Basic Questions about Workers' Compensation How do I file a Workers' Compensation (WC) Claim? If you are injured on the job, or have an illness caused by your workplace, you must notify your employer. Your employer will notify their WC Insurance Company. The insurer will file a First Report of Injury to start the process. Who is covered by Workers' Compensation insurance? By law, employers with 1 or more employees must carry workers' compensation insurance. Sole proprietors, partners, certain real estate, agricultural and domestic service employees are not covered. Police, firefighters, and federal employees are covered under different compensation programs. Municipal employees are only covered if the municipality has chosen to be covered. Independent contractors are not covered. Who can collect Workers' Compensation benefits? Covered employees who are injured at work or who become ill from working may be eligible to collect workers' compensation benefits. If your injury or illness is not work-related, a different program, such as Temporary Disability Insurance or Social Security Disability may provide benefits. What are the injured worker's responsibilities? Seek immediate medical attention and report the injury or illness to your employer immediately or as soon as you realize it is work related. If the injury incapacitates you from earning full wages for at least 3 consecutive days or requires medical treatment, your employer is required by law to notify the insurer to file a First Report of Injury form with the Division of Workers' Compensation within 10 days of the actual injury or knowledge of it. The employer must file within 48 hours if the injury is fatal. What are workers' compensation benefits and how are they determined? Workers' compensation monetary benefits may begin on the fourth day from the date of injury. You may also be entitled to medical treatment, benefits for disfigurement or loss of use, and/or participation in rehabilitation. Dependents of employees who suffer a work-related fatality may also receive benefits. There are several types of weekly benefits paid under workers' compensation: Total disability benefits apply if the employee is physically unable to earn any wages in any employment. The weekly compensation rate for total incapacity is equal to 75% of your spendable base wage. Supplemental earnings and bonuses are considered in determining your benefit rate. Partial disability benefits apply if the employee's ability to earn full wages is affected but the employee is not totally disabled. When the employee reaches maximum medical improvement, the Workers' Compensation Court may reduce the employee's compensation rate. Dependency allowance benefits are $15.00 per dependent per week for total disability, and $40 per dependent per week for fatality benefits. There is no dependency allowance for partial disability. Who chooses my medical care provider? May I change doctors? You may choose your first medical care provider. Treatment at an emergency room after the accident or by a company physician does not count as the first medical care provider. Your first provider may refer you to a specialist without prior approval from the insurer. No matter who your treating physician is, you are entitled to receive a report from him or her within 10 days of each visit. If you decide to change doctors, you must first find out if your insurer or self-insured employer has an approved list of physicians, known as a "preferred provider network". If so, you must either select a physician from that list or get the approval of your insurer or self-insured employer before you see another doctor. To find out if a list of physicians exists, contact your employer/insurer. If your employer or insurer does not have an approved list of physicians, these restrictions do not apply. Who pays the medical bills? Medical bills related to the injury should be paid in full by the employer's insurance company. There are no co-payments or deductibles. How do I find my employer's insurer? Will I receive written notice from the insurer? The name of your employer's insurer should be posted on the Workers' Compensation Act poster in accordance with RI General Law §28-29-13. If you need help in determining the name of your employer's insurer, contact the Fraud and Compliance Unit at (401) 462-8100 or email [email protected]. The insurance company may offer you a Memorandum of Agreement (MOA), sent by certified mail, return receipt requested. The MOA means the insurance company accepts liability for your injury and should start sending you weekly benefits payments within 14 days. Or, the insurance company may offer you a Non-Prejudicial Agreement. This allows the insurer to begin paying you weekly benefit payments without accepting liability for the injury for up to 13 weeks. The insurer can stop benefits at any time. Within 10 days of when benefits stop, the insurer must send you a notice called a Termination of Benefits. If you receive weekly payments for more than 13 weeks, the insurer should issue a Memorandum of Agreement. If the insurer stops payments or you return to work before 13 weeks has passed, you have two years from the date of injury to file a petition with the Workers' Compensation Court to determine if the insurer is liable for the injury. If you have not received any notice from the insurer within 21 days from the date you notified the employer of the injury, you may file a petition for weekly benefits at the Workers' Compensation Court. The insurer is not obligated to file anything or to do anything to let the employee