Can I Sue My Employer for Denying Workers’ Comp in Texas?

When Your Employer Denies Your Workers’ Compensation Claim: Your Legal Rights in Texas

If you’ve been injured on the job in Houston, Austin, Beaumont, or anywhere else in Texas, you already know the physical and emotional toll it takes. What you might not expect is the additional battle that often follows: a denied workers’ compensation claim. The question we hear daily from hardworking Texans is, “Can I sue my employer for denying workers’ comp?” The answer is more complex than a simple yes or no, and it hinges on the unique—and often confusing—landscape of Texas workers’ compensation law.

At Attorney911, The Manginello Law Firm, PLLC, we’ve represented thousands of injured workers across Texas for over two decades. Managing Partner Ralph Manginello, admitted to the Texas Bar in 1998 and the U.S. District Court for the Southern District of Texas, has built a practice dedicated to protecting victims when they’re most vulnerable. “Unlike every other state in the country,” Ralph explains, “Texas operates under an opt-out system. Employers are not required by state law to carry workers’ compensation insurance.” This fundamental difference creates a legal minefield for injured employees, making expert guidance not just helpful, but essential.

This comprehensive guide will walk you through exactly what happens when your claim is denied, the legal avenues available to you—including the critical distinction between a lawsuit and an administrative appeal—and why having a Texas attorney with insider knowledge of insurance company tactics is your greatest advantage. If you’re facing a denied claim, time is of the essence. Call our legal emergency line at 1-888-ATTY-911 for an immediate, no-obligation consultation with our team.

The Texas Workers’ Comp Paradox: An Optional System with Mandatory Consequences

To understand your rights, you must first understand the system. Texas is the only state that does not mandate employers to provide workers’ compensation coverage (Texas Labor Code § 406.002). An employer who chooses not to subscribe loses the “exclusive remedy” defense typically provided by workers’ comp systems. This means if you’re injured and your employer is non-subscribing, you can file a traditional personal injury lawsuit against them. In such a lawsuit, unlike in a workers’ comp claim, you must prove negligence—that your employer’s actions or failure to act caused your injury. The potential recovery, however, can be significantly greater, including compensation for pain and suffering, which is not available through workers’ comp.

For employees of subscribing employers, the path is different. The workers’ compensation system is designed to be a no-fault benefit system. As Ralph Manginello clarifies, “You’re not required by law to prove that your employer was at fault for your injury.” In exchange for these easier-to-obtain (in theory) benefits, you generally give up the right to sue your employer for negligence. However, a denied claim doesn’t mean you’re without recourse. You have the absolute right to appeal that denial through a state-administered process.

Grounds for Denial: Why Employers and Insurance Carriers Say “No”

“Can an employer deny workers’ compensation? Yes, and they often do,” states Ralph. Insurance carriers and employers can deny claims under specific circumstances defined by the Texas Workers’ Compensation Act (Texas Labor Code, Title 5). Understanding these reasons is the first step in fighting back.

Statutory Exclusions: When Injuries Are Not Covered by Law

The Texas Department of Insurance, Division of Workers’ Compensation (DWC) sets clear exclusions. Your injury will not be covered if it was incurred:

• During Horseplay or Willful Criminal Acts: If your injury occurred while you were engaging in horseplay or a willful criminal act, your claim can be denied.
• Due to Self-Inflicted Injury: Intentional self-harm is not compensable.
• While Intoxicated: Injuries sustained when you were intoxicated from drugs or alcohol (unless the intoxicant was provided by the employer) are excluded.
• During Voluntary Off-Duty Recreation: Injuries from purely voluntary recreational activities outside of work duties are not covered.
• By an “Act of God” or Third-Party Criminal Act Unrelated to Work: Generally, injuries caused by natural disasters or a third party’s criminal act with no connection to your employment are excluded.

Procedural and Disputable Grounds for Denial

More commonly, denials hinge on disputes over facts or procedure. These are the battles we fight every day at Attorney911:

• Failure to Report Within 30 Days: Texas law requires you to notify your employer of a work-related injury within 30 days (Texas Labor Code § 409.001). Miss this deadline, and your claim can be denied, though there are exceptions for good cause.
• Dispute Over “Course and Scope”: The carrier may argue your injury did not occur in the course and scope of your employment. Was it on company property? During work hours? While performing a work-related task? These are frequent points of contention.
• Inadequate Medical Treatment or Documentation: Insurers may deny claims if they believe you didn’t seek timely or appropriate medical care, or if medical records are unclear about the work-connection.
• Pre-Existing Condition Aggravation: One of the most complex areas. The carrier may claim your injury was a pre-existing condition and not aggravated by your work activities. Texas law covers injuries that are a “producing cause” of your employment, meaning work must be a substantial factor in the injury, even if a prior condition exists.
• Dispute Over Disability or Extent of Injury: The carrier may accept the injury but dispute the severity, the required treatment, or the length of time you are unable to work.

