WHO IS ELIGIBLE FOR WC BENEFITS?
- Most employees who suffer from any injury or illness, which results from work or working conditions, are covered. However, under the law, certain kinds of employees are not covered as described above in WHO IS REQUIRED TO PROVIDE WC COVERAGE?
- Hawaii's federal workers must file their WC claim through the Office of Workers' Compensation Programs (OWCP), U. S. Department of Labor, District No.13, 71 Stevenson Street, Box 3769, San Francisco, CA 94119-3769. The phone number is (415) 744-6610.
HOW DO I FILE A WC CLAIM?
- If you are injured on the job, you should report the date, time and circumstances of your injury immediately to your employer or supervisor. Your employer should file Form WC-1, "Employer's Report of Industrial Injury/Illness" with its WC carrier and this Division within seven working days after the employer has knowledge of the injury causing absence from work for one day or more or requiring medical treatment beyond ordinary first aid.
- If your employer fails to file Form WC-1, you should contact this Division or on the neighbor-island, the nearest Department of Labor and Industrial Relations District Office and file Form WC-5, "Employee's Claim for Workers' Compensation Benefits."
- Each employer shall post and maintain in places readily accessible to employees a printed statement concerning benefit rights, claims for benefits, and such other matters relating to the administration of the workers' compensation law. Each employer shall furnish within three working days of notice of injury to each injured employee a copy of the brochure, Highlights of the Hawaii Workers’ Compensation Law.
FROM WHOM CAN I OBTAIN MEDICAL TREATMENT?
- You may obtain medical treatment from a physician of your choice. However, you may be under the care of only one attending physician. Your attending physician may refer you to other specialist(s) with the approval of your employer's insurance carrier.
- You may change your attending physician once, but you must notify the insurance carrier before making the change. Any other changes in attending physician require approval from the insurance carrier before the change. You should tell your physician that this is an industrial injury. Ask the physician to send the medical reports and bills to your employer's insurance carrier. You should be able to obtain the name of your employer's insurance carrier from your employer.
- Within seven days after the date of first attendance or services rendered, any physician, surgeon or hospital shall make an initial report, Form WC-2, "Physician's Report" to this Division and the insurance carrier and at appropriate intervals to verify your continued treatment.
- If your claim is accepted, the WC carrier should pay for all required medical care, services, and supplies, as the nature of the injury reasonably requires.
- If your physician does not have Form WC-2, "Physician's Report," you may give him a copy.
WHAT TYPES OF WC BENEFITS ARE AVAILABLE?
1. Temporary Total Disability (TTD)
- If you are unable to work because of an industrial injury, after a three-day waiting period, you may receive temporary wage replacement benefits equal to 66 2/3% of your average weekly wage, but no more than the maximum weekly benefit amount annually set by this Division.
- The weekly compensation for TTD is set and fixed according to your wages or the maximum amount existing the year you were first injured. For example, the maximum weekly benefit amount for the year 2008 is $696.00. In other words, if you were injured anytime in 2008, your weekly TTD benefit payment will either be two thirds of your average weekly wages or $696.00, whichever is less.
2. Permanent Partial Disability (PPD)
- After you reach the point of stability or maximum medical recovery, you may be sent to a physician to evaluate the extent of your permanent impairment. The evaluation will be used to determine the amount of your PPD award. The PPD is an indemnity benefit and is payable even if you have returned to work.
3. Permanent Total Disability (PTD)
- If you are permanently unable to do any kind of work, you may be eligible for PTD benefits. Whether you are eligible for PTD benefits is determined at a hearing held by this Division.
- If an injury results in a permanent disfigurement, you may be entitled to additional compensation. Disfigurement includes scars, deformity, and discoloration. Laceration scars and surgical scars are reviewed six months from date of occurrence; however, burn scars are evaluated after one year. At the appropriate six-month or twelve-month timeframe, you may call this Division or on the neighbor-island, the Department of Labor and Industrial Relations District Office nearest you, to request your disfigurement be evaluated.
5. Death Benefits
- Where an industrial injury results in death, the surviving spouse and dependent minor children (including full-time students up to 21 years of age) are entitled to weekly benefits as provided in the WC law. Funeral expenses up to 10 times the maximum weekly benefit rate and burial expenses up to 5 times the maximum weekly benefit rate are also allowed.
