Request for Increase in Hourly Rate - Hawaii

This printable "Request for Increase in Hourly Rate" is a document issued by the Hawaii Department of Labor & Industrial Relations specifically for Hawaii residents.

Download a PDF of the latest edition of the form down below or find it through the department's forms library.

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DAVID Y. IGE
LEONARD HOSHIJO
GOVERNOR
ACTING DIRECTOR
SHAN S. TSUTSUI
LIEUTENANT GOVERNOR
JOANN VIDINHAR
ADMINISTRATOR
STATE OF HAWAII
DEPARTMENT OF LABOR AND INDUSTRIAL RELATIONS
DISABILITY COMPENSATION DIVISION
830 PUNCHBOWL STREET, ROOM 209
P.O. BOX 3769
HONOLULU, HAWAII 96812-3769
http://labor.hawaii.gov
Phone: (808) 586-9151 / Fax: (808) 586-9219
Section 386-94 HRS relating to attorney fees states:
“In approving fee requests, the director, appeals board, or court may consider factors such as
the attorney’s skill and experience in state workers’ compensation matters, the amount of time
and effort required by the complexity of the case, the novelty and difficulty of issues involved, the
amount of fees awarded in similar cases, benefits obtained for the claimants, and the hourly rate
customarily awarded attorneys possessing similar skills and experience. In all cases reasonable
attorney fees shall be awarded.”
Please complete the information below which will assist us in determining your authorized
hourly rate as required under section 386-94, HRS.
REQUEST FOR INCREASE IN HOURLY RATE
Name:
_________________________________________________
Address:
_________________________________________________
_________________________________________________
License No.: ________________________ Date Licensed: _____________________________
Number of years practicing law in Hawaii: ___________________________________________
Number of years of Hawaii workers’ compensation experience: __________________________
Number of Hawaii workers’ compensation cases handled in the last ten years:
_______________
Last three workers’ compensation cases (Claimant, Case Number, and Date of Accident):
1. ____________________________________________________________________________
2. ____________________________________________________________________________
3. ____________________________________________________________________________
Current Rate
: ________________________ Rate being requested: ________________________
Signature: ______________________________________
Date
: _________________________
Your approved hourly rate is: ______________________
APPROVED BY: ________________________________ DATE: _______________________
WORKERS’ COMPENSATION
TEMPORARY DISABILITY INSURANCE
PREPAID HEALTHCARE
dlir.workcomp@hawaii.gov
dlir.tempdisabilityins@hawaii.gov
dlir.prepaidhealthcare@hawaii.gov
DAVID Y. IGE
LEONARD HOSHIJO
GOVERNOR
ACTING DIRECTOR
SHAN S. TSUTSUI
LIEUTENANT GOVERNOR
JOANN VIDINHAR
ADMINISTRATOR
STATE OF HAWAII
DEPARTMENT OF LABOR AND INDUSTRIAL RELATIONS
DISABILITY COMPENSATION DIVISION
830 PUNCHBOWL STREET, ROOM 209
P.O. BOX 3769
HONOLULU, HAWAII 96812-3769
http://labor.hawaii.gov
Phone: (808) 586-9151 / Fax: (808) 586-9219
Section 386-94 HRS relating to attorney fees states:
“In approving fee requests, the director, appeals board, or court may consider factors such as
the attorney’s skill and experience in state workers’ compensation matters, the amount of time
and effort required by the complexity of the case, the novelty and difficulty of issues involved, the
amount of fees awarded in similar cases, benefits obtained for the claimants, and the hourly rate
customarily awarded attorneys possessing similar skills and experience. In all cases reasonable
attorney fees shall be awarded.”
Please complete the information below which will assist us in determining your authorized
hourly rate as required under section 386-94, HRS.
REQUEST FOR INCREASE IN HOURLY RATE
Name:
_________________________________________________
Address:
_________________________________________________
_________________________________________________
License No.: ________________________ Date Licensed: _____________________________
Number of years practicing law in Hawaii: ___________________________________________
Number of years of Hawaii workers’ compensation experience: __________________________
Number of Hawaii workers’ compensation cases handled in the last ten years:
_______________
Last three workers’ compensation cases (Claimant, Case Number, and Date of Accident):
1. ____________________________________________________________________________
2. ____________________________________________________________________________
3. ____________________________________________________________________________
Current Rate
: ________________________ Rate being requested: ________________________
Signature: ______________________________________
Date
: _________________________
Your approved hourly rate is: ______________________
APPROVED BY: ________________________________ DATE: _______________________
WORKERS’ COMPENSATION
TEMPORARY DISABILITY INSURANCE
PREPAID HEALTHCARE
dlir.workcomp@hawaii.gov
dlir.tempdisabilityins@hawaii.gov
dlir.prepaidhealthcare@hawaii.gov

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