Workers’ Compensation vs. Personal Injury Claims

Workers’ Compensation vs. Personal Injury Claims

Which is Right for Me and My Case?

When you or a loved one sustains a workplace injury of any kind, it makes sense that you’ll have a ton of concerns about your physical and financial recovery. You may also wonder what is available for you and your family in terms of your monetary losses and overall damages associated with your injury.

It’s likely that you’re familiar with workers’ compensation and personal injury claims, but you may not know all of the differences between these types of claims. In states like Pennsylvania and New Jersey, there are stark differences between personal injury claims and workers’ compensation. These differences range from the overall legal procedures and the compensation that’s available to injured workers.

Most people assume that their only option is workers’ compensation when they’re involved in a workplace injury. That is not always true. There are several situations in which workers may also be able to file a personal injury claim as well. Our legal team is here to support you throughout your time of need, and we fully understand the magnitude of workplace injuries and how they impact your financial future. Most importantly, we know how to evaluate whether you can file a personal injury claim and not just a claim for workers’ comp.

Throughout this page we’ll discuss all the details you should know when it comes to differentiating workers’ compensation and personal injury claims. If you have any questions about where your case falls within, feel free to reach out to us for a free consultation so we can review all the facts of your injury and decipher your best course for legal action.

Workers’ Compensation Claims Don’t Require Fault

One of the main differences between workers’ compensation and personal injury claims is the concept of proving fault. When you’re injured on the job at the workplace or while doing any work-related tasks, you do not need to prove someone was at fault in order to receive comp benefits. You do not need to show that your employer or co-workers or anyone else caused or contributed to your injuries in order to receive workers’ compensation benefits. As long as you were working the course and scope of your job then you should be entitled to benefits. That is true even if you are considered at fault for your own injury.

There are very few reasons why comp benefits can be denied. One of the them is if the injured worker was under the influence of drugs or alcohol at the time of the incident. If that is the case, the carrier may attempt to deny comp benefits.   

The whole purpose of workers’ compensation is to protect the rights of workers who have been injured on the job. The idea is to protect workers by guaranteeing they have some continuing income and that their medical bills will be paid when they get hurt while working. These damages are more limited to those that are available in personal injury claims, which allow for greater damages such as pain and suffering.

However, workers’ compensation also protects employers from personal injury lawsuits. A worker is able to bring a workers’ compensation claim to get limited benefits, such as medical coverage and a percentage of the employee’s weekly income. But in exchange for these benefits, the employee generally cannot sue the employer or a direct co-worker in a personal injury claim for additional damages, such as pain and suffering. This is the biggest tradeoff. It balances virtually guaranteed medical and wage benefits in exchange for being able to sue the employer for the damages available in personal injury claims, which are often greater.

Workers’ compensation insurance is required by law for most employers. This is especially true in Pennsylvania and New Jersey. There are criminal and civil penalties that can be imposed when an employer fails to maintain workers’ compensation insurance. Also, if an employer fails to maintain workers’ compensation insurance, the injured worker is then allowed to sue the company directly in a personal injury claim.

Personal Injury Claims Require Fault in Pennsylvania

Personal Injury Claims

Personal injury cases aren’t limited to just workers, and in order to win one of these cases you must be able to prove that another party or entity acted negligently, and that this negligent behavior/inaction was the cause or contributed to your injury.

An injured worker can still have a personal injury claim if he or she is injured on the job. The challenge is showing that the injuries were caused by a third party was at fault or acted negligently in a way that caused your injuries.

While a worker cannot sue his or her own employer or a direct co-employee, he or she can sue another company, subcontractor, or any other person or company that caused the injuries. In these situations, a worker won’t necessarily be “suing the boss” but will be attempting to receive compensation from other entities that contributed to the causation of the accident.

For the most part, workers’ compensation protects employers and co-workers from being sued in workplace injury cases. There are some very limited exceptions to this as well, which we’ll discuss below. But typically the defendant in a workplace personal injury claim will be someone like a subcontractor or another entity that doesn’t directly work for your employer.

