I hereby present my claim for compensation for disability resulting from the foregoing injury/illness arising out of and in the course of my employment and not caused by my intoxification nor by …

Hawaii’s Workers’ Compensation Treatment Plan. The following forms must be submitted via portal access: WC-1 Employer’s Report of Industrial Injury; WC-2 Physician’s Report; WC-21 …

INSTRUCTION SHEET FOR FORM WC-5 EMPLOYEE’S CLAIM FOR WORKERS’ COMPENSATION BENEFITS Instructions IMPORTANT: If information provided is incomplete, …

Claim forms are not available online. Ask your employer for a claim form or contact us if your employer does not have the claim form. FOR EMPLOYERS: TDI-14 Equivalency Tables; TDI …

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 …

WC-5 . This is the form the injured employee submits to the Department of Labor Disability Compensation Division, along with a physician's duly filled out WC-2 whenever the Employer …

INSTRUCTION SHEET FOR FORM WC-5 EMPLOYEE’S CLAIM FOR WORKERS’ COMPENSATION BENEFITS Instructions IMPORTANT: If the information provided is …

Upon notifying your employer of your injury, your employer should file a WC-1 form and submit it to the division within seven days of your injury. If your employer fails to do so, you may file a …

Also, includes the “Verification of Partial Unemployment Status” form for employers to compete and return to confirm their employee’s partial unemployment status. This form is due within 5 …