Claims Kit

Penalties for Late Reporting  28-32-2

Any employer who refuses or neglects to make the necessary reports required by 28-32-1 may be assessed a penalty of $250. This will be levied by the director for each refusal or neglect to make a report.

Rhode Island has added three Covid 19 codes to our online 2020 Workers' Compensation Medical Fee Schedule.

CPT Code 87635

HCPCS Codes U0001 and U0002

The WCIO has updated the Injury Description Tables that are used by the IAIABC to reflect specific coding in response to COVID-19.

(DN0037) - 83 for “Pandemic” and a new Nature of Injury Code (DN0035) - 83 for “COVID-19” were approved. The codes are anticipated to be used for the reporting for any claim effective December 2019 or later. The IAIABC recommends that EDI reporting and collection systems be modified to recognize these new codes by April 1, 2020. The new Injury Description Tables may be found on the WCIO website, Injury Description Table page at:

https://www.wcio.org/Document%20Library/InjuryDescriptionTablePage.aspx.

RIDLT will be ready to accept these new codes as recommended by the IAIABC on 4-1-2020.

Reporting of Claim by Employer  28-32-1

Every employer who is or becomes subject to the provisions of the Workers' Compensation Act must report every personal injury sustained by an employee arising out of and in the course of their employment that requires medical treatment, results in the worker's loss of full wages for a period of more than 3 days, or results in fatality. This must be provided to the director in writing as required.

If the injury is immediately fatal, the report must be made within 48 hours after it occurs. If it proves fatal at a later position, the report must be made within 48 hours after death occurs and comes to the knowledge of the employer. If the injury is not fatal, the report must be made within 10 days after the injury. If the incapacity is due to an occupational disease, the reporting period is 10 days after the incapacity becomes knowledge to the employer.

Posting Requirements  28-29-13

An employer failing to display the workers’ compensation poster faces a fine of $250. Full posting requirements are detailed here.

All employers must disclose to all prospective employees at the time of employment application that the employer is either subject to or exempt from securing workers' compensation coverage and protection. If exempt, the specific type of exemption must be disclosed. The Rhode Island Workers' Compensation Law requires employers to post a notice that includes insurer information.

Accordingly, employers must post their workers’ compensation insurer name and contact information. They should use the below prescribed forms to ensure all relevant information is readily available for any potentially injured employees.

WC Act Summary Poster - DWC-08

WC Act Summary Poster (Spanish) - DWC-08 S

Physician Selection  28-33-8

The employee may choose their first medical care provider. The worker has full medical control for the first initial provider election. Treatment at an emergency room after the accident or by a company physician, however, does not count as the first medical care provider or the worker's initial election. The first provider may refer the employee to a specialist without prior approval from the insurer. If the employee decides to change doctors, they must first determine if the employer or insurer has an approved list of physicians, otherwise known as a preferred provider network. If so, the worker must either select a physician from that preferred provider list or obtain the approval of the employer/insurer before seeing another doctor. These restrictions do not apply if the employer or insurer does not have an approved list of physicians.

No claim for care or treatment by a physician, dentist, or hospital chosen by an employee is valid and enforceable against the employer, insurer, or employee unless the physician, dentist, or hospital gives written notice of the employee's choice to the employer/insurance carrier within 15 days after the beginning of the services or treatment.