Employees of the Honolulu Police Department shall
be guided by this directive in determining and
claiming industrial injury/illness and workers’
compensation coverage and other benefits.
DEFINITIONS
A. Compensable injury/illness: An injury/illness
that entitles an employee to workers’ compensation benefits.
B. Extended sick leave: Leave that lasts more than
five days due to injury or illness.
C. Industrial injury/illness: See work-related injury/illness.
D. Limited duty: A productive work assignment
that does not exceed the temporary limitations placed
on the employee by a physician. Limited duty is also
referred to as light duty.
E. Officer: A member of any metropolitan police
classification (including reserves) or helicopter pilot.
F. Physician: A doctor of medicine, dentist,
chiropractor, osteopath, naturopath, psychologist,
optometrist, or podiatrist.
G. Temporary disability: Impairment of a
physical or mental function that is determined
by a physician to be impermanent.
H. Temporary total disability: A condition
wherein the employee is unable to perform any type of work.
I. Work-related injury/illness: An injury
or ailment that an employee suffers either (1)
by accident resulting from and during employment
(this includes the willful act of a third person
against an employee because of the employee’s job)
or (2) by disease closely caused by or resulting from employment.
J. Workers’ compensation benefits: All
benefits that the Hawaii Revised Statutes (HRS)
provide to an employee or an employee’s dependents
for work-related injury/illness (as defined in
Chapter 386), including medical and rehabilitation
benefits, income and indemnity benefits (for
disability or death), and funeral and burial expense allowances.
K. Workers’ compensation injury/illness: See
work-related injury/illness.
REPORTING INJURY/ILLNESS
A. Kinds of Injury/Illness to Report
1. Employees shall report any injury/illness
that occurs during duty hours.
2. Employees shall report any injury/illness
that occurs outside of duty hours and prevents their performance of full duty.
3. Officers shall report any injury/illness
sustained during special duty or authorized special
activities (refer to Policy 3.18, PHYSICAL FITNESS ACTIVITIES).
B. When to Report Injury/Illness
1. On-Duty Injury/Illness
The employee shall notify his or her immediate
supervisor as soon as practical.
2. Off-Duty Injury/Illness
a. For elements with 24 hour operations,
the employee shall notify the on duty supervisor
at least one hour before the scheduled duty time.
b. For all other elements, the employee shall
notify the supervisor at the start of the work day.
3. Notification shall be on a daily basis except
for extended sick leave.
a. Personnel who anticipate being on “extended
sick/injury leave” shall notify their on-duty
watch commander of the number of days that they expect to be out.
b. Personnel on extended leave shall notify
their watch commander or his or her designee one
day prior to their return to normal duty.
c. Personnel calling in sick or injured shall
be responsible for knowing the identity of the person notified.
ON DUTY INJURIES
A. An employee injured on duty shall be
given medical treatment at the nearest medical
facility or by a private physician.
B. The on duty supervisor shall ensure that
the employee prepares and submits the Report of
Industrial Injury/Illness, CSWC-1 form. The
supervisor shall assist the employee or complete
the form for him or her whenever necessary.
1. The supervisor shall indicate in part 2,
Supervisor’s Certification, whether or not the
injury is compensable. A report shall be submitted
in every instance, no matter what the recommendation.
2. The report shall be submitted in triplicate
through channels to the Human Resources Division (HRD) commander.
a. The supervisor shall submit the report before
going off duty on the day of the incident.
b. If a compensable injury recurs, the supervisor
shall submit a report on the date that he or she is
notified of the recurrence.
c. A numbered police report is required when
the injury is inflicted by another person (e.g.,
motor vehicle accident or assault).
3. The report shall include the following:
a. Exact location of incident;
b. Time and date of incident;
c. Names of persons involved;
d. Department/element;
e. Extent of injury and/or property damage;
f. Brief description of incident, including
number and types of vehicles (in the case of vehicular accidents); and
g. Name of person making the report and name
and telephone number of contact person.
