PDF
Word
This version of the form is not currently in use and is provided for reference only. Download this version of
Form DWC-21
for the current year.
Form DWC-21 Termination of Benefits - Rhode Island
What Is Form DWC-21?
This is a legal form that was released by the Rhode Island Department of Labor and Training - a government authority operating within Rhode Island. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is Form DWC-21?
A: Form DWC-21 is a Termination of Benefits form in Rhode Island.
Q: Who can file Form DWC-21?
A: The employer or the insurance carrier can file Form DWC-21 to terminate an injured worker's benefits.
Q: Why would someone file Form DWC-21?
A: Form DWC-21 is filed to terminate an injured worker's benefits, typically when they are no longer eligible for compensation.
Q: What information is required in Form DWC-21?
A: Form DWC-21 requires the injured worker's name, case number, date of termination, and reason for termination.
Q: What should an injured worker do if Form DWC-21 is filed against them?
A: If Form DWC-21 is filed against an injured worker, they should consult with an attorney to understand their rights and options.
Q: Can an injured worker appeal a termination of benefits?
A: Yes, an injured worker can appeal a termination of benefits by submitting a request for a hearing with the Workers' Compensation Court.
Form Details:
- Released on December 9, 2016;
- The latest edition provided by the Rhode Island Department of Labor and Training;
- Easy to use and ready to print;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a fillable version of Form DWC-21 by clicking the link below or browse more documents and templates provided by the Rhode Island Department of Labor and Training.
Download Form DWC-21 Termination of Benefits - Rhode Island
1
2
