits), recorded and non-recorded statements, summons and subpoena power, and full on-site surveillance.

Our investigators also assist the General Counsel's office and Employer Compliance bureau in service of summons, on-site surveillance/investigations and service of temporary restraining orders.

Violations of the New Mexico Workers' Compensation Act affect everyone. Your assistance is greatly appreciated. If you know of a violation, please fill out the form provided below and either submit the form immediately to Robert Piñon at bob.pinon@state.nm.us or mail/hand deliver the form to our office. All reports are investigated. While it is preferable that the reporting party disclose his/her identity, a report can be submitted anonymously.
Violation Report Form

To receive a free poster discouraging workers' compensation fraud either contact Robert Piñon at (505) 841-6848 or print out the poster below
Fraud Prevention Poster

Hot/Help Line :: 1-866-WORKOMP

Albuquerque :: 1-800-255-7965
Farmington :: 1-800-568-7310
Las Cruces :: 1-800-870-6826
Las Vegas :: 1-800-281-7889
Lovington :: 1-800-934-2450
Roswell :: 1-866-311-8587
Santa Fe :: 505-476-7381