What Disqualifies You From Workers’ Comp in Texas?

Texas workers’ comp is a no-fault system, so you generally don’t have to prove your employer did anything wrong. A handful of situations can still cost you benefits. Here they are, in plain terms.

Intoxication

If drug or alcohol intoxication caused your injury, you may not be covered. The key question is whether intoxication was the cause of the injury. Having a drink after work, or a medication that had nothing to do with the accident, is a different situation, but an insurer may still argue the point, so these cases can get contested.

Horseplay, Fighting, and Self-Injury

Injuries from horseplay, willful criminal acts, or intentionally self-inflicted harm are excluded. Texas also excludes injuries caused by someone else for personal reasons unrelated to the job, such as a personal dispute that spills into the workplace. An attack that’s connected to the job is a different matter.

Off-Duty and Recreational Activities

The injury has to arise from your work. If you're hurt during a voluntary off-duty activity, such as a company softball game or social event you weren’t required to attend, you likely won’t be covered. Injuries during an ordinary commute are also generally not covered.

Acts of God

Injuries from events like floods and hurricanes are typically excluded unless your job exposed you to those hazards at a higher level than the general public. A roofer injured by lightning while working may be treated differently from an office worker injured during a storm.

Misclassification and Missed Deadlines

True independent contractors aren’t covered under an employer’s policy. Employers do sometimes label employees as contractors to avoid coverage, and the label alone doesn’t settle the question, because the actual working relationship does. Timing matters too: report your injury to your employer within 30 days and file a claim with the Division of Workers’ Compensation within one year, or you can lose your benefits.

If Your Employer Has No Coverage

Texas is the only state where most private employers can opt out. If yours is a non-subscriber, you won’t have a workers’ comp claim at all, but you may be able to sue the employer directly for negligence.

What to Do

If your claim is denied, find out which reason the insurer gave and ask for it in writing. Many denials can be disputed through the DWC process. Contact the Texas Division of Workers’ Compensation at 800-252-7031, and consider speaking with a workers’ comp attorney, who often works on contingency.