Our firm includes a former insurance defense attorney, Lupe Peña, who spent years on the other side of these disputes. “Having Lupe on our team is an unfair advantage for our clients,” says Ralph Manginello. “He knows exactly how claims adjusters and defense attorneys evaluate these denials, what evidence they look for to support their position, and where the soft spots in their arguments are. He used to build these denial cases; now he dismantles them.”

The Appeals Process: Navigating the Texas DWC Dispute Resolution System

If your workers’ comp claim is denied, you have the right to file an administrative appeal. This is not a lawsuit in state court but a multi-stage process within the Division of Workers’ Compensation. You are entitled to have an attorney represent you throughout this appeals process, and we cannot stress enough how critical this is. As Ralph notes, “We know that your employer and their insurance carrier are almost always going to have an attorney handle their case. Going up against that legal firepower alone is a recipe for failure.”

When you receive a denial notice, the clock starts ticking. You typically have 90 days to request a Benefit Review Conference (BRC). Here is the complete dispute resolution pathway:

Stage 1: Benefit Review Conference (BRC)

This is an informal, mediation-style meeting with a DWC Benefit Review Officer, you (and your attorney), and a representative from your employer/insurance carrier. The goal is to reach a settlement agreement. If successful, you sign a binding settlement, and the case ends. If no agreement is reached, the officer issues a written report, and the dispute moves to the next stage. At Attorney911, our preparation for a BRC is exhaustive. We gather all medical records, employer reports, witness statements, and even consult with medical experts if needed to build an undeniable case from the start.

Stage 2: Arbitration or Contested Case Hearing (CCH)

If the BRC fails, the next step depends on a choice made by both parties.

• Arbitration: A more formal process where an arbitrator (selected by the DWC) hears the dispute. The process is faster and less formal than a hearing, but the arbitrator’s decision is final and non-appealable. This can be a good option if the issue is relatively straightforward.
• Contested Case Hearing (CCH): This is the more common route for complex denials. A DWC Hearing Officer presides over a proceeding that resembles a trial. Both sides present evidence, call witnesses, and make legal arguments. After considering everything, the Hearing Officer issues a written decision. This is a critical phase where having a litigator like Ralph Manginello, with 25+ years of trial experience, makes a profound difference. We prepare every case as if it’s going to trial because, at this stage, it essentially is.

Stage 3: Appeals Panel Review

If you disagree with the Hearing Officer’s decision from the CCH, you can appeal to the DWC Appeals Panel. You and the other party submit written briefs arguing your positions. The Appeals Panel reviews the briefs and the CCH record and can affirm, modify, or reverse the decision. This is a highly technical, legalistic stage where skilled advocacy is paramount.

Stage 4: Judicial Review in Texas State Court

If you disagree with the Appeals Panel decision, your final recourse is to file an appeal in a Texas state district court. This is a complex civil appeal of an administrative decision. If you did not have an attorney before, it is absolutely vital to have one now. The procedures are intricate, and deadlines are strict. As a firm with attorneys admitted to federal and state courts, including the Southern District of Texas, we have the advanced litigation experience necessary to navigate this high-stakes arena.

“This entire process can be overwhelming for someone recovering from an injury,” says Lupe Peña. “That’s why our case managers, like Leonor who is mentioned in over 80 client reviews, handle the constant communication and paperwork. We fight the legal battle so you can focus on your health.”

When a Lawsuit Is an Option: Suing Non-Subscribing Employers in Texas

As mentioned, Texas’s unique system creates a potential path to a lawsuit. If your employer does not carry workers’ compensation insurance (a “non-subscriber”), you can sue them for negligence under Texas common law. This is a significant decision with different risks and rewards.

The Advantages and Challenges of a Personal Injury Lawsuit

In a lawsuit, you can seek the full spectrum of damages available in Texas tort law, including:

• Past and future medical expenses
• Lost wages and loss of earning capacity
• Physical pain and suffering
• Mental anguish
• Physical impairment
• Disfigurement

However, you must prove your employer was negligent—that they owed you a duty of care, breached that duty, and caused your injuries. Texas also follows a modified comparative fault rule (Texas Civil Practice & Remedies Code § 33.001). If you are found to be 51% or more at fault for your injury, you recover nothing. Even if you are less at fault, your recovery is reduced by your percentage of responsibility.

