FAQs – Frequently Asked Questions
If you suffer a job-related injury or disease, you may be entitled to receive compensation for medical care, lost wages, or other related benefits and/or services, depending upon your individual situation. HEMIC is responsible for paying your workers’ compensation benefits in such cases.
No. Workers’ Compensation law only covers disabilities that are caused by a workplace injury “arising out of and in the course of the employment” or occupational disease.
You do. You are entitled to choose the medical provider. If you want to change doctors, you may do so once, with our approval.
No. HEMIC pays for all essential medical care to treat your job-related injury or disease, and the bills for this medical care should be sent directly to HEMIC. Such care usually includes but is not limited to: payment for emergency medical care, doctor bills, X-rays, prescription medications, hospitalization, crutches and other essential medical care.
Yes. If your doctor certifies that you’re disabled from work due to a job-related injury or disease, you may be eligible for Temporary Total Disability (TTD) benefits, less the three day waiting period. Benefits may continue until you are released by your doctor to return to work.
TTD is computed by taking two thirds of your average weekly wage based on the prior 52 weeks from the accident date. However, it may not exceed the maximum Hawaii workers’ compensation rate in effect on the date of the injury.
Because wage loss benefits are significantly less than your regular pay, returning back to work as soon as medically possible ensures your financial stability.
The workers’ compensation law sets the TTD benefit at 2/3 of an injured worker’s regular wages. This is calculated by multiplying the worker’s average weekly wage (AWW) by 0.6667. If a worker routinely works overtime, does shift work, or performs jobs with differing hourly rates, you must complete a WC-14 form which outlines (or in some cases, averages) the worker’s wages for the 52 weeks prior to their date of injury. This provides the most accurate TTD benefit for the injured worker.
No, TTD benefits are not taxable, however some tax forms may require the injured worker to report what was received. The injured worker should seek advice from a qualified tax expert.
TTD is a wage replacement or time loss benefit paid to a worker who is unable to perform their job due to a work-related injury. To receive this benefit, the worker must be certified as disabled by his or her doctor. The TTD benefit is temporary in nature, and is paid until the injured worker is able to return to work.
By law, no payment of TTD is owed for the first three (3) days of disability, which is a required statutory “waiting period”. The first payment for TTD is due to the worker within ten (10) days of the employer’s knowledge that the injured worker has lost time from work due to a work-related injury or illness. This is why it is important to notify your claims specialist immediately if an injured worker has missed 3 or more days of work.
Modified duty is the work an injured employee can perform after an injury, taking into account any restrictions or limitations noted by their doctor. Modified duty may be temporary or permanent, depending on the injury and the course of recovery. Many employers maintain a modified duty plan or program that provides transitional work that meets the injured employee’s physical capabilities within their organization. If this is not feasible, HEMIC can help match injured workers with non-profit organizations with suitable, light-duty roles.
Studies indicate that a timely return to modified duty benefits both the injured worker and employer by keeping an injured worker physically conditioned, speeding their recovery, and reduces the total cost of the claim.
When an injured worker suffers the loss of a body part, the loss of use of a body part, or the permanent loss of a physical function due to a work-related injury, he or she may have a permanent disability and is entitled to compensation for this loss.
The benefit paid for this permanent disability is referred to as Permanent Partial Disability or PPD. To make this determination, medical experts will examine the injured worker and/or their medical records, then provide a report or “rating” of their findings and measurements of the impairment or loss of function. This rating may cover a variety of factors such as: a diagnosis, range of motion, loss of strength, sensory loss, etc. The rating is expressed in terms of the percentage of functioning lost or the extent of the impairment related to the injury. Impairment, which is a medical term, is then converted to “disability” or PPD – a legal concept under the law. The law provides:
- A schedule and formula for determination of PPD benefits, which when calculated is also expressed as a specified number of weeks of payment due the injured worker for the particular body part involved, and,
- An annual maximum weekly compensation rate, decided by the Department of Labor. A physician’s rating of impairment combined with the schedule and the annual rate of compensation for the year of the injury, are used to determine the amount of PPD benefit owed the injured worker for this permanent loss of a body part or function. This process typically occurs after the injury has resolved and it is necessary to complete prior to closing a claim.
Medical stability is the point at which the injury has reached maximum medical improvement and will not improve with further medical care or the passage of time. The medical condition has stabilized. Medical stability must be established before a determination of PPD is made. The worker may or may not have reached pre-injury status when stability is determined. The following terms are also used synonymously: maximum medical improvement (MMI); permanent & stationary (P&S).
An IME is a medical examination by an independent, qualified physician used to evaluate the injury and the claim. The doctor may be asked to provide information on and opinions about: the injured worker’s prior medical history, the nature of the accident and injury, the cause of the injury, whether the injury is work-related, non-work related causes, medical treatment and prognosis, medical stability, ability to return to work, PPD, consultations and referrals, testing and other related factors. IMEs can also address future medical care and treatment. IMEs can be conducted with or without an Order by the Director of Department of Labor.
The Department of Labor and Industrial Relations or DLIR is the state agency responsible for administering and overseeing state workers’ compensation claims in Hawaii. The DCD is a division within the DLIR. The DLIR and the DCD have the responsibility of providing general workers compensation information to the public, overseeing the claims, and conducting hearings on workers’ compensation claims. The DLIR has offices on Oahu, Hilo, West Hawaii, Maui, and Kauai. A separate federal office exists to oversee claims covered by federal laws.
Yes. If you are able to return to part-time or modified work while you are recovering from your injury, and you are receiving less than your usual earnings, you may be entitled to Temporary Partial Disability (TPD) benefits.
Yes. If medical care is necessary, it will be provided whether or not you are able to continue working.
If it is determined that your workplace injury results in a percentage loss of the use of certain parts or functions of your body, you may be eligible to receive Permanent Partial Disability (PPD) benefits, even if you are able to return to the same or some other type of work.
If you suspect fraud, it is important to report it. Cutting down on fraud reduces costs for everyone, including employers.
If you suspect an employer does not have workers’ comp insurance, you can contact the Investigation Section at the Hawaii Department of Labor and Industrial Relations in Honolulu or the Department of Labor and Industrial Relations District Office at neighbor islands.
If you suspect worker is defrauding HEMIC, please call our Fraud Hotline: 522-5279 on Oahu or toll-free,at (888) 522-5295. You can also submit a Report Fraud form.
When an injured worker is unable to return to their usual job that they were performing at the time of the work-related injury, vocational rehabilitation services provide job review and retraining services to get the worker back to work in another capacity. Here’s how it works:
The injured worker selects a licensed Vocational Rehabilitation Consultant (“VRC”) who:
- confirms the worker’s vocational abilities
- confirms that they’re unable to return to their usual job
- evaluates alternatives for permanent modified positions with their employer.
- If a permanent modified position is unavailable, then the VRC provides for job search opportunities and possible education and training for work with another employer.
While enrolled in VR, the injured worker will receive weekly Temporary Total Disability (TTD) benefits.
All injured workers are eligible for this benefit if they are unable to return to their usual job due to the work-related injury, regardless of the duration of employment with you.