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Frequently Asked Questions

Q:
What is the eligibility and process an Insurance Producer or Agency must take to obtain an appointment with HEMIC?
A:

The producer or agency must be licensed and residing in the State of Hawaii. HEMIC may make the appointment, provided the following requirements are fulfilled:

  1. Be in good standing with the Hawaii Insurance Division
  2. Submit two original Notice of Appointment of General Agent form 402/404, completed and signed
  3. Copy of Errors & Omissions policy or certificate of insurance with a minimum of $1,000,000 occurrence/aggregate
  4. Copy of the producer or agency’s license
  5. Federal Employment Identification Number
  6. Insurance Agency profile
Q:
What is the Cornerstone Agency Program?
A:

This is a program for top producing insurance agencies that have demonstrated proficiency when representing their clients with HEMIC. Cornerstone agencies receive an enhanced commission and other benefits. They also provide valuable feedback to HEMIC, so we may better serve our policyholders.

Q:
Are all Insurance Producers and Agencies licensed in Hawaii guaranteed access to HEMIC?
A:

No. While all Hawaii employers who pay their premiums, follow our safety and claims guidelines, and interact with HEMIC in good faith are guaranteed access, insurance producers and agencies are not. We will make every effort to accommodate all qualifying insurance producers and agencies through a selection process similar to, but more inclusive than, that of most other competitive insurance carriers. Hawaii licensed insurance producers and agencies that meet our qualifications and request an appointment may be contracted to represent their client with HEMIC, receiving one of three commission schedules based on their qualifications and the role they assign to HEMIC. 

 

Q:
Does HEMIC have multiple rating plans and how are they applied?
A:

HEMIC uses a five-tier rating plan. The applicable tier is determined by the policyholder’s service requirements and other characteristics of the risk. Policyholders with a poor loss history and/or who refuse to implement reasonable safety and claims practices may be subject to HEMIC’s high risk rating plan. This plan allows HEMIC to adjust those policyholders premium upwards to cover expected increased safety and claims costs.

Q:
What type of premium credits can be expected?
A:

Policyholders may qualify for one or more premium credits following completion of the Safety Credit Application.

Q:
What are the submission requirements?
A:

The submission to HEMIC should contain the following information:

  1. Accord 130 Workers’ Compensation Application.
  2. Four-year premium, payroll, and loss history (three prior years plus current).
  3. Loss runs from carriers for the past three years and current year.
  4. If there are no losses, a letter from the prior carrier will suffice.
  5. A copy of the current experience modification worksheet, if applicable.  For quoting purposes, we will accept the prior experience modification worksheet if current is not available but will adjust premium upon its receipt.
  6. A copy of the last two quarters Hawaii Department of Labor form UCB6.
  7. Supplemental applications are required for Aircraft Exposures, Federal Exposures, Leasing Companies, Bar/Tavern Exposures and Owner Builders.
Q:
When do rate changes apply to the workers compensation policy:
A:

It will be applied upon your first renewal AFTER the effective date of the rate change.

Q:
What if the employer has knowledge of an injury but unable to fully complete the WC-1 form?
A:

By law, the WC-1 must be submitted within seven (7) days of the industrial accident or the employer may be subject to a penalty. It is important to contact the claims specialist at HEMIC with all available information prior to expiration of the seven (7) days. Questions about the WC-1 and timely submission should be immediately discussed with the claims specialist.

Q:
What should an employer do if fraud is suspected of a Workers Compensation claim?
A:

The employer should notify the claim specialist immediately in order to initiate an investigation of a suspected fraudulent claim. Upon determination of fraudulent activity, a hearing must be held before the Disability Compensation Division.

Q:
How does a HEMIC policyholder qualify for a dividend?
A:

Policyholders who have been insured with HEMIC for more than one policy year, and who possess demonstrated safety records, qualify for the dividend according to the rules of the dividend distribution plan adopted by the Board.

Q:
What is Temporary Total Disability (TTD), and when is it owed to a worker?
A:

TTD is a form of wage replacement or lost time benefits paid to an injured worker who is not able to perform work for the employer because of the work related injury, and, have been certified as disabled by the worker’s attending physician. This benefit is temporary in nature and paid to the injured worker until such time 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, referred to as the required statutory “waiting period”. The first check or 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. These requirements underscore the importance of immediately notifying your claims specialist if an injured worker has missed three (3) or more days of work.

Q:
How is TTD calculated?
A:

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.

Q:
Are TTD benefits taxable?
A:

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.

Q:
What happens if an injured worker files for unemployment benefits while receiving TTD?
A:

This is an important area of concern. When filing an application for unemployment benefits, the injured worker certifies that he/she is capable of performing work. This unemployment certification is contrary to the medical certification of disability from work required for the receipt of TTD benefits and may impact an employer’s obligation within a workers’ compensation claim. The employer should immediately report any unemployment application or information to the claims specialist at HEMIC. This consideration is independent of the employer’s position to contest or accept the unemployment claim.

Q:
What happens if an injured worker receives Temporary Disability Insurance (TDI) benefits and workers' compensation benefits?
A:

TDI is a form of disability payment for a non-work related injury. Workers’ compensation is a state law that covers work related injuries. A worker is not entitled to both of these benefits for the same injury as the injury cannot be both non-work related and work related. However, in some situations, while awaiting an outcome of the workers compensation claim, injured workers may file and receive TDI benefits. If TDI benefits are received and the injury is later determined to be work related, reimbursement is usually owed to the TDI carrier.

Q:
What is “modified duty” and how is it a benefit?
A:

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.