This is where our investigative resources shine. In a recent maritime back injury case, our investigation revealed the employer failed to provide required assistance for lifting heavy cargo, establishing clear negligence. We secured a significant cash settlement for our client. We apply that same tenacious investigation to workplace injury cases across Texas.

Why Attorney911 Is Your Strategic Advantage in a Workers’ Comp Fight

Choosing the right legal team after a denied claim is the most important decision you’ll make. Here is how Attorney911, under Ralph Manginello’s leadership, delivers results others can’t.

Insider Knowledge of Insurance Company Tactics

Lupe Peña’s experience at a national defense firm is our clients’ secret weapon. “I spent years reviewing claims, directing investigations, and formulating denial strategies,” Lupe explains. “I know how they use surveillance, how they select ‘independent’ medical examiners (IMEs) who routinely downplay injuries, and how they manipulate the ‘course and scope’ argument. Now, we anticipate and counter those moves from day one.” This insider perspective allows us to value your claim accurately and avoid the lowball settlement traps that insurers set.

A Proven Record of Multi-Million Dollar Results

We don’t just process claims; we litigate complex cases to win maximum compensation. Our firm’s results speak to our capability:

• We secured a multi-million dollar settlement for a client who suffered a traumatic brain injury with vision loss when a log dropped on him at a logging company.
• We resolved a case in the millions for a client whose leg injury from a car accident led to a devastating infection and partial amputation during treatment.
• Our involvement in the BP Texas City explosion litigation demonstrates our capacity to handle catastrophic workplace injury cases against the largest corporate defendants.

As client Donald Wilcox shared after other firms turned him away: “Then I got a call from Manginello… I got a call to come pick up this handsome check.”

Comprehensive, Client-Centered Representation

From the moment you call 1-888-ATTY-911, you become our priority. Our 4.9-star Google rating from 251+ reviews is built on consistent communication and genuine care. Client Chad Harris said it best: “You are NOT a pest to them and you are NOT just some client… You are FAMILY to them.”

We handle every aspect of your case:

• Immediate Evidence Preservation: We secure workplace reports, witness statements, and safety records before they disappear.
• Medical Lien Network: We can connect you with doctors who will treat you on a lien, so you get care now without upfront costs.
• Aggressive Advocacy: We prepare every case for a Contested Case Hearing or trial. Insurance companies know we are not a settlement mill; we are trial-ready litigators, which forces them to offer more serious settlements.
• Bilingual Services: With Lupe Peña and staff like Zulema, we provide full services in Spanish. Hablamos Español.

Immediate Steps to Take After a Workers’ Comp Denial in Texas

1. Do Not Panic or Accept the Denial as Final: A denial is the opening move in a negotiation, not the end of your claim.
2. Review the Denial Notice Carefully: It must state the specific reason(s) for denial. This is the issue you will fight.
3. Gather and Preserve Everything: Your injury report, all medical records and bills, photos of the hazard or injury, names of witnesses, and any correspondence with your employer.
4. Consult an Attorney Immediately—Do Not Delay: The appeals process has strict deadlines (as short as 90 days to request a BRC). Missing a deadline can forfeit your rights forever.
5. Stop Communicating with the Insurance Adjuster: They are not your friend. Anything you say can be used to undermine your appeal. Direct all communication to your attorney.
6. Continue Medical Treatment: Follow your doctor’s orders. Gaps in treatment are used as evidence that you are not really injured.
7. Call Attorney911 at 1-888-ATTY-911: Your consultation is free, and we work on a contingency fee. We don’t get paid unless we win your case.

Frequently Asked Questions: Texas Workers’ Comp Denials

Can I sue my employer if they have workers’ comp insurance?

Generally, no. Workers’ compensation is typically an “exclusive remedy” for employees of subscribing employers, meaning you cannot sue for negligence. However, there are rare exceptions, such as when an employer intentionally causes injury. Furthermore, you always have the right to appeal a denied claim through the DWC process outlined above.

How long do I have to appeal a denied workers’ comp claim in Texas?

You generally have 90 days from the date you receive the denial notice to request a Benefit Review Conference. However, other deadlines apply throughout the process. Because these deadlines are absolute, you should contact an attorney immediately upon receiving a denial.

