Did you get hurt at work after making a mistake? Maybe you skipped a step, used the wrong tool, or failed to follow a safety rule exactly. Now your employer is asking questions that make it sound like the entire accident was your fault.
Situations like these leave injured workers wondering whether they’ll qualify for workers’ comp. The good news is that fault doesn’t always control whether you can receive benefits in Texas.
Below, we’ll cover the role that fault plays in workers’ comp benefits and which exceptions may apply to your case. We’ll also explain what happens when your employer doesn’t have workers’ comp and when it makes sense to reach out to a lawyer.
You May Still Qualify for Workers’ Comp If You Were Partly at Fault
In most covered cases, yes, you’ll be able to get workers’ comp. Your eligibility depends less on fault and more on whether the injury happened while you were working.
Texas workers’ compensation generally works as a no-fault system. This means that you don’t have to prove that you were blameless or that your employer was at fault. If an injury happened in the course and scope of your work, you can seek workers’ comp.
That’s very different from a personal injury lawsuit. In that type of case, you’d have to prove that someone else acted carelessly and caused your injuries. Workers’ comp cases don’t hinge on fault.
All in all, making a mistake at work won’t usually cost you your workers’ comp benefits. That being said, there are exceptions to this rule.
When Can Being Partly at Fault Prevent You from Receiving Benefits?
Texas workers’ compensation is no-fault, but there are a few narrow exceptions that may block coverage. They include:
Intoxication and Drug-Related Injuries
Your insurance carrier may deny your claim if you were intoxicated when the injury happened. That can involve alcohol, illegal drugs, controlled substances, or certain medications.
Still, the issue isn’t always as simple as a positive test. The timing, dosage, and substance type all affect how your case unfolds. So does your overall condition at the time of the incident.
For example, a worker may test positive for a prescription painkiller after an accident even though they took the medication as directed the night before. That result alone doesn’t prove the worker was intoxicated or that the drug caused the injury.
Intentional Self-Injury or Suicide Attempts
Texas workers’ comp usually won’t cover an injury that an employee caused on purpose. If someone intentionally cuts themselves at work or throws themselves down the stairs, they may lose their right to workers’ compensation benefits.
That’s very different from making a careless move, ignoring a safety rule, or losing your temper for a moment.
Criminal Activity and Serious Misconduct
An insurance carrier may deny workers’ comp benefits if criminal activity or serious misconduct was involved. If a worker was injured while stealing something from the job site and the criminal act directly caused the injury, they probably won’t be eligible for benefits.
But, as with other exceptions, these cases depend heavily on the facts of the case. A carrier can’t use loaded words like “misconduct” and expect that to settle the issue. They still have to show that the worker’s conduct fits a legal exception that allows the claim to be denied.
That’s why you shouldn’t assume the denial is correct just because the insurance company sounds confident. Evidence is what counts.
Gross Horseplay or Willful Misconduct
Horseplay can put your claim in danger if it directly caused the injury. But there’s a big difference between messing around for a few seconds and completely abandoning your job to do something reckless.
Insurance carriers may point to normal workplace behavior as an excuse to deny the claim. But they still have to prove that what happened was serious enough to fall under the exception.
Does It Matter if Your Employer Doesn’t Have Workers’ Comp Insurance?
Yes, because Texas allows private employers to decide whether to carry workers’ compensation insurance.
An employer that chooses not to carry coverage is called a non-subscriber. If your employer is a non-subscriber, you won’t have a normal workers’ compensation policy to file against. But you may have a negligence claim against the employer instead, depending on what caused the accident.
Don’t take your supervisor’s word when it comes to your employer’s workers’ comp coverage status. You can go to the TXCOMP website and look up whether a policy was active on the date of your injury.
Be especially careful if someone at work tells you not to report the accident, asks you to use your health insurance, or says filing a claim will only cause problems. That kind of pressure usually serves the company, not you. Save texts, emails, forms, medical records, and anything else tied to the injury.
Can You Recover Pain and Suffering if You Were Partly at Fault?
Workers’ compensation doesn’t pay for pain and suffering. It mainly covers approved medical care and certain wage benefits.
That doesn’t mean pain and suffering damages are always off the table. You may be able to recover them through a third-party claim if someone outside your employer caused or contributed to the accident.
Fault plays a bigger role in Texas third-party cases because the state’s modified comparative fault rule applies. If you’re found to be more than 50% responsible, you generally can’t recover damages. If you’re 50% or less at fault, your recovery can be reduced by your share of the blame.
For example, if your total damages are $100,000 and you’re found 20% at fault, your recovery will drop to $80,000.
So, yes, you may still recover pain and suffering even if you share some fault, as long as your percentage of responsibility doesn’t cross Texas’s 50% limit.
Learn about other types of work injury damages here.
Should You Hire a Lawyer if You Were Partly at Fault for a Workplace Injury?
It depends. You should consider getting legal help quickly if the carrier denies your claim or accuses you of intoxication or horseplay. A lawyer may also be useful if the carrier says you weren’t working when the injury happened or pressures you to give a recorded statement.
You may also need a lawyer if several companies were involved, your employer didn’t carry workers’ compensation coverage, or someone outside the company helped cause the accident.
Texas lawyers can review your workers’ comp claim and determine whether you may also have a third-party case. They can also preserve evidence, deal with the insurance companies, and explain what compensation may be available.
The key is finding lawyers who understand both workers’ compensation and personal injury law. These claims can overlap, and a mistake in one case can create problems in the other.
Don’t assume the insurance company will explain all of that to you. Their job is to protect their money, not to make sure you recover every dollar available.
Contact Grossman Law Offices Today
You don’t have to let an employer or insurance carrier turn one workplace mistake into an excuse to deny your claim. With a legal expert on your side, you can give yourself the best chance of securing the benefits you deserve.
Grossman Law Offices has more than 35 years of experience handling serious injury cases. Our lawyers know the tactics companies and insurance carriers use when they want to avoid paying. They may shift blame, question how badly you’re hurt, or push you to accept a quick settlement before you understand what your claim may be worth.
We can review the accident details, explain which claims may apply, and deal with the insurance companies on your behalf. That may include workers’ compensation issues, a claim against a non-subscriber employer, or a separate third-party case against another company that contributed to your injury.
Our team can also help you understand how medical bills, lost wages, and other losses may fit into your case. And when several parties are involved, we can sort through who may be responsible and what evidence needs to be preserved right away.
Grossman Law Offices has recovered millions for injured clients and is available 24/7 for consultations. You can speak with our team when questions come up instead of trying to fight through a confusing claims process alone.
We handle qualifying injury cases on a contingency-fee basis. That means you only pay if you win.
Contact Grossman Law Offices today for a free consultation. We’re standing by to answer your questions, explain your options, and help you take the next step.
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