6. Vocational Rehabilitation
- Should your injury prevent you from returning to your usual occupation, you may be eligible for vocational rehabilitation services. You, as the injured worker, may select your own certified provider of rehabilitation services. The carrier does have a right to challenge your right to vocational rehabilitation services. You may obtain a current list of certified providers from your WC carrier.
7. Concurrent Employment Benefits
- If you have two or more jobs and cannot work because of an injury you sustained on one of those jobs, you may be eligible for additional benefits from the WC Special Compensation Fund. To determine your eligibility for this benefit, Form WC-14, "Employee's Wage Report for Fifty-Two Weeks Prior to Date of Injury," must be completed by each of your employers and submitted to this Division or on the neighbor-island, the Department of Labor & Industrial Relations District Office nearest you, with your written request for concurrent benefits.
WHAT DO I DO IF MY EMPLOYER FAILS OR REFUSES TO FILE MY WC CLAIM?
- If you have already reported your injury to your employer or supervisor, and your employer has not filed a claim, you may file Form WC-5, "Employee's Claim for Workers' Compensation Benefits" with this Division or on the neighbor-island, the Department of Labor and Industrial Relations District Office nearest you.
MY EMPLOYER OR MY EMPLOYER'S INSURANCE CARRIER HAS DENIED MY CLAIM OR LIABILITY OF MY CLAIM PENDING FURTHER INVESTIGATION. WHAT SHOULD I DO?
- You may file Form WC-5, "Employee's Claim for Workers' Compensation Benefits" with this Division or on the neighbor-island, the Department of Labor and Industrial Relations District Office nearest you. You may be eligible for Temporary Disability Insurance (TDI) benefits while your WC claim is being investigated. Ask your employer for the name of the TDI insurance carrier and file a TDI claim.
I HAVE TWO JOBS. I GOT HURT ON ONE OF THEM, AND NOW I CANNOT WORK ON EITHER BECAUSE OF MY INJURY. CAN I GET PAID FOR THE SECOND JOB AS WELL?
- You may be eligible for concurrent benefits from the WC Special Compensation Fund. Have all your employers complete Form WC-14 "Employee's Wage Report for Fifty-Two Weeks Prior to Date of Injury," and submit the completed WC-14s with your written request for concurrent benefits to this Division or on the neighbor-island, the Department of Labor and Industrial Relations District Office nearest you.
HOW CAN I REOPEN MY OLD WC CLAIM?
- Call the WC insurance carrier to request a re-opening. If your request is denied, you may file Form WC-5, "Employee's Claim for Workers' Compensation Benefits" with this Division or on the neighbor-island, the Department of Labor and Industrial Relations District Office nearest you.
IF I FILE A WC CLAIM, AM I REQUIRED TO HIRE AN ATTORNEY?
- No. The WC law does not require an employee to hire an attorney. Whether or not you decide to hire an attorney is a personal decision. If you have complaints about the attorney you hired, those complaints are addressed by the Office of Disciplinary Council at (808) 521-4591 and not the Department of Labor & Industrial Relations, Disability Compensation Division.
WHAT IF I HIRE AN ATTORNEY?
- Your attorney should provide a Letter of Representation to you and this Division or on the neighbor-island, the Department of Labor and Industrial Relations District Office nearest you. Your attorney will represent you in all maters with the carrier/employer and this Division or on the neighbor-island, the Department of Labor and Industrial Relations District Office nearest you. Any attorney fees have to be approved by this Division or on the neighbor-island, the Department of Labor and Industrial Relations District Office nearest you . Attorney fees usually are a lien upon any workers' compensation benefits due you.
DISCLAIMER: This article is intended to provide guidance on some of the legal entitlements under the WC process (by no means exhaustive) and should not be used as legal advice on the handling of a workers compensation claim. Contact the State of Hawai’i, Department of Labor and Industrial Relations, Disability Compensation Division, or the Labor and Industrial Appeals Board, or the union, or retain an attorney for legal advice, as appropriate, because each claim is different. This website is intended for educational and informational purposes only. We expressly disclaim any responsibility for actions taken or not taken based on information on this website. The information is provided “as is” without warranties of any kind, either express or implied. The content is general and may not reflect current developments and is subject to change without notice.