What if my injury was partly my fault? Can I still get benefits?

Yes, potentially. The Texas workers’ compensation system is no-fault for employees. Your own negligence (short of intentional acts or intoxication) is not a automatic bar to benefits. This is a key difference from a personal injury lawsuit against a non-subscriber, where your fault percentage directly reduces your recovery.

What does it cost to hire Attorney911 for a workers’ comp appeal?

We handle workers’ compensation appeals and workplace injury lawsuits on a contingency fee basis. You pay no upfront fees or hourly rates. Our fee is a percentage of the compensation we recover for you. If we don’t win, you owe us nothing.

Can I be fired for filing a workers’ comp claim or appeal?

Texas law prohibits employers from retaliating or terminating you for filing a workers’ compensation claim in good faith (Texas Labor Code § 451.001). If you believe you have been fired for pursuing your claim, you may have a separate wrongful termination lawsuit. Document everything and inform your attorney immediately.

My employer is telling me not to get a lawyer. What should I do?

This is a major red flag. Your employer’s interests are directly opposed to yours in a compensation claim. Their goal is to minimize cost. Your goal is to secure fair compensation for your injury and lost wages. You have an absolute right to legal representation, and as client Glenda Walker found, having us fight for her meant getting “every dime I deserved.”

You Don’t Have to Face This Fight Alone: Call Texas’s Legal Emergency Lawyers™

A denied workers’ compensation claim can feel like a second injury—a betrayal that adds financial stress to physical pain. But you have powerful rights under Texas law. The question isn’t just “Can I sue my employer for denying workers’ comp?” but “How do I strategically enforce my rights to secure the future my family needs?”

At Attorney911, we bring every resource to bear: Ralph Manginello’s 25+ years of litigation leadership, Lupe Peña’s insurance defense insider knowledge, a track record of multi-million dollar results, and a client-focused team praised in hundreds of testimonials. We serve injured workers across Texas from our offices in Houston, Austin, and Beaumont.

Don’t let a denial notice dictate your future. The insurance company is already building its case. It’s time to build yours. Call the Legal Emergency Lawyers™ at Attorney911 right now at 1-888-ATTY-911. Your free, confidential consultation is the first step toward turning a denial into a recovery.

Frequently Asked Questions

Can I sue my employer if they have workers’ comp insurance in Texas?

Generally, no. Workers’ compensation is typically the ‘exclusive remedy’ for employees of subscribing employers, meaning you cannot sue for negligence. However, you always have the right to appeal a denied claim through the Texas Division of Workers’ Compensation’s administrative process. In rare cases, such as intentional employer misconduct, a lawsuit may be possible.

How long do I have to appeal a denied workers’ comp claim in Texas?

You generally have 90 days from the date you receive the denial notice to request a Benefit Review Conference, which is the first stage of the appeals process. Other strict deadlines apply throughout the subsequent stages. Missing a deadline can forfeit your rights permanently, so it is critical to consult with an attorney immediately after a denial.

What if my work injury was partly my fault? Can I still get benefits?

Yes, potentially. The Texas workers’ compensation system is a no-fault system for employees. Your own ordinary negligence is not an automatic bar to receiving benefits. This is a key advantage over a personal injury lawsuit against a non-subscribing employer, where Texas’s modified comparative fault rule (51% bar) would apply and reduce your recovery.

What does it cost to hire Attorney911 for a workers’ comp appeal?

We handle workers’ compensation appeals on a contingency fee basis. You pay no upfront fees or hourly rates. Our fee is a percentage of the compensation we recover for you. If we do not win your case, you owe us nothing. This aligns our interests completely with yours—we only get paid when you do.

Can I be fired for filing a workers’ comp claim or appeal in Texas?

No. Texas law (Texas Labor Code § 451.001) specifically prohibits employers from retaliating against or terminating an employee for filing a workers’ compensation claim in good faith or for participating in a related proceeding. If you believe you have been fired in retaliation, you may have a separate wrongful termination claim and should document everything and inform your attorney immediately.

What is the biggest advantage Attorney911 has in fighting a denied claim?

Our firm’s unique advantage is our insider knowledge of insurance company tactics. Associate Attorney Lupe Peña spent years working for a national defense firm, learning exactly how insurance companies value, dispute, and deny claims. He now uses that playbook against them. Combined with Managing Partner Ralph Manginello’s 25+ years of trial experience, we anticipate defense strategies and fight for maximum compensation from a position of strength.