Claims Kit

Reporting of claim by Employer  386-95  12-10-61

The Employer's Report of Industrial Injury (WC-1) must be filed within 7 working days of the employee's notification to the employer of any injury causing absence from work of 1 day or more--or which requires medical treatment beyond first aid.

Submit original and first copy of the WC-1 to the Disability Compensation Division if the accident occurred on Oahu. If occurring on a neighboring island the original and first copy should be sent to the appropriate district office of the Department of Labor and Industrial Relations. Effective 7/1/2016 employers or insurance carriers may file by electronic means as approved by the Director. 

The form must be signed in ink. The signature of the person signing the form constitutes a certification that the person has read the form and that--to the best of the individual's knowledge, information, and belief--all information contained in the form is true. 

A copy of this report must be furnished to the injured employee.

When an injury results in immediate death, the employer must within 48 hours notify a representative of the department in the county where the injury occurred either personally or by phone.

Penalties for Late Reporting  386-95

Employers who fail to submit the Employer's Report of Industrial Injury (WC-1) reports on a timely basis are subject to fines of up to $5,000. Failure of employer to file form reporting employee's injury does not toll the statute of limitations.

Posting Requirements  386-99

Each employer must post and maintain a printed statement concerning benefit rights, claims for benefits, and other such matters relating to the administration of the workers' compensation law and the coverage it affords. This must be a printed statement that is readily accessible to employees. Each employer must furnish each injured employee a copy of the brochure within 3 working days of notice of injury. 

Physician Selection  386-21

The employee may obtain medical treatment from a physician of their choice. However, they may be under the care of only one attending physician at a time. The attending physician may refer the employee to other specialist(s) with the approval of the employer's insurance carrier.

The employee may change their attending physician once but must notify the insurance carrier before making the change. Any other changes in attending physician require approval from the insurance carrier before the change.