Rhode Island Workers' Compensation

       Injured Workers Information Line: (401) 415-6136

 

 

 

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DWC_01 Employer's First Report

DWC_02 Memorandum of Agreement

DWC_03 Wage Statement Full-Time

DWC_03P Wage Statement Part-Time

DWC_03S Wage Statement Seasonal

DWC_04 Employees' Certificate

DWC_05 Suspension Agreement

DWC_20 Non-Prejudicial Agreement

DWC_22 Report of Indemnity Payment

DWC_24 Mutual Agreement

DWC_25 Report of Earnings

DWC_30 Wage Transcript

DWC_31 Employee's Objection

DWC_32 Notice to Employee 

DWC_50 Itemized Statement

DWC_51 Report of Specific Payment

Petition Coversheet

Original Petition

Employee's Petition To Review 

Employer's Petition to Review

Petition for Payment for Medical Services

Request For Major Surgery

Claim For Trial 

Appeal to the Appellate Division

Stipulation

Settlement Worksheet

Petition for Deceased Employee Benefits

 

 


 

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