Workplace injuries across New York are not uncommon, and the need for medical treatment can vary significantly. Oftentimes, dealing with the expenses that follow is not easy, which is why seeking compensation becomes important. If you or someone you know has suffered from a workplace accident, knowing where the workers’ comp vs. personal injury claims comparison stands is crucial. This is because it tells you which of the two you can file.
How Workers’ Compensation Works
The workers’ compensation system is in place so injured employees may get the compensation they need for medical care and lost wages. It is a type of insurance that employees may use to seek monetary benefits and/or medical care for injuries they incur because of their jobs. Employers need to pay for this insurance, and this does not require any contributions from employees.
As per the law in New York, the liability for employees’ injuries that take place during the course of their employment rests with their employers, irrespective of fault, which is why they need to pay for workers’ compensation insurance. The law also prohibits employees from filing personal injury lawsuits against their employers, although there are a few exceptions.
The No-Fault Concept
One of the key differences between workers’ comp and personal injury claims is that you don’t need to prove fault when filing a workers’ comp claim. This means you don’t have to show that your injuries resulted because of your employer’s negligence, and you may seek compensation even if your own fault caused your injuries.
Workers’ Comp Benefits You May Expect
Filing for workers’ comp paves the way for financial and medical support to employees who suffer injuries or illnesses because of employment. The benefits typically include:
- Medical. You may expect workers’ comp to cover all reasonable and necessary medical treatment for a work-related injury or illness. Covered expenses can include emergency care, hospital visits, doctors’ visits, diagnostic tests, prescription medications, physical therapy and rehabilitation, medical equipment, and related travel expenses.
- Lost wages. If your injury results in loss of earnings, you may look forward to some respite through your workers’ comp. The amount you stand to receive is usually two-thirds of your average weekly wage from the year before the accident, up to a preset maximum. If you suffer a disability, its nature and duration can affect the lost wage benefits you receive.
- Death and survivor benefits. If a work-related injury or illness results in loss of life, the victim’s surviving spouse, children, or other dependents may expect workers’ comp benefits in the form of funeral and burial expenses as well as ongoing weekly payments.
- Other benefits. Depending on the nature and severity of your injury or illness, you may also expect mental health benefits and vocational rehabilitation.
What Workers’ Comp Does Not Cover
Another big difference between workers’ comp and personal injury surrounds what workers’ comp does not cover.
- Pain and suffering. Workers’ comp does not provide any compensation for the emotional distress, pain, and loss of enjoyment of life that a serious injury can cause. This is a primary reason why an injured employee might file a third-party claim.
- Punitive damages. Workers’ comp does not punish an employer for gross negligence or recklessness, and you may seek punitive damages only by filing a personal injury lawsuit.
- Full lost wages. Workers’ compensation only provides a portion of your lost wages (typically two-thirds).
How Personal Injury Claims Work
Personal injury claims require proving that someone’s negligence resulted in an accident that caused your injuries. When it comes to work-related injuries, you typically cannot file a personal injury lawsuit against your employer, especially if you plan to rely on ordinary negligence as a basis. The exceptions come in the form of:
- Intentional harm. This is typically a very high standard to meet and requires proving that an employer acted with a deliberate and malicious intent to harm an employee. For example, you can sue an employer who strikes you physically. Another example is if an employer knowingly ignores a serious, dangerous, and unaddressed safety hazard, and it leads to a severe injury.
- Failure to carry workers’ comp insurance. The law requires almost all employers in New York to have workers’ compensation insurance. If they fail to provide it, injured employees can file personal injury lawsuits against them.
- Third-party lawsuits. Employees hold the right to sue third parties if their negligence contributes to their injuries. For example, if you are a construction worker and a defective piece of equipment causes an injury, you may sue the equipment manufacturer. In this scenario, it might be possible for the third party to bring your employer into the lawsuit if the injury classifies as a “grave injury” under Section 11 of New York Workers’ Compensation Law.
- The “grave injury” exception. This specific exception allows a third-party (not an employee) to sue an employer for contribution or indemnification if an employee suffers a “grave injury.” Examples of grave injury, as defined by the law, include loss of life, limb amputation, loss of ear or nose, blindness, deafness, paraplegia, quadriplegia, and permanent total disability caused by an acquired brain injury.
