What type of injuries are covered?
The types of Injuries covered under Workers' Compensation Insurance are called compensable injuries.
When is an injury compensable?
An injury is compensable under the workers' compensation program if the injury occurs within the course and scope of employment. Course and scope means an activity of any kind or character that has to do with and originates in the work, business, trade or profession of the employer and that is performed by an employee while engaged in or about the furtherance of the affairs or business of the employer. The term includes activities conducted on the premises of the employer or at other locations. The term generally does not include transportation to and from the place of employment. Even if an injury does occur within the course and scope of employment, it will not be compensable (Section 406.032, Texas Labor Code) if:
- occurred while the employee was in a state of intoxication;
- was caused by the employee's wilful attempt to injure himself or to unlawfully injure another person;
- arose out of an act of a third person intended to injure the employee because of a personal reason and not directed at the employee as an employee or because of the employment;
- arose out of voluntary participation in an off-duty recreational, social, or athletic activity that did not constitute part of the employee's work-related duties, unless the activity is a reasonable expectancy of or is expressly or impliedly required of the employment;
- arose out of an act of God, unless the employment exposes the employee to a greater risk of injury from an act of God than ordinarily applies to the general public; or the employee's horseplay was a producing cause of the injury. (Section 406.032, Texas Labor Code)
A mental trauma injury or emotional injury that arises principally from a legitimate personnel action, including a transfer, promotion, demotion, or termination, is not a compensable injury. A mental trauma is only recoverable if resulting from accidental injury traceable to a definite time, place and cause rather than repetitious mental trauma.
A heart attack is a compensable injury only if:
- it occurs at a definite time and place;
- it is caused by a specific event, either physical strain or a sudden stimulus but not mental or emotional stress; and
- the work, not a pre-existing condition or disease, is a substantial contributing factor.