Frequently Asked Questions

Workers’ Compensation ι Prepaid Health Care ι Temporary Disability Insurance

EMPLOYEE’S SECTION:

 

What should I do if I am injured on the job?

  1. Immediately report the injury to your immediate supervisor or employer. You can do this orally or in writing.

 

  1. Your immediately informing the employer of the date, time, and circumstances of the work injury is very important. If the work injury causes absence from work for one day or more or requires medical treatment beyond ordinary first aid, the employer is required to inform DCD of the work injury within seven working days of knowledge of the work injury. The employer must also give you a copy of the completed “Employer’s Report of Industrial Injury/Illness (WC-1)”.  If you do not receive a copy of the WC-1, then please contact DCD.

 

  1. Obtain appropriate treatment for the injury.

 

  • Who can receive Workers Compensation (WC) benefits?

Most full-time and part-time employees who suffer from    any injury or disease, which results from work or working conditions, are covered. Under the law, certain kinds of employment are not covered.

  • What do I tell my physician if I am injured on the job?

If you are injured as a result of your work, you should tell the physician treating you that this is an industrial injury. Ask the physician to send the medical reports and bills to your employer’s insurance carrier.  The physician should call the employer for the name of the insurance carrier.

  • From whom can I obtain treatment?

You may obtain treatment from a physician of your choice who is practicing on the island you reside on. However, some physicians elect not to treat patients with a work injury, which is their option.  If your chosen physician chooses not to treat your work injury, then you must choose a different physician.

In addition, you may be under the care of only one attending physician. Your attending physician may refer you to other specialist(s) with the approval of the employer’s insurance carrier.

You may change your attending physician once, but you must notify the employer’s insurance carrier before making the change. Any other changes in physician require approval from the employer’s insurance carrier or the Director before the change.

  • What medical benefits will WC pay for?

If your claim is accepted, workers’ compensation should pay for the following:

  1. Treatments for the injury.
  2. Hospital charges.
  3. Prescription drugs ordered by your doctor.
  4. X-rays as prescribed.
  5. Physical therapy as ordered by your doctor.
  6. Reasonable transportation expense incidental to treatment. (Keep track of your expenses and mileage.)

 

  • What types of disability benefits am I eligible for?

TEMPORARY TOTAL DISABILITY (TTD) If you are temporarily unable to work because of an industrial injury, you may receive temporary wage replacement benefits after a three-day waiting period. You may receive a weekly benefit equal to sixty-six and two-thirds per cent of your average weekly wages up to a specified maximum.  (For example the maximum compensation rate benefit amount for 2016 is $812.00).

If your workers’ compensation claim is disputed and you are not paid benefits, you may file a Temporary Disability (TDI) claim with your employer’s TDI carrier. If eligible, you will be paid benefits at rates allowed by the TDI law.  The TDI carrier may recover the amount they paid from your workers’ compensation benefits, if the claim is deemed compensable.

If you have two or more jobs, you may be eligible for concurrent benefits from the Special Compensation Fund. You must notify the nearest Disability Compensation Division office and submit a record of your wages for the previous fifty two weeks.

 

  1. PERMANENT PARTIAL DISABILITY (PPD) After you reach the point of stability or maximum medical recovery, you may be sent to a physician to be evaluated on the extent of your permanent impairment. The evaluation will be used to determine the amount of your PPD award.

 

  1. PERMANENT TOTAL DISABILITY (PTD) If you are permanently unable to do any kind of work, you may be eligible for PTD benefits. Whether you are eligible for PTD benefits is determined at a hearing held by the Department of Labor and Industrial Relations.

 

  1. DISFIGUREMENT If an injury results in a permanent disfigurement, you may be entitled to additional compensation. Disfigurement includes scars, deformity, and discoloration.  Laceration scars and surgical scars are reviewed after six months from date of occurrence.  However, burn scars are evaluated after one year.  You are responsible for requesting a hearing to determine the disfigurement award.

 

  1. DEATH BENEFITS Where an industrial injury results in death, the surviving spouse and dependent minor children (including unmarried children who are full-time students and under the age of 22 and unmarried children who are incapable of self-support) may be entitled to weekly benefits as provided in the workers’ compensation law. Also, in certain situations, dependent parents, grandparents, grandchild, siblings, and non-dependent parents may be entitled to benefits.  Funeral expenses up to 10 times the maximum weekly benefit rate and burial expenses up to 5 times the maximum weekly benefit rate are also allowed.

 

  1. VOCATIONAL REHABILITATION When an industrial injury has or may have caused permanent disability and prevents you from returning to your usual job, you may self-refer for vocational rehabilitation services to assist you in returning to suitable work. However, if you are a State or County employee, you must first participate in your employer’s Return-To-Work-Priority-Program.

 

  • What do I do if my employer denies compensability?

