2014 -- S 3053 SUBSTITUTE A

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LC005819/SUB A

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2014

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A N   A C T

RELATING TO LABOR AND LABOR RELATIONS - WORKERS' COMPENSATION -

GENERAL PROVISIONS

     Introduced By: Senators P Fogarty, Goodwin, Ruggerio, Ciccone, and Doyle

     Date Introduced: May 29, 2014

     Referred To: Senate Labor

     It is enacted by the General Assembly as follows:

     SECTION 1. Sections 28-33-8, 28-33-17, 28-33-17.3 and 28-33-18.3 of the General

Laws in Chapter 28-33 entitled "Workers' Compensation - Benefits" are hereby amended to read

as follows:

     28-33-8. Employee's choice of physician, dentist, or hospital -- Payment of charges --

Physician reporting schedule. -- (a) (1) An injured employee shall have freedom of choice to

obtain health care, diagnosis, and treatment from any qualified health care provider initially. The

initial health care provider of record may, without prior approval, refer the injured employee to

any qualified specialist for independent consultation or assessment, or specified treatment. If the

insurer or self-insured employer has a preferred provider network approved and kept on record by

the medical advisory board, any change by the employee from the initial health care provider of

record shall only be to a health care provider listed in the approved preferred provider network;

provided, however, that any contract proffered or maintained which restricts or limits the health

care provider's ability to make referrals pursuant to the provisions of this section, restricts the

injured employee's first choice of health care provider, substitutes or overrules the treatment

protocols maintained by the medical advisory board or attempts to evade or limit the jurisdiction

of the workers' compensation court shall be void as against public policy. If the employee seeks

to change to a health care provider not in the approved preferred provider network, the employee

must obtain the approval of the insurer or self-insured employer. Nothing contained in this

section shall prevent the treatment, care, or rehabilitation of an employee by more than one

physician, dentist, or hospital. The employee's first visit to any facility providing emergency care

or to a physician or medical facility under contract with or agreement with the employer or

insurer to provide priority care shall not constitute the employee's initial choice to obtain health

care, diagnosis or treatment.  

     (2) In addition to the treatment of qualified health care providers, the employee shall have

the freedom to obtain a rehabilitation evaluation by a rehabilitation counselor certified by the

director pursuant to § 28-33-41 in cases where the employee has received compensation for a

period of more than three (3) months, and the employer shall pay the reasonable fees incurred by

the rehabilitation counselor for the initial assessment.  

     (b)  Within three (3) days of an initial visit following an injury, the health care provider

shall provide to the insurer or self-insured employer, and the employee and his or her attorney a

notification of compensable injury form to be approved by the administrator of the medical

advisory board. Within three (3) days of the injured employee's release or discharge, return to

work, and/or recovery from an injury covered by chapters 29 - 38 of this title, the health care

provider shall provide a notice of release to the insurer or self-insured employer and the employee

and his or her attorney on a form approved by the division. A twenty dollar ($20.00) fee may be

charged by the health care provider to the insurer or self-insured employer for the notification of

compensable injury forms or notice of release forms or for affidavits filed pursuant to subsection

(c) of this section, but only if filed in a timely manner. No claim for care or treatment by a

physician, dentist, or hospital chosen by an employee shall be valid and enforceable as against his

or her employer, the employer's insurer, or the employee, unless the physician, dentist, or hospital

gives written notice of the employee's choice to the employer/insurance carrier within fifteen (15)

days after the beginning of the services or treatment. The health care provider shall in writing

submit present to the employer or insurance carrier an itemized bill and report for the services or

treatment and a final itemized bill for all unpaid services or treatment within three (3) months

after the conclusion of the treatment. The employee shall not be personally liable to pay any

physician, dentist, or hospital bills in cases where the physician, dentist, or hospital has forfeited

the right to be paid by the employer or insurance carrier because of noncompliance with this

section.  

