If you’re hurt, you might file a claim with an insurance company. If you’re filing a claim against your own insurer, it’s a first-party claim. If you caused your own accident or injuries, you could file a first-party claim.
A third-party claim is one you file against someone else’s insurance company. A third-party insurer conducts an investigation to make a determination on whether the policyholder was negligent. The insurer also goes over each category of damages someone seeking compensation is asking for. Then, the insurer in a third-party claim denies it or offers a settlement.
The term third-party liability can also refer to accidents that happen at work. A third party would be someone other than your employer who’s responsible for causing injuries. You might need to file a personal injury lawsuit to sue that person directly.
If your accident happens while you’re doing work duties, you will file a worker’s compensation claim. If you were, as an example, behind the wheel when the injuries occurred, you could have a personal injury claim against a negligent driver.
These things can also sound complicated, and they can be, which is why people often hire personal injury attorneys or worker’s compensation lawyers to represent them when they’re hurt.
Below is a comparison of personal injury vs. worker’s compensation claims and an overview of the situations that each can apply.
What Is A Personal Injury Claim?
A personal injury case is one that comes up if someone is hurt from an accident or injury, and another person may be responsible for the harm they suffered. The person who’s responsible’s insurance company pays money to the injured person to cover things like medical expenses and pain and suffering. If a case involves medical malpractice, a personal injury attorney works with insurance companies as well as hospital lawyers.
Personal injury cases might be formalized if you hire an attorney to represent you in a court proceeding, which would be civil.
The court seeks to find out who’s legally at fault, but much more often than this, personal injury cases are settled before a lawsuit is filed.
What Is A Worker’s Compensation Claim?
If you’re an employee and you’re hurt or become ill due to something related to your work, then you might file a worker’s compensation claim. There’s a limited amount of time available to report your injury and file a claim, and if you don’t do so within the allotted window of time, your claim may be denied.
Worker’s compensation is something an employer pays for, and the specifics are mandated at the state level. It’s characterized as social insurance, and it protects business owners from civil suits if their workers get injured or sick on the job.
All states, with few exceptions, require businesses with employees who aren’t owners to buy worker’s compensation coverage for their employees. If a business doesn’t provide the coverage, they may have to pay the claims out of pocket, along with other possible penalties.
One of the biggest differences between a personal injury and a worker’s compensation case is the requirement of fault. Fault is required in personal injury. If you were to slip and fall, that on its own doesn’t mean anyone was negligent. There are plenty of situations in which accidents happen that are no one’s fault.
To recover damages in personal injury, you have to prove the other person was negligent. For example, to go back to the example of falling, maybe the property owner was negligent in their maintenance.
In a car accident, you only have the option to recover damages from the other involved driver if they were at fault.
In worker’s compensation cases, anyone who’s working as an employee on the job may be entitled to benefits, with limited exceptions. There’s no element of fault. When you file a worker’s compensation claim, you don’t have to prove that anyone, including your employer, did anything wrong to receive the benefits.
Even if you were negligent and that led to your injuries, you can still receive worker’s compensation benefits.
Pain And Suffering
Another element between these two types of cases is available damages for pain and suffering.
You aren’t entitled to recover damages for pain and suffering in worker’s compensation claims. In a personal injury claim, you may be able to recover all damages you suffer, including pain and suffering.
These damages might also include lost earnings and earning capacity, past, current, and future medical expenses, and loss of enjoyment of life.
Worker’s compensation provides weekly compensation, covers medical bills, provides permanent impairment benefits, and may cover vocational rehabilitation.
You Can’t Sue In A Worker’s Compensation Situation
Worker’s compensation laws were put in place to make sure that if someone was hurt on the job, they’d have financial coverage, but what workers lost in exchange for that was the ability to sue their employer or the people they work with for negligence. There are exceptions, but not many.
One exception would be an employer’s intentional act that led to your injury. If that were the case and you could prove it, you might be able to recover pain and suffering damages.
If you don’t fall under any worker’s compensation laws, you might still be able to sue your employer. In the U.S., there are two groups of people this usually refers to—the crew of vessels and interstate railroad workers.
If you’re a crew of any type of boat, you aren’t entitled to worker’s compensation. Rather, there’s the Jones Act, which is a federal law authorizing you to sue your employer for damages. These damages can include pain and suffering if you’re hurt on the job.
Interstate railroad workers are under the Federal Employers Liability Act or FELA. If you’re injured on your job, you can sue your employer for damages, but commuter rail workers aren’t always protected by this legislation.
If you’re hurt at work, more than likely, you’ll file a worker’s compensation claim, but you should speak to a legal professional to figure out the path that’s right for you and what your next steps should be.