know if the claim is contested. Are there limits on medical care? There are palliative care limits: After maximum medical improvement has been reached, treatment to alleviate the effects of the injury is limited to 12 visits or care rendered within 60 days, whichever comes first. Any additional palliative care must receive prior approval from the insurer. What rehabilitation benefits are provided? You are entitled to any necessary rehabilitation services to help you regain the ability to return to work. The Arrigan Rehabilitation Center provides physical, vocational, and psychological rehabilitation services for people injured at work. If you have questions about rehabilitation, call the Arrigan Center at (401) 243-1200. What is the Medical Review/Impartial Medical Exam? If you receive weekly incapacity benefits for 26 weeks, the Administrator of the Medical Advisory Board will schedule an examination for you by an impartial medical examiner or a comprehensive independent health care review team. The results of the exam will be provided to you within 14 days. Failure to appear for this exam may be reason for suspension and termination of benefits. Repeat examinations will be scheduled every 13 weeks while your are receiving weekly benefits. What is the Anniversary Review? The Workers' Compensation Court schedules an anniversary review once a year for all employees who continue to receive ongoing weekly benefits. What is a Suspension Agreement? If the insurer made payments to you under a MOA, you may be asked to sign a Suspension Agreement. Signing a Suspension Agreement means that you agree to end weekly benefits payments. The insurer continues to be responsible for all reasonable medical expenses relating to your injury. The law allows you up to10 years to reopen your claim. Can I return to my job? In most cases, you have the right to return to your former job if you can perform your job duties with reasonable accommodation by your employer. This is known as your right to reinstatement. You must claim your right to reinstatement within 10 days from the date you are notified by mail that the treating physician has released you for work. You are entitled to reinstatement even if the job has been filled by a replacement. If that position is unavailable, you are entitled to reinstatement to any other vacant and suitable position. If you have been denied this right, or if you would like additional information, contact the Education Unit at (401) 462-8100, or [email protected]. These requirements are subject to union contract and to the Americans with Disabilities Act. What is Coordination of Benefits? There may be an offset (a reduction) of weekly compensation benefits for people who are entitled to retirement benefits. This offset will not include any benefits derived exclusively from the employee's contribution. There will be no offset for those collecting retirement who are injured before age 55 and are injured more than five years before their retirement date. No workers' compensation benefits can be collected after retirement for persons who are injured less than 2 years before retirement. Can I collect Unemployment Insurance (UI) while collecting Workers’ Compensation Benefits? No. You cannot collect both programs at the same time. In order to collect UI benefits you must be able, available and actively looking for work. When released from Workers’ Compensation, can I file for UI Benefits? Yes. You can file for UI Benefits once you are able and available for full time work and released from your doctor with written authorization to return to work. Eligibility will be determined after you file a UI claim. What is the Fraud and Abuse provision? Fraud and abuse provisions include penalties of up to $50,000 or double the amount of the fraud, imprisonment of up to 5 years or both: imposed on attorneys and clients for willful abuse of court proceedings for obtaining benefits through fraud or misrepresentation for obtaining workers' compensation insurance through fraud or misrepresentation for making false statements to discourage a lawful compensation claim False statements include: endorsement of a benefit check if benefits were obtained through fraud or misrepresentation false bills misrepresentation on application for insurance Employees entitled to weekly compensation benefits must report any earnings so that the amount of benefit can be calculated properly. Who can I contact if I have more questions about workers' compensation? If you have problems or questions about workers' compensation, call the Education Unit at (401) 462-8100 or email the Education Unit at [email protected] Questions About Coverage What is workers' compensation? The RI workers' compensation system is a form of no fault insurance designed to provide assistance to employees injured at work for medical expenses and lost wages. The employer buys an insurance policy to cover accidents to employees in the workplace. The employer's insurance company pays claims that are covered under the employer's insurance policy. Who needs to carry worker's compensation insurance? Every person, firm, public service or private corporation, including the State, that employs employees regularly in the same business is subject to the Workers' Compensation law. How does an employer buy workers' compensation insurance? The employer should contact their insurance agent and ask about workers' compensation insurance coverage. There are many insurance carriers that provide workers' compensation insurance. In Rhode Island, The Beacon Mutual Insurance Company is the carrier of