How a Workers’ Compensation Claims Differs from a Personal Injury Claim

Fault

The most significant difference between a workers’ compensation claim and personal injury claim is how fault affects the claim. In a personal injury claim, the employer will only be responsible for compensating the victim if he or she is legally liable for the injuries, meaning that it was his or her fault. In a workers’ compensation claim, an injured worker can receive benefits regardless of fault.

Ordinarily in a personal injury lawsuit, the victim must establish that the defendant was negligent. This requires showing that the defendant owed some legal duty to the victim, breached this duty and the breach caused the victim to suffer quantifiable damages.

In workers’ compensation cases, the victim does not have to establish fault. An employee can usually receive benefits even if another employee’s actions caused the accident or even if the employee was personally negligent.

Damages

In a workers’ compensation claim, the value of benefits is usually based on a percentage of the injured worker’s average salary. There may be statutory damages for certain injuries. In addition to wage replacement benefits, injured workers are usually entitled to compensation for medical expenses. In some instances, they are eligible for rehabilitation services and vocational retraining.

In a personal injury claim, the victim’s damages are based on the harm that he or she suffered. Damages may include compensation for medical bills, including treatment already received as well as treatment that is reasonably anticipate, lost wages, pain and suffering and emotional distress. Pain and suffering damages are not typically available in workers’ compensation cases. In some rare instances, personal injury claim victims may be able to receive punitive damages that are intended to punish the defendant and deter future wrongdoing. Punitive damages are also not available in workers’ compensation claims.

Ability to Sue

Workers’ compensation is a system that was set up to provide benefits to injured workers regardless of fault. In exchange for being covered with this type of insurance, injured workers usually give up their right to sue his or her employer. However, the injured worker may be able to sue other third parties that share responsibility for the accident.

In a personal injury claim, there is not usually a prohibition against suing the party so long as the defendant was directly and proximately responsible for the accident.

In some other cases, employees may still be able to sue the employer rather than pursue a workers’ compensation claim. Some states allow this when the employer’s actions were intentional or grossly negligent. Additionally, maritime workers and interstate railroad workers are able to sue employers directly for damages including pain and suffering if they are injured on the job.

Financial Responsibility

In a workers’ compensation case, the employer’s insurance company pays for the benefits. In a personal injury claim, the defendant may be covered by a business insurance policy, automotive insurance policy or other insurance policy. In some cases, the defendant may personally pay for the damages.

Process of Pursuing the Claim

With a personal injury claim, the victim through his or her legal representative may bring forth a claim through the defendant’s insurance company. The lawyer will attempt to negotiate a fair settlement. If the claim is denied or a fair settlement is not offered, the lawyer may file a lawsuit against the defendant and litigate the case.

With workers’ compensation, the victim may file a claim with the employer’s workers’ compensation insurance company. He or she may be required to follow certain protocol, such as reporting the injury to a supervisor within a specified period of time and be examined by a physician hired by the employer. If the claim is denied, the case usually proceeds through an administrative law judge.

Legal Assistance

Individuals who sustain a work-related injury may wish to contact a lawyer to learn about their rights and responsibilities under the particular circumstances. A lawyer can explain whether the worker is limited to workers’ compensation or whether a third-party claim or personal injury claim is a possibility.

Provided by HG.org

Disclaimer: Every effort has been made to ensure the accuracy of this publication at the time it was written. It is not intended to provide legal advice or suggest a guaranteed outcome as individual situations will differ and the law may have changed since publication. Readers considering legal action should consult with an experienced lawyer to understand current laws and.how they may affect a case.

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