Instances When a Personal Injury Claim Applies to Work Injuries

Anyone who is injured while performing work duties may potentially have a successful personal injury lawsuit when the following occurs:

  • Your injury involved some kind of defective product, which would then be grounds for a claim against that product’s manufacturer.
  • Your employer’s intentional conduct was obviously likely to cause serious harm or even death to their employees.
  • The negligent actions that caused your injury involved an illegal or intoxicating substance.
  • Your employer failed to carry proper workers’ compensation insurance, or simply was not required to carry workers’ compensation.
  • Your injury was directly caused by a third party’s negligence, who doesn’t work for the same employer or company as you.

The Difference in Damages

The major difference in damages between workers’ compensation claims and personal injury lawsuits is that you will not be entitled to pain and suffering benefits through workers’ compensation. Personal injury lawsuits allow you to pursue all the damages associated with your injury, which can include the following:

  • Medical bills (past and future)
  • Lost wages
  • Lost future earning capacity
  • Pain and suffering
  • Loss of quality of life
  • Permanent impairment benefits
  • Punitive damages
  • Loss of consortium (on behalf of the injured person’s spouse)
  • And more…

Workers’ compensation will help you when it comes to benefits for your medical bills and permanent impairment costs, and you’ll also get compensation for any type of vocational rehabilitation that helps you get back to work or prepares you for a new career.

Another big difference in terms of damages includes the timeliness of benefits. This is because an employee will typically receive workers’ compensation benefits within a matter of days, but it may take months or even years to finalize a personal injury claim. Comp benefits can help an injured person get the treatment he or she needs and still have some income available while they attempt to recover. This can help an injured person stay afloat financially while he or she pursues a third-party personal injury case.

The Difference in the Legal Process

Legal Process

When you utilize workers’ compensation, you’ll need to notify your employer of your injuries and then fill out the proper forms to initiate the process towards your fair compensation as it pertains to your employer’s specific insurance plan. The insurance company will then conduct their own investigation into your injury claim, and they typically will make you get a medical examination.

If for any reason you wish to appeal the insurance company’s decision to deny your claim, you can do so through the Department of Labor & Workforce Development. This can vary from state to state, so it is important to consult with a workers’ compensation attorney if you have any questions or before starting the process.

Workers’ compensation claims, including in states like Pennsylvania, typically have a separate court system for many aspects of the claim. There are separate workers’ compensation judges than in third-party personal injury claims. In many ways it is a different legal system.

When an injured worker is also able to file a personal injury lawsuit, that injured person can file a lawsuit with the appropriate state court. In Pennsylvania, this is usually the Court of Common Pleas of the appropriate county; in New Jersey, this is typically the Superior Court.

The lawsuit is brought against any potentially responsible party other than the employer. The defendant is served with the lawsuit and the case begins the discovery phase which includes fact-fiding, written questions and answers, and eventually depositions, which are oral question and answer sessions in which the attorneys can ask questions of the parties and witnesses. A case can settle at any point or it can proceed to an arbitration or trial.

Legal Option Considerations in Pennsylvania

If you’re involved in a workplace injury of any kind, you’ll want to consider the following in terms of better understanding your course for legal action:

  • Who is the liable party or entity for your injury?
  • Was the liable party your employer, a co-worker, or an unrelated third party?
  • What are the injuries and damages you have suffered?

Combination Cases

Workers’ compensation is typically an exclusive legal solution against an employer, which means for the most part you’ll be limited to the workers’ compensation system. This typically includes medical coverage for all your treatment associated with the injury and a portion of your weekly wages while you’re unable to work.

However, if the negligence of a third party causes your workplace injury you’ll potentially have the right to bring about a personal injury lawsuit against that third party. The workers’ compensation system will not stop you in terms of bringing about this kind of claim, just as long as this third party isn’t a co-worker or anyone who works for your employer.

These workplace injury instances involving a third party are called combination cases, and many times in these cases the question as to whether or not the negligent individual is in fact a third party typically is the crux of the case.

How to Protect Your Rights for Workers’ Compensation Philadelphia

Workplace injuries can be just as devastating as a serious vehicle or other accident. Before workers’ compensation law, many employees faced the bleak prospect of suffering an injury on the job and being unable to work while forced to cover the costs of their medical care. Thankfully, the law now requires companies to carry workers’ compensation insurance, so employees’ incomes are protected, and they receive the medical care they need.