 

Q:
What is "medical stability"?
A:

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).

Q:
What is an Independent Medical Examination (IME) and when is it used?
A:

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.

Q:
What is "subrosa" and when is it used?
A:

Subrosa is a confidential investigation into the claim. Subrosa is not used frequently, but it is an investigational tool that can be used when the claim specialist determines that there are questionable statements and activities within the claim. An injured worker may or may not be told about a subrosa investigation. Subrosa is typically performed by private investigators hired by the insurance provider. Subrosa may involve background checks, factual and witness investigation, observation of the injured worker, and development of possible leads for further investigation.

Q:
What are the Department of Labor & Industrial Relations, State of Hawaii (DLIR) and Disability Compensation Division (DCD)?
A:

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.

Q:
What is vocational rehabilitation (VR), who gets it and why?
A:

Vocation rehabilitation services are the vocational review and retraining services provided to an injured worker who is not able to return to the usual and customary employment he/she was performing at the time of the work related injury. VR services are provided by licensed vocational rehabilitation consultants (“VRC”) and the VRC selected by the injured worker. The role of the VRC includes but is not limited to confirming an injured workers vocational abilities, inability to return to the usual and customary employment with the employer, alternatives for permanent modified positions with the employer, which if unavailable, then providing a job search and possible schooling and training for work with another employer. While enrolled in VR, the injured worker continues to receive weekly TTD benefits. VR is often an area of contention in a claim.

Q:
Is the worker entitled to vocational rehabilitation services if only employed for a short period of time?
A:

All injured workers are eligible for this benefit if they are unable to return to their usual & customary employment due to the work related injury, regardless of the duration of employment with you.

Q:
Does HEMIC plan to give a dividend every year?
A:

By law, dividends cannot be guaranteed. Consideration for declaring a dividend is at the discretion of the Board of Directors. Their first obligation is to assure that HEMIC has sufficient surplus to be financially secure, to meet State surplus requirements, to maintain its rating agency status, and to otherwise fulfill its mission and purpose. The Board may declare a dividend whenever it determines that HEMIC has sufficient surplus to fulfill the aforementioned requirements in addition to payment of the dividend.

Q:
How can HEMIC afford to pay dividends?
A:

HEMIC is in a strong financial position with adequate surplus to meet all statutory requirements and is rated “A” excellent & secure by AM Best. The dividend distribution in no way compromises that strong financial position.

Q:
What is ‘modified duty’ and how is it a benefit?
A:

Modified duty is the work an injured employee can perform after an injury, taking into account any restrictions or limitations provided by the attending physician. 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 worker’s physical capabilities within their organization. If this is not feasible, HEMIC may assist in matching injured workers with non-profit organizations in suitable, light-duty roles. Studies also indicate a timely return to modified duty will benefit both the injured worker and employer by keeping an injured worker physically conditioned, speeds the employee’s recovery and reduces the total cost of the claim.

Q:
What is Permanent Partial Disability (PPD), and when is it payable as a benefit?
A:

When an injured worker suffers the loss of a body part or loss of use of a part of the body, or, permanent loss of a physical function (impairment) as a result of the work related injury, he/she may have a permanent disability and is entitled to a benefit 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 related medical records; provide a report of their findings and measurements of the impairment or loss of function, referred to as a “rating”. 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, a medical term, is then converted to “disability” or PPD – a legal concept under the law.  The law provides 1) 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, 2) an annual maximum weekly compensation rate, decided by the Department of Labor, to be used in the formula. 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 is necessary to complete prior to closing a claim.

Q:
What is "subrogation" and what are the benefits?
A:

Subrogation is the legal right an employer and insurance carrier have to pursue recovery from a wrongdoer or third party for the injuries suffered by the injured worker due to the wrongdoer’s or third party’s actions. Subrogation may be pursued with or without the participation of the injured worker. The goal of subrogation is to recover from the wrongdoer monies paid by the employer or insurance carrier to injured workers for injuries actually caused by the wrongdoer’s actions. A subrogation recovery will reduce the net loss of the claim, which may impact either the premium or x-mod.

Q:
How do HEMIC policyholders qualify for dividends?
A:

Policyholders who have been insured with HEMIC for more than one policy year and who have demonstrated safety records qualify for the dividend, according to the rules of the dividend distribution plan adopted by the Board.

Q:
Can I get a copy of the Dividend Plan?
A:

Yes. It is on the HEMIC website behind your Employer Login.

Q:
Does HEMIC plan to give a dividend every year?
A:

By law, dividends cannot be guaranteed. The criteria for declaring a dividend are decided by the Board of Directors. Their first obligation is to assure that HEMIC has sufficient surplus to be financially secure, to meet State surplus requirements, to maintain our rating agency status, and to otherwise fulfill our mission. The Board may declare a dividend whenever all of these obligations have been successfully achieved.

Q:
How can HEMIC afford to pay dividends?
A:

HEMIC is in a strong financial position with adequate surplus to meet all statutory requirements. We are rated “A” excellent and secure by AM Best. The dividend distribution in no way compromises our strong financial position.

Q:
How is TTD calculated?
A:

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.

Q:
Are TTD benefits taxable?
A:

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.

Q:
What is Temporary Total Disability (TTD) and when is it owed to a worker?
A:

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.   

Q:
What happens if my worker files for unemployment benefits while receiving TTD?
A:

This is an important concern. When an injured worker files an application for unemployment benefits, they are certifying that they are capable of performing work. Unemployment certification is contrary to the medical certification of disability from work that is required to receive TTD benefits:  it may impact your obligations within the workers compensation claim. You should immediately report any unemployment application or information to your claim specialist. This consideration is independent of your position as an employer to contest or accept the unemployment claim.

