A. Applicant's
Obligations: An Applicant shall have the following obligations with respect to
an application for compensation:
1. The
application must be made on an application form provided by the
office;
2. The application must be
signed by the Applicant under the pains and penalties of perjury;
3. The application must be accompanied by
copies of bills and other supporting documentation necessary to verify the
application; and
4. The application
must contain a release of information necessary to investigate the
application.
B.
Continuing Obligations: An Applicant shall have a continuing obligation to:
1. provide the office with current
information relating to the application;
2. cooperate with the office in the
investigation of the application including responding promptly to all requests
for further information and verifications, and responding promptly to all
requests to exhaust other sources of reimbursement;
3. notify the office of any change in
address;
4. provide information to
the office about any civil action anticipated or filed in connection with the
crime;
5. exhaust all other sources
of payment or reimbursement for compensable expenses, and promptly notify the
office of any order for payment or eligibility for payment received or to be
received by the victim or by any of his or her dependents and relatives from
any other source, including, but not limited to:
a. life insurance, health insurance,
disability insurance or any other private or public insurance program for
personal injury or death, including lost wages;
b. workers' compensation, social security
benefits, veterans benefits, retirement benefits or other private or public
benefit program from the United States, the state of Rhode Island or any state
or any of its subdivisions;
c.
Medicaid, Medicare, community free service, charity care, free care or
uncompensated care, or any other form of public assistance to the aged and
disabled or any successor;
d.
restitution in the criminal action received from the offender or from any
person on behalf of the offender;
e. proceeds from a civil suit; or
f. institutional gifts, charitable gifts,
contributions, or donations.
6. In the event that an award has been issued
and payment has been made by the office, the Applicant and/or victim shall
promptly reimburse the violent crimes indemnity fund, to the extent of
compensation actually paid, for payments received from any other source that
exceed the total compensable injuries suffered by the victim as determined by
the Administrator.
7. In the event
that an award has been issued but payment has not been made by the office, the
office shall be entitled to withhold payment to the Applicant and/or victim
when said Applicant and/or victim has received payments from or settled any
matter with any other source as mentioned herein that exceeds the total
compensable injuries suffered by the victim as determined by the
Administrator.
C. Burden
of Proof: The Applicant has the burden of demonstrating his/her eligibility for
compensation, and his/her compensable expenses, by a preponderance of the
evidence. The Applicant must provide written documentation to establish the
facts supporting his/her application for compensation. Such documentation shall
include, where appropriate, all expenses, lost wage verifications, W-2 forms,
tax returns, death and birth certificates, and the incident report from the
appropriate law enforcement authorities.
D. Failure to Comply: An Applicant's failure
to comply with any obligation set forth in §
2.11 of this Part may result
in denial of the application for compensation.
E. Fraudulent Application: Any person who
submits a false or fraudulent application; intentionally makes or causes to be
made any false statement or representation of a material fact in relation to
any application pending before the office; or intentionally conceals or fails
to disclose information affecting the amount or the initial or continued right
to any such award shall be punished by a fine or not more than one thousand
dollars ($1,000.00) or imprisonment for not more than six (6) months, or
both.
