Workers' Compensation, RI Dept. of Labor and Training
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Workers' Compensation Proposed Forms for
30 Day Review

 
Termination of Benefits Form DWC-21
Mutual Agreement Form DWC-24
Subsequent Report of Injury Form DWC-52
Notes:
1. Period of review ends December 17, 2013.
2. Subsequent Report DWC-52, payment information section has an error. "Date Dieability Began" will be corrected to "Date Disability Began".


 
RI Department of Labor and Training
Workers' Compensation
Center General Complex
1511 Pontiac Avenue, Cranston, RI 02920


Phone: (401) 462-8100
Fax (401) 462-8105
TTY via RI Relay: 711
1/27/14 MDF
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  DLT is an equal opportunity employer/program. Auxiliary aids and services available upon request