When an injury happens while on the job, you face several pressing concerns beyond your physical recovery. Medical bills pile up, lost wages create financial strain, and uncertainty about your legal options can feel overwhelming. Understanding the distinction between personal injury claims and workers’ comp benefits can help you seek the maximum compensation you deserve.
While workers’ compensation provides coverage for many workplace injuries, it may not be your only legal avenue for financial recovery. In certain situations, you might have grounds for both workers’ compensation benefits and a separate personal injury lawsuit. Knowing which path to pursue – or whether you can pursue both – can significantly affect your compensation.
Differences Between Personal Injury and Workers’ Compensation Cases
The most significant differences between personal injury vs. workers’ compensation claims include the following:
Fault and Liability
The most fundamental distinction between these two legal options lies in the question of fault. Workers’ compensation is a no-fault system in North Carolina. You can receive benefits regardless of who caused the incident – whether it resulted from your own mistake, a coworker’s actions, or equipment failure. The workers’ compensation system prioritizes getting injured workers back on their feet quickly rather than assigning blame. However, you do have to establish that your injury resulted from an accident that happened at work while performing your job duties.
On the other hand, personal injury claims require proving that someone else’s negligence caused your injuries. You must demonstrate that another party (such as a property owner, equipment manufacturer, or contractor) failed to exercise reasonable care, leading to your harm. This burden of proof makes personal injury cases more complex. Additionally, North Carolina is among a small minority of states that still has a contributory negligence defense. This means that, even if a third party was the primary cause of the accident, if your own negligence caused or contributed to the accident happening, even in a small way, you receive nothing.
Potential Compensation
Workers’ compensation benefits cover specific categories of losses and place caps on what you can recover. These benefits typically include:
- Medical expenses, covering all approved treatments and rehabilitation services related to your workplace injury without copay or deductible. (C.G.S. § 97-25)
- Wage replacement, which temporarily pays two-thirds of your average weekly wages while you’re out of work, subject to state maximums. (C.G.S. § 97-29; 97-30)
- Permanent impairment benefits, which make payments for permanent partial disabilities to various body parts that affect your earning capacity. (C.G.S. § 97-29; 97-31)
- Vocational rehabilitation, including training or education to help you return to suitable work. (C.G.S. § 97-32.2)
However, workers’ compensation does not provide payment for pain and suffering, emotional distress, or the full extent of your lost wages.
Personal injury settlements and verdicts can encompass all economic and non-economic losses stemming from your workplace injury. This comprehensive recovery may include:
- Full wage replacement – past and future
- Current and future medical costs
- Loss of future earning capacity
- Pain and suffering past and future
- Emotional distress past and future
- Loss of enjoyment of life past and future
Claims Process
Filing for workers’ compensation benefits typically begins when you report your injury to your employer within 30 days of the incident (N.C.G.S. § 97-22). Your employer must notify their insurance carrier, which investigates the claim and determines benefit eligibility. If the insurer accepts the claim, compensation should start within two weeks. If the insurer denies your claim, you can appeal through the North Carolina Industrial Commission. Appeals often begin with mediation before proceeding to a formal hearing.
Personal injury claims follow a different trajectory. You or your attorney typically file a claim with the at-fault party’s insurance company first. The liability insurance usually pays nothing until you are ready to settle the entire claim. Settlement negotiations may resolve the matter without the need for litigation. However, filing a lawsuit in civil court may be necessary if they won’t make a fair offer, which could lead to a trial. Nothing is paid to or on behalf of the injured person until they are ready to sign a total release.
Getting Medical Treatment
Workers’ compensation insurance directs where you can receive medical care, often requiring approval for treatments and specialists. The insurance company’s medical provider network determines your options, though you can request changes under certain circumstances. (N.C.G.S. § 97-25).
In personal injury cases, you generally have more freedom to choose your healthcare providers and treatments. However, depending on your health insurance coverage and settlement terms, you may need to pay copays and deductibles and seek reimbursement later. You also may be required to reimburse your health insurance company from your liability settlement (that’s a long discussion for another article).
Deadlines
Both claim types operate under strict time limits. Missing these deadlines can mean losing your chance to recover any compensation. North Carolina typically requires workers’ compensation claims to be filed within two years of the date of the injury (N.C.G.S. § 97-24). More immediately, you must report workplace injuries to your employer within 30 days to preserve your rights, with some exceptions (N.C.G.S. § 97-22).
Personal injury lawsuits generally face a three-year statutory deadline (N.C.G.S. § 1-52). While this provides more time than workers’ compensation deadlines, starting the legal process promptly helps preserve evidence and witness testimony that strengthens your case. An ethical attorney must have the time to properly investigate the claim before filing a lawsuit. If you wait until two years and 364 days to contact a lawyer, you will probably not find anyone willing to take the substantial risk.
How Do I Know Which Type of Claim to File?
Most workplace injuries qualify for workers’ compensation benefits, making this the primary option for injured employees. However, certain circumstances create opportunities for additional personal injury claims with third parties (someone other than the employer or coworkers).
You might have grounds for a personal injury lawsuit when:
- Defective equipment or products made by someone other than your employer caused your injury.
- Property owners other than your employer maintained unsafe conditions.
- A negligent driver who was not a coworker caused an auto accident during work hours.
- Contractors or subcontractors created hazardous situations.
Employers generally receive immunity from personal injury lawsuits from employees eligible for workers’ compensation benefits. (N.C.G.S. § 97-10.1) However, there are some very rare exceptions, such as unintentional but substantially certain harm. (Woodson v. Rowland, 329 N.C. 330, 407 S.E.2d 222 (1991)).
The good news is that filing for workers’ compensation does not prevent you from pursuing a personal injury claim against liable third parties. You can potentially receive benefits from both sources, though coordination between the claims may affect total recovery amounts. And, of course, you may have to reimburse the workers’ compensation insurance for some or all of what they paid on the claim.
Get in Touch with Our Attorneys for Legal Assistance
If you want to learn more about personal injury vs. workers’ comp claims, a lawyer can help. Workplace injuries create complex legal situations that benefit from skilled guidance. At Younce, Vtipil, Baznik & Banks, P.A., our attorneys have over 90 years of combined experience handling workers’ compensation and personal injury cases throughout North Carolina. We understand how to evaluate your situation thoroughly and pursue all available compensation sources.
Our recent successes include a $2,625,000 workers’ compensation settlement that demonstrates our commitment to demanding maximum recovery for injured workers (although each case is unique, and past results do not guarantee any future outcome). We utilize state-of-the-art case management tools and provide hands-on treatment with personal attention throughout your case. As one client shared:
“We are very grateful with this firm. They have been our lawyers for more than 17 years, always excellent service and good communication, in Spanish or English! Younce, Vtipil, attorneys at Law always fighting for the rights of their clients!! For that reason I give them 5 stars if I could I would give them more!!!!” – Javier P.
When you face uncertainty after a workplace injury, we will do everything we can to care for you and your family during this challenging time. Contact Younce, Vtipil, Baznik & Banks, P.A. at 919-661-9000 today for a free consultation to discuss your work-related injury and explore all available paths to compensation.
About the Author
Robert C. Younce, JR
Robert C. Younce is an attorney at Younce, Vtipil, Baznik & Banks, P.A. and concentrates his law practice on personal injury and workers’ compensation law. He has tried over 100 workers’ comp cases to Opinion and Award and about a dozen personal injury jury trials to verdict. He has been board-certified by the North Carolina State Bar as a specialist in workers’ compensation law since 2001.
