Hawaii Workers Compensation - Official forms

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