Texas Personal Injury or Worker’s Compensation Claim?
This is a question that comes up frequently in our Houston personal injury law practice. Someone is injured on the job and wonders what the appropriate procedure to obtain necessary compensation for their injuries is.
Whether the claim is a personal injury or one covered by worker’s compensation, or both will depend upon the facts and circumstances of the accident.
Generally, on-the-job injuries are personal injuries; if covered by worker’s compensation, a claim against your employer would be a worker’s comp claim.
However, if a 3rd party was a cause of the on-the-job injury, you may be able to pursue the third party with a personal injury lawsuit, in addition to making a worker’s comp claim.
If you were injured on the job and your employer did not have worker’s comp insurance, you may be able to pursue a “non-subscriber” case against your employer.
You must answer three questions to determine which direction to proceed with your injury claim.
Texas Worker’s Compensation Claims
in Texas, Worker’s Compensation is available to employers who purchase it. If Worker’s Comp covers you, your case against your employer will be limited to a Worker’s Compensation claim in Texas.
The most significant difference between a personal injury claim and a workers’ compensation claim is that with Worker’s Compensation, if you are injured on the job, and your employer has Worker’s Compensation, you do not have to prove fault to collect benefits.
Worker’s Comp Medical Benefits are Generous
With Worker’s Compensation, the injury victim is usually well taken care of from a medical perspective, but human damages, such as pain and suffering, are little to nothing.
Compensation with WC includes weekly benefits, permanent impairment benefits, medical expenses, and rehab.
You Can’t Sue Your Employer if They Have Comp!
Suppose your employer had workers’ compensation coverage in effect during your accident. In that case, your claims against your employer will be limited to those benefits available under Worker’s Compensation in Texas. One exception is if the accident was fatal and the employer was grossly negligent. In that situation, you might be able to sue for punitive damages.
In short, you can’t sue your employer for the on-the-job injury; your recourse is the Worker’s Compensation system.
Worker’s Compensation Limits Human Damages.
Most Workers’ Compensation victims with severe injuries are left holding the bag except for their medical expenses, as the statutory scheme does not allow for items of compensation available to other personal injury victims.
You Don’t Have to Prove Fault with WC.
If Comp covers you, You Don’t Have to Prove Fault by your employer in Texas.
The requirements to be paid from worker’s comp in Texas is that you were injured on the job and your employer has coverage. Proving fault is not necessary.
Is it Worker’s Comp or a Private Insurance Policy?
Many companies have used an alternative insurer other than Worker’s Compensation to reduce costs.
These plans, if they are not registered as workers’ compensation with the state of Texas and generally do not automatically qualify the employer for the benefits of worker’s compensation immunity because of an accident on the job.
Texas provides a method to determine if your employer has Worker’s Compensation coverage at the time of your accident. Or you can reach out to the HR department for verification of coverage.
You can contact the state of Texas Worker’s Compensation Commission for questions regarding workers’ compensation, benefits, and claim procedures.
With Private Insurance, Be Careful What You Sign
It is important that the injured worker not sign paperwork without speaking with an attorney about the consequences of such a signature, particularly when dealing with an insurance policy other than WC.
Nonsubscriber Cases Against Your Employer
If your injury occurred on the job, but your employer was not a subscriber to worker’s compensation in Texas, you may be able to bring a “nonsubscriber” case against your employer.
Texas Law on Nonsubscriber Cases
Texas Labor Code Sec. 406.033 covers the law for nonsubscriber cases in Texas.
Texas Labor Code Sec. 406.033 provides:
(a) In an action against an employer by or on behalf of an employee who is not covered by workers’ compensation insurance obtained in the manner authorized by Section 406.003 to recover damages for personal injuries or death sustained by an employee in the course and scope of the employment, it is not a defense that:
(1) the employee was guilty of contributory negligence;
(2) the employee assumed the risk of injury or death; or
(3) the injury or death was caused by the negligence of a fellow employee.
(b) This section does not reinstate or otherwise affect the availability of defenses at common law, including the defenses described by Subsection (a).
(c) The employer may defend the action on the ground that the injury was caused:
(1) by an act of the employee intended to bring about the injury; or
(2) while the employee was in a state of intoxication.
What are the Differences between WC and Texas Nonsubscriber Cases?
The differences between a worker’s compensation claim and a nonsubscriber case against your employer in general are:
- With nonsubscriber cases, you must prove some fault on your employer.
- With nonsubscriber cases, you are not as limited in damages.
- Nonsubscriber claims likely are not covered by insurance, and collection of damages can sometimes be an issue.
- Contributory negligence (by you) is not a defense for the nonsubscriber.
- Nonsubscriber cases are like personal injury cases (with some exceptions).
On-the-Job Personal Injury Cases in Texas (Third-Party Cases)
To recover damages in a Texas personal injury case, you must prove that the person who caused the accident owed you a duty and caused you legally recoverable damages. If your injury was caused by the actions of another person (not a co-employee) or company, you might have a third-party case.
Some Common Examples of Personal Injury and Worker’s Compensation
By way of example, if you were injured car accident and someone else is at fault, this would be a personal injury case. (But if you were on the job at the time of the crash and your employer had WC, it may be both a personal injury case against the negligent driver and a WC claim with your employer). In this case, you may recover both worker’s comp and personal injury damages.
Third-Party Personal Injury and Non-Subscriber Claims Require Fault
The personal injury claimant must prove someone else was at fault or at least that someone else was greater at fault than they were.
For on-the-job workers, your employer may have workers’ compensation coverage, which limits your claims against the employer to the workers’ compensation statutory scheme.
However, if another person or company was partly at fault for the on-the-job accident, you may be able to file a personal injury lawsuit against that party. That case is called a third-party claim.
Third-Party Cases in Addition to Worker’s Compensation
If parties other than your employer may have been responsible for the accident, you may be able to sue such parties and not be barred by Worker’s Comp.
A few other examples would be where your injury was caused by a dangerous or defective machine or another person not employed by your company.
These are called “third-party” claims, and victims are allowed to pursue Worker’s Compensation and third-party cases simultaneously.
Subrogation or Payback of Comp Benefits
It is noteworthy that Workers’ Compensation in Texas includes statutory subrogation claims. Victims often must repay workers’ compensation out of third-party compensation in personal injury cases. In short, if you get comp benefits and win damages from a third party, your lawyer will need to pay worker’s compensation back.
Damages are More Generous with Third-Party Cases
Damages and Workers’ Compensation claims are extremely limited and defined by statute. Damages in personal injury cases are much different in that damages are generally determined in an agreed settlement or by a jury.
Personal injury damages include such things as:
* Physical pain
* Mental anguish
* Medical expenses
* Lost wages.
Individuals seriously injured on the job should inquire about the Worker’s Compensation situation with their employer.
Also, consider speaking to a personal injury attorney in Houston regarding whether a third-party claim against others may be possible if you believe another (other than your employer) person or company was at fault.
Contact a Leading Personal Injury Lawyer in Texas
If you’ve been injured on the job in Houston and would like to speak with an attorney about a potential third-party claim, contact us at the Baumgartner Law Firm Personal Injury Lawyers for a no-obligation consultation regarding your rights and options.
Our goal is to maximize in-pocket compensation for you. While we do not handle workers comp claims, we have been extremely successful with 3rd party lawsuits.
Ask us about our no-fee promise – you will pay us no fee unless we win your case.
Call (281) 587-1111 or Request a Consultation!