     (c) (1) At six (6) weeks from the date of injury, then every twelve (12) weeks thereafter

until maximum medical improvement, any qualified physician or other health care professional

providing medical care or treatment to any person for an injury covered by chapters 29 - 38 of

this title shall file an itemized bill and an affidavit with the insurer, the employee and his or her

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attorney, and the medical advisory board. A ten percent (10%) discount may be taken on the

itemized bill affidavits not filed in a timely manner and received by the insurer one week or more

late. The affidavit shall be on a form designed and provided by the administrator of the medical

advisory board and shall state:

     (i) The type of medical treatment provided to date, including type and frequency of

treatment(s);  

     (ii) Anticipated further treatment including type, frequency, and duration of treatment(s),

whether or not maximum medical improvement has been reached and the anticipated date of

discharge;  

     (iii) Whether the employee can return to the former position of employment or is capable

of other work, specifying work restrictions and work capabilities of the employee;  

     (2) The affidavit shall be admissible as an exhibit of the workers' compensation court

with or without the appearance of the affiant.  

     (d)  "Itemized bill", as referred to in this section, means a completed statement of

charges, on a form CMS HCFA 1500, UB 92/94 or other form suitable to the insurer, which

includes, but is not limited to, an enumeration of specific types of care provided, facilities or

equipment used, services rendered, and appliances or medicines prescribed, for purposes of

identifying the treatment given the employee with respect to his or her injury.  

     (e) (1) The treating physician shall furnish to the employee, or to his or her legal

representative, a copy of his or her medical report within ten (10) days of the examination date.  

     (2) The treating physician shall notify the employer, and the employee and his or her

attorney immediately when an employee is able to return to full or modified work.  

     (3) There shall be no charge for a health record when that health record is necessary to

support any appeal or claim under the Workers' Compensation Act § 23-17-19.1(16). The treating

physician shall furnish to the employee, or to his or her legal representative, a medical report,

within ten (10) days of the request, stating the diagnosis, disability, loss of use, end result and/or

causal relationship of the employee's condition associated with the work related injury. The

physician shall be entitled to charge for these services only as enunciated in the State of Rhode

Island workers compensation medical fee schedule.  

     (f) (1)  Compensation for medical expenses and other services under § 28-33-5, 28-33-

7 or 28-33-8 is due and payable within twenty-one (21) days from the date a request is payment is

not made within twenty-one (21) days from the date a request is made for payment, the provider

of medical services may add, and the insurer or self-insurer shall pay, interest at the per annum

rate as provided in § 9-21-10 on the amount due. The employee or the medical provider may file

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a petition with the administrator of the workers' compensation court which petition shall follow

the procedure as authorized in chapter 35 of this title.  

     (2) The twenty-one (21) day period in subdivision (1) of this subsection and in § 28-35-

12 shall begin on the date the insurer receives a request with appropriate documentation required

to determine whether the claim is compensable and the payment requested is due.

     28-33-17. Weekly compensation for total incapacity -- Permanent total disability --

Dependents' allowances. -- (a) (1) While the incapacity for work resulting from the injury is

total, the employer shall pay the injured employee a weekly compensation equal to seventy-five

percent (75%) of his or her average weekly spendable base wages, earnings, or salary, as

computed pursuant to the provisions of § 28-33-20. The amount may not exceed more than sixty

percent (60%) of the state average weekly wage of individuals in covered employment under the

provisions of the Rhode Island Employment Security Act as computed and established by the

Rhode Island department of labor and training, annually, on or before May 31 of each year, under

the provisions of  § 28-44-6(a). Effective September 1, 1974, the maximum rate for weekly

compensation for total disability shall not exceed sixty-six and two-thirds percent (662/3%) of the

state average weekly wage as computed and established under the provisions of § 28-44-6(a).

Effective September 1, 1975, the maximum rate for weekly compensation for total disability shall

not exceed one hundred percent (100%) of the state average weekly wage as computed and

established under the provisions of § 28-44-6(a). Effective September 1, 2007, the maximum rate

for weekly compensation for total disability shall not exceed one hundred fifteen percent (115%)

of the state average weekly wage as computed and established under the provisions of § 28-44-

6(a). Effective October 1, 2016, the maximum rate for weekly compensation for total disability

shall not exceed one hundred twenty percent (120%) of the state average weekly wage as

computed and established under the provisions of § 28-44-6(a) and effective October 1, 2017, the

maximum rate for weekly compensation for total disability shall not exceed one hundred twenty -

five percent (125%) of the state average weekly wage as computed and established under the

provisions of § 28-44-6(a). If the maximum weekly benefit rate is not an exact multiple of one

dollar ($1.00), then the rate shall be raised to the next higher multiple of one dollar ($1.00).  

