The Claims Process
In a personal injury case you are usually seeking monetary damages from another individual or corporation who may be responsible for your injuries. Most of the time, that individual or corporation is covered by some type of insurance that would pay the potential claim. In general, you usually seek to make a claim against the insurance company before filing a lawsuit. In the event you must file a lawsuit, the named parties are generally the injured individual as the plaintiff and the named individual or corporation who might be liable as the defendant. The presence of insurance is not admissible and, usually, the insurance company is not named as a defendant. You would then proceed with your lawsuit through the appropriate court of jurisdiction.
In a workers’ compensation claim, the entire process is really just a “claim” against your employer’s workers’ compensation insurance carrier. The process is handled entirely through an administrative claims court before Commissioners (these claims can eventually move into the courts of general jurisdiction on appeal). The named parties would be the injured individual as the plaintiff against your employer and their workers’ compensation insurance carrier, both as named defendants. The claim then proceeds before the South Carolina Workers’ Compensation Commission as an administrative proceeding.
Plaintiff’s Burden of Proof and Applicable Defenses
In a personal injury claim the plaintiff has the burden to prove that the defendant failed to use a certain standard of care and that failure caused the plaintiff’s injuries. Most claims are pursued under a “negligence” theory, meaning the plaintiff must prove the defendant failed to use reasonable care under the circumstances. Likewise, there are numerous defenses that are provided to a defendant that are not applicable in a workers’ compensation claim. For example, comparative negligence, third-party negligence, intervening causation, along with numerous other defenses might allow a defendant to get a claim dismissed or at least minimize their potential exposure.
In a workers’ compensation claim, the plaintiff has no burden to prove fault or negligence on the part of the defendant (employer). So long as the injured employee was an actual employee and acting within the course of scope of their employment at the time of the accident, the employee is entitled to pursue workers’ compensation benefits for their injuries. Likewise, there are different defenses available to a defendant in a workers’ compensation claim such as notice of the injury, intoxication, fraud in the application and numerous other defenses that do not apply in a personal injury claim.
The law provides certain types of damages (monetary compensation) to injured victims in a personal injury claim. For example, an injured victim is allowed to be compensated for economic damages such as past and future medical expenses and past and future lost wages. In addition, an injured victim is allowed to be compensated for non-economic damages such as pain and suffering, emotional distress and loss of enjoyment of life.
In a workers’ compensation claim, an injured employee is provided medical treatment, wage benefits if they miss time from work and compensation for any permanent impairment they may suffer. The amount of compensation for an employee’s permanent impairment is calculated based on the claimant’s earnings, the body part affected and the actual impairment rating assigned by the treating physician. Unlike a personal injury claim, the law does not provide compensation for non-economic damages in a worker’s compensation claim such as pain and suffering and emotional distress. As such, the amount of compensation for a workers’ compensation claim is usually (but not always) less than a personal injury claim.
One Common Similarity
One common similarity to keep in mind between a personal injury claim and a workers’ compensation claim is that, almost always, you are pursuing compensation against an individual or corporation that is covered by some type of insurance. For a personal injury claim, you are usually dealing with an automobile policy, homeowner’s policy, malpractice policy or some type of general liability insurance policy.
For workers’ compensation claims, the law requires certain employers to maintain workers’ compensation insurance for injured employees. Thus, while the named parties in a personal injury lawsuit and workers’ compensation claim may be read one way on the actual paperwork of the claim, the actual payment of money is usually coming from an insurance company that insures that individual or corporation.
We Can Help With Personal Injury and Workers’ Compensation Claims
The Law Office of Jared C. Williams, LLC has experience helping injury victims with personal injury and workers’ compensation claims. If you have been injured and have questions about a possible claim, or you are not sure which type of claim you might have, contact our Charleston personal injury and workers’ compensation attorney to discuss your options. We are always happy to help with any questions you might have. Also, check out our profile on Fixr.com.