Workers' Compensation When a Prior Condition Complicates the Injury

Attorney Answer

Having lupus does not disqualify your mother from workers' compensation for a toe she fractured at work. What it does is hand the insurance carrier its most likely argument — that her problems come from the illness rather than the job — so the medical records need to keep the two apart from the start.

Texas workers' compensation is not a fault system. The question is whether she was an employee and whether the injury is work-related, not whether anyone was careless and not whether she was in perfect health beforehand. Tex. Lab. Code § 401.012(a) defines an employee, for this part of the code, as a person in the service of another under a contract of hire, whether express or implied, oral or written. Unloading a truck for her employer is squarely the kind of work that definition covers, and the fact that she was the only person available to do it does not change her status.

How Texas treats a work injury that lands on top of a preexisting condition — when an aggravation is compensable, and how far a carrier can attribute symptoms to the underlying illness — is a question for a Texas workers' compensation lawyer. What I can tell you is the practical shape of it: a fractured toe is an objective, datable injury, and the strongest thing your mother can do is make sure her doctors document that fracture and its cause separately from her lupus care, in writing, now.

The deadlines are short and they are the part that cannot be repaired later. Tex. Lab. Code § 409.001(a) requires an employee, or a person acting on the employee's behalf, to notify the employer of an injury not later than the 30th day after the date the injury occurs. Tex. Lab. Code § 409.003 requires an employee, or a person acting on the employee's behalf, to file a claim with the Division of Workers' Compensation not later than one year after the date the injury occurred. Both of those sections allow an employee, or a person acting on the employee's behalf, to act — so if she is not up to doing this, you can.

If a deadline has slipped, Tex. Lab. Code § 409.002 relieves the employer and its carrier of liability for late notice unless the employer, a person eligible to receive notice, or the carrier had actual knowledge of the injury, the division determines that good cause exists, or the claim is not contested; § 409.004 gives a similar exception for a late claim.

One more fact to establish: whether the employer carries coverage at all. If it does, Tex. Lab. Code § 408.001(a) makes benefits the exclusive remedy against the employer. If it does not — Texas permits that — a negligence suit is possible, and Tex. Lab. Code § 406.033(a) removes the employer's contributory negligence, assumption of risk and fellow-employee defenses, though § 406.033(d) still requires proof of the employer's negligence.

What you can do

1. Make sure the fracture is documented with imaging and a clear note from the treating doctor connecting it to unloading the truck on a specific date.

2. Ask her doctors to keep the fracture notes and the lupus treatment notes distinct, and get copies of both.

3. Give the employer written notice of the injury, dated, naming the date and the task. Section 409.001(a) sets a 30-day period, and you can do this on her behalf.

4. Ask the employer in writing whether it carries workers' compensation coverage and for the carrier's name.

5. File the claim with the Texas Division of Workers' Compensation within the one-year period in § 409.003 rather than waiting on the employer to do it.

6. Write down what she was doing, that she was alone in the back, and who knew about it.

7. Ask a Texas workers' compensation lawyer how the preexisting condition will be handled before the carrier makes its position final.

Most lawyers offer a brief initial call at no cost, and a few minutes on your specific facts is worth more than any general guidance, including this page.

⏱ Time limits apply. Tex. Lab. Code § 409.001(a) sets 30 days to notify the employer and § 409.003 sets one year to file the claim with the division. Which dates apply to her, and whether an exception saves a late one, depends on her facts. Have a Texas attorney review the dates now rather than calculating them yourself.