HI WC-1 2016-2025 free printable template

Every work injury to an employee causing absence for one day or more or which requires medical services other than first aid treatment must be reported within 7 working days after the injury. Failure

How to fill out hawaii wc form compensation division

How to fill out HI WC-1

1. Obtain the HI WC-1 form from the relevant state department or website.
2. Fill out the claimant's information in the specified fields, including name, address, and contact information.
3. Provide details of the employer, including name, address, and contact information.
4. Describe the nature of the injury or illness, including the date it occurred and where it happened.
5. Include any medical treatment received and the names of healthcare providers.
6. Sign and date the form to certify that the information provided is accurate.
7. Submit the completed form to the appropriate workers' compensation board or agency.

Who needs HI WC-1?

1. Employees who have suffered a work-related injury or illness.
2. Employers who need to report a work-related incident involving their employees.

Video instructions and help with filling out and completing hawaii wc1 form

Instructions and Help about form wc 1

In this video IN×39’m going to reveal five secrets the insurance company doesn't×39;want you to know about your workers compensation claim hi IN×39’m attorney Gary Martin Hays your secret number one you have 30 days in which to report youron-the-job injury now sometimes an employee gets hurt at work, but they assume it×39’s just going to be a minor injury and that×39’ll get better but after a couple of days the pain worsens Botha report the incident to their supervisor some employers will tell you too late so sorry you didn't report the injury the day it happened, so we're not going to provide workers compensation benefits to you this is not the law you have 30 days in which to report your injury now the better practice is to notify your supervisor immediately all right secret number 2 your employers required to post a list of doctors from which you get to choose the doctor that you would like to provide treatment to you the panel must have six doctors listed on it and one of the six doctors has to be an orthopedic surgeon and no more than two of the six can be industrial clinics and if your employer did not post a panel or the panel was not valid you should be able to choose the doctor that you want to treat you and the insurance company has to pay fort all right secret number three if you're receiving workers compensation checks because you've been disabled from working then you may be entitled to see doctor of your choice for an independent medical examination and the insurance company has to pay for this appointment, but you have 120 days from the last time you receive workers comp wage benefits to request the exam, so please do not delay discussing this option with an attorney alright secret number four did you know that you're entitled to be reimbursed for your mileage to and from your medical appointments this includes not just the mileage to your doctor×39;appointments but also mileage to therapy to pick up your prescriptions and parking fees all right secret number five do you really know how much the employer and the insurance company presupposed to pay you in weekly wage checks well most people don't but by layout×39’re entitled to two thirds of your average weekly wage but the most the insurance company is obligated to pay you right now is only five hundred and twenty-five dollars per week it doesn'tmatter if you were making $1,500per week the most the insurance company has to pay you is 525 dollars per week well do insurance companies always pay the correct amount no they do not and if they are paying you less than the maximum amount of 525 dollars per week they are required by law to file a form that lets you know how they calculated the amount of your weekly check another×39’s so many other secrets the insurance company doesn't×39’t want you to know about your workers compensation claim the best advice I can give you into call us right now to learn about allow your rights as well as the insurance companies responsibilities Music

People Also Ask about the wc 1

What is WC-1?

WC-1 EMPLOYER'S FIRST REPORT OF INJURY OR OCCUPATIONAL DISEASE.

How much is disability payment in Hawaii?

Hawaii's Temporary Disability Insurance Program You have to have worked at least 14 weeks for your employer, for at least 20 hours per week, at a rate of at least $400 per week. These short-term TDI benefits are typically 58% of your wages, up to a maximum, but your employer's plan can call for TDI benefits to be more.

How much does workmans comp pay in Hawaii?

The weekly installments will be two-thirds of your average weekly wage. For example, if your pre-injury earnings were $900 a week, you would get PPD benefits at the rate of $600 a week until you received the full amount of your award. However, you may apply to receive your award in a lump sum. (Haw.

Is it hard to get disability in Hawaii?

Hawaii has one of the highest approval ratings among all the states in the nation with only one hearing office and 4 administrative law judges (ALJs) to serve its citizens. Hawaii also has much shorter waiting times and processing times than most states as well.

How much is disability in Hawaii?

If you're approved, you may receive up to 58% of your former wages, although the most you can receive per week is $765 in 2023. Learn more about Hawaii Temporary Disability Insurance.

What is a wc1?

WC-1 Employer's Report of Industrial Injury.

For pdfFiller’s FAQs

Who is required to file hawaii wc 1 form?

The Hawaii WC-1 form, also known as the Employer's First Report of Injury or Disease, is required to be filed by employers in Hawaii when an employee sustains a work-related injury or illness that results in medical treatment beyond first aid or time off work beyond three calendar days. The form must be filed within seven days of the employer's knowledge of the injury or illness.

What is hawaii wc 1 form?