4. When submitting the report, the supervisor
shall include the initial physician’s report, if it is available.
C. Reporting Major Incidents
1. Supervisors shall report all major incidents
and work-related accidents that include any of the following:
a. Loss of life within 30 days of incident;
b. Injury to three or more employees requiring
inpatient hospitalization within 30 days of the incident; or
c. Damage to property, including motor vehicles,
exceeding $25,000.
2. Commanders shall ensure that supervisors
in all major incidents report the information
listed in sections III B 3 a to g above to the following:
a. Occupational Safety and Health Division
of the Department of Labor and Industrial Relations.
Contact information is listed in Attachment 1.
b. Industrial Safety and Workers’ Compensation
Division of the Department of Human Resources. The
report shall be made by telephone to the number
listed in Attachment 1. Incidents occurring from
0600 to 1700 hours on regular work days shall be
reported from the scene as soon as possible.
Incidents occurring at other times shall be
reported at the start of the first regular work day after the occurrence.
c. Appropriate employee unions via telephone
by the start of the first regular work day after the incident.
D. Any officer injured as a result of a criminal
assault, no matter how slight the injury, shall be
examined by a physician. The injured officer’s
immediate superior or the officer in charge of the assault scene shall:
1. Make the necessary arrangements for a
medical examination without undue delay;
2. Have the injuries photographed; and
3. Ensure that complete reports (incident
reports, injury report, etc.) are submitted and
that they accurately detail the injuries suffered.
REPORTS AND LEAVE REQUESTS FOR EXTENDED LEAVE
A. Leave for Compensable Injury/Illness
1. The supervisor shall contact the employee
periodically to ensure that:
a. The employee is aware of the provisions of
this directive and of his or her available leave time;
b. The employee’s health and welfare needs are being met; and
c. The employee’s commander is informed of the
employee’s progress and anticipated date of return to duty.
2. The supervisor shall submit the Supervisor’s
Follow-Up Report of Sick/Injured Employee,
HPD-347A form, within five calendar days after the
employee’s leave begins. Further reports shall be
submitted after each contact with the employee as
described in section IV A 4 below.
3. The employee shall submit an application
for sick leave (with a doctor’s certificate attached)
every 30 calendar days after the first day of injury/illness.
4. In addition, the employee shall contact
the supervisor or a designee at least once every
15 calendar days during the first four months
immediately following the injury/illness and at
least once each month thereafter.
5. If the employee is under continuous treatment
by a physician, the physician is required by Section
386-96, HRS, to submit an interim report every 21 days.
If the physician fails to submit this report, the
employee’s pay may be suspended.
B. Leave for Noncompensable Injury/Illness
1. The supervisor shall contact the employee
periodically for the purposes listed in
section IV A 1 above.
2. The Supervisor’s Follow-Up Report of
Sick/Injured Employee, HPD-347A form, shall be
submitted within five calendar days after the
employee’s leave begins and every 30 calendar days thereafter.
3. The employee shall submit an application
for sick leave (with a doctor’s certificate attached)
every 30 calendar days after the first day of injury/illness.
C. Leave Without Pay for Injury/Illness
1. If leave without pay is necessary, the
employee shall submit a completed Leave Request,
HPD-357 form, and To/From memorandum explaining
the request for leave via channels to the Chief
of Police for approval prior to taking leave.
The request shall include the following:
a. Verification of the employee’s incapacitation
by a licensed physician or other explanation for request; and
b. Prognosis and anticipated date of the employee’s return to work.
2. During periods of leave without pay, the
supervisor shall contact the employee periodically
for the purposes listed in
section IV A 1 above.
3. If the leave without pay begins during
the first five days of the employee’s absence,
the supervisor shall submit the Supervisor’s
Follow-Up Report of Sick/Injured Employee,
HPD-347A form, by the following day. The
supervisor shall submit additional follow-up
reports every 30 days thereafter.
