Complaint Form {DC-54} | Pdf Fpdf Docx | Hawaii

 Hawaii   Workers Compensation 
Complaint Form {DC-54} | Pdf Fpdf Docx | Hawaii

Last updated: 8/21/2025

Complaint Form {DC-54}

Start Your Free Trial $ 15.99
200 Ratings
What you get:
  • Instant access to fillable Microsoft Word or PDF forms.
  • Minimize the risk of using outdated forms and eliminate rejected fillings.
  • Largest forms database in the USA with more than 80,000 federal, state and agency forms.
  • Download, edit, auto-fill multiple forms at once in MS Word using our Forms Workflow Ribbon
  • Trusted by 1,000s of Attorneys and Legal Professionals

Description

DC-54 - COMPLAINT FORM. This form is used by individuals in Hawaii who wish to file a complaint related to Temporary Disability Insurance (TDI) or Prepaid Health Care (PHC) issues. It enables claimants or employees to formally report grievances such as an employer failing to provide healthcare coverage or improperly handling TDI benefit claims. Upon submission, the Disability Compensation Division’s Enforcement Branch reviews the complaint, assigns an investigator who contacts the complainant, and may request further details if needed. The form collects essential information about the complainant, their employer, disability details, and the nature of the complaint to facilitate investigation and resolution. It also provides instructions on submitting the complaint by mail, fax, or in person, along with the contact information for various regional offices in Hawaii. www.FormsWorkflow.com

Related forms

Our Products