If your employer denies compensability, you should contact your nearest Disability Compensation Division (DCD) office and file an “Employee’s Claim for Workers’ Compensation Benefits” (WC-5). In addition, you should also have your doctor submit a “Physician’s Report” (WC-2) and any disability certificates to both the employer and the DCD office.

  • What do I do if the adjuster denied my treatment plan? What do I do if the adjuster stops sending me TTD benefits? What do I do if I disagree with what the adjuster did on my claim?

 

If there are any issues which cannot be resolved by agreement, you may request for a hearing. A hearing will be held, and a decision will be rendered.  If you or the employer/insurance carrier/adjuster disagrees with the decision, the decision may be appealed by filing a notice of appeal with the department within 20 calendar days after a copy has been sent to each party.

  • What is the Status of my claim?

You may contact your nearest Disability Compensation Division (DCD) office to receive information as to the status of your claim. Contact the Division’s Facilitator’s Unit at (808)-586-9161(Oahu); (808)-974-6464 (Hilo); (808)-274-3351 (Kauai); (808)-322-4808 (Kona); and (808)-984-2702 (Maui).

 

  • Can I file a complaint if I was terminated from work?

 

It is unlawful for any employer to suspend or discharge any employee solely because the employee suffers any work injury which is compensable under the workers’ compensation law unless it is shown that the employee will no longer be capable of performing the employee’s work as a result of the work injury and that the employer has no other available work which the employee is capable of performing.

  • What if I have a permanent disability which prevents me from performing my normal job duties after my injury?

 

If you cannot return to your normal job duties after your injury, you may self-refer for vocational rehabilitation services to assist you in returning to suitable work. However, if you are a State or County employee, you must first participate in your employer’s internal Return-To-Work-Priority Program.  While you are receiving vocational rehabilitation services, you may receive temporary total disability benefits.

  • What can I do if I feel I am being discriminated against at work?

 

You may file a discrimination complaint with the Hawaii Civil Rights Commission within 180 days of: (1) the alleged discriminatory practice, or (2) the date of the most recent occurrence in a pattern of ongoing discrimination. Additional information may be found at http://labor.hawaii.gov/hcrc/files/2012/12/PCQ_1.pdf or call (808) 586-8636.

  • How do I file a complaint against my employer?

 

Depending on the nature of the complaint, DCD may or may not be the agency with which to file a complaint. For example, complaints as to unemployment insurance benefits (http://uiclaims.hawaii.gov/) (808) 586-8970; unpaid wages (http://labor.hawaii.gov/wsd/) (808) 586-8777; and racial discrimination (http://labor.hawaii.gov/hcrc/) (808) 586-8636 are all handled by state agencies other than DCD.

  • How do I get my scar evaluated?

 

You may request a hearing. When you attend the hearing, a hearings officer will examine the scar and mail you a decision stating the amount the insurance carrier must pay you for the scar.  If you or the insurance carrier disagree with the decision, you may file an appeal to review the decision.

  • How do I schedule a hearing/when is my hearing scheduled?

 

If you have an attorney, then DCD is obligated to contact you only through your attorney. Please have your attorney contact DCD.

If you do not have an attorney, you may request a hearing by properly filling out a WC-77 Application for Hearing Form (WC-77) and filing it with DCD. After filing a WC-77, you will receive a hearing notice by mail.

  • What if I work more than one job? Do I receive additional compensation?

 

Certain benefits may be capped. If your benefits are not capped from your wages earned from the employer where you sustained your work injury, you may be entitled to additional compensation from wages earned from another employer.  Those benefits will not be paid by your other employer.  Those benefits would be paid by the Special Compensation Fund.

  • I haven’t received my benefit payments. Can you tell me when it is expected?

 

Please contact the insurance carrier/adjuster handling your claim. If you disagree with the insurance carrier/adjuster, then you may request a hearing.

  • How do I obtain copies of prior awards for old injuries?

 

Please contact your nearest Disability Compensation Division office.

  • How do I appeal a decision? Do I need an attorney?

 

You must file your written appeal within 20 days of the mailing of the decision you are appealing. You may file your appeal with the Labor and Industrial Relations Appeals Board or at your nearest Disability Compensation Division office by the 20th day.  Postmarked date is not sufficient.

  • How do I know if I’m eligible for Vocational Rehabilitation?

 

The purposes of vocational rehabilitation are to restore an injured worker’s earnings capacity as nearly as possible to that level that the worker was earning at the time of injury and to return the injured work to suitable gainful employment in the active labor force as quickly as possible in a cost-effective manner.

Vocational rehabilitation is not mandatory. If you desire vocational rehabilitation services, you may contact a certified provider of rehabilitation services.  If you are a State or County employee, contact your employer’s Return-To-Work-Priority-Program.