Q:
What is “modified duty” and how is it a benefit?
A:

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.

 

Q:
What is Permanent Partial Disability (PPD) and when is it payable as a benefit?
A:

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:

  1.  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,
  2. 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.
Q:
What is "medical stability"?
A:

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).

Q:
What is an Independent Medical Examination (IME) and when is it used?
A:

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.

Q:
What is "subrosa" and when is it used?
A:

Subrosa is a confidential investigation into the claim. Subrosa is not used frequently, but it is an investigational tool that can be used when the claim specialist determines that there are questionable statements and activities within the claim. An injured worker may or may not be told about a subrosa investigation. Subrosa is typically performed by private investigators hired by the insurance provider. Subrosa may involve background checks, factual and witness investigation, observation of the injured worker, and development of possible leads for further investigation.

Q:
What are the Department of Labor & Industrial Relations, State of Hawaii (DLIR) and Disability Compensation Division (DCD)?
A:

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.

Q:
What is "subrogation" and what are the benefits?
A:

When a worker’s injury is caused by the actions of a wrongdoer or a third-party (and not the workplace), subrogation is the legal right of the employer and insurance carrier to pursue compensation recovery from them.  Subrogation may be pursued with or without the participation of the injured worker. The goal of subrogation is to recover from the wrongdoer monies that the employer or insurance carrier have paid to the injured worker for injuries actually caused by the wrongdoer’s actions. A subrogation recovery reduces the net loss of the claim, which may impact the employer’s Experience Modification Factor (X-Mod) and/or premium.

Q:
Should I call my Claim Specialist when a worker returns to work?
A:

Yes. To ensure accurate and proper payment of workers’ compensation benefits, notify your claim specialist immediately when your worker returns to work.

Q:
We have had an excellent safety record. How will a costly claim impact my premium?
A:

A costly claim will not affect the premium for your current policy. However, future policies and premiums may be affected if the claim is significant enough to adversely impact your Experience Modification Factor.

Q:
What is the Experience Modification Factor and how does it affect my premium?
A:

Your standard annual premium for workers’ compensation coverage is determined by the industry in which you operate and this equation:

Annual Gross Wages Paid   X   The Established Dollar Rate for Every $100 of Payroll

  X   The Experience Modification Factor = Standard Annual Premium    

The experience modification factor (usually known in the industry as “X-Mod” for short) is calculated every year by the NCCI.  The calculation formula uses claims information from your company’s prior three years.  The formula is weighted to place more emphasis on the frequency of claims, so it is very important to focus your efforts on loss prevention to maintain a good X-Mod.  An X-Mod of 1.0 is considered average, but beating the average will lower your insurance costs.

Q:
What is done by Department of Labor & Industrial Relations (DLIR) and Disability Compensation Division (DCD)?
A:

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. These agencies are responsible for providing general workers’ compensation information to the public, overseeing claims, and conducting hearings on workers’ compensation claims. The DLIR has offices on Oahu and in Hilo, West Hawaii, Maui, and Kauai. A separate federal office exists to oversee claims covered by federal laws.

Q:
What if I disagree with the worker's' description of the cause of the injury?
A:

Contact your claim specialist immediately to explain why you disagree and why you suspect fraud. Your reasons may include:

  • the details of the incident
  • contrary objective or witness information
  • inconsistent statements or facts
  • suspicions as to other reasons for the injury
  • etc.

Keep your concerns confidential within your office, and only discuss them on a need-to-know basis. The claim specialist will determine the course of follow-up actions.

Q:
What if I know that my worker isn't as disabled as they claim to be?
A:

Contact your claim specialist immediately with all available information that supports your concern. This may include personal observations, co-employee statements, and other information that may provide the basis for an investigation.

Q:
What happens if my worker receives Temporary Disability Insurance (TDI) benefits and workers' compensation benefits?
A:

TDI is a disability benefit for non-work related injuries. Workers’ compensation is a benefit for work-related injuries. A worker is not allowed to receive both these benefits for the same injury, since an injury is either work-related or non-work related. In some situations, while awaiting an outcome of the workers’ compensation claim, an injured worker may file and receive TDI benefits. If TDI benefits are received and the injury is later determined to be work-related, the worker will need to pay back the TDI carrier for any TDI money they received.

Q:
What if I suspect the injuries were a result of the worker’s willful intention to injure himself or herself, intoxication or possible illegal substance abuse?
A:

Contact your claims specialist immediately with any information that supports your concerns. Any additional information you have may affect your WC-1 position on denial of liability. Be sure to keep your concerns confidential within your office, and only discuss them on a need-to-know basis. You may also want to contact your company attorney to discuss these issues and applicable company policies.

Q:
What if I know or suspect that an injured worker receiving disability benefits is active (surfing, fishing, golfing, working, etc.)?
A:

Contact your claims specialist immediately with all available information about your suspicions. Often comments or statements by co-employees or your own personal observations may provide a basis to investigate an injured worker’s disability status. Keep this information confidential within your company. Discuss it only on a need-to-know basis.

Q:
What do I do if I don't have all the information needed to complete the WC-1?
A:

By law, the WC-1 must be submitted within seven (7) days of the industrial accident or the employer may be subject to a penalty. It is important that you contact the claims specialist with all available information prior to expiration of the seven (7) days. Questions about the WC-1 and timely submission should be immediately discussed with your claims specialist.

