If you are receiving weekly workers' compensation benefits, you must report any earnings you receive to the claim administrator that is paying your benefits.
Earnings: report pre-tax earnings. Include any cash, bonus, commission, and the cash value of any payment received in any form other than cash.
Work: you must report any work for any business or person, even if the business or person lost money or if profits or income were reinvested or paid to others.
Where to return: return the form to the claim administrator, not to the Department of Labor & Training.
Signature: this form must be signed, dated and returned to the Claim Administrator even if you have no earnings.
Witness: a witness to the employee's signature must sign and date the form.
| Question | Answer |
|---|---|
| Form Name | Form DWC-25 |
| Form Length | 2 pages |
| Fillable? | Yes |
| Fillable fields | 55 |
| Avg. time to fill out | 10 min |
| Other names | DWC-25, DWC25, DWC 25, DWC-25 form, Form DWC-25, Rhode Island DWC-25, RI DWC-25, Report of Earnings |
| Edition | 01/2021 |
| Issuing agency | Department of Labor and Training, Division of Workers' Compensation |
| Where to send | The claim administrator, not the Department of Labor & Training |
| Who signs | The employee, and a witness to the employee's signature |
| Official source | Form DWC-25 (Rev 01/2021), Department of Labor and Training, Division of Workers' Compensation |
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