All Rhode Island Workers Compensation forms

Workers Compensation - Agreements

• Mutual Agreement for Workers' Compensation RI-DWC-24-WC
• Non Prejudicial Agreement for Workers' Compensation RI-DWC-20-WC
• Memorandum of Agreement for Workers' Compensation RI-DWC-02-WC

Workers Compensation - Attorneys

• Workers Compensation Attorney Certification for Pro Hac Vice Admission RI-002-WC

Workers Compensation - Claims

• Workers Compensation Claim for Trial RI-003-WC
• Workers Compensation Claim of Appeal to the Appellate Division RI-001-WC
• Checklists - Worker's Compensation Claims US-04076BG

Workers Compensation - Clients

• Workers Compensation Client Certification RI-004-WC

Workers Compensation - Dependency

• Employee Certificate of Dependency for Workers' Compensation RI-DWC-04-WC

Workers Compensation - Discovery

• Claimant's First Set of Interrogatories to Employer and Carrier US-01365
• Claimant's First Set of Requests for Production US-01366
• Requests for Production of Documents to Carrier US-01367

Workers Compensation - Injury and Claims

• Notice of Work-Related Injury and Claim for Worker's Compensation US-01495BG

Workers Compensation - Injury Reports

• Report of Injury by Employee to Employer to be Filed with Worker's Compensation Agency of State US-01494BG

Workers Compensation - Insurance

• Agreement of Employee Service Provider to Maintain Workers Compensation Insurance US-01625BG

Workers Compensation - Petitions

• Miscellaneous Petition for Admission Pro Hac Vice RI-012-WC
• Petition for an Order Concerning Payment for Medical Services RI-011-WC
• Workers Compensation Petition Coversheet RI-010-WC
• Workers Compensation Original Petition RI-009-WC
• Employers Petition to Review Agreement or Decree Concerning Compensation RI-006-WC
• Employees Petition to Review and/or Amend Agreement or Decree Concerning Compensation RI-005-WC

Workers Compensation - Questionnaires

• Workers Compensation Questionnaire US-Q1038

Workers Compensation - Reports

• Report of Earnings for Workers' Compensation RI-DWC-25-WC

Workers Compensation - Requests

• Workers Compensation Request for Permission for Major Surgery RI-008-WC

Workers Compensation - Settlements

• Workers Compensation Attorney Worksheet Settlement for Lump Sum or Structural Type Payments RI-013-WC

Workers Compensation - Statements

• Itemized Statement of Compensation RI-DWC-50-WC

Workers Compensation - Stipulations

• Workers Compensation Stipulation RI-007-WC

Workers Compensation - Suspensions

• Suspension Agreement and Receipt for Workers' Compensation RI-DWC-05-WC

Workers Compensation - Wages

• Wage Transcript RI-DWC-30-WC
• Objection to Wage Transcript RI-DWC-31-WC
• Seasonal Wage Statement RI-DWC-03S-WC
• Wage Statement Part Time for Workers' Compensation RI-DWC-03P-WC
• Wage Statement for Workers' Compensation RI-DWC-03F-WC