Workers in Hawaii who are injured while at work or develop a workplace related sickness or industrial disease may file a claim with their employers’ insurance carrier. Most employers in the island state are required to provide insurance cover for their employees. Compensation should help to pay for medical treatment and replace some of the wages that might be lost because of absence from work. Not every claim is honored and you may have to challenge the insurer’s decision to deny a claim. A workers’ comp attorney can help you do this. Workers' Compensation Law in Hawaii Few employers are exempt from providing workers’ compensation cover to their employees. If you are injured at work or develop an illness while at work you should notify your employer as soon as you can. The state body that oversees workers’ compensation insurance matters in Hawaii is the Hawaii Disability Compensation Division. This is the body that you will deal with if your employer’s insurer denies your claim for some reason. Workers’ compensation laws in Hawaii dictate what can be compensated. Most industrial or work related illnesses are covered including some mental illnesses as long as these are not due to disciplinary stress. Compensation should cover all medical costs and two thirds of lost wages. The calculation of what exactly you can claim for is not straightforward so you should examine the claim form carefully and if necessary get help from an attorney. Reasons for a Hawaii WC Claim Denial Sometimes, there are simple reasons for a Hawaii workers' comp denial, which can be rectified with your employer. The employer may have inadvertently given wrong details to its own insurer which may have confused their claims administrator about your eligibility for compensation. Hawaii does impose time limits on notifying your employer and making a claim although these limits are quite generous. Failure to keep to these limits may be a reason for a denial. Other reasons for a denial include: you are claiming for mental stress caused by your job; an allegation that you did not follow safety procedures at work; you made up your injuries; not going to a doctor after the injury; claiming for an injury or illness that did not take place at work. If any one of these above reasons is stated, they may be refuted at a hearing you request with the state’s Disability Compensation Division office. The Hawaii WC Appeal Procedure If your WC claim is denied for some reason, and you wish to challenge the decision, you should request a hearing with the Hawaii Disability Compensation Division. The hearing is the first step in the appeals procedure. The hearing will take place at one of the Division’s regional offices close to where you live. An officer will hear both sides of the dispute at the hearing and make a preliminary decision. Evidence can be presented by you to support your claim. The insurer’s representative will do the same. If you are unhappy with the decision made at the hearing you have a limited time (20 days) to make an appeal directly with the Hawaii Labor and Industrial Relations Appeals Board. A trial will be arranged and you will have another chance to make your case before a panel of three attorneys. This is not the last chance to appeal as there are further levels of appeal which are possible if you are still disappointed with the result. At this point, if you have not already done so, you should certainly have representation by an experienced attorney. Why a Workers' Comp Attorney May be of Help As the procedure involved in both a hearing and an appeal after a WC claim is quite complex it is strongly advised that you use a workers’ compensation attorney, even if it is just for advice. The insurer will certainly have an attorney representing them at any hearing or trial, so it is sensible to have someone to represent you as well who is experienced in WC law.