     (2) The average weekly wage computed and established under § 28-44-6(a) is applicable

to injured employees whose injury occurred on or after September 1, 2000, and shall be

applicable for the full period during which compensation is payable.  

     (3) (i) "Spendable earnings" means the employee's gross average weekly wages, earnings,

or salary, including any gratuities reported as income, reduced by an amount determined to reflect

amounts which would be withheld from the wages, earnings, or salary under federal and state

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income tax laws, and under the Federal Insurance Contributions Act (FICA), 26 U.S.C.  3101 et

seq., relating to social security and Medicare taxes. In all cases, it is to be assumed that the

amount withheld would be determined on the basis of expected liability of the employee for tax

for the taxable year in which the payments are made without regard to any itemized deductions

but taking into account the maximum number of personal exemptions allowable.  

     (ii) Each year, the director shall publish tables of the average weekly wage and seventy-

five percent (75%) of spendable earnings that are to be in effect on May 10. These tables shall be

conclusive for the purposes of converting an average weekly wage into seventy-five percent

(75%) of spendable earnings. In calculating spendable earnings the director shall have discretion

to exempt funds assigned to third parties by order of the family court pursuant to § 8-10-3 and

funds designated for payment of liens pursuant to  § 28-33-27 upon submission of supporting

evidence.  

     (b) (1) In the following cases, it shall for the purpose of this section be that the injury

resulted in permanent total disability:  

     (i) The total and irrecoverable loss of sight in both eyes or the reduction to one-tenth

(1/10th) or less of normal vision with glasses;  

     (ii) The loss of both feet at or above the ankle;  

     (iii) The loss of both hands at or above the wrist;  

     (iv) The loss of one hand and one foot;  

     (v) An injury to the spine resulting in permanent and complete paralysis of the legs or

arms; and  

     (vi) An injury to the skull resulting in incurable imbecility or insanity.  

     (2) In all other cases, total disability shall be determined only if, as a result of the injury,

the employee is physically unable to earn any wages in any employment; provided, that in cases

where manifest injustice would otherwise result, total disability shall be determined when an

employee proves, taking into account the employee's age, education, background, abilities, and

training, that he or she is unable on account of his or her compensable injury to perform his or her

regular job and is unable to perform any alternative employment. The court may deny total

disability under this subsection without requiring the employer to identify particular alternative

employment.  

     (c) (1)  Where the employee has persons conclusively presumed to be dependent upon

him or her or in fact so dependent, the sum of fifteen dollars ($15.00) shall be added to the

weekly compensation payable for total incapacity for each person wholly dependent on the

employee, except that the sum of forty dollars ($40.00) shall be added for those receiving benefits

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under § 28-33-12, but in no case shall the aggregate of those amounts exceed eighty percent

(80%) of the average weekly wage of the employee, except that there shall be no limit for those

receiving benefits under § 28-33-12.  

     (2) The dependency allowance shall be in addition to the compensation benefits for total

disability otherwise payable under the provisions of this section. The dependency allowance shall

be increased if the number of persons dependent upon the employee increases during the time that

weekly compensation benefits are being received.  

     (3) For the purposes of this section the following persons shall be conclusively presumed

to be wholly dependent for support upon an employee:  

     (i) A wife upon a husband with whom she is living at the time of his injury, but only

while she is not working for wages during her spouse's total disability.  

     (ii) A husband upon a wife with whom he is living at the time of her injury, but only

while he is not working for wages during his spouse's total disability.  

