Rhode Island (RI) Workers’ Compensation for Injured Workers

Though Rhode Island is the state that started the Industrial revolution, today almost 99% of firms there are small businesses. But large or small, it’s a requirement for most employers to protect employees by providing Rhode Island workers’ compensation benefits.

A form of no-fault insurance, workers’ compensation covers an employee who gets hurt on the job. It doesn’t cost the employee anything and can pay for medical bills, lost wages, and even lump-sum disability payments. However, in return for this coverage, an employee forfeits the right to sue their employer over the injury.

In most cases, the system is mutually beneficial. However, it’s important to be aware of all the ins-and-outs of Rhode Island workers’ compensation benefits.

If you’re experiencing a work injury or illness but aren’t clear about Rhode Island’s workers’ comp requirements, keep reading. Our guide will explain what you must know to successfully file your claim, and when you need an attorney’s help.

Who Qualifies for Workers’ Compensation in Rhode Island?

Almost all employers in Rhode Island who have at least one employee must carry a workers’ compensation policy. This isn’t just a recommendation or suggestion, it’s a law.

“Employers with one or more workers are required to carry workers’ compensation insurance.”

–Rhode Island Department of Labor & Training

That means just about every Rhode Island worker has protection in case they experience an on-the-job injury or illness.

Who is Exempt from RI Workers’ Comp?

Of course, there are always exceptions to the rule. Per Rhode Island workers’ compensation law, the following types of employees do not have to receive coverage:

• Sole proprietors
• Partners
• Certain real estate, agricultural and domestic service employees

Police officers, firefighters, and federal employees will all have coverage under a different type of compensation program. Municipal employees will be on the “must insure” list only if their municipality opts to mandate coverage.

Independent contractors are also exempt from workers’ comp. However, an employer may always choose to extend their policy to any workers who technically aren’t under their employ.

In some cases, it may be advantageous to do so rather than risk a personal injury lawsuit down the line.

Injuries Covered By Rhode Island Workers’ Compensation

Generally, workers’ comp covers any injury, illness or disease that stems from an employee’s job. The caveat is that it must happen during the course and scope of employment.

In other words, your condition has a direct correlation to what happens while you’re working and doing your normal duties.

Accordingly, you may receive coverage for any number of conditions ranging from broken bones, herniations, to repetitive strain injuries. Workers’ comp may also cover illnesses that develop as a result of on-the-job exposure to pollutants or toxins.

Rhode Island workers’ comp extends to cases where a pre-existing condition worsens due to a person’s employment. RI law says that employers hire employees “as is”, so an aggravation of a condition counts. This is true whether or not the pre-existing condition was a work-related injury.

Rhode Island workers’ compensation also addresses “flow-from” conditions — or injuries that lead to another injury.

For example, let’s say an employee has work-related carpal tunnel syndrome in their right hand. If overcompensation with the left hand leads to crippling arthritis in that hand, the secondary condition relates to the first.

The new injury that “flows from” the initial work-related injury may also be covered by workers’ comp depending on circumstances.

Responding to a Work-Related Injury in Rhode Island

Every employer in Rhode Island must post evidence of their workers’ compensation plan in the workplace. This includes not only the name of the insurance company, but also their phone number. It also offers important details about their policy.

If an employer fails to post this information per Rhode Island workers’ compensation laws, they may receive a $250 fine. More importantly for the employee, however, it lets them know that they do have insurance in case of emergency.

How to Start Your Rhode Island Workers’ Compensation Claim

If you experience a job-related injury or illness, part of the claim process is your responsibility.

However, the first thing to know is that if it’s an emergency situation, get the help you need immediately. Advise any hospitals or doctors that your injury was work-related, making note of it in their records (of which you’ll also want to get copies).

If it’s a non-emergency situation, then you don’t have to act quite as quickly. You must tell your employer within 30 days of the onset of your injury, but it’s best to present your claim as soon as possible.