last resort. This means that if an employer is unable to obtain workers' compensation insurance from another carrier, Beacon Mutual should provide the coverage. What if the employer experiences difficulty when attempting to obtain workers' compensation insurance coverage? The employer should contact the Department of Labor and Training's Workers' Compensation Fraud and Compliance Unit at (401) , and the Department of Business Regulation's Insurance Division at (401) 462-9520. Who is covered under workers' compensation insurance? Employers with one or more employees are required to carry workers' compensation insurance. Sole proprietors, partners, certain real estate, agricultural and domestic service employees are not covered. Police, firefighters, and federal employees are covered under different compensation programs. Municipal employees are only covered if the municipality has chosen to be covered. Independent contractors are not covered. Who can collect workers' compensation benefits? Covered employees who are injured at work or who become ill from working may be eligible to collect workers' compensation benefits. If your injury or illness is not work-related, a different program, such as Temporary Disability Insurance or Social Security Disability may provide benefits. Employer Questions Who needs to carry workers' compensation insurance? Every person, firm, public service or private corporation, including the State, that employs employees regularly in the same business is subject to the Workers' Compensation law. Who is exempt from the workers' compensation law? Exemptions include: Sole proprietors, partners, and independent contractors. Certain real estate, agricultural and domestic service employees may be exempt. Any person who was appointed a corporate officer between January 1, 1999 and December 31, 2001, and was not previously an employee of the corporation is exempt, but can elect to be covered by filing a DWC-11C form with the Division of Workers' Compensation. Are there penalties for not carrying workers' compensation insurance? There are civil and administrative penalties that can be imposed for each day of noncompliance. There are also criminal penalties, which can result in fines and possible imprisonment. For further information see RI Workers' Compensation Law, Section 28-36-15 Are there any disclosure and posting requirements regarding workers' compensation? Yes, all employers must disclose to all prospective employees at the time of application either that the employer is subject to or exempt from workers' compensation. If exempt, the specific type of exemption must be disclosed. RI Workers' Compensation Law Section 28-29-13, requires employers to post a notice that includes insurer information. The posters are available in English and Spanish. You may contact the Education Unit at (401) 462-8100 or [email protected] to request a copy of the poster, or click here to download them from the web. Can an employee complete a first report of injury? No. The employer must report the injury to his workers’ compensation insurance carrier. The insurance company will send a first report to RI DLT electronically on behalf of the employer. An employee can complete a company accident report. Can I send an injured worker to a physician under agreement with my company? An injured employee may choose the initial medical treatment. The first visit to any facility or physician under contract or agreement with you or your insurer to provide priority care shall not constitute the employee's initial choice. Is there a waiting period before commencing workers' compensation? No weekly indemnity is paid for an injury that does not incapacitate the employee for 3 days from earning full wages. There is a 3-day waiting period. Do I have to continue health care benefits for my injured employee? Under Rhode Island Workers' Compensation Law, Section 28-33-44, you are required to provide for the continuation of health benefit coverage for a period of up to 2 years from the commencement of workers' compensation benefits. However, in 1992, the United States Supreme Court held that ERISA's preemption clause is activated whenever a conflicting state law references an already existing benefit play. If you fall under the aegis of ERISA, then the preemption clause negates the requirement of the RI Workers' Compensation Act to provide continuing health care coverage. For further information contact the Education Unit at (401) 462-8100 or [email protected] Can I replace an injured worker who is out on compensation? A worker who has sustained a compensable injury and is not disabled from performing the duties of the position, with reasonable accommodation made by you, shall be reinstated to his or her former position upon demand, if the position exists and is available. This is considered the Right to Reinstatement. This requirement does not apply to: a worker hired on a temporary basis or employed in a seasonal occupation; a worker hired out of a union hiring hall; employers who employ 9 or fewer workers at the time of injury or a worker who is on a probationary period of less than 91 days. This section includes certain provisions which may terminate the employee's right to reinstatement. Any violation of this section is deemed an unlawful employment practice, and the RI Workers' Compensation Court will render reinstatement disputes. If an employee is entitled to reinstatement but the position sought does not exist or is not available, the employee may file for unemployment as if then laid off from that employment. For more complete