     (iii) Children under the age of eighteen (18) years, or over that age but physically or

mentally incapacitated from earning, if living with the employee, or, if the employee is bound or

ordered by law, decree, or order of court, or by any other lawful requirement, to support the

children, although living apart from them. Provided, that the payment of dependency benefits to a

dependent child over the age of eighteen (18) years shall continue as long as that child is

satisfactorily enrolled as a full-time student in an educational institution or an educational facility

duly accredited or approved by the appropriate state educational authorities at the time of

enrollment. Those payments shall not be continued beyond the age of twenty-three (23) years.

"Children," within the meaning of this paragraph, also includes any children of the injured

employee conceived but not born at the time of the employee's injury, and the compensation

provided for in this section shall be payable on account of any such children from the date of their

birth.  

     (d) "Dependents," as provided in this section, does not include the spouse of the injured

employee except as provided in paragraphs (c)(3)(i) and (ii) of this section. In all other cases

questions of dependency shall be determined in accordance with the facts as the facts may be at

the time of the injury.  

     (e) The court or any of its judges may in its or his or her discretion order the insurer or

self-insurer to make payment of the nine dollars ($9.00) or fifteen dollars ($15.00) for those

receiving benefits under § 28-33-12 directly to the dependent.  

     (f) (1) Where any employee's incapacity is total and has extended beyond fifty-two (52)

weeks, regardless of the date of injury, payments made to all totally incapacitated employees shall

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be increased as of May 10, 1991, and annually on the tenth of May after that as long as the

employee remains totally incapacitated. The increase shall be by an amount equal to the total

percentage increase in annual consumer price index, United States city average for urban wage

earners and clerical workers, as formulated and computed by the bureau of labor statistics of the

United States Department of Labor for the period of March 1 to February 28 each year.  

     (2) If the employee is subsequently found to be only partially incapacitated, the weekly

compensation benefit paid to the employee shall be equal to the payment in effect prior to his or

her most recent cost of living adjustment.  

     (3) "Index" as used in this section refers to the consumer price index, United States city

average for urban wage earners, clerical workers, as that index is formulated and computed by the

Bureau of Labor Statistics of the United States Department of Labor.  

     (4) The May 10, 1991 increase shall be based upon the total percentage increase, if any,

in the annual consumer price index for the period of March 1, 1990 to February 28, 1991.

Thereafter, increases shall be made on May 10 annually, based upon the percentage increase, if

any, in the index for the period March 1 to February 28.  

     (5) The computations in this section shall be made by the director of labor and training

and promulgated to insurers and employers making payments required by this section. Increases

shall be paid by insurers and employers without further order of the court. If payment payable

under this section is not paid within fourteen (14) days after the employer or insurer has been

notified or it becomes due, whichever is later, there shall be added to the unpaid payment an

amount equal to twenty percent (20%) of that amount, which shall be paid at the same time as,

but in addition to the payment.  

     (6) This section applies only to payment of weekly indemnity benefits to employees as

described in subdivision (1) of this subsection, and does not apply to specific compensation

payments for loss of use or disfigurement or payment of dependency benefits or any other

benefits payable under the Workers' Compensation Act.  

     (7) Notwithstanding any other provision of the general law or public laws to the contrary,

any employee of the state of Rhode Island who is receiving workers' compensation benefits for

total incapacity, as a result of brain injury due to a violent assault, on or before July 19, 2005,

shall be entitled to receive the health insurance benefit he or she was entitled to at the time of the

injury for the duration of the total incapacity or until said employee and his or her spouse are both

eligible for Medicare.

     28-33-17.3. Fraud and abuse. -- (a) (1) The workers' compensation court is authorized

and directed to impose sanctions and penalties necessary to maintain the integrity of and to

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maintain the high standards of professional conduct in the workers' compensation system. All

pleadings related to proceedings under chapters 29 - 38 of this title shall be considered an

attestation by counsel that valid grounds exist for the position taken and that the pleading is not

interposed for delay.  

     (2) If any judge determines that any proceedings have been brought, prosecuted, or

defended by an employer, insurer, or their counsel without reasonable grounds, then:  

     (i) The whole cost of the proceedings shall be assessed upon the employer, insurer, or

counsel, whoever is responsible; and  

     (ii) If a subsequent order requires that additional compensation be paid, a penalty of

double the amount of retroactive benefits ordered shall be paid to the employee and the penalty

shall not be included in any formula utilized to establish premium rates for workers'

compensation insurance.  

