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At Workers' Compensation Shop.com, we offer free access to the most common forms needed relating to Indiana Workers' Compensation Insurance. We strive to keep these forms up to date and accurate.
As with all information we provide please verify the accuracy of this information with the Hawaii Department of Commerce and Community Affairs, Insurance Division.
If you have any questions about any of these forms, feel free to contact one of our Workers' Comp Specialist's at 888-611-7467. If you are ready you can start a quote online today.
HI Acord 130 Workers' Compensation Application.
The standard Acord 130 application form for workers' comp coverage in Hawaii.
Hawaii Report of Injury Form
Report of Injury Form. Employers should complete this form and send to their insurance company each time an injury occurs.
Hawaii Workers' Compensation Laws- Form WC-101
The Hawaii Department of Labor and Industrial Relations requires that all HI employers provide this brochure to employees within 3 days of an injury.
Hawaii Application for Exclusion of Officers and Stockholders
Owners and Officers of corporations should complete this form to exclude themselves from a work comp policy.
Hawaii Employee Claim Form
Complete this form to file for a workers' compensation claim.
Complete this form to file for a workers' compensation claim for a claimant that is deceased.
Application for Safety and Health Certification
Hawaii Occupational Safety and Health Professional Application for certification.
Facts for Injured Workers In Hawaii
Information about workers' compensation in Hawaii for workers and employers.
Each state has its own laws and requirements regarding when and how employers are allowed to opt-out of coverage under their workers' compensation policy. Some states make it easier than others because they don't require anything to be filed. Other states require special inclusion or exclusion affidavit documentation. Failure to comply often causes employers to have to pay premium on themselves even when they wanted to be excluded form coverage.
A waiver of subrogation means that a business and their insurance company is foregoing all rights to file suit, or seek damages, from another business. This is common in the construction industry as builders attempt to protect their company from negligence. A workers' comp waiver of subrogation does not prevent an injured employee from filing a lawsuit for damages. This coverage typically add about $100 to the cost of a work comp policy.
A Certificate of Insurance is a document that serves as evidence of insurance or proof of coverage. Certificates indicate your current coverages and policy limits. Insurance Agencies issue on an insured's behalf and they often list a third party as a certificate holder. This means they should be notified if a policy cancels prior to expiration. Requests for any special wording should be carefully checked against the policy language before being added to a certificate as they can create legal issues with coverage.
Improve your business cash flow with our Agency Pay As You Go Workers' Comp plans. Available through most of our insurance companies.
State Resources for Hawaii
HI Dept of Commerce
Insurance DivisionP.O. Box 3614Honolulu, HI 96811808-586-2790 Hawaii Insurance Dept
HI Dept of Labor and Industrial Relations
830 Punchbowl StreetHonolulu, Hawaii 96813808-586-8842 HI Dept of Labor
Workers' compensation insurance is required by law for Hawaii employers.
Hawaii forms and applications such as owners inclusion or exclusion forms are sometimes updated by the state. Contact us if you need help or can't find the workers' compensation form your need for Hawaii.
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