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Rhode Island Workers Compensation
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All employers who apply for approval to self insure shall pay an application fee based on what?
- ✔✔The number of employees What is the application fee for a company with 1000 or more employees? - ✔✔$500. If an employer is approved to self insure from the director, what happens to the application fee? - ✔✔The application fee is applied as a credit to reduce the amount of the assessment apportioned to that employer pursuant to subdivision (b)3 of this section Non Work related injuries that are not compensable - ✔✔ Injuries caused by
- willful intent
- intoxication
- injuries occurring during employer-sponsored non work related events True or False: The Fraud Prevention Unit's documents, reports or evidence relative to a workers compensation investigation are not privileged and are open to public inspection. - ✔✔False- they are privileged and not open to public inspection and are not subject to subpoena unless the unit consents or by court order True or False: in the absence of fraud, malice or bad faith, an insurer (or agents and employees of the insurer) are subject to civil liability for damages as a result of any statement, report or investigation made pursuant to chapter 16.1 - ✔✔False: no insurer or agent of the insurer is subject to civil liability for damages as a result of any statement, report or investigation made
the weekly straight time earnings which an employee could have received if the employee accepted an actual offer of suitable alternative employment - ✔✔Earnings Capacity Earnings Capacity can also be established by what? - ✔✔Court based evidence of ability to earn including determination of functional impairment/disability "Employee" - ✔✔any person who has entered into the employment of or works under contract of service or apprenticeship with any employer Employer - ✔✔Any person, copartnership, corporation or voluntary association and the legal representative of a deceased employer General Employer - ✔✔temporary help companies and employee leasing companies Special Employer - ✔✔a person who contracts for services with a general employer for the use of an employee, a vehicle or both "Independent Contractor" - ✔✔means a person who has filed a notice of designation as independent contractor with the director pursuant to § 28 - 29 - 17. Maximum Medical Improvement (MMI) - ✔✔a point in time when any medically determinable physical or mental impairment as a result of an injury has become stable and when no further treatment is reasonably expected to improve the condition Physician - ✔✔medical doctor, surgeon, dentist, licensed psychologist, chiro, osteopath, podiatrist or optometrist
Suitable Alternative Employement - ✔✔means employment or an actual offer of employment which the employee is physically able to perform and will not exacerbate the employee's health condition and which bears a reasonable relationship to the employee's qualifications, background, education, and training Atty fees must not exceed - ✔✔15% of lump sum Can insurer choose med provider? - ✔✔no IW can choose own providers Can report of earnings be used to delay payment - ✔✔No, they are sent periodically to IW. Helps prevent fraud Can settlements be modified? - ✔✔Yes, at any time by subsequent decree or agreement or within 10 days after comp has ceased Division of Worker's Compensation - ✔✔Monitors the WC system, ensuring that appropriate documents are filed to protect insured workers and employers. It is a division of Department of labor and training Does RI law apply if the IW is injured in another state? - ✔✔Yes, if the IW regularly works in RI Fatality must be reported w/in - ✔✔ 48 hours
How long does an injured worker have to file a claim? - ✔✔Statute of limitations is 2 yrs How long can an insurer pay compensation benefits without accepting liability (pay without prejudice or PWOP) - ✔✔ 13 weeks non prejudicial How many months of payments must be made prior to settlement - ✔✔six months How many weeks of wages do you request for a Full time employee? - ✔✔13 weeks (52 weeks for Overtime) preceding the date of disability How many weeks of wages do you request for a seasonal employee - ✔✔52 weeks prior calendar year How many weeks do you request for a part time employees? - ✔✔26 weeks preceding the date of disability What is considered part time? - ✔✔less than 20 hrs a week What is considered full time? - ✔✔More than 20 hrs a week How many weeks of payment for perm disfigurement - ✔✔no more than 500 weeks How many years must insurer pay for related medical bills? - ✔✔10 years from last date of service
What is the penalty for late report or failure to report? - ✔✔$250.00 for each refusal or neglect to make a report Waiting period for indemnity compensation - ✔✔3 days Seasonal Occupation - ✔✔occupations in which work is performed on a seasonal basis of not more than 16 weeks Occupational Disease - ✔✔a disease which is due to causes and conditions that are characteristic and peculiar to a particular trade, occupation or employment License renewal fee - ✔✔$50. no license shall remain in force for a period in excess of yrs - ✔✔ 4 years Child support liens must be confirmed within 30 days of making any payment in excess of $ - ✔✔$3000. Within how many days of an initial visit must a health care provider provide a notification of compensable injury form? - ✔✔ 3 days When is an Itemized Statement of Compensation due to the DLT? - ✔✔within 60 days after the discontinuance or suspension of compensation payments.
