What Is the Difference Between a Worker’s Comp and a Personal Injury Claim?

Injuries change lives. They impose financial burdens associated with medical expenses and loss of income. They cause disabilities that alter lifestyles. They cause pain and may lead to emotional distress.

Injury victims may be entitled compensation. Where and how the injury occurred determines whether compensation is available and the kind of compensation that can be awarded.

The two primary sources of compensation are personal injury liability and worker’s compensation. Personal injury liability is determined by state law. Worker’s compensation is usually determined by state law, but federal law requires worker’s compensation for employees who work in certain occupations.

Personal injury compensation and worker’s compensation are significantly different. Personal injury claims are filed in court and compensation is usually awarded by juries when cases do not settle. Worker’s compensation claims are filed with an administrative agency and claims that do not settle are decided by administrative law judges.

Other key differences between personal injury claims and worker’s compensation claims are the circumstances under which compensation is paid and the kinds of compensation that are available.

Personal Injury Liability

With limited exceptions, personal injury liability is based on negligence. Liability means legal responsibility. People are liable for the payment of compensation to injury victims for the injuries that they negligently cause. 

Negligence is another word for carelessness. To establish another person’s liability for a personal injury claim, the injury victim must prove that the person acted carelessly and that the careless action caused or contributed to the victim’s injury.

Negligence can be established by proving that someone caused an accident by violating a law that is intended to keep people safe. The violation of most traffic laws (including laws that prohibit speeding, running red lights, and driving while intoxicated) is proof of negligence.

Negligence can also be established by proving that most prudent people would anticipate that an action might cause harm and would therefore not take that action. Even in states that permit drivers to make cellphone calls while driving, most prudent drivers understand that distracted driving creates a danger to other drivers. Scrolling a contacts list while driving is therefore an act of negligence.

In many cases, both of the people involved in an accident share some fault. A driver entering an intersection who fails to yield to a driver entering from the right is negligent. On the other hand, the driver who had the right of way might also have been negligent if he or she was speeding or not watching for oncoming traffic.

When fault is shared, state laws govern how their shared fault affects liability. In most states, an injury victim’s compensation is reduced in proportion to the victim’s share of fault. An injury victim who was 25% at fault would therefore receive 75% of full compensation. 

Some states do not allow the victim to recover anything if the victim was more at fault than the other person. In Florida, a driver who has the greater share of fault can still recover a proportionate share of compensation from the other driver. A driver who is 60% at fault can therefore recover 40% of full compensation from the other driver.

Personal Injury Compensation

Injury victims who can prove liability are entitled to compensation for their injuries. Compensation generally falls into these categories:

• Past and future expenses for medical treatment
• Past wage loss and loss of future earning capacity
• Past and future expense of coping with a disability
• Pain, suffering, and emotional distress

In most cases, emotional distress damages are limited to the psychological impact of a physical injury. Depression, anxiety, and post-traumatic stress are common examples of emotional injuries for which compensation can be awarded.

Worker’s Compensation Liability

Worker’s compensation laws allow employees to recover compensation for injuries that occurred at work or that are related to work, including medical conditions (such as illnesses and disabilities) that were caused by work. An injured employee does not need to prove that the employer was negligent or that the employer did anything to cause the injury.

With only a few exceptions (such as injuries caused by starting a fight), an employee can recover worker’s compensation even if the injuries were the worker’s fault. Unlike personal injury compensation, worker’s compensation is not reduced in proportion to the worker’s share of responsibility for the injury.

Worker’s Compensation Benefits

Worker’s compensation laws are based on a tradeoff. In exchange for receiving compensation without being required to prove negligence, injured workers receive less compensation than they could claim in a personal injury lawsuit. Since worker’s compensation is the exclusive remedy for work injuries, an employee cannot bring a personal injury claim against an employer for work injuries, even if the employer’s negligence caused the injury. Workers may, however, be entitled to bring a personal injury claim against people who did not work for the employer if their negligence contributed to the worker’s injury.

Injured workers cannot recover compensation for pain, suffering, or emotional distress. The compensation that can be awarded is defined by the applicable worker’s compensation law. In general, worker’s compensation benefits fall into three categories.

First, employers are responsible for assuring that medical care is provided for work injuries. Under Florida law, employers choose the care provider. Under federal law and the law of some states, employers pay doctors chosen by the injured worker.

Second, workers who miss more than a few days of work because of a work injury are usually entitled to a temporary disability benefit. The benefit typically pays about two-thirds of normal wages, subject to a minimum and maximum payment. The benefit is intended to replace some of the worker’s lost income while the worker recovers from the work injury. The benefit lasts until the worker returns to work or the injury stops healing.

Third, workers who have a permanent impairment that results from a work injury may be entitled to a permanent disability benefit. The law prescribes payment schedules that tie the benefit to the severity of the disability. Severity is roughly measured by the degree to which the injury affects the ability to earn income.