Act of a Third Person for Personal Reasons
When someone attacks a worker on the job, coverage turns on why. Attacks connected to the work are covered; attacks over purely private disputes are not. This page explains how Texas law draws that line.
What the defense is
The Texas Labor Code relieves the insurance carrier (the company that pays benefits on the claim) of liability when the injury was caused by the act of a third person who intended to injure the worker for a personal reason, and not because of the employment or the worker's role as an employee. It is one of the statutory defenses collected at Statutory Defenses, and like the rest of that list, it is the carrier's burden to prove.
Read the elements closely, because both must be true. The attacker must have acted for a personal reason, and the attack must not have been directed at you as an employee or because of the job. An assault at work is covered unless the carrier proves the dispute belonged entirely to your private life.
Attacks that remain covered
The workplace exposes people to other people, and the law treats violence that grows out of that exposure as a work risk. Attacks in these situations are generally covered:
1. Crime aimed at the business. A clerk hurt in a robbery, a driver assaulted for the cargo, a cashier attacked at the register. The criminal wanted the employer's money or goods; the worker was hurt as an employee. 2. Customers, patients, and the public. An angry customer, a combative patient, an intoxicated bar patron. The contact existed only because of the job. 3. Work disputes between coworkers. A fight that begins over job duties, assignments, workmanship, or authority on the site is a dispute about the employment, even when tempers make it personal in the moment. The worker who is attacked in such a dispute is generally covered. The one who started an unlawful attack faces a different defense, covered at Willful Attempt to Injure Self or Another.
Attacks the defense actually reaches
The defense fits the case where a private conflict follows the worker to the job. The most common example is domestic: an estranged spouse or former partner who comes to the workplace and attacks the worker there. The location is the job; the reason is not. Other examples include a feud between neighbors that erupts at work, or a dispute over a private debt collected violently on the clock. In these cases the employment supplied only the address, and the statute places the loss outside the comp system.
The gray cases sit between the lists: a coworker conflict that began over work and turned into a lasting personal grudge, or a friendship outside work that soured over something on the job. These cases are decided on evidence of what the fight was actually about when it happened, drawn from witnesses, messages, and history between the people involved.
One evidentiary point favors workers. Where the attacker is never identified, or the motive is never established, the carrier has difficulty carrying its burden, because the defense requires proof of a personal reason. An unexplained assault at work is not automatically excluded; the carrier must prove the private motive, not merely suggest one.
What to do with this denial
A denial on this ground usually arrives as a PLN-01 naming the defense. Treat it as the carrier's opening position. Preserve everything that shows the dispute's true subject: witness names, texts and messages, prior incident reports to the employer, and police reports. The dispute path runs through a benefit review conference requested on DWC045, described at Dispute Resolution. Where an attack causes a death, the family's rights are covered at Death Benefits in Texas Workers' Compensation Claims. The broader question of injuries traced to a worker's private life, beyond assaults, is covered at Injury Arising From Personal Issues.
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Attorney notes regarding carrier defenses
An insurance carrier’s denial is not the final word on your workers’ compensation claim. Carriers have many legal defenses available to them, but whether a defense actually applies depends on the facts, the medical evidence, and Texas law.
Take a closer look when the carrier claims:
- Your injury did not happen at work: Details about where you were, what you were doing, and why you were doing it may be important.
- A medical condition is not part of your injury: Medical records, testing, and expert opinions may tell a different story.
- A prior injury or condition is to blame: Having a medical history does not automatically mean your current condition was not caused by a work injury.
- You are able to work: Your medical restrictions, actual job duties, and ability to earn your pre-injury wages can matter.
- You missed a deadline: Some deadlines have exceptions, and the carrier may not have the complete story.
At Abbott, Clay & Bedoy, we examine the carrier’s defense, compare it with the evidence, and determine where its position can be challenged.
A denial letter tells you the carrier’s position. It does not tell you whether the carrier can prove it. Let us take a look at what they are claiming and what can be done about it.
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