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Hawaii Form Center -

Type & Print Forms - programmed for direct type and print functionality.

Each form may be downloaded in Adobe Acrobat format. Download the form by clicking on the form number below.
If you do not have Adobe Acrobat Reader, you may download it here for free. Download Adobe Here

All of these forms may now be auto-populated from your claims software program! Click here to learn about FlashForm SSL.


Form

Description

wc-1.pdf Employer's Report of Industrial Injury
wc-2.pdf Physician's Report
wc-3.pdf Carrier's Case Report - Per DOL must be filed in duplicate on pink paper.
wc-5.pdf Employee's Claim for Workers' Compensation Benefits
wc-5a.pdf Dependent's Claim for Compensation
wc-14.pdf Employee's Wage Report
wc-21.pdf Application for Self-Insurance Authorization
wc-42.pdf Request for Information or Photo Copies
wc-77.pdf Application for Hearing
wc-77a.pdf Response to Application for Hearing
Attorney-Fee-Request.pdf Request for Approval of Attorney's Fee
attorney_hourlyrate_increase.pdf Request for Increase in Hourly Rate
lir27.pdf Application for Certificate of Compliance with Section 3-122-112, HAR
highlights.pdf BROCHURE - Highlights of the Hawaii Workers' Compensation Law
labor-law-poster.pdf POSTER - Labor Law Posters (Complete set)
Special-Instructions.pdf Special Instructions for Insurance Carriers, Adjusters and Self-Insured Employers to Complete and File Industrial Accident (WC-1), Physician (WC-2) and Carrier Case (WC-3) Reports Under the Hawaii Workers' Compensation Law