Workplace Injury Claim Form (Hong Kong)

A Workplace Injury Claim Form in Hong Kong sets out a party's case and the orders it asks the court or tribunal to make.

Hong Kong’s Labour Department Employees’ Compensation Division recorded over 48,000 work injury reports in a recent reporting year, with construction, catering, cleaning, and transportation industries accounting for the highest incidence rates. The no-fault nature of Cap. 282 means the injured worker does not need to prove employer negligence to receive statutory compensation — the entitlement arises automatically from the fact of injury during and arising out of employment.

The compensation framework under Cap. 282 operates on three tiers. Permanent total incapacity compensation under Section 9 is calculated as 96 months of the employee’s averaged monthly earnings, subject to the annual earnings cap set by the Commissioner for Labour (HK$26,830 per month for 2024). Permanent partial incapacity under Section 10 is assessed as a percentage of the permanent total incapacity amount, with specific body part percentages prescribed in Schedule 1 — for example, loss of a dominant hand at the wrist attracts 57%, while loss of a thumb attracts 25%. Temporary incapacity compensation under Section 11 pays 80% of earnings during the certified sick leave period.

Beyond Cap. 282 statutory compensation, injured workers retain the right to elect a common law negligence action in the District Court or Court of First Instance, where damages — including full loss of earnings, medical expenses, pain and suffering, and loss of future earning capacity — may substantially exceed Cap. 282 amounts. Section 26 of Cap. 282 requires the election to be made in writing within six months of the accident. Legal advice is essential before making this election, as it is irrevocable.

Employers are required to maintain employees’ compensation insurance under Section 40 of Cap. 282 — operating without valid insurance is a criminal offence attracting a fine of HK$100,000 and two years’ imprisonment. The Insurance Authority maintains the register of authorised insurers. Where an employer is uninsured or insolvent, the Employees’ Compensation Assistance Fund under Cap. 365 provides emergency financial assistance to injured workers, funded by a levy on insurance premiums.

The Occupational Safety and Health Ordinance (Cap. 509) imposes parallel obligations on employers: providing and maintaining a safe workplace, safe plant and equipment, safe work systems, adequate information and training, and adequate supervision. Cap. 509 is enforced by the Labour Department’s Occupational Safety and Health Branch, which investigates serious accidents, issues improvement and suspension notices, and institutes prosecutions in the Magistrates’ Court. A single serious accident can result in simultaneous Cap. 282 compensation proceedings and Cap. 509 criminal prosecution.

Occupational diseases listed in Schedule 2 of Cap. 282 — including pneumoconiosis, noise-induced deafness, mesothelioma, occupational asthma, and repetitive strain injuries — are compensable on the same basis as traumatic injuries. The Pneumoconiosis (Compensation) Ordinance (Cap. 360) provides a parallel scheme for pneumoconiosis victims, administered by the Pneumoconiosis Compensation Fund Board.

Workplace Injury Claim Form in Hong Kong is required in any situation where an employee suffers a personal injury arising out of and in the course of employment, triggering statutory obligations on both the employer and the injured worker under the Employees’ Compensation Ordinance (Cap. 282).

Traumatic workplace accidents are the most common scenario: falls from height on construction sites, machinery accidents in factories and industrial undertakings, vehicle accidents during delivery or transport work, electric shocks, chemical burns, and lacerations from sharp equipment. Any injury requiring medical treatment — whether outpatient or inpatient — should be documented with a formal claim.

Slip-and-fall accidents in offices, retail premises, restaurants, and hotels give rise to Cap. 282 claims regardless of whether the premises are controlled by the employer. If the employee is injured at a third-party’s premises while performing work duties, the employer’s Cap. 282 liability is not diminished — the employer may have a separate claim against the third party for indemnity.

Commuting accidents — specifically, accidents occurring while the employee is travelling between the employer’s place of business and the employee’s place of residence for work purposes — are covered under Cap. 282 where the employee uses transport provided or paid for by the employer, or where the journey is an integral part of the employment contract.