Q:
What if I suspect a general contractor, subcontractor or third person is responsible for my worker’s’ injuries and now I have to pay the claim? What should I do?
A:

Contact your claims specialist immediately with the information supporting your concerns and an evaluation can be made whether any action for reimbursement and recovery from the wrongful party is possible.

Q:
If one of my workers has a pre-existing condition and/or disability and is injured while working for my company, what am I responsible for?
A:

You are legally responsible for the injuries sustained by the injured worker while employed with your company. With any employee you hire, you “take the employee asis”, so an employee that has a pre-existing condition or disability and is injured in your employ often requires reliance on medical opinions to separate the medical and legal consequences of the work-related injury from the medical and legal consequences of the pre-existing condition or disability. If a dispute exists as to your responsibilities, then medical opinions and determination by a hearing at the DCD may be required to administratively determine the extent of your responsibilities for payment of benefits to the injured worker. Since each situation is factually dependent, these matters should be discussed with your claims specialist to ensure a thorough investigation and evaluation of this issue is completed.

Q:
What should I do if my worker gets an attorney? Can I still talk to them?
A:

Inform your claim specialist of the attorney’s involvement. Unless you are instructed by your attorney or the injured worker is instructed by his or her attorney not to speak to you about the case, you can still talk to your worker as his or her employer. It’s a good rule of thumb to always be careful discussing any matters regarding the workers’ compensation claim with the injured worker to avoid confusion, misunderstanding or communicating any information that is different than what your claim specialist has said or done. If you are uncertain how to answer a question from your injured employee about any aspect of the workers’ compensation claim, please contact your claim specialist.

Q:
I received a Notice of Hearing on the claim, should I attend?
A:

We encourage policyholders to attend hearings, because your attendance demonstrates your concern for your workers and the proceedings with the claim. If you wish to attend, please contact your claim specialist as far in advance of the scheduled hearing as possible.

Q:
As the employer, do I have any input in the selection of my injured worker's treating physician?
A:

Generally, the injured worker selects his or her treating or attending physician. Some employers offer suggestions if the injured worker inquires or does not have a doctor in mind. In the case of a work-related injury where there is a need for immediate emergency care and treatment, the employer is encouraged to help the injured worker secure emergency care and treatment. In such situations, the concern is to afford the injured worker all reasonable and necessary medical care and treatment the injury requires.

Q:
What happens if an injured worker wants to use a physician other than the one he or she initially began treating with?
A:

The injured worker is allowed to select his or her attending doctor and thereafter, is allowed to make one change of doctor without requiring the consent or approval of the employer or carrier.  Any subsequent change of doctor requires the approval or consent of the employer, carrier or DLIR to be valid under the workers’ compensation law.

Q:
How can I find out the status of my bills and payments?
A:

We give authorized medical providers real-time access to medical bill payment status from any web-enabled device through our secure, online portal 24/7. Login to our Medical Provider Portal or register as a new provider.

Q:
What information do I need to register as a new provider?
A:

First, we need to have processed and paid one bill submitted by you. On your check stub for this first payment, you will find an assigned provider registration code. Use that during your registration process.  Click here to register! 

Q:
Can I request Electronic Funds Transfer (EFT)?
A:

Yes. HEMIC offers EFT thru HEMICPay a payment automation solution offering payers and payees the ability to streamline the payment and remittance process by leveraging the use of Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA).

Q:
I need help signing up. Who do I call or email for support?
A:

If you have questions or difficulties, please call Jopari support at 800-630-3060 ext 5207 or email support@jopari.com. Hours of operation are 8:30 a.m. to 5:30 p.m. PST.

Q:
Can other medical providers see my information?
A:

No. Your claim information is protected. Only you, as the authorized user, can access it with your login user ID and password.

Q:
What information do I need to treat CBWC patients?
A:

When treating injured workers covered under Collectively Bargained Workers’s Compensation (CBWC), providers must comply with the Official Disability Guidelines (ODG), an evidence-based guide for the treatment of work-related injuries.

ODG was selected by Labor and Management for the existing CBWC programs in the State of Hawaii to provide quality medical care through evidence-based medicine.

HEMIC pre-approves treatment for CBWC patients that is within the ODG. You do not need to submit a Treatment Plan for approval as long as the entire course of treatment is within ODG. This benefits you and your patients by enabling prompt, effective treatment.

ODG provides treatment and lost-time guidelines using actual experience data from federal government databases, including the annual CDC National Health Interview Survey, the BLS Survey of Occupational Injuries and Illnesses, and over 2 million medical records from actual workers’ compensation claims. ODG guidelines are based on actual outcomes, which makes them a fair approach for all parties.

Q:
What are workers' compensation benefits?
A:

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.

Q:
Are all injuries or disabilities covered under Workers' Compensation Law?
A:

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.

Q:
Who chooses my doctor?
A:

You do. You are entitled to choose the medical provider. If you want to change doctors, you may do so once, with our approval.

Q:
Do I pay for my medical care?
A:

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.

Q:
Do I receive wage loss benefits if I am off work due to a work-related injury?
A:

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. 

Q:
How is TTD calculated?
A:

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.

Q:
Are TTD benefits taxable?
A:

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.

Q:
What is Temporary Total Disability (TTD) and when is it owed to a worker?
A:

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.   

Q:
What is “modified duty” and how is it a benefit?
A:

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.

 

Q:
What is Permanent Partial Disability (PPD) and when is it payable as a benefit?
A:

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:

  1.  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,
  2. 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.
Q:
What is "medical stability"?
A:

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).

Q:
What is an Independent Medical Examination (IME) and when is it used?
A:

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.

Q:
What are the Department of Labor & Industrial Relations, State of Hawaii (DLIR) and Disability Compensation Division (DCD)?
A:

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.

