You need Adobe Acrobat Reader (free) to view these form. Click here if you do not have Adobe Acrobat Reader to obtain a copy.

 

Hawai'i Workers' Compensation Forms

 

 
WC-1

Your employer is supposed to file this form and send it to the Department of Labor's Disability Compensation Division ("DCD") within 7 working days from the date of the injury. The employer can also file the report if the employer believes the injury is not work-related. While you may be required to provide you employer with information conerning the circumstances of the injury so that the WC-1 can be filled out, it is not the injured employee's obligation to fill out or submit this form to the DCD.

 
WC-2 The WC-2 is the form which must be used by your doctor in making the initial report of industrial injury and periodically during the medical care and treatment of your work injury.  
WC-5

 

This is the form the injured employee submits to the Department of Labor Disability Compensation Division, along with a physician's duly filled out WC-2 whenever the Employer fails to file a WC-1 or otherwise delays the processing of the claim. All claimed injured body parts should be listed. Failing to list all injured body parts and then later trying to claim such can be prejudicial to your claim.

 

 

 

The foregoing is a general statement of Hawai'i law and is not legal advice and not intended as such. So that you may gain a better understanding of your matter, contact our office and speak with a lawyer about the specifics of your case.

Home Page