Workers’ Compensation information and forms for the state of HI
Workers’ Compensation Insurance can seem complicated to administer. There are many forms and various specific state regulations concerning postings and employee notification. To get the help you need to ensure employees understand coverage’s and how to report a work place injury, select the link located below.
- 221-10000 – Claim Kit Cover Letter
Letter from The Hanover welcoming the employer to the insurance plan, includes instructions for claim reporting and creating medical provider panels.
- 221-10001 – Take Control of Workers' Compensation Costs
This guidance will help ensure the best outcome for you and your employees following a work related injury.
- WC9862d – Disability Compensation Law: Notice to Employees
Required to be conspicuously posted at the employer's place of business so all employees have access to it.
- WC9948 – Highlights of the Hawaii Workers' Compensation Law
To be provided to an injured worker at the time of a work related injury.
- WC9246 – Employer Report of Industrial Injury
This form is completed by the employer to report an on the job injury or accident involving an employee.