WC-1 is the form used for reporting a workers' compensation claim in Hawaii. It is also known as the "Employer's First Report of Injury or Illness" form. This form is typically completed by the employer and submitted to the Hawaii Department of Labor and Industrial Relations (DLIR) and the workers' compensation insurance carrier or self-insured employer when an employee suffers a work-related injury or illness. The WC-1 form includes information such as the employee's details, the nature of the injury or illness, the date and time of the incident, and the medical treatment provided. It is an important document for initiating the workers' compensation claim process in Hawaii.

What is the purpose of hawaii wc 1 form?

The Hawaii WC-1 form, also known as the "Employer's Report of Industrial Injury or Occupational Disease," is used for reporting work-related injuries or occupational diseases in the state of Hawaii. The purpose of this form is to document and report such incidents to the Hawaii Department of Labor and Industrial Relations (DLIR), Disability Compensation Division. The form serves several purposes, including: 1. Notification: The WC-1 form provides formal notification to the DLIR about an employee's work-related injury or occupational disease. 2. Claims process: The information provided on the WC-1 form initiates the workers' compensation claims process, allowing the injured employee to seek benefits for medical treatment, lost wages, and other related expenses. 3. Record-keeping: The completed WC-1 form becomes part of the employee's official workers' compensation claim file, ensuring accurate record-keeping of the incident and facilitating future communications. 4. Compliance: Filing the WC-1 form is a legal requirement in Hawaii for employers to comply with workers' compensation laws and regulations. In summary, the purpose of the Hawaii WC-1 form is to report and document work-related injuries or occupational diseases, initiating the workers' compensation claims process and ensuring compliance with state regulations.

What information must be reported on hawaii wc 1 form?

The Hawaii WC-1 form, also known as the Employer's Report of Industrial Injury or Accident, requires the following information to be reported: 1. Employer Information: Name, address, and contact information of the employer or its representative. 2. Employee Information: Name, address, social security number, and occupation of the injured employee. 3. Date and Time of Injury: The exact date and time when the injury or accident occurred. 4. Description of Injury: A detailed description of the injury or accident, including the body parts affected and the nature of the injury. 5. Medical Treatment: Information about the medical treatment rendered, including the name and address of the treating physician or hospital. 6. Lost Time: The number of days the employee is absent or unable to work due to the injury. 7. Gross Wages: The employee's gross wages at the time of injury or accident. 8. Employer's Insurance: The name, address, and policy number of the employer's workers' compensation insurance carrier. 9. Signature: The form must be signed and dated by the employer or its representative. 10. Copies: The employer must keep a copy of the completed form for their records and provide the injured employee with a copy. It is important to note that this information may vary slightly depending on the specific instructions provided by the Hawaii Department of Labor and Industrial Relations Division of Workers' Compensation.

How to fill out hawaii wc 1 form?

To fill out the Hawaii WC-1 form, follow these steps: 1. Start by downloading the WC-1 form from the State of Hawaii Department of Labor and Industrial Relations website or obtain a physical copy from your employer or insurance company. 2. Begin filling out the form by entering your personal information in Section 1, including your full name, home address, telephone number, and date of birth. 3. In Section 2, provide your employer's information, such as the company's name, address, and telephone number. Indicate whether your employer is uninsured or uninsured self-insured. 4. Complete Section 3 by entering the date, time, and place of the work-related injury or illness. 5. In Section 4, briefly describe the injury or illness that occurred, including specific body parts affected and how the incident happened. 6. Section 5 is for the employer to complete, providing information about the employment relationship, such as the date of hire, the employee's job title, wages, and hours worked per week. 7. In Section 6, indicate whether you sought medical treatment for your injury and provide details about the medical provider, including their name, address, and phone number. 8. Section 7 is for the attending physician to complete. If you have seen a doctor for the injury or illness, they should fill out this section, providing their diagnosis, treatment given, and any work restrictions or disability assigned. 9. In Section 8, indicate any witnesses to the incident, providing their names, addresses, and telephone numbers. 10. Sign and date the form at the bottom, certifying that the information provided is true and accurate to the best of your knowledge. 11. Keep a copy of the completed WC-1 form for your records and submit the original to your employer or their workers' compensation insurance carrier.

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What is HI WC-1?

HI WC-1 is a form used in Hawaii for reporting workers' compensation insurance coverage.

Who is required to file HI WC-1?

Employers in Hawaii who have employees subject to the workers' compensation law are required to file HI WC-1.

How to fill out HI WC-1?

To fill out HI WC-1, employers must provide information about their business, including the number of employees, type of business, and insurance coverage details.

What is the purpose of HI WC-1?

The purpose of HI WC-1 is to ensure compliance with Hawaii's workers' compensation laws and to maintain up-to-date records of employers' insurance coverage.

What information must be reported on HI WC-1?

The information that must be reported on HI WC-1 includes the employer's name, address, number of employees, type of business, and details of their workers' compensation insurance policy.