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Can Insurers Deny Workers’ Comp Benefits by Alleging an Injury Was Deliberately Self-Inflicted?

Texas Workers' Compensation Defense: Injury Was Self-Inflicted

With Texas workers' compensation coverage, one of the main goals is to have a somewhat simple process for employees to receive automatic compensation for work related injuries. The past system in Texas required employees to go through a lengthy lawsuit in order to receive any benefits or compensation from their employers after they were injured in a work accident. Seeing how time consuming and uncomfortable the process could be for both the employer and the employee, Texas lawmakers created the workers' compensation system, which is ultimately a claim-filing system for work injuries. With this system, employees who work for companies that subscribe to workers' comp benefits now have their work injury claims treated like a claim for disability or unemployment benefits.

Theoretically, workers' comp benefits are to be issued once your claim is received and processed, irrespective of who bears the fault, but there are times when an employer will attempt to deny your claim. Texas lawmakers understood the need to provide employers with certain defenses that would allow them to deny an injured worker compensation if they could prove the employee was at fault for the accident leading to the injury. One defense that can be used by an employer is called "Self-Inflicted Injury." For this defense, an employer could argue that the employee purposefully injured himself in order to receive workers' comp benefits.

In this article, Dallas attorney Michael Grossman discusses the self-inflicted injury defense and when it is applicable in a workers' compensation case.

Questions answered on this page:

  • What is a self-inflicted injury in the work place?
  • When can an employer use the "Self-Inflicted Injury" defense in a workers' comp case?
  • How can a lawyer help me when my employer refuses to pay my workers' comp benefits?

Overview of Possible Employer Defenses in Workers' Comp Claims

Overall, the Texas Labor Code outlines eight defenses an employers could utilize in a workers' comp claim to deny the injured worker any benefits. They are are:

While there are only a few defenses, employers will use any and all defenses available because a work injury affects their reputation and their bottom lines. In situations were employers can argue one of these defenses successfully, the injured employee is denied all workers' comp benefits and will not receive any compensation.

How Employers Use The "Self-Inflicted Injury" Defense

While most injured employees have valid workers' comp claims, there are some occasions where an employee will intentionally injure herself in order to receive workers' comp benefits. Knowing some people will try to defraud the system, lawmakers felt it was a necessary defense to put in the Texas Labor Code statute for employers use when these situations arise. Under the "Self-Inflicted Injury" defense, the employer argues that the worker caused his or her injuries to get compensation and get some time off of work by cheating the workers' compensation system.

What This Defense Is Not

Just to be clear, this defense has nothing to do with claiming that and employee accidentally caused their own injury. In order for this defense to be valid, the employer must prove that the worker:

  • Caused his or her own injury and
  • Did so on purpose to get benefits.

There is a clear difference here. If an employee injures themselves through carelessness, that is precisely the kind of misfortune that workers' comp is supposed to cover. This defense merely exists to not allow those who deceitfully try to game the system to receive compensation. Below are some examples of when this defense cannot be used and some examples of when it can:

  • Let's say Jeff accidentally dropped a brick on his foot while moving bricks from one location to another. Obviously, Jeff did this accidentally, and was not aiming for workers' comp benefits. However, since he was injured on the job and his employer is a subscriber to workers' comp coverage, then he becomes eligible for those automatic recovery benefits.
  • Let's say that Jeff dropped a brick on his foot on purpose. He wanted a few days off of work to watch some of his favorite sport team's midday games. He knew that he would be out of work for a few days to a few weeks, and he saw this accident as an opportunity to get benefits while being able to stay home. This example, while rare, is an example of when the employer could rightfully use this defense.

You may be wondering how to tell the difference between these two examples. How would an employer know that Jeff dropped that brick on purpose? Well, that's one of the major problems with this defense; it allows employers to speculate as to the supposed underlying cause of an employee's injury. Certainly you can imagine a scenario wherein an employer would try to abuse this opportunity at denying payment to an injured worker, and many employers abuse this defense in exactly that fashion.

Texas Workers' Compensation Attorney Michael Grossman Can Help

The fact of the matter is that these defenses, deemed legitimate by Texas lawmakers, don't just lessen the payout that an injured worker may get. No, instead, these defenses take the claim completely off the table. So, if your employer can somehow use this defense against you, even though its patently false, you need a lawyer in return that can shut down their argument before it even gets off the ground. Call the workers' compensation attorneys at Grossman Law Offices now for free legal advice on your workers' comp case: (855) 326-0000.

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