However, workers’ compensation law has requirements that injured workers must fulfill to maintain these rights. If an injured worker is unaware of these responsibilities, he or she may miss a key requirement and suffer from a claim denial.

Firstly, before an injury even happens, review your company’s workers’ compensation policies and guidelines. These documents provide essential information, such as time limits on filing a claim. Be sure to follow these procedures if you suffer an injury on the job.

After an injury, be certain to take the following actions:

Never assume you need no medical attention because the injury is too minor. Often, over the course of hours, days, or weeks, the true gravity of the injury becomes apparent. For example, an employee may fall at work and feel no immediate effects. However, over time, the employee's back may begin to hurt and become a serious medical problem. If the employee neglects to report the injury and seek medical attention, then a claim for damages due to the fall may fail.

Review your workers’ compensation documents to understand the procedure for receiving medical attention. For example, many workers’ compensation policies mandate seeing a specific doctor. If this is the case, you will need to schedule an appointment with this physician immediately. Later in the process, you can seek a second opinion if you disagree with the results, but you must see the plan-mandated doctor. 

Bear in mind that seeing the doctor is to your benefit. You pay nothing out of pocket and have your injury examined promptly. In addition, it creates a medical record that establishes your claim. 

Notify Your Employer in Writing

Make certain to document the injury in writing. This establishes when the accident occurred and its relation to the workplace. You want to report the injury as soon as it happens. Any delay in notification could result in a claim denial or feed into an insurance company's claim that your injury is unrelated to work.

Fill Out an Official Claim Form

Once you inform your employer of the injury, your supervisor or human resources department should furnish you with an official claim form. Complete this promptly, as it’s vital to the process.

The forms ask for several details, including when the injury happened, where it occurred, and what body parts the accident affected. 

Keep Detailed Records About Your Treatment

Keep notes on your injury treatments and their effects. Recording your treatment helps to establish what harm you suffered due to injury. In addition, a detailed diary is vital if you have a chronic injury that worsens over time, such as a back injury from stooping at work. In those cases, records demonstrating how the injury progressed are critical.

How To Protect Your Rights for Workers’ Compensation Pennsylvania

After suffering an injury due to someone else's neglect or recklessness, you want to ensure that you protect your rights by seeking immediate medical attention, keeping the details of your case confidential, gathering evidence, and hiring an experienced personal injury lawyer.

Seek Medical Attention Immediately 

While this may seem obvious after a serious injury, make sure to receive medical attention even if the injury appears minor. Often, what seems like a slight injury later turns into a chronically painful and limiting problem. In other cases, internal injuries may show symptoms at a later time. For non-emergencies, most insurance companies recommend seeking medical help within 72 hours. 

Keep the Details of Your Case Private

You should discuss your case only with your attorney and doctor. This is especially true if you suffer a workplace injury. Also, refrain from posting about the case on social media.

Gather Evidence 

Personal injury cases hinge on proving that the accident occurred, that the other party was negligent, and that negligence is responsible for your injuries. The following forms of evidence help you build a case:

  • Medical records 
  • Police reports 
  • Witness statements 
  • Photographic evidence 
  • Video evidence
  • Expert witnesses 

Hire An Experienced Litigator in Workers’ Compensation PA

Personal injury is a legal specialty that requires litigation experience. Most cases end in a settlement with the insurance company. An experienced litigator understands that insurers must be convinced they will lose in court before presenting their best settlement offer. By hiring a tenacious attorney who builds an ironclad case, you gain the leverage you need to force the insurance company to pay all damages.

An Experienced Personal Injury Attorney is Required for Work Accident Claims

Our team of highly qualified Philadelphia & New Jersey Personal Injury Lawyers is here to help you when you get hurt at work. When you call us for a free consultation we’ll be able to better understand the root cause of your injury and determine whether bringing about a workers’ compensation claim or filing a personal injury lawsuit is in your best interest.

No matter what type of case if right for you, we’ll be able to help you properly prepare your case so you can receive the maximum amount to assist you in your full recovery.

Related Content: What Are Special Damages in Personal Injury Cases?

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