Personal Injury or Workers’ Compensation? Here’s a Guide to the Differences

If you are injured while working and have a valid case, you can seek care and/or compensation from your employer’s insurance through a workers’ compensation claim. Workers’ compensation laws cover employees in all 50 states, either under federal laws (for federal employees) or state workers’ compensation laws. There are, however, some circumstances where you may have grounds to sue your employer in civil court. We’re going to explore those circumstances further but first, it might be helpful to have a basic understanding of the differences between workers’ compensation and personal injury.

Workers’ Compensation Claim

Unlike a personal injury lawsuit, workers’ compensation (WC) is a claim against an insurance policy. Each State administers its own workers’ compensation insurance laws and has an agency that processes any claims filed (Federal employees have their own workers’ compensation insurance laws, administered by the federal government). In New York State, workers’ compensation is defined as “insurance that provides cash benefits and/or medical care for workers who are injured or become ill as a direct result of their job.”[1] Your employer pays for this insurance, which unlike health insurance, does not require you to pay or share in the premiums. Benefits arising from a claim are paid to you through your employer’s insurance carrier.

Personal Injury Lawsuit

A personal injury is an injury to a person’s body or mind, as opposed to injury to property like a fender bender or somebody breaking the windows in your house. It is a legal action that is filed in civil court against the person(s) or entities that caused the injury, typically referred to as “third parties.” There are three kinds of personal injury suits: (1)intentional harms (such as being punched in the nose), (2) defamation (libel or slander harmful to your reputation, where malice or negligence is present), and (3) negligence (such as slipping on ice because the property owner carelessly failed to remove it). Personal injury lawsuits must be filed within a deadline called a statute of limitations.

Some significant differences between personal injury and workers’ compensation are:

Personal injury:

  1. A lawsuit filed against a person or entity and decided in a civil court.
  2. Requires that some proof of fault or negligence be made.
  3. Requires that you show proof of the damages you are claiming.
    1. Compensatory damages (medical costs, lost wages, future prognosis, ability to work, loss of future earning capacity, effects on your lifestyle).
    2. May include punitive damages (to punish the defendant and deter them from committing the same act again).
  4. Awards may be higher than benefits paid by workers’ compensation for the same injury.
  5. Lawsuits have an unpredictable outcome and take more time to resolve, and you may not win.

Workers’ Compensation

  1. An insurance claim filed against a policy held by your employer.
  2. NO proof of fault is required for benefits to be paid.
  3. Requires proof that you were injured on the job and the injury was connected with the work you were performing (for instance, you are a house painter who fell off a ladder while painting).
  4. Instead of damages, you receive benefits – a percentage of your wages while you are injured, medical costs, compensation if the injury is permanent, and possibly job retraining.
  5. If a dispute arises about your claim, the Workers’ Compensation Board in your state determines the benefits to be paid, based on the laws of your state.
  6. You cannot recover punitive damages.
  7. Benefits may be less than an award in civil court for the same injury.
  8. Benefits are paid in a short time after the claim is approved – no long wait or uncertainty of outcome as with a personal injury lawsuit.

There are also limited situations where you might sue your employer under personal injury. These include:

  • If your employer or another employee harms you intentionally or through negligence (e.g., your boss or a coworker physically hit you).
  • If your employer has failed to carry worker’s compensation insurance or is not required to do so.
  • If the injury was caused by a toxic substance or defective product and a responsible third party might be subject to suit.

Remember, this is a simplified explanation of your options when you are injured in the workplace. Workers’ compensation and/or personal injury claims can be complicated, so it is best to obtain the advice of an attorney who can assess your case and help you understand the pros, cons, and process for each approach. The team of lawyers at Martin, Harding and Mazzotti, LLP may be able to help. Click here or call us at 1.800.LAW.1010 (1.800.529.1010).