  • What do I do if my Vocational Rehabilitation counselor isn’t finding me a job?

 

The Vocational Rehabilitation counselor provides services to assist you in obtaining gainful employment.

  • I was receiving medical benefits for the work injury and then the employer closed my case. What should I do if I need further medical treatment for the work injury?

 

You should first obtain a treatment plan from your attending physician and have a copy sent to the employer. If the employer denies the treatment plan, you may request a hearing.

The treatment plan from your attending physician is very important. Without the treatment plan, further treatment may not be authorized and a hearing may not be scheduled.

 

  • If I file a WC claim, am I required to hire an attorney?

 

 No. The WC law does not require an employee to hire an attorney.  Whether or not you decide to hire an attorney is a personal decision.  If you have complaints about the attorney you hired, those complaints are addressed by the Office of Disciplinary Council at (808) 521-4591 and not the Department of Labor & Industrial Relations, Disability Compensation Division.

  •  What if I hire an attorney?

 

Your attorney should provide a Letter of Representation to you and this Division or on the neighbor-island, the Department of Labor and Industrial Relations District Office nearest you. Any attorney fees have to be approved by this Division or on the neighbor-island, the Department of Labor and Industrial Relations District Office nearest you.  Attorney fees are usually a lien upon any workers’ compensation benefits due you.

  • What do I do if my employer fails or refuses to file my WC claim?

If you have already reported your injury to your employer or supervisor, and your employer has not filed a claim, you may file a 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.

EMPLOYER’S SECTION:

  • How do I get a Department of Labor (DOL) number?

 

An employer may obtain a DOL number through the Unemployment Insurance (UI) Office, Employer Services Section, (http://uiclaims.hawaii.gov/) (808) 586-8970.

When UI determines you are exempt under the UI law, you may obtain a temporary DOL account number assigned by this Division known as a “Z”-number. If you need a Z-number, contact the Insurance Section at (808) 586-9178, or (http://labor.hawaii.gov/dcd/contact/).

  • How do I determine the Average Weekly Wages (AWW)?

 

According to Hawaii law, average weekly wages shall be computed in a manner that the resulting amount represents most fairly, in the light of the employee’s employment pattern and the duration of the employee’s disability, the injured employee’s average weekly wages from all covered employment at the time of the personal injury. If an employee is working full-time, then the AWW cannot be computed to be less than the hourly rate of pay multiplied by 35.

There are other considerations that may affect your AWW.

  • How do I get Workers’ Compensation insurance?

You may contact Department of Commerce and Consumer Affairs (DCCA) for a list of workers’ compensation insurance carriers. You purchase workers’ compensation insurance from these carriers and not through DCD.  Also, if you have some sort of liability insurance, your carrier may be able to help you with obtaining workers’ compensation insurance.

 

  • Do I have to provide WC insurance to all employees?

 

If you do not have a valid reason for not obtaining workers’ compensation insurance, the penalty for failure to obtain workers’ compensation insurance is not less than $500.00 or $100.00 for each employee for every day of non-coverage. Thus, if no coverage for two employees for five days, total penalty would be $1,000.00 ($100.00 x 2 employees x 5 days).

  • Who is required to provide WC coverage?

 

Any employer, other than those excluded below, having one or more employees, full-time or part-time, permanent or temporary, is required to provide WC coverage for the employees.

Excluded employment includes voluntary or unpaid workers for a religious, charitable, education or nonprofit organization, student workers performing services for a school, university or college club in return for room, board or tuition; duly ordained, commissioned or licensed minister, priest or rabbi; domestic workers earning less than $225 (cash) per calendar quarter; domestic workers of public welfare recipients, certain twenty-five percent stockholders; all fifty percent stockholders; and real estate salespersons and brokers paid solely on a commission basis. An employer may, however, elect to cover the excluded employees.

Federal laws cover workers employed by the federal government and workers engaged in fishing, maritime and longshoring activities.

Each employer shall post and maintain in places readily accessible to employees a printed statement concerning benefit rights, claims for benefits, and such other matters relating to the administration of the workers’ compensation law. Each employer shall furnish within three working days of notice of injury to each injured employee a copy of the brochure, Hawaii Workers’ Compensation Law (Highlights).

(http://labor.hawaii.gov/dcd/files/2014/04/WC-Highlights.pdf)

  • How does an employer provide WC coverage?

 

An employer may secure WC coverage by:

  • Purchasing insurance from a carrier authorized to transact WC insurance in this State. Hawaii has no State Fund from which employers can purchase WC insurance.

 

  • Becoming a self-insured employer who pays statutory benefits directly to its employees. The employer must be approved to self-insure by showing proof to the Director of Labor and Industrial Relations of its solvency and ability to pay benefits or by depositing securities. (Form WC-21 Application for WC Self-Insurance Authorization)