The workers’ compensation program in Texas understandably confuses many people. Even those who should have a straightforward claim for benefits may feel uncertain about their rights. Misinformation about workers’ compensation spreads rapidly, and workers might spend years believing inaccurate information about basic workplace protections.
For example, could is quite common for employees to believe that companies can deny them benefits if they are at fault for the incident that caused their injuries. However, workers’ compensation is a no-fault form of insurance protection. Employees don’t need to prove that the company was to blame, and allegations of personal fault usually do not affect someone’s right to seek benefits.
There are a few exceptions to this rule, and workers familiar with those exceptions can more easily evaluate whether they qualify for workers’ compensation coverage or not. When does fault potentially affect a worker’s compensation claim?
When a worker caused their injury on purpose
Intentionally staging a workplace incident to request workers’ compensation coverage is a type of fraud. Therefore, if employers have evidence that a worker intentionally hurt themselves to qualify for benefits or a leave of absence from work, that could prevent the employee from obtaining benefits. Prior conversations with coworkers and management or security camera footage could lend credence to claims that a worker may have staged a scenario to cause an injury intentionally.
When a worker got hurt due to drugs or alcohol
Technically, the law no longer mandates that all Texas employers maintain drug-free workplaces and conduct testing after failed breath tests. However, quite a few employers voluntarily participate in drug-free workplace programs, and many others require chemical testing after any workplace incident resulting in injury or death. Someone failing a drug test does not instantly invalidate a worker’s compensation claim. If an employer can prove that someone was under the influence and their impairment is the reason for their injury, then a worker may not be able to obtain coverage.
When a worker violated company policy
Businesses usually have certain protocols in place that workers must abide by throughout their employment. For example, employers may require that workers only do certain jobs when there is someone else on hand to monitor their safety or with certain equipment. In cases involving a clear-cut violation of company policy, those infractions could affect eligibility for workers’ compensation benefits.
In the vast majority of cases, what a worker did immediately before getting hurt has little or no bearing on their eligibility for workers’ compensation benefits. Understanding the exceptions to the rule may help people feel more confident and their pursuit of benefits following a workplace injury.