Employees in Hawaii who become ill or injured from the workplace are eligible for workers' compensation benefits. The purpose of these benefits is to compensate employees for lost wages and to provide medical care for work-related injuries. If you claim a work-related injury or illness, you are presumed to be eligible for benefits unless your employer can produce substantial evidence that your claim is not work-related.
Hawaii employers with one or more full or part-time employees, including temporary employees, are required to provide workers' compensation coverage to their employees. Certain employees are not required to be covered, however, including:
For more information, see What Jobs Aren't Covered by Workers' Compensation?
If you get hurt or sick as a result of your work, let your employer know immediately. Once you do this, your employer will normally file an Employer's Report of Industrial Injury (WC-1) within seven working days. Within three days after making your report to your employer, your employer should give to you a brochure about workers' compensation benefits entitled Highlights of the Hawaii Workers' Compensation Law.
If your employer refuses to file a claim for you, you will need to file the claim yourself. To do so, you must complete and submit an Employee's Claim for Workers' Compensation Benefits form (Form WC-5).
After you are injured or become ill, you should see a doctor as soon as possible. You are allowed to choose your own doctor for a work-related injury in Hawaii. However, you can only receive care from one primary care physician, and you can only see specialists to whom that doctor refers you. Make sure to tell your doctor that your condition is work-related so the doctor's office can bill your employers' insurer directly.
If you're not happy with the doctor you chose, you may make a one-time change of physicians. If you're unhappy with the second doctor you choose, you'll have to get permission from your employer's workers' compensation carrier in order to change doctors again.
If your claim is approved, workers' compensation will pay for all reasonable and necessary medical treatment, including hospital bills, prescriptions, medical supplies, X-rays, physical therapy, and more.
Workers' compensation pays benefits if you need time off work while you are recovering from your injury and if your injury leaves you permanently disabled.
If you are unable to work for at least three days due to your injury or illness, you will be eligible for temporary total disability (TTD) payments. These benefits compensate you for the wages you are losing while you remain unable to work. You will receive two-thirds of your average weekly wages, not to exceed a maximum amount set by law. For 2019, the maximum amount you can receive in Hawaii is $899. You will only be able to receive these TTD payments while your doctor says you are unable to work or have reached maximum medical improvement (meaning you are unlikely to improve any further).
If you don't fully recover from your illness or injury, you will be eligible for permanent disability payments. A doctor will evaluate your condition to determine whether you have a permanent disability and to what extent. Your permanent disability benefits will be based on the severity of your disability.
If you have a partial disability, meaning that you can still work in some capacity, you will receive permanent partial disability (PPD) payments. These benefits are two-thirds of your average wage before the injury, up to the state maximum mentioned above. They can be paid for anywhere from 12 to 312 weeks, depending on the injury. Some injuries are scheduled, which means there are a pre-set number of weeks that will be paid for the injury. For instance, the loss of use of a thumb is paid for 75 weeks, the loss of use of a hand is paid for 244 weeks, and loss of vision in an eye is paid for 140 weeks. (To learn more, see How Are Permanent Partial Disability Benefits Calculated?)
If your doctor determines you are permanently unable to work because of a severe illness or injury, you will receive permanent total disability (PTD) benefits. Your eligibility for PTD will be determined at a hearing held at your local office. These benefits are higher than PPD benefits and paid as long as the permanent disability lasts.
If your work-related injury has left you disfigured or with a permanent scar, you may be eligible for additional payments of up to $30,000. Disfigurement includes deformity, discoloration, and scars. Scars from being cut or resulting from surgery won't be evaluated for six months, and burn scars will be evaluated after one year.
If you have submitted a claim for workers' compensation benefits in Hawaii and it has been denied, or you are unhappy with the decision, you have the right to file a request for a hearing. To do so, you will need to complete an Application for Hearing form (Form 77) with the Hawaii Disability Compensation Division. A hearing officer from the division will hold an administrative hearing, at which both parties will present evidence and testimony. The hearing officer will make a decision within 60 days.
If you are unhappy with the hearing decision, you have the right to file an appeal with the Hawaii Labor and Industrial Relations Appeals Board. You must act quickly, though. You have only 20 days from the date of the hearing decision to file a Notice of Appeal with the Board. If you have questions about the form, call the Appeals Board at (808) 586-8600 or visit the Board's website.
The Appeals Board consists of three attorneys who will oversee your appeal and preside at your trial. At the Appeals Board trial, the presiding board member will review the facts in your case and the legal conclusions reached at your hearing. You and your employer will have the right to present witnesses and evidence. The rules governing these trials are complex, so it is important to have an attorney. If you don't abide by the rules, it will hurt your case.
The trial will be held in Honolulu at the offices of the Appeals Board. It is very important to appear for your trial or to have your lawyer appear. Otherwise, the Board will base its decision on only the information in your file, and you will lose your opportunity to present witnesses and evidence. After the trial, the Board might agree with the hearing officer's decision, agree only with part of it, or disagree with it entirely. The Board can also simply send the case back for further review or action.
If you are unhappy with the decision of the Appeals Board, you have 30 days to appeal to the Intermediate Appellate Court. This requires you to submit a written Notice of Appeal to the Appeals Court. You will have to pay a filing fee of approximately $100.
No new evidence can be submitted to the Appeals Court. The court will review only the legal decision of the Appeals Board. The only exception is if there is new, relevant evidence that would have been impossible for you to discover any sooner.
The Appeals Board has complex rules and procedural requirements that are quite difficult to understand and comply with without the assistance of a workers' comp attorney. Before your hearing, there will be an initial conference to determine issues to be decided at the hearing. There may also be pre-trial orders from the judge, legal motions made by your employer's lawyer, and other legal proceedings such as settlement conferences. In addition, you may need to request that subpoenas be issued to require witnesses to show up and testify in your case.