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Difference Between Personal Injury and Workers’ Compensation Claims

When an employee gets injured at work, they have to make a lot of considerations about the recovery of their damages, both physical and financial. If you’ve been in such an accident, then you’re probably wondering what options you can avail to cover your financial losses.

Your employee or colleagues may have mentioned workers’ compensation, and you may have heard of personal injury claims. But how do you know which one applies to your case? Most importantly, what is the difference between personal injury lawsuits and workers’ compensation claims?

There are many factors that make workers’ compensation and personal injury two different procedures. From legal liabilities to payment procedures, both the claims function differently. Let’s explore these differences in further detail below.

What is a workers’ compensation claim?

All employers are required to offer a workers’ compensation insurance program for all their employees. The law requires employers to buy this insurance program even if they have employed one person for their business.

Workers’ compensation claim allows the employees to recover damages if they get hurt on their job or during the period of their employment. Regardless of who was responsible for the injury or accident, the employees have the right to claim payments from the insurance program.

What is a personal injury claim?

Personal injury claims are lawsuits filed in court against the opposite party who you think is responsible for your injury. To succeed in recovering damages in this claim, you’re required to prove that the other party was at-fault or negligent. So, you’ll have to convince the court with proof that the opposite party didn’t take enough measures of caution or care, and that caused your injuries.

Personal injury claims are either settled out of court or tried in court. They are usually very tricky, so the assistance of an experienced personal injury lawyer is highly recommended in most cases.

Differences between workers’ compensation and personal injury

Personal injury cases vary from workers’ compensation in terms of recoverable damages and legal procedures. Let’s overview these differences individually below.

1.    Fault requirements

The most significant difference between personal injury claims and workers’ compensation is that you don’t need to prove anyone’s fault for your injuries to recover workers’ compensation successfully. No matter who was at fault for your injuries or if it was just an accident with no one to blame, workers’ compensation allows you to recover your losses for the damage.

On the other hand, personal injury is entirely fault-based. In order to successfully recover your losses, you must convince the court that your injuries are a result of someone else’s fault or negligence. As a result, the legal procedure takes longer, and you have to provide evidence to support your claim.

Personal injury claims can sometimes be difficult to prove because you’re working to prove the other party’s fault while they also work towards defending themselves. For example, if you suffered an injury due to a slip-and-fall accident at a utility store, you’ll have to prove to the jury that the store staff was negligent for leaving the floor slippery or for not putting a cautionary sign to inform the customers about it.

2.    Damage recovery is different

With workers’ compensation, you primarily receive a recovery of your medical expenses and lost wages. The insurance company calculates the average amount that you earn weekly, based on your payroll history. You receive compensation for all the medical procedures and bills involved in the recovery of your injury. Depending on the severity of your injury, you may also be eligible to receive benefits for temporary or permanent impairments or disabilities caused as a result. Additionally, the coverage may include vocational rehabilitation required for you to get back to work or train for new employment.

Similarly, personal injury claims also allow you to recover most of the same damages as you do with workers’ compensation, such as medical bills, lost wages, etc. However, with a personal injury claim, you can also recover compensation for your suffering and pain. Personal injury claims can also help your recover punitive damages. Personal injury claims allow you to pursue compensation for various damages, including the following:

  • Past and future medical expenses
  • Lost wages
  • Lost ability to earn in the future
  • Suffering and pain
  • Permanent disability or impairment
  • Lost quality of life
  • Punitive damages
  • Lost consortium for your spouse

On the other hand, workers’ compensation doesn’t allow you to recover any punitive damages or receive compensation for your pain and suffering. That is one of the major differences in recovering damages amongst the two claims.

Another difference between the two is the time it takes to recover these damages. As an employee, you would receive compensation within a few days of the injury. In comparison, a personal injury claim can take months and sometimes years to recover damages. Plus, it’s not certain whether your personal injury lawsuit would succeed because it requires evidence to convince the jury of someone else’s fault.

3.    Difference in procedures

The procedure for filing a personal injury lawsuit is very different from filing a workers’ compensation claim. In order to receive workers’compensation, you need to inform your employer about your injury first. You and your employer both will have to fill out a few forms to begin the process of filing for workers’ compensation.

You are then required to file the claim with your employers’ insurance company. The insurance company may ask you to follow their procedural protocol, which may include submitting further details or going through a medical examination with a physician employed by the insurance company.

After doing your due part, the insurance company then evaluates the information provided by you and investigates your claim. If the company’s decision isn’t in your favor, then you can appeal your case with the Division of Industrial Relations. In case the insurance company denies your claim, you can also proceed with your case through a judge of administrative law.

