Claim Reporting: Policyholders can call Beacon 24 hours a
day at 1-(888) 886-4450 to report a claim. Beacon will complete the
Employer's First Report of Injury on behalf of the employer and file it with
the state. We will also and provide a copy to our policyholder and
agent. R.I. law requires completion of a First Report of Injury
within 10 days of injury or knowledge of injury/illness (48 hours in event of
fatality). A $250 fine may be assessed directly to policyholder by the State
for failure to comply.
click here to retrieve the form. However, it is the
policyholder's obligation to fill out, sign, and fax back to Beacon at
1-401-825-2980. NO First Report of Injury forms will be
accepted online at this time.
Out of state claims should be reported to 1-888-824-2234 (Argonaut). Out
of state claims are defined as any claim occurring for a business insured with
Beacon, but located out of the State of Rhode Island.
Choice of Physician: An injured worker has first choice
of medical provider. A change in provider must be with a provider from The
Beacon's Preferred Provider Network (PPN). Employers and employees should be
familiar with Beacon's PPN and rules. Copies are available at Beaconmutual.com
or from your representative.
Payment of Indemnity: Benefits are typically paid on a
weekly basis to the injured worker. The insurer has the option to pay an
injured worker up to 13 weeks without formal acceptance of liability (payment
under a Non Prejudicial Agreement or Form DWC20), or formally accept liability
(payment under a Memorandum of Agreement or Form DWC 02). The insurer also has
the right to deny liability. The employee has the right to file a claim for
benefits at the Workers' Compensation Court after 21 days following the injury,
to commence benefits or to establish liability.
Termination of Benefits: For an accepted claim, the
employee voluntarily signs a Suspension Agreement and Receipt (form DWC05). The
insurer also has the right to file a petition with the Workers' Compensation
Court to suspend/discontinue benefits. If the claim is being paid under a
Non-Prejudicial Agreement, the insurer can terminate benefits with a Report of
Indemnity Payment (DWC22). Benefits can be paid under a Non Prejudicial
Agreement for up to 13 weeks.
Weekly Benefits: Injured workers are reimbursed at a
state-mandated rate, which is approximately 75% of the net weekly wage, based
upon a calculation of an injured workers pre-injury, average weekly wage. The
employer is required to complete a state wage statement to determine the
average weekly wages. Overtime and bonuses are used in the computation of the
average weekly wage.
Maximum Weekly Rate: As of September 1, 2005, the
maximum, weekly compensation rate is $785. The maximum rate changes each
September 1. No minimum rate exists. Yearly Cost of Living adjustments are paid
for injuries classified as total disability and fatalities.
Liens: Any indemnity payment made in excess of $3,000
require Beacon to access a Child Support Database to determine, and satisfy,
outstanding liens. State T.D.I. is entitled to a lien for payments made when an
injured worker is eligible for workers' compensation.
Dependency Benefits: $15 per week for each dependent only
with payments made for total disability. The employee can never collect more
than 80% of their average weekly wage with dependency benefits. Additional
dependency benefits are paid for fatalities.
Medical Payments: Providers may bill Beacon or its
designated agent for reimbursement. Employees are reimbursed directly for
payments they may have made with an appropriate receipt for out-of-pocket
expenses, including prescription reimbursement based on guidelines and fee
Date of Incapacity: The first date an employee does not
receive wages as the result of a workplace injury.
Waiting Period: Three days, non-retroactive, as mandated
by workers' compensation laws.
Scarring And Loss of Use: Employees are entitled to
additional compensation for permanent scarring and loss of use based upon
guidelines and schedules in the RI Workers' Compensation Act. Beacon claim
representatives will initiate discussion for such when an end result is
medically determined, generally at least six months after an injury or surgery
as a result of an injury.
The "Gate": An employee can collect partial disability
benefits for up to 312 weeks (6 years). Payment of total disability benefits
does not count against the 312-week gate.
Right to Reinstatement: An employee has a right to his
regular job back for up to one year from the date of injury, with some
exceptions. The job is considered available even if it has been given to
someone else. For further information, contact your claim representative.
Modified Duty: Beacon expects employers to accommodate
the work restrictions of its injured employees and offer light duty/modified
duty employment. On some occasions, a more formal offer of Suitable Alternative
Employment may be made. For further information, contact your Beacon claim
Beacon's ergonomic consultants are available for the purpose of evaluating
specific jobs to help reduce and prevent injuries, as well as assisting
employees in successful return to light duty and regular duty work.
Second Opinions: Beacon claim representatives and nurses
will assist injured workers in obtaining a second medical opinion, to ensure
quality and appropriate treatment, when appropriate.
Independent Medical Exams: Periodically, the employee may
be asked to submit to an independent medical examination, at the insurer's
expense, for an independent opinion regarding the treatment plan, diagnosis,
and work capability. The employee is entitled to receive a copy of that report.
Report of Earnings: Employees have an affirmative duty to
report any wages earned while receiving workers' compensation benefits. An
employee is required to complete periodic Reports of Earnings (DWC 25).
Medical Management: Beacon's nurse case managers serve as
a resource to the injured worker and the claim staff, in managing our serious
and catastrophic injuries.
Subrogation: Subrogation is seeking recovery
against a responsible third party and/or its insurance carrier for benefits
paid on a workers' compensation claim. Beacon has the legal right to
pursue action against a negligent party and/or its insurance carrier for the
damages paid by Beacon.
Fraud: Please report suspected cases of employee or
employer workers' compensation fraud to the State of RI Fraud Hotline at:
1-401-462-8100, and/or Beacon's Special Investigation Unit at 1-401-825-2667.