RECURRENCE OF COMPENSABLE INJURY
A. The employee shall obtain medical
verification of (1) incapacitation and
(2) the fact that the incapacitation
resulted from a previously reported, compensable injury.
B. The employee shall notify the supervisor
immediately so that form CSWC-1 can be processed.
C. Each reported period of leave must be verified.
The original date of injury shall be inserted under the
description of illness on the Application for Sick Leave, DF-2 form.
ABUSE OF SICK LEAVE
A. Whenever abuse of paid sick leave is
suspected, a supervisor shall investigate.
B. The supervisor may require the employee
to be examined by a city and county physician.
1. If the supervisor requires the employee
to be examined by a city and county physician,
the supervisor shall prepare a written request
to the HRD commander documenting the suspected abuse.
2. The HRD commander shall prepare a written
request from the Chief of Police to the Health
Services Division, Department of Human Resources,
to schedule the examination and shall direct the
employee to report for the medical evaluation.
3. The employee shall request that his or
her private physician forward all pertinent medical
information to the city and county physician.
RETURN TO DUTY
A. Work-Related Injury/Illness
1. Before returning to full or limited duty,
the employee shall obtain a written release from
the attending physician. The physician shall
include a description of the ailment or injury
and the dates of the employee’s incapacitation.
2. If there is a loss of 80 or more scheduled
working hours due to an injury or illness, the
employee shall explain his or her duties to the
physician. The physician’s written release must
certify that the employee is able to perform the
general duties of his or her assignment.
a. Sworn employees shall provide their
physician with a Medical Return to Work, HPD-347
form, to serve as the physician’s written release.
b. Civilian employees shall provide their
physician with the Treating Physician’s Clearance
to Return to Work form from the Health Services Division.
3. After obtaining the attending physician’s
written release, the employee shall obtain a
medical evaluation from the city and county
physician for clearance to return to duty.
a. The employee shall call the city and
county physician for an appointment and also
inquire if additional medical reports will be needed.
b. At the designated time, the employee
shall report to the city and county physician
with the completed physician’s written release
and any other necessary medical reports. Three
additional days should be allowed for a medical evaluation.
4. If the absence was due to stress leave
or any psychological condition, the employee
shall obtain clearance from the police psychologist.
a. The employee shall call the department’s
Human Services Unit to schedule an appointment
with the psychologist.
b. At the designated time, the employee shall
report to the police psychologist with the completed
physician’s written release.
c. Employees shall not be returned to duty
from stress leave or leave as a result of any
psychological condition until cleared by the police psychologist.
5. Before an employee may perform any duty,
the above provisions must be complied with, and
the employee must submit an Application for
Sick Leave, DF-2 form, to the supervisor. The supervisor shall:
a. See that the proper category for leave is marked;
b. Ensure that the physician’s certificate is attached; and
c. If limited duty is specified by the
physician or police psychologist, make a
tentative assignment to a recommended duty
position, subject to approval by the Chief of Police.
B. Nonwork-Related Injury/Illness
1. Any absence of five or more consecutive
working days requires a licensed physician’s
certification of injury/illness before the employee may return to duty.
2. If an employee sustains a significant
injury/illness, the employee shall obtain medical
clearance from the city and county physician and/or
police psychologist before returning to duty.
The significant injuries and illnesses are listed in Attachment 2.
C. Pending Clearance
1. While waiting for a return-to-duty
clearance from the city and county physician
or police psychologist, the employee shall
comply with the following and return to limited duty:
a. Obtain a written clearance from his
or her attending physician to return to duty.
b. Obtain an appointment with the city
and county physician or police psychologist
for a return-to-duty clearance.
(1) The appointment shall not be later
than seven days after the date of the written
clearance from the attending physician.
(2) If no earlier appointment can be made,
exceptions to the seven-day limitation may be
made by the HRD commander.
c. Make arrangements with his or her
commander for an assignment to a limited-duty
position until clearance is received from the
city and county physician or police psychologist.
