How “Damages” Resulting From A Car Accident Differ From “Benefits” Received For A Work Injury

If a person is injured due to the negligence or fault of another, compensation for the consequences of the injury is called “damages.” Such compensation for a work injury is called “benefits.” This article explains how damages for a personal injury negligence claim (most commonly an auto accident) differ from benefits received as a result of a Workers’ Compensation claim. This is a companion to the article on proving medical causation and damages in this JOURNAL.

In a personal injury case, future medical costs must be estimated and awarded in their totality at the end of trial or settlement. This differs from an Oregon Workers’ Compensation claim, where the benefits include lifetime medical expenses related to the injury, paid by the comp insurance company as they arise.

Another form of medical damages in a personal injury claim is susceptibility to re-injury. If the person suffers a back injury, for example, which leaves the person vulnerable to future injuries in that area, the person is entitled to an award of medical damages for this potential loss. This is true even though no dollar loss has been suffered.

So, in an auto accident case the jury (or the parties in their settlement negotiations) will award money damages for probable “future medical expenses,” in addition to past and present medical expenses related to the injury. Also, the jury will assign a dollar value to the patient’s susceptibility to re-injury. These are the medical damages.

Based on the medical evidence presented, the jury in a personal injury case decides the amount of medical damages to be awarded. This differs from the way an injured workers’ medical benefits are determined. Benefits for the disabling effects of a work injury are specifically defined by statutes and regulations. Disability ratings are medically determined and applied mechanically. There is no room for jury discretion as in a personal injury case.

Other damages for a personal injury claim include pain and suffering, lost income, and impaired earning capacity.

Damages for “pain and suffering” are considered “non-economic” damages since they are not tied to any specific expense or out-of-pocket monetary loss. In addition to the actual pain, physical and mental, endured as a result of the injuries, “pain and suffering” also contemplates interference with the normal activities of life. To comment on these, then, it is important that the doctor know what types of activities the injured patient was engaged in before suffering the injuries. The person who led a physically active lifestyle and suffered injuries that rendered him/her sedentary will be entitled to more “damages” than someone who was sedentary before the injuries. The amount of damages awarded is totally up to the jury’s discretion. There is no parallel to “pain and suffering” in workers’ compensation cases.

“Lost income” and “impaired earning capacity” are two distinct types of damages. Lost income is based on the actual amount of past and future income lost as a result of the injury. Impaired earning capacity refers to reduced future employment possibilities due to the physical limitations resulting from the injury. For example, if a shoulder injury permanently renders the injured patient unable to raise her arm to or above shoulder level, this will eliminate the possibility of waiting/waitressing, housekeeping/cleaning and work as a certified nurses’ assistant. The injured person may be awarded damages for the loss of these options whether or not he/she was planning to work in those areas. Vocational rehabilitation professionals perform these evaluations.

By contrast, in Workers’ Compensation claims, the worker only receives a percentage of the actual income lost (“time loss benefits”). Future income loss and impairment to earning capacity are not awarded as such, but are encompassed within the highly structured disability ratings and awards system mentioned above.

In summary, in a personal injury case, the jury has considerable discretion in setting the amount of damages, allowing for a greater range of possible outcomes for the injured person, as compared to the benefits available to a person injured on the job. As explained in the companion article in this issue, the medical evidence, including the doctor’s opinion on several specific questions, is key to proving damages and is the basis for the jury’s decision.

This article was prepared by Robert L. Chapman.