With that in mind, here are the steps you must take to initiate your Rhode Island workers’ compensation claim.

Step 1: Report Your Injury to Your Employer

The first thing you want to do is immediately report your injury to your supervisor. You may also need to share this information with your employer’s workers’ comp designee or HR department.

Most major companies will outline the correct protocol in your company handbook, which you should receive upon hire. However, for small businesses, your procedure may change depending on your employment.

The important thing is reporting the injury to your employer in some way, shape, or form as soon as possible.

Per RI workers’ comp laws, if the injury requires medical treatment, your employer must then notify their insurance company. They must also report if your condition prevents you from earning full wages for at least three consecutive days.

Step 2: Send the Required Workers’ Comp Forms

Upon receiving notification of a claim, your employer’s insurer must file a First Report of Injury form (DWC-01). They have 10 days from the initial incident to submit this form to the RI Department of Labor and Training. If an injury is fatal, however, they must make the report within 48 hours.

In many states, part of the requisite workers’ compensation paperwork submissions will fall to the employee. But in Rhode Island, once an employee makes a report, the onus falls on the employer to alert the DLT.

Step 3: Wait for A Letter of Approval

You should receive a letter from your insurer within 21 days of notifying your employer of your injury.

There are a couple options as to what they may offer. The insurance company may send you a Memorandum of Agreement (MOA), which means they accept liability for your injury. With a MOA, they should start sending you weekly benefits payments within 14 days.

Alternatively, the insurance company may offer you a Non-Prejudicial Agreement without yet accepting liability. This allows the insurer to continue to investigate your claim while still paying you weekly benefit payments. A Non-Prejudicial Agreement lasts for up to 13 weeks and the insurer can stop benefits at any time.

The danger with this agreement is if a worker returns to work before 13 weeks, there’s no future liability. Because the insurer never accepts liability, if the condition worsens, they can deny additional payments.

The third option is that the insurer contests your claim. The tricky part here is that the insurer is under no obligation to inform you that they’re contesting.

As such, if you don’t receive a notice within 21 days of reporting your injury, you should check your claim. At that point, you may also file a petition for weekly benefits directly with the Workers’ Compensation Court.

What if RI Workers’ Comp Denies Your Claim?

There are a few reasons that are perfectly legitimate for not giving a claim the green light. Some valid reasons for a claim not receiving approval include when the injury was:

• Self-inflicted or intentional
• Due to horseplay or fighting
• A result of being under the influence of drugs or alcohol
• In violation of company policy

An insurer may also deny claims if they question whether the injury was truly a result of the employee’s work. Remember, workers’ comp only covers injuries or illnesses that occur within the course and scope of employment.

So, someone injured in a car accident driving to work doesn’t qualify because they’re not yet doing their job. The coming and going rule in RI workers’ comp laws covers this and presents a valid reason for claim rejection.

If you don’t feel your claim fits any of the workers’ comp denial categories, then you may need to appeal.

How to File an Appeal in Workers’ Compensation Court

Injured workers have the right to file an Employee’s Petition for Review with the Rhode Island Workers’ Compensation Court. This may have to do with claims of unfair denials or unpaid benefits, along with other disputes.

Any appeal will begin with requesting a further review in a benefits hearing, which will include your employer and insurer. If you reach this phase, you’ll want legal representation by your side. That’s because a judge will review medical records and hear about the claim from both sides without taking any testimony.

Retaining a workers’ comp attorney raises the chances you’ll receive fair consideration in court. The insurance company will bring lawyers of their own, so be prepared with your own legal representation.

Types of Benefits Available for Injured Workers

Rhode Island workers’ compensation law provides several different benefits for injured workers. These include medical care and lost wages, as well as qualified job reinstatement.

Medical Care

Workers who experience an injury at work should have all of their medical care paid for by their employer/insurer.

Medical care includes all hospital, doctor and surgery bills, but also things like prescription drugs, diagnostic tests, and blood work.