When to File a Personal Injury Claim
The most common scenario when injured employees file personal injury claims is when there’s the involvement of third parties. For example, a construction worker can sue a site owner if unsafe site conditions resulted in the worker’s injuries. In this case, you would need to file a third-party claim.
When you file a personal injury claim, the onus of showing that the other party’s negligent or intentional actions led to your injuries rests upon you. This requires proving that:
- The other party owed you a duty of care.
- They breached the duty of care.
- The breach of duty was the direct cause of your injury.
- You sustained damages because of your injury.
If you cannot prove fault for an injury in a personal injury case, filing a claim or a lawsuit might not be the best way forward.
Personal Injury Claim Benefits
An important aspect of filing a personal injury claim is that you may look forward to receiving broader compensation in comparison to workers’ comp. The typically higher payouts are because they account for damages that workers’ compensation does not. These include:
- Complete reimbursement of loss of earnings.
- All past and future medical expenses.
- Compensation for emotional distress, pain and suffering, and loss of enjoyment of life.
- Punitive damages (in cases of willful misconduct or extreme negligence).
The Role of Comparative Negligence
New York follows the comparative negligence principle that allows personal injury victims to seek damages based on a party’s degree of negligence. For example, if a court finds the party you are suing to be 75% at fault and assigns the remaining 25% to you, you may recover 75% of the damages from the other party.
Workers’ Comp vs. Personal Injury: Statute of Limitations
Whether you’re filing a workers’ compensation or personal injury claim for a workplace accident, you must pay attention to the statute of limitations, because once this period ends, you lose the legal right to file a claim or a lawsuit.
To file a workers’ compensation claim, you have to notify your employer of your injuries within 30 days of the accident. You also need to file an Employee Claim (Form C-3) with the Workers’ Compensation Board. You must file this form within two years of the date of the accident or two years from the date you had knowledge (or should have had knowledge) of the condition/disease in question.
When it comes to personal injury lawsuits, the statute of limitations stands at three years for most cases.
Can You File Workers’ Comp and Personal Injury Claims?
In New York, it is possible to file a workers’ compensation claim and a third-party personal injury claim simultaneously, and this can be an effective strategy to maximize the compensation you receive after a workplace injury. This is how the two separate claims would work.
- Workers’ compensation claim. This no-fault claim against your employer provides you with prompt benefits for medical expenses and a portion of your lost wages. What helps is that you don’t have to prove your employer was negligent.
- Third-party personal injury claim. This is a lawsuit typically against someone other than your employer or a co-worker who was at fault for your injury. The purpose of this claim is to seek damages that workers’ comp does not cover, such as pain and suffering, emotional distress, and future lost earnings.
Remember that New York’s workers’ compensation system acts as a bar to suing your employer, but it does not prevent you from filing a lawsuit against a third party. The law recognizes that the negligence of someone outside your direct employment can be the cause of your injury, which is why it gives you the right to file a third-party claim.
Some common examples of third-party claims include filing a lawsuit against:
- A general contractor, property owner, or subcontractor whose negligence caused your injury.
- An at-fault driver, if you suffer injury in a car accident while working.
- The manufacturer or distributor of a faulty piece of equipment that resulted in your injury.
- A property owner, if you suffer injury while working on their property due to an unsafe condition.
The Role of the Workers’ Compensation Lien
While you can file workers’ comp and personal injury claims at the same time, you have to account for the workers’ compensation lien as defined by law. This gives your workers’ compensation insurance carrier the right to get reimbursement for the benefits it pays out from any settlement or judgment you receive from a third-party claim or lawsuit. This law is in place to prevent claimants from getting a “double recovery” for the same damages.
Another important aspect when it comes to settling third-party lawsuits is getting the written consent of your workers’ compensation carrier or a court order approving the settlement. If you fail to do so, it can result in the loss of all future workers’ compensation benefits.
Conclusion
Now that you’ve looked at the differences between workers’ comp and personal injury claims, you should have an indication of which path might work better for you. In addition, you should also consider seeking advice from an experienced personal injury attorney who can guide you based on the specifics of your case. Your attorney can also help you file a workers’ comp claim, a personal injury claim, or both.