Q:
If I go back to part-time or modified work, do I receive wage loss benefits?
A:

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.

Q:
Will I receive medical care for a workplace injury even if I don’t lose time from work?
A:

Yes. If medical care is necessary, it will be provided whether or not you are able to continue working.

Q:
If my accidental injury results in a permanent partial loss, condition, will I receive benefits for this? What if I am able to return to some sort of work?
A:

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.

Q:
I think someone may be taking advantage of, or defrauding HEMIC. What do I do?
A:

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.

Q:
What is vocational rehabilitation (VR), who gets it and why?
A:

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.

Q:
Is the worker entitled to vocational rehabilitation services if only employed for a short period of time?
A:

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.

Q:
What are workers' compensation benefits?
A:

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.

Q:
Are all injuries or disabilities covered under Workers' Compensation Law?
A:

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.

Q:
Who chooses my doctor?
A:

You do. You are entitled to choose the medical provider. If you want to change doctors, you may do so once, with our approval.

Q:
Do I pay for my medical care?
A:

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.

Q:
Do I receive wage loss benefits if I am off work due to a work-related injury?
A:

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. 

Q:
What is the eligibility and process an Insurance Producer or Agency must take to obtain an appointment with HEMIC?
A:

The producer or agency must be licensed and residing in the State of Hawaii. HEMIC may make the appointment, provided the following requirements are fulfilled:

  1. Be in good standing with the Hawaii Insurance Division
  2. Submit two original Notice of Appointment of General Agent form 402/404, completed and signed
  3. Copy of Errors & Omissions policy or certificate of insurance with a minimum of $1,000,000 occurrence/aggregate
  4. Copy of the producer or agency’s license
  5. Federal Employment Identification Number
  6. Insurance Agency profile
Q:
What is the Cornerstone Agency Program?
A:

This is a program for top producing insurance agencies that have demonstrated proficiency when representing their clients with HEMIC. Cornerstone agencies receive an enhanced commission and other benefits. They also provide valuable feedback to HEMIC, so we may better serve our policyholders.

Q:
Are all Insurance Producers and Agencies licensed in Hawaii guaranteed access to HEMIC?
A:

No. While all Hawaii employers who pay their premiums, follow our safety and claims guidelines, and interact with HEMIC in good faith are guaranteed access, insurance producers and agencies are not. We will make every effort to accommodate all qualifying insurance producers and agencies through a selection process similar to, but more inclusive than, that of most other competitive insurance carriers. Hawaii licensed insurance producers and agencies that meet our qualifications and request an appointment may be contracted to represent their client with HEMIC, receiving one of three commission schedules based on their qualifications and the role they assign to HEMIC. 

 

Q:
Does HEMIC have multiple rating plans and how are they applied?
A:

HEMIC uses a five-tier rating plan. The applicable tier is determined by the policyholder’s service requirements and other characteristics of the risk. Policyholders with a poor loss history and/or who refuse to implement reasonable safety and claims practices may be subject to HEMIC’s high risk rating plan. This plan allows HEMIC to adjust those policyholders premium upwards to cover expected increased safety and claims costs.

Q:
What type of premium credits can be expected?
A:

Policyholders may qualify for one or more premium credits following completion of the Safety Credit Application.

Q:
What are the submission requirements?
A:

The submission to HEMIC should contain the following information:

  1. Accord 130 Workers’ Compensation Application.
  2. Four-year premium, payroll, and loss history (three prior years plus current).
  3. Loss runs from carriers for the past three years and current year.
  4. If there are no losses, a letter from the prior carrier will suffice.
  5. A copy of the current experience modification worksheet, if applicable.  For quoting purposes, we will accept the prior experience modification worksheet if current is not available but will adjust premium upon its receipt.
  6. A copy of the last two quarters Hawaii Department of Labor form UCB6.
  7. Supplemental applications are required for Aircraft Exposures, Federal Exposures, Leasing Companies, Bar/Tavern Exposures and Owner Builders.
Q:
When do rate changes apply to the workers compensation policy:
A:

It will be applied upon your first renewal AFTER the effective date of the rate change.

Q:
What if the employer has knowledge of an injury but unable to fully complete the WC-1 form?
A:

By law, the WC-1 must be submitted within seven (7) days of the industrial accident or the employer may be subject to a penalty. It is important to contact the claims specialist at HEMIC with all available information prior to expiration of the seven (7) days. Questions about the WC-1 and timely submission should be immediately discussed with the claims specialist.

Q:
What should an employer do if fraud is suspected of a Workers Compensation claim?
A:

The employer should notify the claim specialist immediately in order to initiate an investigation of a suspected fraudulent claim. Upon determination of fraudulent activity, a hearing must be held before the Disability Compensation Division.

Q:
How does a HEMIC policyholder qualify for a dividend?
A:

Policyholders who have been insured with HEMIC for more than one policy year, and who possess demonstrated safety records, qualify for the dividend according to the rules of the dividend distribution plan adopted by the Board.

Q:
How do HEMIC policyholders qualify for dividends?
A:

Policyholders who have been insured with HEMIC for more than one policy year and who have demonstrated safety records qualify for the dividend, according to the rules of the dividend distribution plan adopted by the Board.

Q:
Can I get a copy of the Dividend Plan?
A:

Yes. It is on the HEMIC website behind your Employer Login.