Additionally, medical fees include physical therapy, chiropractic care and assistive devices (like wheelchairs or crutches), as well as transportation.

In Rhode Island, an injured employee has the right to choose their first medical care provider. This doesn’t include any physicians seen in emergency or hospital situations.

After making their choice of doctor, workers also have the right to accept referrals to certain specialists.

Beyond that, however, if they decide to switch doctors, they must get clearance from their employer and insurer.

Percentage of Lost Wages 

Under RI workers’ comp laws, injured workers have a right to receive a percentage of their weekly wage. This is in place to help them survive financially while unable to work due to their condition.

The actual calculation depends on the claimant’s average earnings before their injury and their degree of disability. But in general, as of January 1, 2022, the compensation rate equals 62% of the claimant’s average weekly wage. However, it’s capped at a weekly maximum rate as set annually by the state.

Scarring and Loss of Use Compensation

Any worker who suffers scarring or loss of use of a body part from their injury may receive compensation. However, this benefit is available even if the injured worker doesn’t lose any time at work due to the injury.

A formula calculating the loss of use from a doctor’s assigned degree of impairment determines this award’s amount.

Vocational Rehabilitation

Injured workers in Rhode Island with total or partial disability may submit a proposal for a vocational rehabilitation program. The proposal may include anything from job search assistance to formal retraining and schooling.

This benefit supports the idea that workers’ comp is there to help employees return to the Rhode Island job force. If they’re unable to do their former job, then this helps prepare them for adjusted work after their injury.

Reinstatement to Employment

An employee who wants to return to their former job after a work-related injury has that right. This is true whether they can fully perform their previous duties, or if they need the employer to make reasonable accommodations. They also have the right to another existing available job which is suitable.

The caveat here is that there are time limits within which an employee must request their reinstatement. The worker must return in accordance with whichever of these happens first:

• Within one year from the date of disability
• Within 30 days of attaining maximum medical improvement
• Within 10 days of receiving written clearance from their doctor that they may return to work

How Long Can You Receive Workers’ Comp in RI?

The limits for how long you can receive Rhode Island workers’ compensation benefits depends on the classification of your disability.

Benefits for a total disability continue for as long as the condition is still completely disabling.

If the injury or illness renders the employee partially disabled, then they may receive benefits up to 312 weeks. After that six-year mark, benefit payments will cease, unless the employee can show the condition is still a “material hindrance” affecting their ability to get suitable work.

Is There a Time Limit to File Your RI Workers’ Compensation Claim?

An employer must receive the notice within 30 days after the injury occurs.

After that, if an employer or insurance pays workers’ comp bills without accepting liability, a worker has more time. The statute of limitations to file a legal claim with the Workers’ Compensation Court is two years from the injury date.

Employees who sign a Suspension Agreement thereby ending their weekly payments, have up to 10 years to reopen their claim.

Are There Attorney Fees for Filing a Rhode Island Workers’ Comp Claim?

The Rhode Island workers’ compensation system is set up such that all injured workers can have an attorney. This is very important for protecting their interests, especially if a claim goes all the way to Workers’ Compensation Court.

If a lawyer successfully represents the injured worker and they receive a settlement, then they will take a percentage. As part of a settlement, a judge may also order the insurance company to pay your attorney’s fee. This representation structure means your lawyer is working on a contingency basis.

Essentially, you won’t have to pay anything out-of-pocket for legal services if you qualify for a claim.

Submit Your Case with a Rhode Island Workers’ Compensation Attorney

If you have a pending Rhode Island workers’ compensation claim, it’s a good idea to consult with an attorney.

Workers’ compensation cases are tricky and having someone in your corner who knows Rhode Island’s system can only help! Especially since RI workers’ comp laws don’t require employers to notify you when they’re contesting a case. That can markedly delay benefits that you need now.

Let us help connect you with a lawyer in your area today! We can help you get the benefits you deserve so you can start healing and hopefully get back to work.