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Reporting of claim by Employer HRS 386-95
The Employer's Report of Industrial Injury (WC-1) must be filed within seven (7) working days of the employee's notification to the employer of any injury causing absence from work of one day or more, or which requires medical treatment beyond first aid.
Submit original and first copy of the WC-1 to DCD if the accident occurred on Oahu. If the accident occurred on a neighbor island, the original and first copy shall be sent to the appropriate district office of the Department of Labor and Industrial Relations. Effective 7/1/2016, Employers or insurance carriers may file by electronic means as approved by the director.
The form must be signed in ink. The signature of the person signing the form constitutes a certification that the person has read form and that, to the best of the individual's knowledge, information, and belief, all information contained in the form is true. 12-10-61
A copy of this report must be furnished to the injured employee.
When an injury results in immediate death, the employer must within 48 hours notify personally or by telephone a representative of the department in the county where the injury occurred.