“Compensable” is a legal term used to describe a particular illness or injury resulting incident that qualifies the injured worker involved for compensation under the Texas Workers’ Compensation system. When a worker in Texas suffers an illness or injury while on the job and every condition is met for this ailment to be included in the employer’s worker’s insurance plan, then, the incident is technically labeled as “compensable”. On the other hand, you should also be aware that just because an illness results from some exposure to dangerous or toxic materials or, an injury is sustained while on the job, the incident causing event and resulting injury may not necessarily qualify for coverage under Texas Worker’s Compensation.
Elements of Compensable Injuries
In order for injuries to be “Compensable” Injuries, the illness or injury has to be sustained through the course and under the scope of employment. In other words, the injured worker must have sustained an illness or injury while performing behaviors and duties that are commonly considered and expected of a person in that line of work for that type of employer.
Here are some other key elements of compensable insurance:
The illness or injury was not sustained during or by “horseplay” (i.e. goofing off). There are many work environments where managers and supervisors tolerate physical banter, shenanigans, games, and/or occasional joking. If your injury or illness occurred in moments of horseplay such as described, then the insurance company has no obligation to compensate you for medical bills or lost wages.
The illness or injury was sustained when “furthering the affairs of your employer”. In short, for an illness or injury to be compensable, the worker must have sustained while going about performing the normal duties associated with employment with that company. Events that are expected during the average workday but are not exactly part of the assigned work duties are also included such as taking a break, eating lunch, trips to the bathroom, etc. Each situation is considered different and it’s always important to consult a professional if you have any questions about the specifics described above. A job injury lawyer is always a good resource to help determine whether a “Compensable” injury or illness was sustained under the circumstances.
The employee needs to have been hired in Texas or hired by an employer in Texas if the injury was sustained in another state. Oilfield workers, truck drivers, and other similar occupations could see this situation when an employee gets injured out-of-state.
The illness or injury cannot be pre-existing. In other words, the employee wasn’t treating, or even had recently treated for an illness or injury that had occurred previously. For example, let’s consider an employee who received a back surgery some time in the past and has not received treatment any time recently. If an employee suffers any injury to his/her back during normal scope and course of employment, has good reason to believe that the injury will be considered compensable. However, it would be different when an employee has had prior back problems and has continued to treat it off and on for for some period of time before the more recent incident occurred. There would be a good chance that the “older injury” never went away and poses a continuous problem then there is a good chance that new workplaces will view the injury as “pre-existing” and not compensable as a result.
These few examples only cover a small number of the possible situations that would impact the determination of whether an employee’s illness or injury at the workplace is considered compensable. If you need clarification as to whether your injury or illness is covered by the Texas Workers’ Compensation Program, it’s advisable to call a Texas workers’ compensation attorney for help.
Do You Need Help?
The laws surrounding Texas Workers’ Compensation are voluminous, complicated and can impact the future and life of injured workers in many ways. Insurance companies always have one goal which is to dispute and limit medical care and entitlement you may have to any income benefits. Fortunately, Sandoval Law Firm, PLLC is on your side, helping injured workers and their families.
Call (346) 347-7777 to speak with our experienced and hard-working Texas Workers’ Compensation lawyer. It’s in your best interest to speak with an expert attorney with the ability to help you better understand the options, responsibilities, and the rights you have during this difficult time in your life. You won’t have to pay anything for the call, there isn’t any obligation, and each conversation is confidential. You deserve to have someone help you navigate the workers’ compensation laws.