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Claims Process Unveiled: Navigating Workers’ Compensation in Hawaii

Last updated on January 23rd, 2024 at 04:12 pm

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When an employee is injured on the job, a workers’ compensation claim is often necessary to ensure they get the medical treatment and compensation they deserve. But navigating the system can be daunting.

Unlike Montana and Georgia, Hawaii doesn’t allow employees to recover twice and requires carriers to prove they made the worker whole before recouping expenses.

Getting Started

Hawaii’s workers’ compensation law requires employers to provide employees with coverage for work-related injuries, illnesses and diseases. This exclusive remedy waives employees’ rights to sue their employer for negligence and provides them with a fixed amount for medical expenses, lost wages and partial disability benefits.

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In addition, Hawaii workers’ compensation is a vital aspect that businesses must prioritize, ensuring the well-being of employees by providing necessary coverage in the event of work-related injuries or illnesses.

Employees should always report their injury or illness to their employer immediately after it occurs. They should also ensure their employer has a designated person to contact for help, such as someone in human resources or a health and safety representative.

Working with an experienced workers’ compensation attorney to assist with the claims procedure is a good idea. These specialists typically work on a contingency basis and only charge a one-time fee when they win a cash settlement for their clients.

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They can also help with RTW plans, such as developing light-duty assignments that fit an injured employee’s capabilities and medical restrictions.

Benefits of Doing Business in Hawaii
Ho’omaluhia Botanical Gardens Oahu Hawaii. Credit: Darren Lawrence on Unsplash

If the insurance company rejects a claim, they can also help with appeals. Death benefits are available for spouses, and the surviving spouse can apply for a lump-sum payment of two years of death benefits in certain situations.

You can just deny the fact that Hawaii is not just a great place for workers, but the Aloha State also has a business-friendly environment.

Documenting Your Injury

When you get hurt at work, it’s important to report the injury immediately. You must notify your employer within seven working days of the accident. Upon notification, your employer must file a WC-1 report of industrial injury with its WC carrier and the Division.

Documenting your injury and keeping all receipts related to medical treatments, like X-rays or surgery, is important.

You should also notify your attending physician(s) and obtain all needed medical care. In Hawaii, you can choose your own treating doctor.

Workers’ compensation covers the majority of occupational diseases, including lung cancer from smoke exposure at a fire scene, as well as most industrial injuries. But there are some exceptions, such as mental stress that isn’t work-related.

The law presumes an injury is work-related unless the employee can introduce “substantial evidence” to rebut this presumption.

For example, a worker suffering a heart attack caused by high cholesterol might not receive benefits because the injury did not arise out of employment since the heart attack could have occurred anywhere.

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Notifying Your Employer

Hawaii workers’ compensation laws and temporary disability insurance (TDI) programs help injured employees return to work after an accident. The state’s official website and related pages explain the program and provide forms and other relevant information for injured workers.

Generally, workers’ compensation covers injuries and illnesses directly connected to an employee’s job.

But there are exceptions. For example, a heart attack caused by high cholesterol probably wouldn’t qualify as a workers’ comp claim because the injury didn’t arise strictly from employment.

If you get hurt on the job, you must notify your employer. Doing so is required by state law and helps protect your rights in the event of a dispute.

It also allows the employer to file an Employer’s Report of Industrial Injury with the state within seven working days. The employer must also provide the worker with a copy of the state’s Highlights of the Hawaii Workers’ Compensation Law brochure. Injured workers are entitled to medical treatment from a physician of their choice. This includes ambulance rides, hospital visits, X-rays and prescription medication.

Filing Your Claim

Hawaii workers’ compensation laws provide medical and financial benefits for injured workers. The state requires businesses to carry insurance unless they legally opt out of coverage or are on the list of exempt employment types.

If you’ve been injured, report it to your employer immediately. Your employer must file a WC-1, Employer’s Report of Industrial Injury, with the Hawaii Disability Compensation Division within seven days.

Your employer must also give you a copy of the report. Generally, you can get the medical treatment you need from any doctor approved by your employer’s insurance carrier.

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If you can’t return to your usual job, you may receive vocational rehabilitation services, including testing, counseling and training to help you find a new job.

Death benefits are available to surviving spouses and dependent children in work-related death cases.

The death benefit amount is two years of average weekly wages (AWW). Death benefits also include funeral costs. Spouses’ death benefits end upon remarriage.

Appeals

Most employers in Hawaii are required to carry workers’ comp insurance. It’s usually a wise investment since personal health plans do not cover work-related injuries or illnesses. In addition, it can prevent employees from filing a lawsuit against their employer in the event of an injury.

Hawaii workers’ compensation covers medical care and financial benefits to injured employees who are hurt during their employment. It’s a no-fault system, so employees don’t need to prove their employer is at fault to receive benefits.

Injured workers can choose their doctors, but the doctor must agree to treat them as a workers’ compensation case and refer them to a specialist. Employees can change their treating physician once but must notify the insurance company.

Workers’ compensation subrogation practitioners in Hawaii have held their breath for 2021, waiting to see whether the Supreme Court of Hawaii will incorporate the common law-made Whole Doctrine into statutory workers’ compensation liens. The Supreme Court has now decided that it does not.

Author

  • Opeyemi Quadri

    Ope is a finance writer and researcher with 10+ years of experience in content creation. His interests cut across decentralized finance, investment, foreign exchange, government policies and politics.

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