All Hawaii Workers Compensation forms

Workers Compensation - Claims

• Checklists - Worker's Compensation Claims US-04076BG

Workers Compensation - Discovery

• Claimant's First Set of Interrogatories to Employer and Carrier US-01365
• Claimant's First Set of Requests for Production US-01366
• Requests for Production of Documents to Carrier US-01367

Workers Compensation - Injury and Claims

• Notice of Work-Related Injury and Claim for Worker's Compensation US-01495BG

Workers Compensation - Injury Reports

• Report of Injury by Employee to Employer to be Filed with Worker's Compensation Agency of State US-01494BG

Workers Compensation - Insurance

• Agreement of Employee Service Provider to Maintain Workers Compensation Insurance US-01625BG

Workers Compensation - Official - Applications

• Application For Hearing HI-DCD-77-WC
• Application for Certificate of Compliance with Section 3-122-112 HAR HI-DCD-LIR27-WC

Workers Compensation - Official - Authorizations

• Application for Self-Insurance Authorization HI-DCD-21-WC

Workers Compensation - Official - Claims

• Employees Claim For Workers Compensation Benefits HI-DCD-5-WC
• Dependents Claim for Compensation HI-DCD-5A-WC

Workers Compensation - Official - Responses

• Response To Application For Hearing HI-DCD-77A-WC

Workers Compensation - Official - Wages

• Employees Wage Report for Fifty-Two Weeks HI-DCD-14-WC

Workers Compensation - Questionnaires

• Workers Compensation Questionnaire US-Q1038