Can You Be Disqualified from Receiving Workers’ Compensation in Texas?
Workers’ compensation provides a financial lifeline to employees who suffer injuries on the job. However, in Texas, coverage is not guaranteed for every injured worker. The state’s unique approach to workers’ compensation allows some employers to opt out of the system entirely, and even when coverage is available, certain actions or circumstances can prevent a worker from receiving benefits.
Understanding when disqualification may occur is essential for protecting your rights after a workplace injury.
Not All Texas Employers Must Provide Workers’ Compensation
Texas generally does not require private employers to carry workers’ compensation insurance. Employers who opt into the system are called subscribers. Those who do not are referred to as non-subscribers, and injured employees can sue them directly for workplace injuries.
If your employer is a non-subscriber, you are not covered by workers’ compensation, but you may still have a legal claim through a personal injury lawsuit. If they are a subscriber, then the Texas workers’ comp system governs your rights.
Common Reasons You Can Be Disqualified from a Worker’s Comp Claim
If your employer is a subscriber, workers’ compensation should cover your injury, but not always. Here are some common disqualifiers:
- The injury did not happen on the job: Your injury must occur within the scope of your employment to qualify for benefits. Your claim could be denied if you were hurt while commuting, running personal errands, or doing off-the-clock activities.
- Intoxication or drug use: Under Texas law, if you were under the influence of drugs or alcohol at the time of your injury, you may be completely disqualified from receiving benefits. Employers often require post-injury drug testing for this reason.
- Intentional or reckless conduct: Your claim may be denied if your injury was the result of willful misconduct, horseplay, or intentionally trying to harm yourself or someone else. Workers’ comp is designed to protect workers from accidents, not self-inflicted or reckless injuries.
- Failure to report the injury promptly: In Texas, you must report a workplace injury to your employer within 30 days. Failing to do so could jeopardize your ability to receive benefits, even if the injury is legitimate.
- Disputed or pre-existing injuries: Your employer or their insurance carrier may deny the claim if they believe your injury is tied to a pre-existing condition. However, you may still be eligible if the work incident aggravated a pre-existing issue, but you’ll need medical evidence.
- Refusal of medical treatment: While you can choose your treating doctor within the workers’ compensation network, unreasonably refusing necessary medical treatment recommended by your doctor could lead to a suspension or denial of benefits.
Understanding these disqualifiers can help you avoid mistakes that could jeopardize your right to workers’ compensation benefits.
What If Your Claim Is Denied?
A denied claim does not necessarily mean you are out of options. You can appeal the decision through the Texas Division of Workers’ Compensation (DWC), which includes a benefit review conference, contested case hearing, and potentially further appeals.
Protecting Your Rights After a Workplace Injury
To avoid disqualification:
- Report your injury immediately.
- Seek medical treatment from an approved provider.
- Avoid horseplay or misconduct on the job.
- Stay sober while working.
- Document everything, including witness statements, accident reports, and medical records
Workers’ compensation laws in Texas are complex, and mistakes can cost you your right to financial support.
Get Help Navigating a Workers’ Compensation Claim in Texas
If you have been injured at work in Texas and are concerned about your eligibility for workers’ compensation benefits, or if your claim has been denied, seeking experienced legal guidance from a Dallas workers’ compensation lawyer is essential. They can help you understand your rights, navigate the claims process, and advocate for your best interests.
Contact The Dallas Personal Injury Law Firm of Benton Accident & Injury Lawyers Today
If you’ve been injured in an accident in Dallas, TX, contact us for more information, please contact the experienced Dallas personal injury lawyers at Benton Accident & Injury Lawyers today. We offer free consultations.
We proudly serve in Dallas County and its surrounding areas:
Benton Accident & Injury Lawyers
1825 Market Center Blvd # 350, Dallas, TX 75207
Phone: (214) 556-8321
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Our firm is located near you. We have an office in Dallas.
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