Workers’ compensation laws like California’s statute have been a blessing to many injured workers in the Golden State. Workers do not (at least in theory) have to struggle or haggle with their employers following a workplace accident, hoping to convince their bosses to help them meet their medical expenses. Nor do workers have to be placed in the unenviable position of having to file a lawsuit against their employer whom they would like to return to work for once their injury has healed.
The Downside to Workers’ Compensation Laws
Workers’ compensation statutes provide that an employee who is injured on the job is entitled to compensation to help that worker address his or her medical needs, lost wages, and other covered losses. Obtaining these benefits is nearly- automatic, assuming the worker follows the steps that he or she must complete to properly notify his or her employer of the injury. What is more, these benefits are available regardless of whose carelessness contributed to or caused the accident.
The downside to workers’ compensation laws is that a worker is not entitled to sue his or her employer for any additional compensation if the workers’ compensation benefits are inadequate, no matter how compelling the evidence is that the employer acted carelessly in some fashion or other. In return for near-guaranteed benefits, the workers have lost the ability to sue their employers for any damage or loss in excess of the workers’ compensation benefits.
Third Party Claims Compared with Workers’ Compensation Claims
Where a third party – that is, someone else other than your employer – is responsible for causing your injuries, however, you may be able to bring a third-party personal injury claim against this other person. The damages that can be obtained through a third-party lawsuit may be in excess of the benefits you are receiving under the workers’ compensation program.
Workers’ compensation claims are not like third-party personal injury claims, even though they may be based off of the same negligent accident. Some important differences between the two types of claims include:
- In a workers’ compensation claim, you are not required to prove that anyone’s negligence caused or contributed to your accident. All that must be demonstrated is that you were engaged in the performance of your job duties at the time of your injury.
- In a third-party liability claim, you bear the burden of proving that another person acted in a careless or negligent fashion and that this caused you to suffer your injury. You bear the burden of proving this by proof beyond a reasonable doubt.
- In a workers’ compensation claim, the employer is not permitted to raise any affirmative defenses to your claim for benefits, other than challenging whether you were about your job duties at the time you were injured and/or the nature and extent of your injuries.
- A defendant in a third-party personal injury claim has a number of affirmative defenses that he or she may raise to attempt to defeat your claim for compensation. This means that third-party claims are generally more contentious than your typical workers’ compensation claim.
- In a workers’ compensation claim, your own fault or negligence is not an issue (unless you deliberately injured yourself) and any carelessness attributable to you does not affect the amount of workers’ compensation benefits you would receive.
- In a third-party liability claim, your own negligence is relevant and can negatively affect your case. While you can still recover some compensation even if the accident was 99 percent your own fault, the compensation you receive will be reduced in proportion to the fault attributable to you.
- In a workers’ compensation claim, your benefits are dictated by statute and do not change depending on your needs. You are “stuck” with the benefits provided to you by the statute and workers’ compensation program.
- In a third-party liability claim, you are able to seek compensation for your actual losses. For example, while you can receive lost wages through a workers’ compensation claim, the actual amount you would receive would only be a portion of your average wages from just before the accident. In contrast, in a third-party claim, if you suffered $900 in lost wages, you can recoup $900 in lost wages. You can also obtain damages for pain and suffering and other non-economic damages through a workers’ compensation claim.
Beware of Subrogation
If you file both a workers’ compensation case as well as a third-party case, be aware that your workers’ compensation insurer will want to be reimbursed first from any damages you obtain in your third-party case. For example, if your workers’ compensation insurer pays you $100,000 in benefits and you are able to obtain $150,000 in damages through a third-party lawsuit, your workers’ compensation insurer would be entitled to $100,000 of your damages.