     (3) If any judge determines that any proceedings have been brought or defended by an

employee or his or her counsel without reasonable grounds, the whole cost of the proceedings

shall be assessed against the employee or counsel, whoever is responsible.  

     (4) The court shall determine whether an action or defense is frivolous or conduct giving

rise to the action or defense was unreasonable. Where the amount at issue is less than the actual

attorneys' fees of the parties combined, the court shall exercise particular vigilance. Nothing in

this subsection, however, is intended to discourage prompt payment in full of all amounts

required to be paid.  

     (5) The appropriate body with professional disciplinary authority over the attorney shall

be notified of the action.  

     (6) Where any party intentionally and unreasonably utilizes the twenty-one (21) day

demand process of § 28-35-12 in order to harass or hinder any opposing entity, the cost of the

proceedings shall be assessed against the party, in the discretion of the trial judge, in accordance

with subsection (a) herein.

     (b) (1) It is unlawful to do any of the following:  

     (i) Make or cause to be made any knowingly false or fraudulent material statement or

material representation for the purpose of obtaining or denying any compensation;  

     (ii) Present or cause to be presented any knowingly false or fraudulent written or oral

material statement in support of, or in opposition to, any claim for compensation or petition

regarding the continuation, termination, or modification of benefits;  

     (iii) Knowingly assist, aid and abet, solicit, or conspire with any person who engages in

an unlawful act under this section;  

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     (iv) Make or cause to be made any knowingly false or fraudulent statements with regard

to entitlement to benefits with the intent to discourage an injured worker from claiming benefits

or pursuing a claim;  

     (v) Willfully misrepresent or fail to disclose any material fact in order to obtain workers'

compensation insurance at less than the proper rate for the insurance including, but not limited to,

intentionally misleading or failing to disclose information to an insurer regarding the appropriate

rate classification of an employee;  

     (vi) Willfully fail to provide a lower rate adjustment favorable to an employer as required

by an approved experience rating plan or regulations promulgated by the insurance

commissioners;  

     (vii) Willfully fail to report or provide false or misleading information regarding

ownership changes as required by an approved experience rating plan or regulations promulgated

by the insurance commissioner; or  

     (viii) Knowingly assist, aid and abet, solicit or conspire to coerce an employee to

willfully misrepresent an employee's status as a shareholder, director or officer of a corporation,

or as a member or manager of a limited liability company, or as a partner, in a general or, limited

partnership, registered limited liability partnership or a registered limited liability limited

partnership, or as an independent contractor for the purpose of avoiding the inclusion of that or

other employees in a workers' compensation insurance application, renewal or both.  

     (2) For the purposes of this section, "Statement" includes, but is not limited to, any

endorsement of a benefit check, application for insurance coverage, oral or written statement,

proof of injury, bill for services, diagnosis, prescription, hospital or provider records, x-rays, test

results, or other documentation offered as proof of, or in the absence of, a loss, injury, or

expense.  

     (3) If it is determined that any person concealed or knowingly failed to disclose that

which is required by law to be revealed, knowingly gave or used perjured testimony or false

evidence, knowingly made a false statement of fact, participated in the creation or presentation of

evidence which he or she knows to be false, or otherwise engaged in conduct in violation of

subdivision (1) of this subsection, that person shall be subject in criminal proceedings to a fine

and/or penalty not exceeding fifty thousand dollars ($50,000), or double the value of the fraud,

whichever is greater, or by imprisonment up to five (5) years in state prison or both.  

     (4) There shall be a general amnesty until July 1, 1992 for any person receiving

compensation under chapters 29 - 38 of this title, to the extent compensation has been voluntarily

reduced or relinquished by the employee prior to that date.  

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     (c)  The director of labor and training shall establish a form, in consultation with the

attorney general, to be sent to all workers who are presently receiving benefits and those for

whom first reports of injury are filed in the future which shall give the employee notice that the

endorsement of a benefit check sent pursuant to § 28-35-39 is the employee's affirmation that he

or she is qualified to receive benefits under the Workers' Compensation Act. The insurers and

self-insured employers are directed to send the form to all workers receiving benefits.  

