Get University Of Hawai I

This guide provides a step-by-step approach to accurately complete the University of Hawai'i form for the computation of average weekly wages for temporary disability payments. Ensuring correct information is submitted is crucial for the processing of benefits.

Follow the steps to accurately complete the form.

1. Click the ‘Get Form’ button to obtain the necessary form and open it in your preferred user interface.
2. Begin by entering the name of the employee or claimant in the designated field. Ensure that the spelling is correct for accurate records.
3. Fill in the date of injury or illness accurately. This date is essential for establishing the correct computation of average weekly wages.
4. Input the regular salary or wage at the time of the injury. Specify if the employee is a student assistant or a casual hire, and provide the wage rate per month or per hour.
5. Calculate and enter the total earned wages, which includes payments made or owed for work performed during the 52 weeks preceding the date of injury. This should be reflected in the total earned field.
6. List any additional compensation received in the 52 weeks prior to the injury, if applicable. If no additional compensation was earned, select the check box indicating no additional compensation.
7. For each additional compensation type listed (e.g., ordinary overtime, holiday overtime), enter the corresponding amount in the designated fields next to each description or code.
8. Provide the total amount of additional compensation incurred, ensuring that all calculations are accurate.
9. Address any unpaid overtime, standby, or shift differentials as of the injury date. Answer the yes/no question and specify the total amount earned but not yet paid, if applicable.
10. Indicate whether the employee was on a temporary assignment at a higher pay rate than their regular rate at the time of injury. Answer the question accordingly and provide the employee’s regular pay rate if applicable.
11. Review all filled sections carefully. Confirm that all pertinent information has been provided relative to regular and premium pay.
12. The WC Coordinator must sign the form, including their phone number and email address, before submitting.
13. Finally, save any changes you've made, and download, print, or share the completed form as necessary.

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