When Does Workers’ Compensation Not Cover an Injury in Texas?

Unlike other states, Texas does not require every employer to carry workers’ compensation coverage on their employees. This can leave individuals who sustain workplace injuries in a very tough spot when it comes to recovering compensation. Essentially, they will have to proceed forward with a Houston personal injury lawsuit against the at-fault party. Additionally, even if an employer has workers’ compensation insurance, there are situations where the insurance carrier will not cover an injury.

Texas Doesn’t Require Workers’ Compensation

One thing that often causes confusion among workers is that there is no requirement for employers to carry workers’ compensation coverage in Texas. In these situations, when a worker sustains an injury, their only recourse to recovering compensation will be to file a civil personal injury lawsuit against the employer or the individual or entity who caused the injury. 

If the employer does not carry workers’ compensation insurance, the injury victim will need to prove the other party’s liability in order to recover compensation. This is different from the workers’ compensation system, where individuals will recover benefits even if they are responsible for causing their own workplace injury.

Reasons for Workers’ Compensation Denials 

If an employer does carry workers’ competition insurance for their employees, there are still times when the insurance carrier may not cover an injury. This includes, but is not limited to, the following:

• Injuries not reported on time. Work injuries must be reported to the employer or supervisor relatively soon after they occur. Additionally, the actual workers’ compensation claim must be filed within a specified time frame. In the event individuals fail to meet the deadlines put in place, they will likely not be able to recover compensation for their losses.
• Workplace intoxication. In the event an employee sustained an injury when they were on the job but intoxicated by alcohol or drugs, it is very likely that the insurance carrier or the employer will deny the claim, regardless of who was at fault for the incident.
• Horseplay or practical jokes. Employees are expected to behave at work, and any injury caused by horse playing, roughhousing, or practical jokes will likely not be eligible for compensation recovery.
• Injury did not occur on the clock. If the injury did not occur when a worker was on the clock, they may not be able to recover compensation. Depending on the employer, this could include lunch or rest breaks. Additionally, the commute to and from work is typically not considered on-the-clock time. Finally, there is always a gray area when it comes to work social gatherings.

Contact a Skilled Texas Workplace Injury Lawyer

If you or somebody you care about has been injured on the job and have any questions about whether or not you should receive workers’ compensation benefits, we encourage you to reach out to a skilled lawyer as soon as possible. A workplace injury lawyer in Houston can examine your case and help you determine whether or not you’re eligible for workers’ compensation benefits or whether you may be able to file a civil personal injury lawsuit against the at-fault party.