     (d)  Any employer, or in any case where the employer is a corporation, the president, vice

president, secretary, treasurer, and other officers of the corporation, or in any case where the

employer is a limited liability company, the managers, and the managing members or in any case

where the employer is a general partnership or a registered limited liability partnership, or in the

case where the employer is a limited partnership or a registered limited liability limited

partnership, the partners, that are found to have violated this section or § 28-36-15, shall be guilty

of a felony for failure to secure and maintain compensation, and upon conviction, shall be subject

to imprisonment of up to two (2) years, a fine not exceeding ten thousand dollars ($10,000), or

both. In any case where the employer is a corporation, the president, vice president, secretary,

treasurer, and other officers of the corporation, shall be severally liable for the fine or subject to

imprisonment, or both. In any case where the employer is a limited liability company, the

managers and managing members shall be severally liable for the fine or subject to imprisonment,

or both. In any case where the employer is a partnership or a registered limited liability

partnership, the partners shall be severally liable for the fine or subject to imprisonment, or both.

In any case where the employer is a limited partnership or a registered limited liability limited

partnership, the general partners shall be severally liable for the fine or subject to imprisonment,

or both.

     28-33-18.3. Continuation of benefits -- Partial incapacity. -- (a) (1) For all injuries

occurring on or after September 1, 1990, in those cases where the employee has received a notice

of intention to terminate partial incapacity benefits pursuant to § 28-33-18, the employee or his or

her duly authorized representative may file with the workers' compensation court a petition for

continuation of benefits on forms prescribed by the workers' compensation court. In any

proceeding before the workers' compensation court on a petition for continuation of partial

incapacity benefits, where the employee demonstrates by a fair preponderance of the evidence

that his or her partial incapacity poses a material hindrance to obtaining employment suitable to

his or her limitation, partial incapacity benefits shall continue. For injuries on and after July 1,

2016 2018, "material hindrance" is defined to include only compensable injuries causing a greater

than sixty-five percent (65%) degree of functional impairment and/or disability. Any period of

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time for which the employee has received benefits for total incapacity shall not be included in the

calculation of the three hundred and twelve (312) week period.  

     (2) The provisions of this subsection apply to all injuries from Sept. 1, 1990, to July 1,

2016 2018.  

     (b) (1) Where any employee's incapacity is partial and has extended for more than three

hundred and twelve (312) weeks and the employee has proved an entitlement to continued

benefits under subsection (a) of this section, payments made to these incapacitated employees

shall be increased annually on the tenth (10th) day of May thereafter so long as the employee

remains incapacitated. The increase shall be by an amount equal to the total percentage increase

in the annual consumer price index, United States city average for urban wage earners and

clerical workers, as formulated and computed by the Bureau of Labor Statistics of the United

States Department of Labor for the period of March 1 to February 28 each year.  

     (2) "Index" as used in this section refers to the consumer price index, United States city

average for urban wage earners and clerical workers, as that index was formulated and computed

by the Bureau of Labor Statistics of the United States Department of Labor.  

     (3) The annual increase shall be based upon the percentage increase, if any, in the

consumer price index for the month of a given year, over the index for February, the previous

year. Thereafter, increases shall be made on May 10 annually, based upon the percentage

increase, if any, in the consumer price index for the period of March 1 to February 28.  

     (4) The computations in this section shall be made by the director of labor and training

and promulgated to insurers and employers making payments required by this section. Increases

shall be paid by insurers and employers without further order of the court. If payment payable

under this section is not mailed within fourteen (14) days after the employer or insurer has been

notified by publication in a newspaper of general circulation in the state it becomes due, there

shall be added to the unpaid payment an amount equal to twenty percent (20%) of it, to be paid at

the same time as but in addition to the payment.  

     (5) This section applies only to payment of weekly indemnity benefits to employees as

described in subdivision (1) of this subsection, and does not apply to specific compensation

payments for loss of use or disfigurement or payment of dependency benefits or any other

benefits payable under the Workers' Compensation Act.  

