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A9.720 Attachment 1University of Hawaii REPORT OF WORKRELATED INJURY/ILLNESS I.Employees Statement (to be completed by Employee or WC Coordinator in consultation with Employee)Name:Last Home Address:Date

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What is hawaii workers compensation claim?

Hawaii workers compensation claim is a form filed by an employee who has been injured on the job to request benefits for medical treatment and lost wages.

Who is required to file hawaii workers compensation claim?

Any employee who suffers a work-related injury or illness in Hawaii is required to file a workers compensation claim.

How to fill out hawaii workers compensation claim?

To fill out a Hawaii workers compensation claim, the employee must provide details about the injury or illness, medical treatment received, and any lost wages incurred.

What is the purpose of hawaii workers compensation claim?

The purpose of Hawaii workers compensation claim is to provide benefits to employees who have been injured on the job without the need to prove fault.

What information must be reported on hawaii workers compensation claim?

Information that must be reported on Hawaii workers compensation claim includes details about the injury, medical treatment received, and any lost wages.

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