Hawaii Required Postings and Forms
Download Hawaii Claims Kit
Please print and post the following notices, both in English and Spanish, in a conspicuous location frequented by employees such as the break room, lunchroom or time clock. If you have multiple office locations be sure to post the notices at each location.
The following forms need to be completed and submitted to EMPLOYERS when a work-related injury occurs:
- WC-1 Employer’s Report of Industrial Injury. As soon as you have been notified of a work-related injury, please fill out this form and submit it to EMPLOYERS. This form must be completed within ten days from notice of a work-related injury. Fatalities must be reported within 24 hours. Please use this form to notify EMPLOYERS of every work-related injury or disease suffered by an employee, regardless of severity.
- WC-14 Employee’s Wage Report. This form enables us to calculate the correct compensation owed to an injured employee. Please complete the form and submit it to EMPLOYERS within five days after your knowledge of any accident that has caused your employee to be disabled for more than three scheduled work days.
- Accident Investigation Report. This basic accident form should be completed by the employee’s supervisor/manager as soon as possible after the accident. Please send the report to the following EMPLOYERS address as soon as it has been completed by the supervisor/manager: EMPLOYERS Claim Department, P.O. Box 14791, Lexington, KY 40512-4791. You should also keep a copy on file for your records.
In this state, claims are adjusted by Broadspire. Once a claim is reported to EMPLOYERS, the report will be sent to Broadspire for assignment.
More Hawaii Workers’ Comp Resources
- Off-Site Transitional Duty Program – Helping Your Injured Employees Get Back to Work. A successful transition back to work relies on the collaborative efforts of the manager/supervisor, the injured employee and their adjuster. As a manager/supervisor, learn what you can do to help facilitate a successful return to work.