GQ Corner

Q. The claimant was walking to the bathroom and tripped over her own feet; nothing caused her to slip/trip/fall. Confirmed nothing wrong with the floors – no water – no substances on the ground; she confirmed in a recording that she tripped over her own feet.  Can we deny this?

A. Unfortunately, no. This is a compensable claim in Texas. Comp is no fault in Texas. The question is only whether the injury originates in a risk or hazard of the employment and whether it occurred while the employee was furthering the work of the employer. The furthering element is clear. Walking to the bathroom meets that test under the personal comfort doctrine. The origination element is also clear. That element looks to what caused the injury, not what caused the accident. The injury (presumably) was caused by a fall to the ground. The risk of injury was the ground, which is a risk of the employment. See General Ins. Corp. v. Wickersham, 235 S.W.2d 215 (Tex.Civ.App.1950, writ ref’d n. r. e.). 

Q. Does the carrier have to await results of the suit pending in District Court in order to seek reimbursement from SIF for overpayment made in IIBs? Is there a certain timeframe on when the carrier must request reimbursement from SIF?

A. You do have to wait for a final decision on Judicial Review before you can request reimbursement from the SIF. That decision cannot be an agreed decision. It must be a decision that follows a Contested Case Hearing. There is no statutory deadline for reimbursement following reversal of a DD’s decision. But I recommend you do so promptly after any decision on Judicial Review has become final.