HAR §12-11-85. Periodic reports

(a) On March 1 of each year, the employer's insurance carrier, self-insured employers, employers with collective bargaining agreements, or an association of employers shall file an annual report covering the most recently completed calendar year in a form prescribed by the director for each employer and for each plan, furnishing the following information: (1) Number of covered employees for each month of the year (number of individuals employed during the pay period including the 12th day of the month). (2) Amount of total wages paid in the year. (3) Amount of taxable wages paid in the year. (4) Amount of employer contributions paid in the year, if DLIR 12-11 Page 25 applicable. (5) Amount of employee contributions paid in the year, if applicable. (6) Amount of benefits paid in the year. (7) Number of different persons paid disability benefits during the year. (8) Number of weeks for which benefits were paid. (9) Number of separate periods of disability for which benefits were paid. (10) Number of claims denied. (11) Amount of subrogated payments received. (b) On March 1 of each year, the employer's insurance carrier, self-insured employers, employers with collective bargaining agreements, or an association of employers shall file an annual report for each employer and for each plan the information listed in subsection (a) and, in addition, furnish by sex, information listed in items (1) and (6) through (10) of subsection (a) covering the most recently completed calendar year in a form prescribed by the director. [Eff 5/11/81](Auth: HRS §392-91) (Imp: HRS §392-91)