In a personal injury case, the procedure begins when you file your lawsuit in court. Then, you serve a copy of your lawsuit to the defendant party. The case proceeds when the other party files their court papers. During this process, you can demand information, any related records, and conduct disposition to help you prepare a strong case. 

At this point, the defendant can decide to settle the case with you outside of court, or the case can proceed in court. It’s common for the defendant’s legal and insurance representatives to negotiate a settlement with you. In case the defendant’s insurance company denies your claim or offers an insufficient settlement, then you should hire a personal injury lawyer to proceed with your case in court.

4.       Financial liability

Another difference between workers’ compensation and personal injury claim is the party that will be directly responsible for paying for the damages. When you file for a workers’ compensation, your employers’ insurance company becomes liable to pay for the recoverable benefits.

However, in a personal injury case, the financial responsibility could either be covered by any of the defendant’s insurance policies or by the defendant themselves.

5.    Right to sue

Workers’ compensation program provides coverage and benefits to employees of an organization in case of injuries. This compensation is provided, regardless of who the at-fault party may be. The workers’ compensation laws made sure that all employees who get injured during their employment, are covered for their medical expenses as well as weekly wages benefit.

However, with this law, the injured employees had to give up their right to sue their organization, employer, and colleagues for negligence. Workers’ compensation doesn’t allow employees to recover any damages for their suffering and pain.

There are a few exceptions to this law. In cases where the employee feels that the injury was a result of an intentional act by the employer or a co-worker, then the employee can sue them for additional pain and suffering damages. Moreover, the employee can file a lawsuit against a third party to sue them for their share of responsibility for injuries and other damages. 
On the other hand, there are no prohibition laws against filing for a personal injury claim against an at-fault party. However, you’ll have to prove the direct or proximate responsibility of the defendant. You’ll have to provide evidence to the jury to prove the negligence or direct action of the other party that causes you to suffer injuries.

Are there any workers with the legal right to sue their employers?
The answer is yes. Two groups of workers still retain the right to sue their employers for injuries. That is because the workers’ compensation laws do not apply to them. These workers include:

  • Interstate railroad workers
  • Crewmembers of vessels

If you work as a crewmember on any type of boat or ship, such as a commercial fishing boat or a cruise ship, you aren’t eligible for workers’ compensation benefits. Thus, under the federal law of the Jones Act, you have the right to file a lawsuit against your employer in case of an injury. You can claim for the recovery of damages, including pain and suffering. If you get injured as a crewmember of a ship, you need to contact an attorney who has experience in Jones Act cases to help you recover as many damages as possible.

If you’re an interstate railroad worker, then the Federal Employers Liability Act (FELA)gives you the right to sue your employer in case you get injured. You can recover damages by contacting a FELA lawyer to proceed with your case. However, be sure not to confuse commuter rail workers with interstate railroad workers because FELA doesn’t apply to commuter rail workers.

Combination cases

Workers’compensation law bounds you to an exclusive legal solution from your employer in case of an injury. Under this system, you’re offered coverage for medical bills, treatment, and other procedures associated with your recovery, along with the recovery of your lost wages. That means that you can’t usually proceed with additional legal action against your employer.

However, if a third party also contributed to the accident that caused you injuries, the workers’ compensation law doesn’t prohibit you from pursuing a personal injury claim against them.For instance, if you get hurt due to the negligence of a contractor, customer, or any other third-party individual, you can sue them for damages.  As long as the third-party isn’t your co-worker, you can proceed with the personal injury claim.

The workplace injury cases that involve a third party are termed as combination cases. However, it’s usually challenging to prove the fault of a third party in these cases because they are usually not entirely responsible for injuries.

Additional considerations

If you get injured at your workplace, you’ll have to consider a few things to understand your situation before taking any legal action. They include the following:

  • Who is the responsible party for your injuries?
  • Is the responsible party a colleague, employer, or a third-party individual?
  • How many and what kind of injuries have you suffered?

In case your employer terminates your employment for filing for a workers’ compensation claim, you can file a lawsuit against them in court. Additionally, if you feel like your employer isn’t taking enough measures to keep your workplace safe, you can report them to OSHA (the Occupational Safety and Health Administration)

Final word

Workers’ compensation and personal injury claims are different due to the reasons mentioned above. If you fall under the compensation law, you won’t be able to take legal action against your employer. However, you can sue a third party for damages with a personal injury lawsuit.

Before proceeding with any legal action or signing any release, it’s essential that you consult with a personal lawyer to evaluate your case. Contact us at Keith Zaid law today!

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