What to do if the insurer’s top offer won’t cover your treatment and lost wages

Short answer: You have several routes — document your losses, demand a better settlement with proof, use alternative insurance coverages, file a complaint with the state insurance regulator, pursue mediation or arbitration, or file a lawsuit before New Mexico’s time limits run. Consider talking with a personal injury attorney early so you understand legal deadlines, medical liens, and what a fair recovery should look like. This is general information only and not legal advice.

Detailed answer — practical options under New Mexico law

1. Verify the insurer’s offer and your policy coverage

Start by getting the insurer’s offer in writing and comparing it to your policy. Read the declarations page, limits, and any “payments for medical expenses,” wage-replacement, or uninsured/underinsured motorist (UM/UIM) provisions. Check whether the insurer treated your claim as a first-party (your own policy) or third-party (someone else’s liability). If you don’t understand the policy language, an attorney or consumer counselor can help explain what the policy should pay.

2. Build a thorough paper trail proving treatment costs and lost wages

Insurers often lowball offers when claim documentation is incomplete. To improve your position, assemble:

• Medical records and itemized bills from each provider.
• A clear billing ledger showing what’s been paid and what remains outstanding.
• Proof of lost income: pay stubs, employer letters showing missed hours/days, tax records, and documentation of expected overtime or future earnings, if relevant.
• Records of other out-of-pocket costs (transportation to appointments, prescription costs).

3. Send a reasoned demand and negotiate

With organized documentation, send a written demand that itemizes medical bills and lost wages and explains why the insurer’s offer is inadequate. Request a written response and a breakdown of how they calculated their offer. Many insurers will increase offers if presented with clear, verifiable evidence of damages.

4. Explore other insurance coverages

Depending on facts, other coverages may apply:

• Personal health insurance or Medicaid may pay treatment now; those payers may have subrogation or lien rights.
• PIP (personal injury protection) or medical payments coverage in an auto policy can cover medical bills regardless of fault.
• UM/UIM coverage (if you have it) can cover gaps when the at-fault driver’s liability limits are too low.

5. Consider mediation, appraisal, or arbitration

Your policy or the other party’s insurer might allow (or require) dispute resolution such as mediation or binding arbitration. Mediation can produce a better result than the insurer’s initial offer while avoiding court. Arbitration can be quicker than litigation but may be binding. Review your policy for dispute-resolution terms and consider an attorney to represent you in those processes.

6. File a lawsuit before the statute of limitations expires

If negotiation fails, you can sue the at-fault party for negligence (medical bills, lost wages, pain and suffering). New Mexico law imposes time limits for bringing claims, so act promptly. For information on New Mexico statutes and timing rules, see the New Mexico Legislature statutes page: https://www.nmlegis.gov/Legislation/Statutes. The New Mexico court system explains filing procedures: https://www.nmcourts.gov/.

7. File a complaint with the New Mexico insurance regulator for bad faith or unfair practices

If the insurer refuses to handle your claim fairly or ignores proof of loss, you can file a complaint with the New Mexico Regulation and Licensing Department — Insurance Division. The regulator can investigate unfair claim practices and help you understand your rights: https://www.rld.nm.gov/industry/insurance/. Filing a complaint doesn’t replace a lawsuit, but it may push an insurer to negotiate.

8. Understand medical liens and subrogation

If your health insurer or medical provider paid treatment, they may have a lien or subrogation claim against any settlement. When negotiating, you must account for those claims. An attorney can help calculate net recovery after liens and negotiate reductions where possible.

9. Talk to a lawyer about whether an attorney’s involvement will increase your recovery

Many injury lawyers in New Mexico work on contingency: they advance costs and are paid a percentage if you recover. An attorney can evaluate your damages, communicate with insurers, protect your rights, and file suit before deadlines. If the insurer’s offer is well below documented losses, an attorney can advise whether immediate litigation or further negotiation is the better path.

Helpful hints — practical steps to improve your chances

• Document everything immediately: dates, conversations (who you spoke with, what was said), and copies of correspondence.
• Keep all medical bills and receipts in one place and get itemized bills from every provider.
• Ask your employer for a written statement confirming missed work and lost income.
• Don’t sign a full release until you know it covers all current and future medical care and wage losses; a release is often final.
• Be careful with recorded statements to the insurer — you can politely decline until you get legal advice.
• Preserve physical evidence and take photos of injuries and the scene, if applicable.
• Don’t post details or photos about the injury or recovery on social media; insurers may use posts against you.
• Get multiple medical opinions if your diagnosis or need for future treatment is disputed.
• If offered an advance or “structured settlement,” understand how it affects your ability to pursue additional damages later.

Where to get help in New Mexico

Contact resources that can assist you with complaints, consumer help, or court procedures:

• New Mexico Regulation and Licensing Department — Insurance Division (consumer complaints): https://www.rld.nm.gov/industry/insurance/
• New Mexico Courts (filing a claim, small-claims information, and court forms): https://www.nmcourts.gov/
• New Mexico Legislature (statutes and legal timelines): https://www.nmlegis.gov/Legislation/Statutes

Important legal disclaimer: This article provides general information about options in New Mexico when an insurer’s offer doesn’t cover treatment and lost wages. It is not legal advice, does not create an attorney-client relationship, and may not apply to the specific facts of your case. Consult a licensed New Mexico attorney to get advice tailored to your situation.