     (c)  No petitions for commutation shall be allowed or entertained in those cases where an

employee is receiving benefits pursuant to this section.

     SECTION 2. Section 28-35-12 of the General Laws in Chapter 28-35 entitled "Workers'

Compensation - Procedure" is hereby amended to read as follows:

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     28-35-12. Petition for determination of controversy -- Contents and filing. -- (a) In

all disputes between an employer and employee in regard to compensation or any other obligation

established under chapters 29 - 38 of this title, and when death has resulted from the injury and

the dependents of the deceased employee entitled to compensation are, or its apportionment

among them is, in dispute, any person in interest or his or her duly authorized representative may

file with the administrator of the workers' compensation court a petition prescribed by the court,

setting forth the names and residences of the parties, the facts relating to employment at the time

of injury, the cause, extent, and character of the injury, the amount of wages, earnings, or salary

received at the time of the injury, and the knowledge of the employer of notice of the occurrence

of the injury, and any other facts that may be necessary and proper for the information of the

court, and shall state the matter in dispute and the claims of the petitioner with reference to it;

provided, that no petition shall be filed within twenty-one (21) days of the date of the injury and

no petition regarding any other obligation established under chapters 29 - 38 of this title shall be

filed until twenty-one (21) days after written demand for payment upon the employer or insurer

or written notice to the employer or insurer of failure to fulfill the obligation, except that any

petition alleging the non-payment or late payment of weekly compensation benefits, attorneys'

fees, and costs, may be filed after fourteen (14) days from the date the payment is due as set forth

in §§ 28-35-42, 28-35-43, and 28-35-20(c). All demands seeking payment of bills for medical

services rendered shall include reference to a claim number or a legible copy of the agreement,

order, and/or decree, if appropriate, establishing liability. Medical bills for services ordered paid

by decree or pretrial order shall be paid within fourteen (14) days of the entry of the decree or

order. In the event that the bills are not paid within the fourteen (14) day period, a petition may be

filed to enforce said order or decree without any additional written notice to the employer or

insurer.  

     (b) (1)  If one or more claims are filed for an injury and there are two (2) or more

insurers, any one of which may be held to be liable to pay compensation, and the judge

determines that the injured employee would be entitled to receive compensation but for the

existence of a controversy as to which one of the insurers is liable to pay compensation, one of

the insurers shall be selected by a judge of the workers' compensation court, to pay to the injured

employee the compensation, pending a final decision of the workers' compensation court as to the

matter in controversy, and that decision shall require that the amount of compensation paid shall

be deducted from the award if made against another insurer and shall be paid by that other insurer

to the insurer selected by the judge.  

     (2) The workers' compensation court shall award compensation, costs, and attorneys' fees

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in its discretion if one of the insurers is held to be liable following the hearing.  

     (c)  If any determination of the workers' compensation court entitles an employee to

retroactive payment of weekly benefits, the court shall award to the employee interest at the rate

per annum provided in § 9-21-10 on that retroactive weekly payment from six (6) months

subsequent to the date that the employee first filed a petition for benefits to the time when that

retroactive payment is actually made. If the proceedings are unduly delayed by or at the request

of the employee or his or her attorney, the judge may reduce or eliminate interest on retroactive

payment; provided, that the provisions of this section as they relate to interest shall apply only to

petitions filed on or after July 1, 1984.  

     (d)  Any fine, penalty, or interest expense incurred by an insurer under this section may

not be used as an expense for the purpose of seeking a rate increase before the department of

business regulation.

     SECTION 3. Sections 28-53-2 and 28-53-7 of the General Laws in Chapter 28-53

entitled "Rhode Island Uninsured Employers Fund" are hereby amended to read as follows:

     28-53-2. Establishment -- Sources -- Administration. -- (a) There shall be established

within the department of labor and training a special restricted receipt account to be known as the

Rhode Island uninsured employers fund. The fund shall be capitalized from excise taxes assessed

against uninsured employers pursuant to the provisions of § 28-53-9 of this chapter and from

general revenues appropriated by the legislature. Beginning in state fiscal year ending June 30,

2015 2016, the legislature may appropriate up to two million dollars ($2,000,000) in general

revenue funds annually for deposit into the Rhode Island uninsured employers fund.  