2. For work-related injuries or illnesses,
workers’ compensation will not supplement the
employee’s pay after the employee receives
clearance from his or her attending physician.
3. After consultation with the city and
county physician or police psychologist, the
Chief of Police or designee may deny the return to limited duty.
LIMITED DUTY
A. Work-Related Injury/Illness
An employee may be eligible for limited
duty if an injury/illness prevents the
employee’s performance of full duty and is work related.
B. Nonwork-Related Injury/Illness
1. An employee may be eligible for limited duty
if a nonwork-related injury/illness prevents the
employee’s performance of full duty, a licensed
physician certifies that the injury/illness is not
permanent, and the treating physician provides an
estimated date for the employee’s return to full duty.
2. An employee is not eligible for limited
duty if a nonwork-related injury/illness prevents
the employee’s performance of full duty but the
other conditions specified in section VIII B 1
above are not met. The employee must take sick
leave, vacation leave, or leave without pay until
a physician certifies that he or she is able to return to duty.
ALTERNATIVES TO LIMITED DUTY
If an employee does not qualify for limited
duty and is unable to meet the requirements
of the job, the employee may apply for:
A. Service connected disability;
B. Ordinary disability;
C. Ordinary retirement;
D. Leave without pay;
E. Temporary or permanent transfer to a
position for which the employee is physically qualified;
F. Temporary or permanent demotion
(voluntary/ disability) to a position for
which the employee is qualified;
G. Regular or limited-term promotion
to a position for which the employee is
physically qualified (provided that the
employee is eligible and within certification);
H. Separation from service in compliance
with existing civil service rules and regulations; or
I. Referral to the city’s program for the
retention and placement of disabled employees.
MILEAGE FOR TREATMENT AND/OR REHABILITATION
A. Subsidized Personnel
1. Personnel who receive subsidies for the
use of their personal vehicles may draw gas and
oil from departmental facilities for travel to
and from required treatment and/or rehabilitation
for compensable injuries.
a. If incapacitated for more than a calendar
month, the employee shall arrange with the
immediate supervisor or element commander to submit the mileage slip.
b. The first mileage slip submitted during
the employee’s incapacitation shall include a
mileage verification by the physician or other
authority (Section 386 1, HRS) to certify the
distance from the employee’s home to the treatment
site. The reasons for treatment/rehabilitation shall also be indicated.
2. When allowed to draw gas, the employee
cannot claim mileage reimbursement from workers’ compensation.
3. If automobile allowance is temporarily
suspended or terminated while an employee is on
injured leave, the employee may request reimbursement
for travel. The employee may not draw gas or oil
from departmental facilities. Reimbursement shall
be obtained as outlined in section X B below.
B. Nonsubsidized Personnel
1. Employees whose use of their personal
vehicles is not subsidized may be reimbursed
for travel to and from required treatment/
rehabilitation for compensable injuries.
2. The employee must submit a verified
list of miles driven to the Workers’ Compensation
Section, Department of Human Resources.
3. The verified list shall be submitted on
the Statement for Reimbursement of Travel Performed
for Medical Treatment of Workers’ Compensation Injury, CSWC-22 form.
NOTIFICATIONS REGARDING HOSPITALIZATION OR DEATH
A. When an employee or an employee’s spouse
is confined to the hospital, the employee shall
notify the commander immediately.
The commander shall inform the HRD commander, who
will make the proper notifications.
B. When an employee or officer is injured,
either on or off duty, the supervising investigator shall ensure that:
1. If hospital confinement is anticipated,
the supervisor notifies the spouse or whoever is
designated by the employee to be notified in such emergencies.
2. In case of death, the following persons are notified immediately:
a. HRD commander, and
b. Police chaplain.