Q:
Does HEMIC plan to give a dividend every year?
A:

By law, dividends cannot be guaranteed. The criteria for declaring a dividend are decided by the Board of Directors. Their first obligation is to assure that HEMIC has sufficient surplus to be financially secure, to meet State surplus requirements, to maintain our rating agency status, and to otherwise fulfill our mission. The Board may declare a dividend whenever all of these obligations have been successfully achieved.

Q:
How can HEMIC afford to pay dividends?
A:

HEMIC is in a strong financial position with adequate surplus to meet all statutory requirements. We are rated “A” excellent and secure by AM Best. The dividend distribution in no way compromises our strong financial position.

Q:
What is Temporary Total Disability (TTD), and when is it owed to a worker?
A:

TTD is a form of wage replacement or lost time benefits paid to an injured worker who is not able to perform work for the employer because of the work related injury, and, have been certified as disabled by the worker’s attending physician. This benefit is temporary in nature and paid to the injured worker until such time 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, referred to as the required statutory “waiting period”. The first check or 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. These requirements underscore the importance of immediately notifying your claims specialist if an injured worker has missed three (3) or more days of work.

Q:
How is TTD calculated?
A:

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.

Q:
Are TTD benefits taxable?
A:

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.

Q:
What is Temporary Total Disability (TTD) and when is it owed to a worker?
A:

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.   

Q:
What happens if my worker files for unemployment benefits while receiving TTD?
A:

This is an important concern. When an injured worker files an application for unemployment benefits, they are certifying that they are capable of performing work. Unemployment certification is contrary to the medical certification of disability from work that is required to receive TTD benefits:  it may impact your obligations within the workers compensation claim. You should immediately report any unemployment application or information to your claim specialist. This consideration is independent of your position as an employer to contest or accept the unemployment claim.

Q:
What happens if an injured worker files for unemployment benefits while receiving TTD?
A:

This is an important area of concern. When filing an application for unemployment benefits, the injured worker certifies that he/she is capable of performing work. This unemployment certification is contrary to the medical certification of disability from work required for the receipt of TTD benefits and may impact an employer’s obligation within a workers’ compensation claim. The employer should immediately report any unemployment application or information to the claims specialist at HEMIC. This consideration is independent of the employer’s position to contest or accept the unemployment claim.

Q:
What happens if an injured worker receives Temporary Disability Insurance (TDI) benefits and workers' compensation benefits?
A:

TDI is a form of disability payment for a non-work related injury. Workers’ compensation is a state law that covers work related injuries. A worker is not entitled to both of these benefits for the same injury as the injury cannot be both non-work related and work related. However, in some situations, while awaiting an outcome of the workers compensation claim, injured workers may file and receive TDI benefits. If TDI benefits are received and the injury is later determined to be work related, reimbursement is usually owed to the TDI carrier.

Q:
What is “modified duty” and how is it a benefit?
A:

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.

 

Q:
What is Permanent Partial Disability (PPD) and when is it payable as a benefit?
A:

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:

  1.  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,
  2. 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.
Q:
What is "medical stability"?
A:

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).

Q:
What is an Independent Medical Examination (IME) and when is it used?
A:

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.

Q:
What is "subrosa" and when is it used?
A:

Subrosa is a confidential investigation into the claim. Subrosa is not used frequently, but it is an investigational tool that can be used when the claim specialist determines that there are questionable statements and activities within the claim. An injured worker may or may not be told about a subrosa investigation. Subrosa is typically performed by private investigators hired by the insurance provider. Subrosa may involve background checks, factual and witness investigation, observation of the injured worker, and development of possible leads for further investigation.

Q:
What are the Department of Labor & Industrial Relations, State of Hawaii (DLIR) and Disability Compensation Division (DCD)?
A:

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.

Q:
What is "subrogation" and what are the benefits?
A:

When a worker’s injury is caused by the actions of a wrongdoer or a third-party (and not the workplace), subrogation is the legal right of the employer and insurance carrier to pursue compensation recovery from them.  Subrogation may be pursued with or without the participation of the injured worker. The goal of subrogation is to recover from the wrongdoer monies that the employer or insurance carrier have paid to the injured worker for injuries actually caused by the wrongdoer’s actions. A subrogation recovery reduces the net loss of the claim, which may impact the employer’s Experience Modification Factor (X-Mod) and/or premium.

Q:
What is vocational rehabilitation (VR), who gets it and why?
A:

Vocation rehabilitation services are the vocational review and retraining services provided to an injured worker who is not able to return to the usual and customary employment he/she was performing at the time of the work related injury. VR services are provided by licensed vocational rehabilitation consultants (“VRC”) and the VRC selected by the injured worker. The role of the VRC includes but is not limited to confirming an injured workers vocational abilities, inability to return to the usual and customary employment with the employer, alternatives for permanent modified positions with the employer, which if unavailable, then providing a job search and possible schooling and training for work with another employer. While enrolled in VR, the injured worker continues to receive weekly TTD benefits. VR is often an area of contention in a claim.

Q:
Is the worker entitled to vocational rehabilitation services if only employed for a short period of time?
A:

All injured workers are eligible for this benefit if they are unable to return to their usual & customary employment due to the work related injury, regardless of the duration of employment with you.

Q:
Should I call my Claim Specialist when a worker returns to work?
A:

Yes. To ensure accurate and proper payment of workers’ compensation benefits, notify your claim specialist immediately when your worker returns to work.

Q:
We have had an excellent safety record. How will a costly claim impact my premium?
A:

A costly claim will not affect the premium for your current policy. However, future policies and premiums may be affected if the claim is significant enough to adversely impact your Experience Modification Factor.

