Rhode Island Workers' Compensation Claims: Eligibility, Filing, and Appeals

All employers in Rhode Island with one or more employees must carry workers' compensation insurance. As in other states, the workers' compensation system in Rhode Island is a no-fault system that compensates injured workers for medical bills, lost wages, and permanent impairments resulting from their injuries. To take advantage of these benefits, injured workers must follow certain procedures required by Rhode Island law.

Who Is Eligible for Workers' Comp Benefits?

Workers' compensation covers all injuries or illnesses that happen in the course of employment. In general, injuries that happen while you are performing your work duties or running work errands are covered by workers' comp. On the other hand, injuries that occur while you're off duty are generally not compensated through workers' comp. For example, if you were injured during your lunch break or during your commute to and from work, you will typically not be covered by workers' comp. For more information, see our article on what types of injuries are not covered by workers' comp.

Workers' comp covers both traumatic injuries and occupational illnesses. Traumatic injuries are those that result from a one-time accident at work, such as a broken bone from a slip and fall. Occupational diseases are injuries or illnesses that occur over a period of time, including injuries caused by repetitive movements at work (such as carpal tunnel syndrome) and illnesses developed from exposure to toxic substances at the workplace (such as cancer from exposure to asbestos).

What Should I Do if I'm Injured at Work?

To start your claim for benefits, you should report your injury to your employer right away, but no more than 30 days from the date of your accident. Your employer will notify its insurance company of your claim, and the insurance company will file a First Report of Injury with the Rhode Island Department of Labor and Training (the state agency responsible for overseeing workers' compensation). The insurance company will then decide whether to accept or deny your claim. While there is no deadline for this decision, the insurance company usually makes a decision within a few weeks.

How Do I Get Medical Treatment?

In Rhode Island, injured workers have the right to choose their initial treating doctor. However, if you want to switch to a different doctor later, you will need to see if your employer's insurance company has a preferred provider network (PPN). If there is a PPN, you will need to select a new doctor from that list. If there is no PPN, you will still have to get the insurance company's approval to switch to a different doctor.

What Benefits Can I Receive?

All reasonable and necessary medical treatment related to your work injury will be covered through workers' comp, including the cost of doctors' visits, hospital bills, prescriptions, and prosthetic devices. You'll also be reimbursed for the mileage you incur in traveling to and from medical appointments. In addition to medical benefits, you will also be eligible to receive disability benefits.

Total Disability Benefits

Rhode Island provides total disability benefits to workers who are unable to work due to their injuries. These benefits are 75% of your spendable base wage, which is calculated using a formula that takes into account your average weekly wages, your marital status, and how many dependents you have.

If you have dependents—for example, a non-working spouse, children under 18, or children older than 18 who are incapable of caring for themselves—you can receive an additional dependency benefit. This benefit is an additional $15, per dependent, each week.

Each year, Rhode Island sets a maximum weekly compensation rate for these benefits. As of October 1, 2016, your combined total disability and dependency benefits cannot be more than $1,154 per week. You will receive these benefits for as long as you are completely unable to work.

Partial Disability Benefits

Partial disability benefits are available if you are able to return to work but are earning less due to your injuries. These benefits are 75% of the difference between your spendable base wage before the injury and your earning capacity after the injury. These benefits are generally available for a maximum of 312 weeks and subject to the same weekly maximum mentioned above. Once you reach the point where your condition has stabilized and is not likely to improve further (called "maximum medical improvement"), your benefits can be reduced to 70% of the difference in your earnings.

Scheduled Awards

Rhode Island also provides specific awards for injuries to certain body parts listed in a state schedule. The award is one-half of your average weekly earnings, subject to a minimum of $90 and a maximum of $180 per week. This amount is then multiplied by the number of weeks specified in the state schedule for the body part injured. For example, for the amputation of an arm, the schedule provides payment for 312 weeks. The award is typically paid in one lump sum.

What If My Claim Is Denied?

If the insurance company denies your claim, or you don't receive payment within 21 days of giving notice, you can file a petition with the Rhode Island Workers' Compensation Court. A hearing will be held before a workers' comp judge, who will issue a written decision. If you disagree with the judge's decision, you may file an appeal with the Appellate Division. For more information on the appeals process, see our article on appealing a denial of your Rhode Island workers' comp claim.