This page provides answers to the following questions:
- I had an accident at work. How do I file a workers compensation claim in my state?
- Should my employer have workers compensation insurance? How do I know I am covered?
- What are the conditions that enable me or prevent me from claiming benefits under my state's law?
- What benefits might I be eligible to receive?
- How much time do I have to file my claim? What are the stages of the claim process? What should I expect?
- If I'm not happy with the determination, how do I appeal?
1. I had an accident at work. How do I file a workers compensation claim in my state?
If you have an accident at work, you should report the circumstances and extent of the accident as soon as possible. If the accident results in an injury of some sort, you should inform your employer of this as well. The notification will serve as the start to filing a claim; upon receiving information about your accident, you employer should file a report with the employer's insurance coverage provider.
2. Should my employer have workers compensation insurance? How do I know if I am covered?
All employers employing one or more individuals are expected to provide workers' compensation insurance.
3. What are the conditions that enable me or prevent me from claiming benefits under my state's law?
If your employer is required to provide workers' compensation insurance coverage under the law, you may qualify for workers' compensation benefits if you are injured or become ill as a result of an accident or conditions at your place of employment. Essentially, your injury or illness has to be work related to qualify for consideration to receive workers' compensation benefits.
4. What benefits might I be eligible to receive?
To qualify for benefits consideration, you must be unable to attend work or earn wages for at least three consecutive wages. Benefits become payable on the fourth day you are absent or unable to go to work. Workers' compensation benefits typically fall into one of the following categories: wage compensation, medical treatment, benefits for disfigurement or loss of use, participation in a rehabilitation, and death benefits.
Wage compensation benefits are split into different categories and depending on the extent of your injuries and your ability to return to work, you may be entitled to varying amounts. Total disability benefits apply when you are physically incapable of maintaining any gainful employment, more specifically that physically you cannot earn wages. If you are considered to be totally disabled, you may expect to receive up to seventy-five percent (75%) of your previously earned average weekly wages at the time of your injury. Partial disability benefits apply if your ability to earn wages is affected but you are not considered totally disabled. In these circumstances, your employer or employer's insurance provider communicates with your treating physician regularly to get an idea of when you have reached maximum medical improvement (i.e. further medical treatment will not change or improve the condition of your injury or illness). At this point, your employer may choose to alter the amount of the benefits paid. If you are either totally or partially disabled and you claim dependents, your dependents may receive up to fifteen ($15) dollars a week for your disability. Dependents who survive you in the event that your injury or illness results in your death may receive up to forty dollars.
Rehabilitation benefits are services you may choose to participate in to help you return to work or gain different forms of employment
5. How much time do I have to file my claim? What are the stages of the claims process? What should I expect?
Once your employer files a report about your accident with the employer's insurance provider, the insurance company will review the incident and determine whether the insurance company will accept liability on behalf of your employer. The insurance company will send you a Memorandum of Agreement if the insurance company decides to accept liability for your injury or illness. The insurance company may also choose to not accept liability for your injury or illness, in which case the insurance company will send you a Non-Prejudicial Agreement. This means that the insurance provider will pay you benefits for up to thirteen weeks, but will not accept liability. At thirteen (13) weeks from the date of your injury, the insurance provider may stop payments to you. If the insurance provider discontinues payments prior to the thirteen week cut off, you may file a petition with the Workers' Compensation Court. You must file such a petition within two (2) years of the date of your injury.
Once you file a petition with the Workers' Compensation Court, you should expect to receive a pretrial notice informing you of your court date. Typically, these court dates are scheduled for twenty-one (21) days after the date of your filing. The Workers' Compensation Court will ask you to participate in a pre-trial conference to see if any of the issues of your case or the opposing party's may resolved. If not, the judge presiding over the pre-trial conference will enter a pre-trial order addressing the relief sought. This entry and the determination made within it is effective immediately and requires immediate compliance. If either you or the opposing party are unhappy with the pretrial order, the matter may be appealed for trial. The petition for appeal must be made within five (5) days of the entry of the pretrial order.
The appeal then proceeds with the initial hearing, which can either prioritize the issues and disputes of the claim to help streamline the appeal process or function as a means of scheduling whereby the court can form lists or gain an idea of the number of witnesses or the length of time required for the appeal.
The appeal process is a full evidentiary hearing on all of the issues raised in the petitions or identified at the pretrial hearing. At the close of the trial, the trial judge will make a decision with regards to the relief sought. A final decree is then entered.
6. If I am not happy with the determination, how do I appeal?
Rhode Island state law provides for the initial appeal of a trial judge's determination to the Appellate Division of the Workers' Compensation Court. The Chief Trial Judge is required to assemble an appellate panel to review the case on appeal. The panel will make a decree on the legal and factual issues presented on appeal, a decision to either affirm, reverse or modify the lower court's order. Any subsequent appeals from the Appellate Division will be assigned to the Rhode Island Supreme Court, but only if a Writ of Certiorari has been granted by the Rhode Island Supreme Court.