Occupational diseases diagnosed by a registered medical practitioner as arising from the employee’s occupation and listed in Schedule 2 of Cap. 282 require a formal claim, with the limitation period running from the date of diagnosis rather than the date of exposure.

Work-related mental health conditions — such as post-traumatic stress disorder arising from a traumatic workplace incident — may be compensable under Cap. 282 where the mental health condition constitutes a ‘personal injury’ diagnosed by a registered psychiatrist and arising from a specific work incident.

Aggressions and assaults at work — for example, violence against healthcare workers, security personnel, or social workers in the course of their duties — are covered by Cap. 282 where the assault arises from the employment.

The claim form should be completed and submitted to the employer’s compensation insurer as soon as possible after the accident, with supporting medical documentation from the Government Outpatient Clinic or a registered private practitioner.

Workplace Injury Claim Form in Hong Kong must contain specific elements to satisfy the requirements of the Employees’ Compensation Ordinance (Cap. 282) and to support the compensation assessment by the employer’s insurer or the District Court.

Employee identification: Full name, Hong Kong Identity Card number (HKID), residential address, contact number, nationality (relevant for foreign domestic helpers under separate regulations), and the employee’s employment status (full-time, part-time, casual). The date the employee commenced employment determines the continuity of employment for Cap. 282 purposes.

Employer identification: Registered company name, Companies Registry number, registered address, and the name of the employer’s employees’ compensation insurer and policy number. Under Section 40A of Cap. 282, the insurance certificate must be displayed at the workplace — the policy details should be obtainable from the certificate.

Accident details: Date, time, and precise location of the accident (including floor and area within the workplace); the nature of the work the employee was performing at the time of the accident; a factual description of how the accident occurred; names and contact details of witnesses; and whether the accident was reported to a supervisor or safety officer and when.

Injury description: Precise description of all injuries sustained — body parts affected, type of injury (laceration, fracture, burn, crush injury, sprain), and whether any pre-existing conditions were aggravated by the accident.

Medical treatment: Name of the hospital or clinic where treatment was received; date and time of first medical attendance; diagnosis by the treating registered medical practitioner; sick leave certificate duration; and whether hospitalisation was required. Government Outpatient Clinic certificates and Hospital Authority discharge summaries are standard supporting documents.

Compensation sought: Specification of the heads of compensation claimed — temporary incapacity payments under Section 11 (80% of earnings during sick leave), medical expenses under Section 13, permanent incapacity assessment under Section 9 or 10, and any claim for rehabilitation expenses.

Statutory notifications: The claim form should cross-reference the employer’s Form 2 notification to the Labour Department under Section 15 of Cap. 282, confirming the accident was reported within 14 days.

Election of remedy: A statement of whether the injured worker elects Cap. 282 statutory compensation or reserves the right to elect a common law negligence action within six months under Section 26 of Cap. 282. Legal advice should be sought before this election is made.

Declaration and signature: The claimant must sign and date the form, confirming the information is true and accurate to the best of their knowledge. A false or misleading statement in the claim form may affect the claimant's entitlement and could constitute an offence.

Language: The claim form may be completed in English or Chinese. The Labour Department provides bilingual versions of Form 2 and related claim documentation. For non-Chinese-speaking claimants, translation assistance is available from the Labour Department's Telephone Interpretation Service.

Solicitor or representative details: Where the claimant is represented by a solicitor, trade union official, or other representative, their details and authority to act should be stated. Under the Labour Tribunal Ordinance (Cap. 25), a trade union official may represent a member at the Labour Tribunal without restriction on legal representation rules.

Forms-legal.com provides a complete Hong Kong Workplace Injury Claim Form template aligned with Cap. 282 requirements, covering all statutory notification, compensation, and election provisions, suitable for use by injured workers without legal representation.

Related documents include the Settlement Agreement (Employment) for documenting any agreed resolution, and the Workplace Safety Assessment for identifying and rectifying the conditions that caused the accident.