information, refer to the RI Workers' Compensation Law, Section28-33-47. Can an employer be accused of workers' compensation fraud? What are the penalties? The Workers' Compensation Court is authorized to impose sanctions and penalties. It is unlawful for an employer to willfully misrepresent or not disclose information to an insurer to obtain insurance at lower rates; to make or cause to be made any knowingly false statement for the purpose of obtaining or denying compensation; to fail to report earnings during the payment of compensation benefits; to make knowingly false statements regarding an employee's right to benefits and to knowingly assist and abet, solicit, or conspire to coerce an employee to willfully represent their status as a corporate officer or independent contractor to avoid workers' compensation coverage required or to decrease premium. These are a partial listing of offenses. See Section 28-33-17.3 of the RI Workers' Compensation Law. Any person found guilty of violating this section of the law shall be subject to criminal proceedings and to a fine and/or penalty up to $50,000 or double the fraud, whichever is greater, or by imprisonment up to 5 years in state prison or both. Independent Contractor Questions What is the difference between an employee and an independent contractor? Many factors are considered when determining whether someone is an employee or independent contractor. Some of those factors are: Independent contractors set their own hours, use their own tools, work when and for whom they choose, and are responsible for paying their own State and Federal withholdings. What is the difference between a sole proprietor and an independent contractor? Many circumstances contribute to this determination, and sometimes there isn't a difference. A sole proprietor can act as an independent contractor and when they do, they should file the DWC-11-IC form. If a controversy arises, a determination may be made by the Workers' Compensation Court. As an independent contractor, am I entitled to collect workers' compensation benefits if I am injured? No, you are exempt from the RI Workers' Compensation Act and are not eligible to collect benefits. For purposes of workers' compensation, domestic employees, independent contractors, sole proprietors and partners are exempt. For further information on exemptions and coverage requirements contact the Education Unit at (401) 462-8100 or [email protected] As an independent contractor I occasionally hire employees; should I obtain workers' compensation insurance coverage? Yes, all RI employers with one or more employees are required to obtain workers' compensation insurance. If you hire an independent contractor, they should provide you with either proof of workers' compensation insurance coverage or a copy of a DWC-11-IC form, which has been filed with the Department of Labor and Training. Can you give me an example of who may be required to file a DWC-11-IC form? If a homeowner hires an independent contractor such as a landscaper, the landscaper does not need to have a form on file because the homeowner is not in the business of landscaping. However, if you, as an independent contractor hire the landscaper as part of your business, you should be sure that the landscaper has a DWC-11-IC form on file with DLT, which will remain in effect, unless withdrawn, for every time that particular independent contractor works for you. Also, should that landscaper hire independent contractors to work for him/her, forms should be completed for each independent contractor hired. When do I file a Notice of Designation as Independent Contractor? You should file a form whenever you are contracted to work for a hiring entity. A separate form should be on file for each hiring entity you work for. How do I file a Notice of Designation as Independent Contractor form? There are 2 ways; securely online or download a pdf form, complete it and mail or fax it back to the RI Department of Labor & Training, P.O. Box 20190, Cranston, RI 02920-0942. The original form will be kept by the Department. The independent contractor and hiring entity will receive by mail a "Notice of Designation" as evidence of the filing. The notice will contain the names of the independent contractor, the hiring entity, and the date the form was received by the Department. There is no fee to fill this form, or the withdrawal form. The form becomes effective when received and date-stamped by the Department. Incomplete forms will be returned for corrections. What if the employer misrepresents an employee as an independent contractor to avoid obtaining workers' compensation insurance or to decrease their premium? What if my employer or the person hiring me to work requires that I sign a DWC-11-IC? If an employer misrepresents the employee as an independent contractor, the employer may be subject to criminal prosecution. Visit here for more information. You may be asked to sign a form, but an employer that forces or coerces an employee to sign the Notice may be subject to criminal prosecution. If you feel that you have been forced or coerced, report this to the Workers' Compensation Fraud Prevention Unit at (401)462-8100. I am still unclear as to whether I am an independent contractor or not, how do I find out? Call the RI Division of Taxation at (401) 574-8941 or the US Internal Revenue Service at (800) 829-1040. If calling the IRS, ask for form #SS-8, which is the Determination of Employee Work Status Form. Should you be determined to be an employee, the hiring entity may be required to obtain workers' compensation coverage.