Total Disability means: - ✔✔Physically unable to earn any wages in any employment. If the insurer does not decide on a claim in 21 days and the IW successfully petitions, the insurer pays an additional $ - ✔✔$50. Claim for trial - ✔✔Document filed to claim trial from pre-trial order; must be filed with in five days pre-trial hearing What is exclusive remedy? - ✔✔Bars an IW that was injured on the job from making a tort liability claim against their employer The right to reinstatement of IW's employment does not apply to whom? - ✔✔-Temp workers
- seasonal workers
- a worker who works out of a hiring hall pursuant to a collective bargaining agreement
- a worker who's employer employees less than 10 workers at the time of the workers injury - a worker who is still in the 90 day probationary period What percentage of AWW is an IW paid? - ✔✔75% of spendable base wage What protects a company if an IW says an injury was caused by employer negligence - ✔✔Employers liability coverage B When are suspension receipts used - ✔✔When the IW returns to work
When can IME be arranged - ✔✔Employer can arrange for medical exams at reasonable intervals. After 26 weeks and again every 13 weeks, any person obtaining incapacity benefits may be examined by an impartial medical examiner appointed by the state. Stabilized condition, condition not likely to impact, employee refuses surgery, no indication of total disability When can vocational rehabilitation be proposed - ✔✔After 3 months of paid comp When shall retired employee not collect indemnity benefits? - ✔✔If Injury sustained less than 2 years prior to retirement Who determines if a PPN (preferred provider network) is acceptable? - ✔✔Medical Advisory Board Who handles legal disputes - ✔✔WC court Who holds jurisdiction over all medical disputes? - ✔✔WC court. Health providers may charge $20 for forms. 10% discount if bill is filed more than one week late. Bills payable within 21 days from receipt of bill True or False- The Medical Advisory Board must approve settlements - ✔✔False- settlements must be approved by the WC Court
How much can a health care provider charge to the insurer or self insured employer for timely filing of the RI state physician forms? - ✔✔$20. Employer's first report of injury must be filed within - ✔✔10 days of knowledge of injury if the injury incapacitates the IW for at least 3 days or if medical treatment was required regardless of incapacity First report of injury involving death must be filed within - ✔✔ 48 hours $250.00 Penalty may be assessed for what? - ✔✔Failure to report or late reporting What is the Non-Prejudicial Agreement - ✔✔allows for the payment of 13 weeks of wages without accepting liability If payment of compensation is terminated during the Non Prejudicial period, notice must be given to the employee or attorney within - ✔✔ 10 days of the termination Memorandum of Agreement - ✔✔if payments are made for more than 13 weeks an MOA must be filed within 10 days This form accepts liability for the claim - ✔✔Memorandum of agreement This form is only between the insurer and employee and is not submitted to the DLT - ✔✔Report of Earnings
Employees who would be excluded from workers compensation benefits - ✔✔Sole proprietors and partners, fire and police departments, independent contractors, volunteers, certain real estate persons and farm laborers waiting period - ✔✔ 3 days, no retro Burial Benefit on a regular death claim - ✔✔$15,000. Dependency - ✔✔is not paid on partial incapacity claims. $15.00 a week total incapacity $40. a week for death claim Applicants are exempt from taking the Rhode Island exam only if they are licensed in their home state and their home state is one of the following reciprocal states: - ✔✔Connecticut, Kentucky, Maine, Michigan, New Hampshire, North Carolina, Oklahoma, South Carolina, Texas, Vermont, or Wyoming Powers and duties of the insurance commissioner - ✔✔ability to rescind a license, promulgate rules and regulations, investigate violators and administer penalties