Q:
What is the Experience Modification Factor and how does it affect my premium?
A:

Your standard annual premium for workers’ compensation coverage is determined by the industry in which you operate and this equation:

Annual Gross Wages Paid   X   The Established Dollar Rate for Every $100 of Payroll

  X   The Experience Modification Factor = Standard Annual Premium    

The experience modification factor (usually known in the industry as “X-Mod” for short) is calculated every year by the NCCI.  The calculation formula uses claims information from your company’s prior three years.  The formula is weighted to place more emphasis on the frequency of claims, so it is very important to focus your efforts on loss prevention to maintain a good X-Mod.  An X-Mod of 1.0 is considered average, but beating the average will lower your insurance costs.

Q:
What is done by Department of Labor & Industrial Relations (DLIR) and Disability Compensation Division (DCD)?
A:

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. These agencies are responsible for providing general workers’ compensation information to the public, overseeing claims, and conducting hearings on workers’ compensation claims. The DLIR has offices on Oahu and in Hilo, West Hawaii, Maui, and Kauai. A separate federal office exists to oversee claims covered by federal laws.

Q:
What if I disagree with the worker's' description of the cause of the injury?
A:

Contact your claim specialist immediately to explain why you disagree and why you suspect fraud. Your reasons may include:

  • the details of the incident
  • contrary objective or witness information
  • inconsistent statements or facts
  • suspicions as to other reasons for the injury
  • etc.

Keep your concerns confidential within your office, and only discuss them on a need-to-know basis. The claim specialist will determine the course of follow-up actions.

Q:
What if I know that my worker isn't as disabled as they claim to be?
A:

Contact your claim specialist immediately with all available information that supports your concern. This may include personal observations, co-employee statements, and other information that may provide the basis for an investigation.

Q:
What happens if my worker receives Temporary Disability Insurance (TDI) benefits and workers' compensation benefits?
A:

TDI is a disability benefit for non-work related injuries. Workers’ compensation is a benefit for work-related injuries. A worker is not allowed to receive both these benefits for the same injury, since an injury is either work-related or non-work related. In some situations, while awaiting an outcome of the workers’ compensation claim, an injured worker may file and receive TDI benefits. If TDI benefits are received and the injury is later determined to be work-related, the worker will need to pay back the TDI carrier for any TDI money they received.

Q:
What if I suspect the injuries were a result of the worker’s willful intention to injure himself or herself, intoxication or possible illegal substance abuse?
A:

Contact your claims specialist immediately with any information that supports your concerns. Any additional information you have may affect your WC-1 position on denial of liability. Be sure to keep your concerns confidential within your office, and only discuss them on a need-to-know basis. You may also want to contact your company attorney to discuss these issues and applicable company policies.

Q:
What if I know or suspect that an injured worker receiving disability benefits is active (surfing, fishing, golfing, working, etc.)?
A:

Contact your claims specialist immediately with all available information about your suspicions. Often comments or statements by co-employees or your own personal observations may provide a basis to investigate an injured worker’s disability status. Keep this information confidential within your company. Discuss it only on a need-to-know basis.

Q:
What do I do if I don't have all the information needed to complete the WC-1?
A:

By law, the WC-1 must be submitted within seven (7) days of the industrial accident or the employer may be subject to a penalty. It is important that you contact the claims specialist with all available information prior to expiration of the seven (7) days. Questions about the WC-1 and timely submission should be immediately discussed with your claims specialist.

Q:
What if I suspect a general contractor, subcontractor or third person is responsible for my worker’s’ injuries and now I have to pay the claim? What should I do?
A:

Contact your claims specialist immediately with the information supporting your concerns and an evaluation can be made whether any action for reimbursement and recovery from the wrongful party is possible.

Q:
If one of my workers has a pre-existing condition and/or disability and is injured while working for my company, what am I responsible for?
A:

You are legally responsible for the injuries sustained by the injured worker while employed with your company. With any employee you hire, you “take the employee asis”, so an employee that has a pre-existing condition or disability and is injured in your employ often requires reliance on medical opinions to separate the medical and legal consequences of the work-related injury from the medical and legal consequences of the pre-existing condition or disability. If a dispute exists as to your responsibilities, then medical opinions and determination by a hearing at the DCD may be required to administratively determine the extent of your responsibilities for payment of benefits to the injured worker. Since each situation is factually dependent, these matters should be discussed with your claims specialist to ensure a thorough investigation and evaluation of this issue is completed.

Q:
What should I do if my worker gets an attorney? Can I still talk to them?
A:

Inform your claim specialist of the attorney’s involvement. Unless you are instructed by your attorney or the injured worker is instructed by his or her attorney not to speak to you about the case, you can still talk to your worker as his or her employer. It’s a good rule of thumb to always be careful discussing any matters regarding the workers’ compensation claim with the injured worker to avoid confusion, misunderstanding or communicating any information that is different than what your claim specialist has said or done. If you are uncertain how to answer a question from your injured employee about any aspect of the workers’ compensation claim, please contact your claim specialist.

Q:
I received a Notice of Hearing on the claim, should I attend?
A:

We encourage policyholders to attend hearings, because your attendance demonstrates your concern for your workers and the proceedings with the claim. If you wish to attend, please contact your claim specialist as far in advance of the scheduled hearing as possible.

Q:
As the employer, do I have any input in the selection of my injured worker's treating physician?
A:

Generally, the injured worker selects his or her treating or attending physician. Some employers offer suggestions if the injured worker inquires or does not have a doctor in mind. In the case of a work-related injury where there is a need for immediate emergency care and treatment, the employer is encouraged to help the injured worker secure emergency care and treatment. In such situations, the concern is to afford the injured worker all reasonable and necessary medical care and treatment the injury requires.

