Compensable Injuries in Texas Workers’ Comp Claims

If a Texas worker suffers an injury or illness on the job and all conditions are met for the injury to be covered by the employer’s workers’ compensation insurance plan, then the injury or illness is said to be “compensable”.  Simply because an injury happens on the job or an illness occurs as the result of exposure to toxic or dangerous materials does not automatically qualify that injury as being covered under the Texas Workers’ Compensation program.

Elements of A Compensable Injury

For an injury to be considered a Compensable Injury, the injury or illness had to be suffered during the course and scope of employment. In short, this means that you suffered an injury or illness while performing duties and behaviors that would commonly be expected of an employee in your situation. Other elements of a compensable injury include:

  • The injury or illness was not caused by or during “horesplay” (goofing off). In many work environments, occasional joking, shenanigans, games and even physical banter is tolerated by supervisors or managers. If your illness or injury occurred during moments of horseplay, the insurance company is under no obligation to cover your lost wages or medical bills.
  • The injury or illness happened while you were “furthering the affairs of your employer”. In other words, for an injury to be compensable, it must have happened while you were “about business” in the normal duties of your employment. This also includes things that are normally expected during work hours, such as trips to the restroom, during lunch, taking a break, etc. Every situation is different and you should always consult a lawyer if there is any question about whether the injury occurred while furthering the affairs of the employer.
  • The employee was either hired in Texas, or if the employee lived in another state at the time of the injury, was recruited from Texas by a Texas employer. This situation arises often for workers who were injured out-of-state such as truck drivers, oilfield workers, etc.
  • The injury is not pre-existing. This means that the employee was not actively treating (or has not recently treated) for an injury that previously occurred. For example: if an employee had previous back surgery years ago and has not actively treated in a long time, then the employee re-injures his or her back during the normal course and scope of employment, chances are, the injury is compensable. However, if another employee with previous back problems has continued to receive treatment for the old injury from time to time, or if there is evidence that the “old injury” has never gone away and continues to cause problems, then there’s a chance any new workplace back injury may be deemed “pre-existing” and therefore, not compensable.

These examples are only a few of the many situations that could arise which would affect whether an employee’s workplace injury or illness is compensable. If you have any question as to whether or not your injury or illness should be covered by the Texas Workers’ Compensation program, call an experienced workers’ comp attorney right away.

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Texas Workers’ Compensation laws are complex and impact many areas of an injured workers’ life and future. The insurance carrier has one goal: to limit or dispute your medical care and your entitlement to income benefits. Call 888-434-COMP (888-434-2667) and talk to our hard-working, experienced workers’ comp lawyers. You owe it to yourself to talk to an attorney who can help you understand your rights, responsibilities and options in this difficult time of your life. The call is free, there is no obligation, and all conversations are kept strictly confidential. Call today.

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Abbott, Clay & Bedoy attorneys are licensed only in the state of Texas unless otherwise indicated in the biographical section. Past performance is no guarantee of future results. We consider employment in another State only in association with co-counsel licensed in that State. References to laws are limited to federal and State of Texas law.