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Before filing a Notice of Designation as Independent Contractor form (DWC 11-IC)
you need to read the following information.
WARNING -- No one can force you to sign this form. Signing this form means that you
are stating you are an independent contractor NOT an employee and that in the event
of injury, you are NOT eligible for Workers’ Compensation benefits.
Many factors are considered when determining whether someone is an employee or an
independent contractor. Some of those factors are: independent contractors set their
own work hours, have their own tools and work when and for whom they choose. An
employer generally does not have to withhold or pay any taxes on payment to independent
contractors, such as Social Security, Medicare, Unemployment and Temporary Disability
Insurance (TDI).
Warning! This form is for purposes of Workers’ Compensation only and completion of
this form does not mean that you are an Independent Contractor under the rules,
regulations or statutes of the Internal Revenue Service or the R.I. Division of
Taxation. Information on this form will be shared within the Department of Labor
and Training, the RI Division of Taxation and the Internal Revenue Service.
Information about an independent contractor’s name, business name, hiring entity
and address of the hiring entity is available to the public, including the hiring
entity’s workers’ compensation insurance carrier.
SHOULD YOU HAVE ANY QUESTIONS ABOUT WHETHER YOU ARE AN INDEPENDENT CONTRACTOR OR
AN EMPLOYEE, PLEASE CONTACT THE RI DIVISION OF TAXATION AT (401) 574-8941, OR THE
US GOVERNMENT INTERNAL REVENUE SERVICE AT 800-829-1040.
IF YOU FEEL YOU HAVE BEEN COERCED OR FORCED TO SIGN THE INDEPENDENT CONTRACTOR FORM,
REPORT THIS TO THE WORKERS’ COMPENSATION FRAUD AND COMPLIANCE UNIT AT (401) 462-8100,
option 7.
When your work as an independent contractor ends with this employer, complete and
return the form titled Notice of Withdrawal of Designation as Independent Contractor,
DWC-11-ICR, to the Department of Labor and Training, Division of Workers’ Compensation.
A hiring entity that knowingly assists, aids and abets, solicits, conspires with
or coerces an employee to misrepresent the employee’s status as an independent contractor
may be subject to criminal prosecution under RIGL §28-33-17.3.
If you have any questions, contact the Division of Workers’ Compensation at (401)
462-8100, option 5. For further information, contact the Workers’ Compensation Information
Line at (401) 462-8100, option 1.
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