Rhode Island Required Postings and Forms
The adjusting of the claims in this state are handled by Broadspire Services, Inc. Once a claim is reported to EMPLOYERS, the report will be sent to Broadspire Services, Inc. for assignment. The contact information for Broadspire Services, Inc. is:
P.O. Box 14645 Lexington, KY 40512
- Combination Poster (English, Spanish and Portuguese)
- Workers’ Compensation Compliance Poster DWC-8 (English and Spanish)
- Anti-Fraud Notice (English and Spanish)
The following forms need to be completed and submitted to EMPLOYERS when a work-related injury occurs:
- First Report of Injury (FROI) Form DWC-01. Immediate reporting is a major step in cost and time containment of any claim and is beneficial to all parties involved. Any delays in the reporting of claims can result in delayed access to medical care, which in some instances may lead to further injury, resulting in the need for additional treatment subsequently leading to higher medical costs. An injury must be reported if medical treatment is needed, if the injured worker is unable to earn full wages for at least 3 days, or if the injury is fatal. Fatalities must be reported within 48 hours and non-fatal injuries must be reported within 10 days of the employer’s knowledge. Please use this form to notify EMPLOYERS of every work-related injury or disease suffered by an employee, regardless of severity.
- Wage Statement (Full Time, Part Time or Seasonal). This form enables us to calculate the correct compensation that may be owed to your injured employee. Please complete the form and submit it to EMPLOYERS within five days after your knowledge of any accident that has caused your employee to be disabled for more than three scheduled work days. Please note the following breakout of each wage schedule:
- Full time is hired for greater than 20 hours or more per week
- Part time is hired for less than 20 hours per week
- Seasonal is hired for 16 weeks or less
- Accident Investigation Report. This basic accident form should be completed by the employee’s supervisor/manager as soon as possible after the accident. Please send the report to the following EMPLOYERS address as soon as it has been completed by the supervisor/manager: EMPLOYERS Claim Department, P.O. Box 32036, Lakeland, FL 33802-2036. You should keep a copy on file for your records.