Q:
What happens if an injured worker wants to use a physician other than the one he or she initially began treating with?
A:

The injured worker is allowed to select his or her attending doctor and thereafter, is allowed to make one change of doctor without requiring the consent or approval of the employer or carrier.  Any subsequent change of doctor requires the approval or consent of the employer, carrier or DLIR to be valid under the workers’ compensation law.

Q:
Does HEMIC plan to give a dividend every year?
A:

By law, dividends cannot be guaranteed. Consideration for declaring a dividend is at the discretion of the Board of Directors. Their first obligation is to assure that HEMIC has sufficient surplus to be financially secure, to meet State surplus requirements, to maintain its rating agency status, and to otherwise fulfill its mission and purpose. The Board may declare a dividend whenever it determines that HEMIC has sufficient surplus to fulfill the aforementioned requirements in addition to payment of the dividend.

Q:
How can I find out the status of my bills and payments?
A:

We give authorized medical providers real-time access to medical bill payment status from any web-enabled device through our secure, online portal 24/7. Login to our Medical Provider Portal or register as a new provider.

Q:
What information do I need to register as a new provider?
A:

First, we need to have processed and paid one bill submitted by you. On your check stub for this first payment, you will find an assigned provider registration code. Use that during your registration process.  Click here to register! 

Q:
Can I request Electronic Funds Transfer (EFT)?
A:

Yes. HEMIC offers EFT thru HEMICPay a payment automation solution offering payers and payees the ability to streamline the payment and remittance process by leveraging the use of Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA).

Q:
I need help signing up. Who do I call or email for support?
A:

If you have questions or difficulties, please call Jopari support at 800-630-3060 ext 5207 or email support@jopari.com. Hours of operation are 8:30 a.m. to 5:30 p.m. PST.

Q:
Can other medical providers see my information?
A:

No. Your claim information is protected. Only you, as the authorized user, can access it with your login user ID and password.

Q:
What information do I need to treat CBWC patients?
A:

When treating injured workers covered under Collectively Bargained Workers’s Compensation (CBWC), providers must comply with the Official Disability Guidelines (ODG), an evidence-based guide for the treatment of work-related injuries.

ODG was selected by Labor and Management for the existing CBWC programs in the State of Hawaii to provide quality medical care through evidence-based medicine.

HEMIC pre-approves treatment for CBWC patients that is within the ODG. You do not need to submit a Treatment Plan for approval as long as the entire course of treatment is within ODG. This benefits you and your patients by enabling prompt, effective treatment.

ODG provides treatment and lost-time guidelines using actual experience data from federal government databases, including the annual CDC National Health Interview Survey, the BLS Survey of Occupational Injuries and Illnesses, and over 2 million medical records from actual workers’ compensation claims. ODG guidelines are based on actual outcomes, which makes them a fair approach for all parties.

Q:
How can HEMIC afford to pay dividends?
A:

HEMIC is in a strong financial position with adequate surplus to meet all statutory requirements and is rated “A” excellent & secure by AM Best. The dividend distribution in no way compromises that strong financial position.

Q:
What is ‘modified duty’ and how is it a benefit?
A:

Modified duty is the work an injured employee can perform after an injury, taking into account any restrictions or limitations provided by the attending physician. 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 worker’s physical capabilities within their organization. If this is not feasible, HEMIC may assist in matching injured workers with non-profit organizations in suitable, light-duty roles. Studies also indicate a timely return to modified duty will benefit both the injured worker and employer by keeping an injured worker physically conditioned, speeds the employee’s recovery and reduces the total cost of the claim.

Q:
What is Permanent Partial Disability (PPD), and when is it payable as a benefit?
A:

When an injured worker suffers the loss of a body part or loss of use of a part of the body, or, permanent loss of a physical function (impairment) as a result of the work related injury, he/she may have a permanent disability and is entitled to a benefit 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 related medical records; provide a report of their findings and measurements of the impairment or loss of function, referred to as a “rating”. 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, a medical term, is then converted to “disability” or PPD – a legal concept under the law.  The law provides 1) 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, 2) an annual maximum weekly compensation rate, decided by the Department of Labor, to be used in the formula. 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 is necessary to complete prior to closing a claim.

Q:
What is "subrogation" and what are the benefits?
A:

Subrogation is the legal right an employer and insurance carrier have to pursue recovery from a wrongdoer or third party for the injuries suffered by the injured worker due to the wrongdoer’s or third party’s actions. Subrogation may be pursued with or without the participation of the injured worker. The goal of subrogation is to recover from the wrongdoer monies paid by the employer or insurance carrier to injured workers for injuries actually caused by the wrongdoer’s actions. A subrogation recovery will reduce the net loss of the claim, which may impact either the premium or x-mod.

Q:
If I go back to part-time or modified work, do I receive wage loss benefits?
A:

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.

Q:
Will I receive medical care for a workplace injury even if I don’t lose time from work?
A:

Yes. If medical care is necessary, it will be provided whether or not you are able to continue working.

Q:
If my accidental injury results in a permanent partial loss, condition, will I receive benefits for this? What if I am able to return to some sort of work?
A:

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.

Q:
I think someone may be taking advantage of, or defrauding HEMIC. What do I do?
A:

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.

Q:
What is vocational rehabilitation (VR), who gets it and why?
A:

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.

Q:
Is the worker entitled to vocational rehabilitation services if only employed for a short period of time?
A:

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.

If your have any additional questions please email us, or call us at (808) 524-3642 ext 400.
Neighbor Islands call toll free 1 (888)-292-3642.