Hawaii Workers' Comp Forms Explained: WC-1, WC-2, WC-5 and What Comes After

Hawaii's workers' compensation system runs on a short list of forms issued by the Disability Compensation Division (DCD) of the Department of Labor and Industrial Relations. Each one has a specific filer, a specific deadline and a specific place it goes. Most claim problems trace back to one of those three things going wrong.

This page lists every form an injured worker, employer or adjuster is likely to meet, in the order they appear in a claim. It links to the official DCD version of each form and to the statute that sets the deadline, so you can check the source rather than take anyone's word for it.

It is a reference, not legal advice. For a dispute about benefits, the Division's facilitators and a workers' comp attorney are the right calls. For getting the medical side of a claim right from day one, that is what Vally Medical Group does across Kona, Hilo, Lihue and Kihei.

The Deadlines That Matter Most

Every Form at a Glance

Source: the DCD Forms page, checked November 14, 2026. The WC-21 (self-insurance application) and WC-36 (carrier form) also exist but are not part of an injured worker's claim.

How the Forms Fit Together

A straightforward claim moves through the forms in a predictable order. Knowing the order tells you who is late when something stalls.

1. The worker reports the injury to the employer. Verbal is enough to start the clock, written is better. Keep the date.
2. The employer files the WC-1 with its carrier and the Division within seven working days, and sends the worker a copy. The WC-1 includes whether the employer is accepting or denying liability.
3. The worker sees a doctor of their choice. Hawaii law lets the injured worker pick the treating physician. The doctor files the first WC-2 within seven days of that visit, with a copy to the employer.
4. The carrier opens its file (WC-3 and related carrier forms) and starts paying medical bills and, if the worker is off work, temporary disability.
5. The doctor keeps reporting. Interim WC-2s cover diagnosis, treatment, test results, work restrictions and return-to-work dates. If care will run past fifteen visits in sixty days, a Treatment Plan goes to the employer at least seven days ahead.
6. Treatment ends, and the doctor files the final WC-2 within seven days. If there is permanent impairment, a rating report follows.
7. If the employer never filed, or the carrier denies or stops paying, the worker files a WC-5 with the Division. Disputes that cannot be resolved go to a hearing through the WC-77.

Form by Form

WC-1: Employer's Report of Industrial Injury

The WC-1 is the employer's form and the document that opens the claim. HRS 386-95 requires it within seven working days after the employer learns of an injury that causes at least one day of absence or needs medical treatment beyond ordinary first aid. A death must be reported to the Division within 48 hours.

The form records the employer, the employee's wages and occupation, the date and hour of the accident, the nature and cause of the injury, and whether the employer accepts or denies liability. The employer must send the employee a copy. An employer that willfully fails to file can be fined up to $5,000.

The WC-1 is now a portal submission rather than a public PDF. Full detail, including what to do if your employer will not file, is in the WC-1 guide.

WC-2: Physician's Report

The WC-2 is the treating doctor's report to the Division and the employer, required by HRS 386-96. The first report is due within seven days of the first visit, interim reports follow at appropriate intervals, and the final report is due within seven days after treatment ends. When a worker is released to any kind of work, the doctor has seven calendar days to tell the employer.

This is the document the adjuster reads to decide what to authorize. A physician who misses the reporting deadlines can be fined up to $500, and a claim for the treatment itself is not valid unless the reports were made. The WC-2 guide covers the report types, the contents and what adjusters look for.

WC-3: Carrier's Case Report

The WC-3 belongs to the insurance carrier or self-insured employer. It is how the carrier reports its handling of the claim to the Division. Workers and physicians do not file it, but if a carrier tells you a claim is "not set up yet," this is the paperwork it means.

WC-5: Employee's Claim for Workers' Compensation Benefits

The WC-5 is the worker's own claim form, and it exists for three situations printed right on it: the employer has not filed a WC-1, the carrier has not paid benefits, or an old claim needs reopening. It is also the form a worker uses when the employer denies that the injury was work related.

Under HRS 386-82 the written claim must reach the Division within two years of the date the injury's effects became manifest and within five years of the accident. The form asks for the employer, the carrier if known, how the injury happened and the reason for filing, in plain language. It is a fillable PDF delivered to a DCD office by mail, fax or in person, and the Division's facilitators will help with it.

WC-5A: Dependents' Claim

When a worker dies from a work injury, dependents file the WC-5A rather than the WC-5. The same limitation periods apply, and the form asks for the decedent's information, the dependents and the circumstances of the death.

Hawaii Workers' Compensation Treatment Plan

This one is not a WC-numbered form but it decides more treatment disputes than any other document. Under HAR 12-15-32, a physician may provide fifteen treatments in the first sixty days without authorization. Anything beyond that needs a treatment plan sent to the employer at least seven calendar days before the additional treatment starts.

The plan covers up to 120 days and fifteen treatments, and the front page and the envelope or fax cover must say WORKERS' COMPENSATION TREATMENT PLAN. The DLIR asks providers to use its standard form. The employer has seven days after receipt to object in writing; a plan with no objection on file is treated as accepted.

WC-14, WC-42, WC-77 and WC-77A

The WC-14 is the wage report the Division uses to set the weekly benefit rate; it comes from the employer's payroll. The WC-42 is how a worker or attorney requests copies of the Division's file. The WC-77 opens a hearing when the parties cannot agree on compensability, disability or treatment, and the WC-77A is the other side's response.

Where to File on the Neighbor Islands

The Division's main office is in Honolulu, but each neighbor island has a district office that takes WC-5 filings and answers status questions. The West Hawaii office does not receive mail; use its P.O. box.

Source: DCD contact page, November 2026. Call before visiting; hours and room numbers change.

Why the Doctor's Paperwork Decides the Claim

Of all the forms above, the ones the carrier reads most closely are the physician's. The WC-1 establishes that an injury happened; the WC-2 says what the injury is, whether work caused it, what treatment it needs and when the worker can return. Every authorization and every disability check flows from those answers.

A note from Dr. Vally: I have treated work injuries on four islands long enough to see the same pattern repeat. A report that states the mechanism of injury, ties it to the diagnosis and lists restrictions in plain terms gets approved, while a vague one draws a request for more information and the worker waits. That is why we treat the reporting as part of the treatment.

Four Locations Across Hawaii

All locations accept workers' compensation. Appointments are by scheduling only. Call (808) 935-6353 or start your intake online.

Frequently Asked Questions

Related Reading

• Hawaii WC-1 Form: How to Fill It Out, Deadlines, Where to Send It
• Hawaii WC-2 Physician's Report: Who Files It, When, and What Adjusters Look For
• The Hawaii Workers' Compensation Guide
• What Happens at Your First Workers' Comp Appointment
• The Workers' Comp Treatment Timeline in Hawaii
• Your Right to Choose Your Own Workers' Comp Doctor
• Employer's Guide to a Work Injury in Hawaii
• Workers' Comp Claim Denied in Hawaii: Next Steps

Statutes cited: HRS 386-95 (employer's report), HRS 386-96 (physician's reports), HRS 386-82 (time to file a claim) and HAR 12-15-32 (treatment plans). This page is general information about Hawaii's system and is not legal advice.