Rhode Island's system of workers' compensation is compulsory, meaning that employers are required to provide workers' compensation insurance to their employees. Workers' compensation insurance may be provided through private insurance carriers, a competitive state fund, or self-insurance. Waivers may be permitted to exclude certain employees from coverage, including corporate officers.
Exemptions from coverage may apply to certain employees, including some agricultural workers, domestic employees, and casual labor.
Medical Benefits are provided to employees entitled to workers' compensation benefits, including coverage for necessary medical care. Once the injured worker reaches maximum medical improvement (MMI) limits are imposed on palliative care, and additional care must be authorized by the employer or workers' compensation insurance company.
The employee makes the initial choice of treating physician. If care is provided through a PPO, the employee may change the treating physician to another doctor within the network.
Indemnity benefits are payable to injured workers to help make up for lost income. There is a waiting period of 3 days before a worker is eligible for indemnity benefits.
Benefits available to injured workers include the following:
Temporary Total Disability (TTD)
Temporary total disability (TTD) benefits are paid to workers who are unable to work due to injury, but who are expected to make full or partial recovery such that they may return to work. Benefits are based upon 75% of the worker's after-tax take-home pay, subject to a cap, and continue for the duration of the temporary disability. Offsets may apply if the injured worker is receiving retirement benefits.
Permanent Total Disability (PTD)
When a worker is not expected to recover from a total disability caused by a work-related injury, and as a result suffers a total loss of earning capacity, the worker becomes eligible for permanent total disability (PTD) benefits. In Rhode Island PTD benefits are calculated based upon 75% of the after-tax net weekly earnings, subject to a cap, and may continue for life. Benefits are periodically adjusted for inflation. Offsets may apply for retirement benefits.
Permanent Partial Disability (PPD)
Once an injured worker has recovered to the maximum possible extent, the worker may be able to return to employment but nonetheless remain partially disabled, and in most states may potentially qualify for permanent partial disability (PPD) benefits. Under Rhode Island's odd lot doctrine, an injured worker who is partially disabled may qualify for TTD benefits based upon a determination that the worker is effectively totally disabled due to a combination of the injury with factors such as the worker's age, occupation and education.
Temporary Partial Disability (TPD)
When a worker suffers an injury that limits his ability to return to work, resulting in a reduction of income as a result of reduced hours or wages, the injured worker may be eligible to receive a benefit based on the difference between the worker's pre-injury earnings and their reduced, post-injury earnings. In Rhode Island, TPD benefits are paid based upon 75% of the difference between the injured worker's pre-injury and post-injury wage, subject to a cap. Benefits may be payable for up to 312 weeks.
For some, more serious injuries, workers' compensation indemnity benefits may be paid according to a statutory schedule, instead of following the standard model of the weekly benefit based on the duration of the disability. Scheduled injuries include such injuries as the amputation of an arm, the loss of a dominant hand, the loss of a leg, the loss of a foot, the loss of an eye, or loss of hearing in an ear.
Coverage may be available for cumulative trauma, disfigurement, mental stress and occupational hearing loss.
When a worker dies as the result of a work-related injury, workers' compensation pays additional benefits, including a burial allowance, and benefits for a surviving spouse and dependents. Survivor benefits are calculated based the benefits awarded for total disability, subject to a cap in amount. Benefits may continue for minors until the age of 18, the age of 23 if the dependent is a student, or indefinitely in the event of disability. Spousal benefits end upon remarriage, with the payments going to any remaining dependents.
If a deceased worker has no dependents, an additional amount is paid to the estate.
Fees are determined by the judge or by agreement of the parties, and are not to exceed 20% of the recovery.
This article provides a quick overview of the benefits available to injured workers, but the full formulas used for assessment of benefits, coordination of different types of benefits, and assessment of injuries and disability ratings can quickly complicate the determination of benefits. Also, states frequently revise their workers' compensation laws. Most workers who suffer a significant injury or wage loss as the result of a workplace injury will benefit from consulting a workers' compensation lawyer.
The state agency responsible for workers' compensation is:
Rhode Island Department of Labor & Training
Division of Workers' Compensation
1511 Pontiac Ave., Building 71-1, 1st Floor
P. O. Box 20190
Cranston, RI 02920-0942