This page provides answers to the following questions:
- I had an accident at work. How do I file a workers compensation claim in my state?
- Should my employer have workers compensation insurance? How do I know I am covered?
- What are the conditions that enable me or prevent me from claiming benefits under my state's law?
- What benefits might I be eligible to receive?
- What medical benefits will workers' compensation pay for?
- How much time do I have to file my claim? What are the stages of the claim process? What should I expect?
- If I'm not happy with the determination, how do I appeal?
1. I had an accident at work. How do I file a workers compensation claim in my state?
If you are injured on the job, you should notify your supervisor and/or employer immediately and seek the appropriate medical treatment
Upon notifying your employer, your employer should complete and submit a WC-1 Form to the division within seven (7) days of your injury. If your employer fails to do so, you may complete a WC-5 Form and submit it to the division yourself.
Your employer is also expected to provide you with a copy of the Hawaii Workers' Compensation Law (Highlights) brochure within three (3) days of your injury. This pamphlet will give you a brief overview of your rights and the procedures entailed in filing a workers' compensation claim.
In order to proceed with a workers' compensation claim, your injury must be the result the work you perform at your place of employment or a result of working conditions at your place of employment. Certain fields of employment are exempted from workers' compensation laws in Hawaii. As excerpted from the Hawaii Division of Labor website, these include:
Voluntary or unpaid workers for a religious, charitable, educational or nonprofit organization; student workers performing services for a school, university or college club in return for room, board or tuition; duly ordained, commissioned or licensed minister, priest or rabbi; domestic workers earning less than $225 (cash) per calendar quarter; domestic workers of public welfare recipients; certain twenty-five (25) percent stockholders; all fifty (50) percent stockholders; and real estate salespersons and brokers paid solely on a commission basis. An employer may, however, elect to cover the excluded employees.
2. Should my employer have workers compensation insurance? How do I know if I am covered?
Any employer with one or more employees, whether full- or part-time, permanent or temporary, is expected to provide workers' compensation coverage. Although not required to purchase, most employers do purchase workers' compensation insurance from an insurance provider. The employer, however, is not permitted to force an employee to contribute to payment for premiums. Some employers prefer to become self-insured, in which case the employer may be expected to provide some proof of financial solvency to the division.
Regardless of the form of coverage your employer chooses to pursue, your employer must post information about the coverage plan, benefits, and procedures for filing a claim at your place of work that is readily accessible to all employees.
3. What are the conditions that enable me or prevent me from claiming benefits under my state's law?
In order to receive benefits under the Hawaii Workers' Compensation system, your injury must be a result of the work performed at your place of employment or as a result of the working conditions at your place of employment.
4. What benefits might I be eligible to receive?
The benefits you will be able to receive will depend on the nature and severity of your injury. Your doctor will play a large role in determining the extent of your injury, the time expected for recovery, and the extent to which you will be able to return back to work. Generally, however, workers' compensation benefits under Hawaii law will fall into the following categories:
- Medical Benefits: Cover the expenses related to treatments, services, and supplies related to your workplace injury.
- Temporary Total Disability Benefits: Wage loss compensation for the duration of time your doctor deems you are injured.
- Permanent Partial Disability Benefits: Payments related to wage losses resulting from the percentage of function and ability to work lost.
- Permanent Total Disability Benefits: Money paid to you in the event that your injury prevents you from returning back to work at all.
- Disfigurement Benefits: Money paid to you for any disfigurement caused to you by your injury. This is usually a set amount based on the type of disfigurement to a certain body part or organ.
- Death Benefits: Benefits paid to your survivors and/or dependent(s) in the event that your workplace injury results in your death.
- Vocational Rehabilitation: Services and opportunities for job placement and re-training to help you return back to work in your former field or in a new one.
5. What medical benefits will workers compensation pay for?
If your claim is accepted, workers’ compensation should pay for the following:
- Treatments for the injury.
- Hospital charges.
- Prescription drugs ordered by your doctor.
- X-rays as prescribed.
- Physical therapy as ordered by your doctor.
- Reasonable transportation expense incidental to treatment. (Keep track of your expenses and mileage.)
6. How much time do I have to file my claim? What are the stages of the claims process? What should I expect?
Upon notifying your employer of your injury, your employer should file a WC-1 form and submit it to the division within seven days of your injury. If your employer fails to do so, you may file a WC-5 form on your own behalf. Your employer and/or your employer's insurance provider will make a determination about whether to approve or deny your claim. Your claim remains open until your employer has made the final payment of benefits to you.
7. If I am not happy with the determination, how do I appeal?
If issues emerge or you are unsatisfied with the determination made, you may request a hearing with the division. A hearing will be scheduled and overseen by a hearings officer who will make a decision about your case within sixty (60) days of the hearing.
You or your employer may file an appeal within twenty (20) days of the hearings officer's determination if you remain unsatisfied. The determination at this point is considered final within the administrative proceedings of the division.
If the issues of the claim remain unresolved or your remain unsettled, you may file an appeal to the Hawaii Supreme Court within thirty (30) days of your final appeal to the division pursuant to § 12-14-49.