Act Summary Poster DWC-08 (English) and DWC-08S (Spanish)
are required to display posters summarizing the major points of the Workers'
Compensation Act in conspicuous places where they can be read by workers.
The poster is available in English and in Spanish. The employer
must complete the poster with the insurer named on the workers' compensation
insurance policy and the policy effective date. Fill in the adjusting
company name if one is used. You will need Adobe Acrobat Reader
Version 4 or higher to display this form.
of Claim of Common Law Rights ("Waiver") Form DWC-11 Revised
An employee or corporate officer of an employer covered by the Workers'
Compensation Act may choose to submit this form to waive rights under the Worker' Compensation
Act and claim common law rights instead.
Notice of Claim of Common Law Rights Form
An employee submits this form to rescind a previously filed Notice of
Claim of Common Law Rights and so be covered by the Workers' Compensation
by Exempt Corporate Officer to Become Subject to Workers' Compensation
Form DWC-11C Revised
This form only applies to a person who was appointed a corporate officer
between 1/1/1999 and 12/31/2001 and was not previously an employee of
the corporation. This form allows only these corporate officers to elect
to be covered by the Workers' Compensation Act by filing this form. All
other corporate officers are covered by the Workers Compensation
of Designation as an Independent Contractor Form
Filing this form clarifies the relationship between a contractor and the
business hiring the contractor. Submitting this form means that the contractor
is not an employee of the hiring business for workers' compensation purposes.
The contractor is responsible for his own workers' compensation insurance
coverage. The hiring business is not responsible to provide workers' compensation
coverage for the independent contractor.
of Withdrawal of Designation of Independent Contractor
Form DWC 11-ICR Revised January, 2001
The purpose of this DWC-11-ICR form is to end the relationship between
a contractor and the hiring business. Submitting this form means that
the contractor is no longer independent of the hiring business named on
this form. If the contractor continues to work for this business, the
business would be responsible to provide workers' compensation coverage
for the contractor.
of Issuance, Cancellation, or Failure to Renew Policies
Insurers are required to notify the Division on issuance, renewal, cancellation,
non-renewal, or changes to workers' compensation insurance policies. This
information must be reported electronically to the Division's designated
vendor for information gathering, NCCI. For more information,
please contact The Fraud & Compliance Unit at (401) 462-8100, option
8. To contact NCCI, call (800) 622-4123 or visit their web site
Insurance Coverage Certification for Temporary Employment and Employee Leasing Companies
Form DWC 09 Revised November, 2005
This DWC-09 form is issued by the insurance company, not
by the insurance agent, to certify that a temporary or leasing agency
has RI workers' compensation insurance coverage. If the temporary or leasing
agency does not have RI coverage, the employer using or leasing the temporary
employee may be held responsible in the event of a job-related injury
to the temporary or leased employee.