Hawaii Workers Compensation Claims: Eligibility, Filing and Appeals

Employers with one or more employees must provide worker’s compensation insurance. Employees who work as an employee or apprentice are covered under workers’ compensation. Exempt employees include domestic employees and volunteers for religious organizations, schools and school clubs, non-profit organizations.

Employers and employees can opt out of workers compensation by contract and negotiation as long as the Workers Compensation Board Director approves the agreement and ensure that the agreement provides the required coverage and benefits.

How to file a Hawaii Workers Compensation Claim

You should report an illness, accident or injury as soon as possible after the injury occurs. You can report the date, time and details about the injury. Your employer then must file Form WC-1 (Employer’s’ Report of Industrial Injury/Illness) with the Insurer and the Worker’s Compensation division. The employer must file this report within seven days of notification of the injury.

If the employer fails to do so, you can contact the Worker’s Compensation Division directly to file Form WC-5 (Employee’s Claim for Workers’ Compensation Benefits).  This form can be obtained from your employer or the worker’s Compensation Division.

Your doctor who is providing you with medical care must fill out Form WC-2 (Physicians Report) and forward it to both the Worker’s Compensation division and the insurance carrier in order for you to begin receiving benefits.

Common Covered Work Related Injuries

Covered injuries include injuries caused by an “accident arising out of and in the course of the employment” or “disease proximately caused by or resulting from the nature of the employment.”  Willful acts by third parties based on the employee’s position are considered to be accidents arising out of the nature of employment, but willful acts arising out of personal disputes are not covered.

Injuries that occur on business trips and off-premises on coffee breaks have been found to be covered under worker’s compensation as long as the injury occurred during activity that was both reasonable and necessary during the break.

Claims for mental stress injuries resulting form good faith disciplinary actions are not covered. Claims are also not covered if the injury arose out of an employer’s willful attempt to self-injure, or when the employee was intoxicated. Death by heart attack has generally not been found to be a compensable injury unless a causal relationship between the work and the heart disease can be proven.

Workers Compensation Claim Denials

Common reasons for denial include disputes that the injury is covered, and insufficient medical evidence of a covered disability. Failure to file the appropriate forms and paperwork may also result in a denial.

Appealing a Hawaii Workers Compensation Denial

If your employer denies your workers compensation claim, you can file Form WC-5 (Employee’s Claim for Workers Compensation Benefits) with the Workers Compensation Division or the Department of Labor and Industrial Relations District office closest to your home or work location.

When the Department of Labor receives your form, the Director of the Disability Compensation Division will review the forms and documentation. You may be asked to provide additional evidence or submit to additional medical examinations. The Director will then issue a decision.

If you wish to appeal a decision by the Director of the Disability Division, you must file written notice with the Hawaii Labor and Industrial Relations Appeals Board. This board reviews decisions made by the director and holds a hearing to determine your entitlement to benefits. Prior to the hearing, the Board may request pretrial and settlement conferences in order to attempt to facilitate settlement.

If no agreement is reached, a hearing is conducted in which both sides present evidence and testimony. Finally, a written decision and order is issued following a hearing.

Hawaii Workers Compensation Benefits

Benefits include payments for the cost of medical care, temporary and permanent disability payments for loss of wage, disfigurement benefits, and death and burial benefits.

Injured workers are entitled to choose their own physician or specialist in Hawaii. The employee must provide notice of their selection to an employer, and must notify their employer before changing physicians.  You may only change physicians once without approval. Employees may not refuse medical treatment by a qualified physician, and if they do so they risk forfeiting the benefit payments for medical care.

Medical and vocational rehabilitation may also be provided. Medical rehabilitation includes access to physical therapies and other medical apparatuses designed to assist in coping with the disability or recovering from the injury. Vocational rehabilitation is rehabilitation designed to restore work skills lost as a result of the injury, or teach new work skills if the injury has made it impossible to return to the previous employment.

Temporary disability payments are paid at a rate of 66 and 2/3 percent of the workers average weekly wages.

Permanent disability payments are paid at the rate of 66 and 2/3 percent of the average weekly wages up to a state maximum. Permanent disabilities include loss of sight, loss of feet or hands, the loss of a foot and hand, a spinal injury resulting in full or partial paralysis, and a head injury resulting in insanity. Other permanent disabilities are determined on a case by cases basis.

Permanent partial disability is also paid if the worker is able to work but is permanently disabled in some fashion. The rate is calculated by multiplying the permanent disability payment times a specific number indexed to the type of permanent disability.

Hiring a Hawaii Workers Compensation Lawyer

Hiring a worker’s compensation attorney is optional, but may be advisable. A workers compensation attorney can help you to ensure you are filing the proper forms and meeting all notification requirements. A workers compensation attorney can file appeals with the Director of the Disability Division, and with the Appeals Board. Finally, an attorney can help you to facilitate settlements with your employer’s workers compensation insurer, and help you to determine what is the appropriate course of action in your particular case.

Hawaii Workers Compensation Office Locations

WC Facilitator Section
830 Punchbowl St., Room 209
Honolulu, HI 96813
Tel. (808) 586-9161

WC Insurance Section
830 Punchbowl St., Room 209
Honolulu, HI 96813
Tel. (808) 586-9166

Hearings Review Section
830 Punchbowl St., Room 209
Honolulu, HI 96813
Tel. (808) 586-9164

Hearings Branch
830 Punchbowl St., Room 209
Honolulu, HI 96813
Tel. (808) 586-9162

Voc Rehab Unit
830 Punchbowl St., Room 209
Honolulu, HI 96813
Tel. (808) 586-9171

Hawaii District Office
State Office Building
75 Aupuni St., Room 108
Hilo, HI 96720
Tel. (808) 974-6464

West Hawaii District Office
P.O. Box 49
Kealakekua, HI 96750
Tel. (808) 322-4808

Maui District Office
State Office Building, #2
2264 Aupuni St.
Wailuku, HI 96793
Tel. (808) 243-5322

Kauai District Office
3060 Eiwa St., Room 202
Lihue, HI 96766
Tel. (808) 274-3351

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