Hawaii Injury Report Form

State:
Multi-State
Control #:
US-1340837BG
Format:
Word; 
Rich Text
Instant download
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Public form

Description

This form is an example of an injury report form that may be used by a Company in order to report injuries on the job.

How to fill out Injury Report Form?

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FAQ

Hear this out loud PauseThe sum total of weekly benefits paid to all of the dependents can't be more than two-thirds of the deceased employee's average weekly wage. Hawaii workers' comp also pays for funeral expenses (up to ten times the maximum weekly TTD benefit) and burial expenses (up to five times the maximum weekly benefit). How Much Are Workers' Compensation Benefits in Hawaii? nolo.com ? legal-encyclopedia ? how-much... nolo.com ? legal-encyclopedia ? how-much...

How do you apply for workers' compensation? Write down the details of the injury or illness in detail, with photos and the names of witnesses when possible. Report the injury or illness to your employer. The employer should take it from there, filing your claim with the insurer. Workers' Compensation: What It Is, How It Works, and Who Pays investopedia.com ? terms ? workers-compen... investopedia.com ? terms ? workers-compen...

Hear this out loud PauseAny employer, other than those excluded (section 386-1), having one or more employees, full-time or part-time, permanent or temporary, is required to provide WC coverage for its employees. Disability Compensation Division | About Workers' Compensation (WC) hawaii.gov ? dcd ? home ? aboutwc hawaii.gov ? dcd ? home ? aboutwc

Compensation for permanent partial disability shall be paid in weekly installments at the rate of sixty-six and two-thirds per cent of the worker's average weekly wage, subject to the limitations on weekly benefit rates prescribed in section 386-31.

Workers' comp waiting periods by state StateWaiting period to receive workers' compGeorgia7 daysHawaii3 daysIdaho5 daysIllinois3 working days48 more rows ? When Does Workers' Comp Start Paying? The Waiting Period in ... atticus.com ? advice ? workers-compensation atticus.com ? advice ? workers-compensation

You may file Form WC-5, "Employee's Claim for Workers' Compensation Benefits" with this Division or on the neighbor-island, the Department of Labor and Industrial Relations District Office nearest you. You may be eligible for Temporary Disability Insurance (TDI) benefits while your WC claim is being investigated.

TTD benefits are calculated as two-thirds of your average weekly wage before your injury (usually determined based on your earnings during the previous 12 months). Like other states, however, Hawaii law sets a maximum weekly rate for TTD benefits, based on a percentage of statewide average wages.

You have two years to formally file a worker's compensation claim. The timeline begins from when the effects of the injury manifest, which is immediately for an acute injury. It may be delayed for a disease.

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Hawaii Injury Report Form