Why Workers’ Compensation Doesn’t Cover All Workplace Accidents in Texas—and What You Can Do About It

For more than 100 years, the majority of workers in the U.S. have been covered by state or federal workers’ compensation programs. Most states require employers to participate in the workers’ compensation scheme.

But Texas is different. Workers’ compensation is optional for employers in our state. And even when an employer participates in a workers’ comp program, some workplace accidents still aren’t covered.

However, when an accident is outside the scope of the workers’ compensation program, it can sometimes work to the advantage of the employee and their family. A dedicated personal injury lawyer may be able to recover more compensation through a personal injury claim. Every situation is unique, so if you are wondering about the recovery potential in your case, we invite you to contact DeKeyzer Law for a free case evaluation.  

In the meantime, for background information, here are some reasons an on-the-job injury may not be covered by workers’ comp in Texas, as well as options for recovery through other means.

Understanding the Workers’ Comp Trade-Off

Workers’ compensation programs were promoted as a way to ensure that employees injured on the job would receive medical care and some financial support while they were out of work. Employers agreed to this scheme because they gained one critical advantage—employees hurt on the job would not be allowed to sue them for damages.

The trade-off for workers is that on the one hand, they don’t have to prove that they were hurt due to employer negligence. That should make it easier to receive benefits. On the other hand, since they cannot sue, the amount employees can receive is extremely limited. There is no compensation for pain, suffering, and damage to the quality of life. Instead, all they can receive is medical care from an approved provider and amounts to make up 2/3 of the wages lost due to time off work.

These days, the trade-off is not a good deal for employees because obtaining workers’ compensation benefits is nearly as difficult as recovering damages through a personal injury lawsuit. The Insurance companies that are supposed to be providing workers’ comp benefits put a lot of effort into finding reasons to deny benefits. To receive the benefits that should be relatively easy to obtain after a workplace injury, an employee will often need to go through a workers’ compensation legal process with multiple appeals and a hearing before an administrative law judge. It has become nearly impossible to obtain full benefits without an attorney specializing in workers’ comp claims.

Texas Employers Can Choose Whether to Subscribe to State-Regulated Workers’ Comp Insurance

Workers’ compensation insurance insulates employers from the liability they could be subjected to in a personal injury lawsuit. It is generally a pretty good deal for them. But many employers do not want to pay the insurance premiums. Employers who don’t choose to subscribe to the state workers’ comp system may purchase private non-subscriber insurance to provide benefits similar to those available through the workers’ comp program. Or they may choose to assume the risk.

Because workers’ comp insurance is optional in Texas, many employers are “non-subscribers.” But that does not mean injured employees cannot recover when they are injured at work.

Workers’ Comp Only Covers Employees

Even when an employer carries workers’ compensation insurance, some workers who perform tasks for that employer may not be covered by the program because they are classified as independent contractors rather than employees. Workers who operate independently or work with a subcontractor may not be covered by the employer’s workers’ comp insurance that manages the job site. Their position puts them outside the scope of workers’ compensation coverage but could allow for a lawsuit.

Some Accidents are Specifically Excluded from Workers’ Comp Coverage

Another reason a workplace injury may not be covered by workers’ compensation insurance is that the rules allow employers to exclude certain accidents from coverage. Some of the reasons a claim for benefits could be denied include:

• The employee was hurt while under the influence of drugs or alcohol
• The employee was hurt while doing something inappropriate not related to the job, such as playing a game
• The injury was considered to be deliberately self-inflicted
• The injury occurred while the employee was on the way to or from work

While insurers sometimes deny benefits based on legitimate grounds, there are other times where they try to unjustifiably evade their obligations by claiming an injury was outside the scope of coverage. Some injuries not covered by workers’ comp may be the fault of third parties, and workers may recover compensation through a claim against those parties.

Obtaining Compensation for Workplace Injuries Not Covered by Workers’ Compensation

When an injury is not covered by workers’ compensation, then it may be possible to recover compensation through a personal injury lawsuit. It will be necessary to demonstrate that the negligence of the employer or a third party is what caused the injury, so that makes the case a little more complicated than a workers’ comp claim. However, the damages that can be obtained are potentially much more extensive.

In a workers’ comp claim, you can only receive 2/3 of your lost wages and medical care. You may receive a small additional amount if your injuries lead to permanent disabilities.

By contrast, if you establish liability in a personal injury case, you can receive the full amount of lost wages, medical care, and amounts to cover losses such as:

• Pain
• Emotional anguish
• Loss of enjoyment of favorite activities
• The cost of caregivers
• Special equipment or modifications needed to the home

If a workplace injury leads to an untimely death, the amounts available through a wrongful death claim are much, much greater than the amounts provided through the workers’ compensation scheme. But the recovery can be substantially higher in any personal injury claim than it would be through a workers’ comp claim.

DeKeyzer Law Fights to Secure the Best Compensation Available for Injured Workers

At DeKeyzer Law, we know how to hold employers accountable when their negligence leads to injuries. We fight effectively to recover full compensation for on-the-job injuries. For a free case evaluation to learn the recovery options in your case, call us at 713-904-4004 or contact us online today.