     (b)  All moneys in the fund shall be mingled and undivided. The fund shall be

administered by the director of the department of labor and training or his or her designee, but in

no case shall the director incur any liability beyond the amounts paid into and earned by the

fund.  

     (c)  All amounts owed to the uninsured employers fund from illegally uninsured

employers are intended to be excise taxes and as such, all ambiguities and uncertainties are to be

resolved in favor of a determination that such assessments are excise taxes.

     28-53-7. Payments to employees of uninsured employers. -- (a) Where it is determined

that the employee was injured in the course of employment while working for an employer who

fails to maintain a policy of workers' compensation insurance as required by Rhode Island general

laws § 28-36-1, et seq., the uninsured employers fund shall pay the benefits to which the injured

employee would be entitled pursuant to chapters 29 to 38 of this title subject to the limitations set

forth herein.  

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     (b)  The workers' compensation court shall hear all petitions for payment from the fund

pursuant to Rhode Island general laws § 28-30-1, et seq., provided, however, that the uninsured

employers fund and the employer shall be named as parties to any petition seeking payment of

benefits from the fund.  

     (c)  Where an employee is deemed to be entitled to benefits from the uninsured

employers fund, the fund shall pay benefits for disability and medical expenses as provided

pursuant to chapters 29 to 38 of this title except that the employee shall not be entitled to receive

benefits for loss of function and disfigurement pursuant to the provisions of Rhode Island general

laws § 28-33-19.  

     (d)  The fund shall pay cost, counsel and witness fees as provided in Rhode Island

general laws § 28-35-32 to any employee who successfully prosecutes any petitions for

compensation, petitions for medical expenses, petitions to amend a pretrial order or memorandum

of agreement and all other employee petitions and to employees who successfully defend, in

whole or in part, proceedings seeking to reduce or terminate any and all workers' compensation

benefits; provided, however, that the attorney's fees awarded to counsel who represent the

employee in petitions for lump sum commutation filed pursuant to Rhode Island general laws

§ 28-33-25 or in the settlement of disputed cases pursuant to Rhode Island general laws § 28-33-

25.1 shall be limited to the maximum amount paid to counsel who serve as court appointed

attorneys in workers' compensation proceedings as established by rule or order of the Rhode

Island supreme court.  

     (e)  In the event that the uninsured employer makes payment of any monies to the

employee to compensate the employee for lost wages or medical expenses, the fund shall be

entitled to a credit for all such monies received by or on behalf of the employee against any future

benefits payable directly to the employee.  

     (f)  This section shall apply to injuries that occur on or after January 1, 2015 2016.

     SECTION 4. Section 36-10-31 of the General Laws in Chapter 36-10 entitled

"Retirement System-Contributions and Benefits" is hereby amended to read as follows:

     36-10-31. Deduction of amounts received from workers' compensation or as

damages. -- Any amount paid or payable under the provisions of any workers' compensation law

exclusive of Medicare set-aside allocations, specific compensation benefits or any benefits

authorized by the terms of a collective bargaining agreement or as the result of any action for

damages for personal injuries against the state of Rhode Island on account of the death or

disability of a member shall be offset against and payable in lieu of any benefits payable out of

funds provided by the state under the provisions of this chapter on account of the death or

LC005819/SUB A - Page 14 of 16

disability of the member. If the value of the total commuted benefits under any workers'

compensation law or action is less than the present value on an actuarial basis of the benefits

otherwise payable under this chapter, the value of the commuted payments shall be deducted

from the present value of the benefits and the balance thereof shall be payable under the

provisions of this chapter.

     SECTION 5. This act shall take effect upon passage.

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LC005819/SUB A - Page 15 of 16

EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO LABOR AND LABOR RELATIONS - WORKERS' COMPENSATION -

GENERAL PROVISIONS

***

     This act would make various changes to the procedure, and administration of the Rhode

Island workers' compensation court.

     This act would take effect upon passage.

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LC005819/SUB A

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