Can I Sue My Insurance Company for Denying Me Workers' Comp?
Workers' compensation denials in Texas are far more complex than standard insurance disputes — and whether you can sue depends on a set of legal rules that are unique to the workers' comp system. There are many variables to consider.
The Hard Truth: Suing the Workers' Comp Insurer Directly Is Extremely Difficult
Texas law has dramatically limited the ability of injured workers to sue workers' compensation insurance carriers directly for bad faith denials. In the past, injured workers in Texas could sue insurance companies for bad faith if their claims were unfairly denied or delayed — but everything changed after a Texas Supreme Court decision ruled that injured employees cannot bring a common-law bad faith lawsuit against a workers' compensation insurance company. Most of those protections are now gone — and there used to be a law against treating people like this, but courts and the legislature have declared that an insurance company can do almost anything with almost no civil consequences. Do not attempt to sue the insurance company in civil court for bad faith — this will likely result in a dismissal and cause you to miss critical administrative appeal deadlines.
The Correct Path: The DWC Administrative Process
When a workers' comp insurer denies your claim, the legally required response is to fight through the Texas Division of Workers' Compensation — not civil court. You can dispute insurance company decisions any time they deny something through a request for a Benefit Review Conference, which starts the litigation process at the Division of Workers' Compensation. From there, if unresolved, you can request a Contested Case Hearing — and if the hearing officer rules against you, you can appeal to the Appeals Panel and ultimately to Texas district courts.
When You Can Sue Your Employer Directly
The legal landscape changes completely if your employer is a non-subscriber. If your employer is a non-subscriber — meaning they opted out of workers' compensation — you can file a personal injury lawsuit against them directly for negligence, and the employer loses three critical legal defenses. Non-subscriber lawsuits can yield full damages including medical expenses, lost wages, and pain and suffering — far more than workers' comp benefits provide. If your workers' comp claim was denied and you discover your employer may actually be a non-subscriber, contact a workers' comp attorney immediately.
Third-Party Claims: A Separate Legal Pathway
Even under the workers' compensation system, you have the ability to sue other parties whose negligence caused your damage. If your job injury was caused by a defective product, a negligent contractor, or another motorist, you can receive workers' compensation benefits while also suing the negligent third party for full damages, including pain and suffering. That particular combination considerably improves total healing.
What Texas Injured Workers Should Do
Request a Benefit Review Conference immediately after any denial — do not wait. Contact the Texas Division of Workers' Compensation at 800-252-7031, and consult a licensed workers' compensation attorney before any administrative deadline expires.