C. When an employee is confined to the
hospital for critical injuries or when death
occurs as a result of injuries received while
an employee is on duty, the HRD commander shall
notify the following:
1. Occupational Safety and Health Division
of the Department of Labor and Industrial Relations;
2. Workers’ Compensation Division of the
Department of Labor and Industrial Relations; and
3. Safety Division of the Department of Human Resources.
WORKERS’ COMPENSATION COVERAGE
A. Injured Leave and Compensation Claims
Any employee injured in the line of duty shall
be placed on appropriate leave by the Finance
Division. When so authorized, the employee’s
commander shall indicate “injured leave” on
the Payroll Time and Attendance, HPD-25 form.
1. Officers
a. Every officer injured in the line of
duty shall be placed on injured leave as
provided by Section 79 15, HRS, when
certification for benefits is received from
the Department of Human Resources.
b. If the Department of Human Resources
denies the certification for benefits, a
hearing will be scheduled by the Department
of Labor and Industrial Relations. The
employee will be notified of the hearing so
that he or she can appear and explain the claim.
c. Fifteen days prior to expending the
last of the 120 calendar days of workers’
compensation coverage provided by
Section 79 9, HRS, the employee shall
complete the Election of Compensation for
Industrial Injury, CSWC-14 form. This form
is available at the Human Resources Division.
2. Civilian Employees
A civilian employee injured in the line of
duty may go on injured leave and claim
compensation benefits as provided by Section
79 9, HRS. The employee must submit civil
service form CSWC 14, which is available at the Human Resources Division.
B. Duration of Compensation Payments
1. Compensation payments under section
XII A 1 above will be provided only during
periods of temporary, total disability.
2. A licensed physician must certify
the employee as “incapacitated from work
or duty” during the period of temporary,
total disability. Any other certification
by the physician, such as “under my professional
care” or “under my treatment,” may result in
forfeiture of temporary, total disability compensation.
3. When the physician indicates that the
employee is able to return to duty (full or
limited), the compensation payments will cease.
C. Settlement of Claims Against a Third Person
1. Employees are cautioned against settling
any personal claims for injuries or property damage
caused by a third person in any accident or injury
that occurred while the employee was on duty.
2. When it appears that an employee’s
injuries were caused by a third party, the
city automatically has a lien against any
settlement the employee may receive from
the third party. As a result, any settlement
must have the approval of the city to be valid.
3. Therefore, before an employee enters
into any settlement with a third party, the
Claims Section, Department of the Corporation
Counsel, shall be notified through proper channels.
4. Failure to obtain written approval
from the corporation counsel prior to settlement
of a claim against a third party may result in
the forfeiture of workers’ compensation benefits
for the injury or its future recurrence. It may
also result in the employee having to refund
payments made under workers’ compensation.
RELATED BENEFITS
A. Automobile allowance for police
officers is continued during any authorized
leave of absence with pay, including injured
leave, for a period not to exceed six continuous months.
B. Payroll deductions made according to
law or at the employee’s request may be affected
by the change in the employee’s salary under workers’ compensation.
1. The city is prohibited from deducting
anything from that part of the injured employee’s
salary that is paid by workers’ compensation.
Deductions (e.g., for the retirement system) can
only be made from that part of the employee’s salary
paid from sick/vacation leave while the employee is
covered under Section 79 9, HRS.
2. The employee should evaluate his or her
own situation and decide on adjustments to be made
in payments to the retirement system, Honolulu
Police Relief Association, credit union, unions, etc.
C. The employee may be eligible for benefits
for injuries sustained during travel to and from
work when all of the following conditions are met:
1. The employee receives an automobile allowance
or is authorized to take home a marked police vehicle
(such as a motorcycle);
2. The employee is in uniform with a mounted blue light on the vehicle;
3. The travel to or from work was by a direct route;
4. The injury was not caused by the employee’s
negligence or desire to cause self injury; and
5. The injury was not the result of the employee’s use of alcohol or drugs.
Whether the injury is compensable is determined by the
city’s Industrial Safety and Workers’ Compensation Division,
Department of Human Resources. Decisions on compensability
may be appealed under the Hawaii Workers’ Compensation Law (Chapter 386, HRS).