Frequently asked questions – TDI

Workers’ Compensation ι Prepaid Health Care ι Temporary Disability Insurance

 

Temporary Disability Insurance (TDI)

Employer’s section

Who is required to provide TDI coverage?
How does an employer provide TDI coverage?

Employee’s section

Who is eligible for TDI benefits?
Who is not eligible for TDI benefits?
How much benefit am I entitled to receive?
How do I file a TDI claim?
What are subrogation rights?
What is the TDI Special Fund and who may file a claim against it?
What is the timeframe for the employer to complete the claim form?
What if I am denied benefits or disagree with my benefit amount?
While on TDI, can my employer terminate my employment?
If my employer does not have a TDI policy for the employees, what recourse do I have?
If I am a State or City and County employee, am I entitled to TDI benefits?

Insurance Carrier’s Section
What is a TDI policy?

Who is required to provide TDI coverage?

Other than those excluded (refer to section 392-5 of the Hawaii Revised Statutes for exclusions), all employers are required to provide TDI, or sick leave benefits, when their eligible employees are unable to work because of a nonwork-related illness or injury. The State does not pay TDI benefits; instead, it makes sure every employer covered by the law provides benefits to the eligible employees. As for the cost of providing TDI coverage, the employer may pay for the entire cost or share the cost with the employees eligible for coverage, in which case the employer may deduct one-half the premium cost but not more than 0.5% of the employees’ weekly wages up to the maximum of $4.51 per week for 2010, which is set annually by this Division (refer to the Maximum Wage Base and Weekly Benefit Amount). Example: An employee’s weekly wage is $300. The premium cost is 80 cents per $100 of covered wages. Since the employer cannot charge the employee more than one-half the premium cost, the employee’s share is $1.20. To further determine whether this amount is within statutory limit, calculate 0.5% of the employee’s weekly wage of $300, which equals $1.50. The $1.20 premium cost withheld from employee per week is within the statutory limit.

Back to top

How does an employer provide TDI coverage?

An employer may adopt one or more of the following methods of providing TDI benefits:

  • By purchasing insurance, called an “insured” plan, from an insurance carrier authorized to write TDI policies in Hawaii.
  • By adopting a sick leave policy, called a “self-insured” plan, which must be approved by this Division. A self-insured employer pays benefits directly to its disabled employees. As a self-insurer, the employer must show proof of financial solvency and ability to pay benefits by:

Furnishing this Division with the latest audited financial statements for review. Following the initial approval, the audited financial statements must be submitted annually for continued approval of the employer’s self-insured plan, or

Depositing securities, or

Posting surety bonds in an amount determined pursuant to sections 12-11-69 and 12-11-70, Hawaii Administrative Rules.

  • By a collective bargaining agreement that contains sick leave benefits at least as favorable as required by the TDI Law.

All plans must be submitted to this Division for review with Form TDI-15 and must be approved before they can be put into effect. The benefits provided by an employer’s plan will fall into one of the following categories:

  • Statutory benefits, meaning benefits that follow the minimum standards as set forth in Sections 392-22, 392-23, 392-24 and 392-41 of the Hawaii Revised Statutes.
  • Equivalent benefits, meaning benefits “as favorable as” statutory benefits, as determined by this Division. See Equivalency Tables (Form TDI-14).
  • Better-than-statutory benefits, meaning benefits that are superior to statutory benefits.

Back to top

Who is eligible for TDI benefits?

To be eligible for TDI benefits, you must have at least 14 weeks of Hawaii employment during each of which you were paid for 20 hours or more, and earned not less than $400 in the 52 weeks preceding the first day of disability. The 14 weeks need not be consecutive nor with only one employer.

  • You must also meet the following conditions in addition to the eligibility requirements described above:
  • Your injury or illness is not work related; not caused by your job.
  • Your injury or illness prevents you from performing your regular duty.
  • Your disability is certified by and you are under the care of a licensed physician, surgeon, dentist, chiropractor, osteopath, naturopath, or an accredited practitioner of a faith-healing group.
  • You must be in current employment to qualify for benefits. You are considered to be in current employment if you were employed immediately before the date you suffered your injury or illness, or if you were separated from your job, your disability occurred within two weeks from your last day of work. Current employment includes the period you were receiving vacation or sick leave pay, TDI benefits or workers’ compensation benefits for temporary total disability.

Any employee who meets the eligibility requirements must be provided with TDI coverage by the employer. If you were in concurrent employment or had more than one job, whether full-time or part-time, you may qualify for TDI benefits from each employer if you meet the eligibility requirements.

Back to top

Who is not eligible for TDI benefits?

Some employees are excluded from coverage (refer to section 392-5 of the Hawaii Revised Statues for exclusions) such as the employees of the federal government, certain domestic workers, insurance agents and real estate salespersons paid solely on a commission basis, individuals under 18 years of age in the delivery or distribution of newspapers, certain family employees, student nurses, interns and workers in other categories specifically excluded by the law.

Besides the exclusions mentioned above, you are not eligible for benefits if:

  • You performed work for pay for any day during your period of disability.
  • You were denied unemployment insurance benefits because of a work stoppage due to a labor dispute.
  • Your injury was willfully and intentionally self-inflicted or it was received while committing a criminal offense.
  • You received or will receive unemployment insurance, workers’ compensation or federal disability benefits.
  • You knowingly made a false statement or failed to disclose information in order to obtain benefits.
  • You filed your claim beyond 90 days from the commencement of your disability period with no valid reason.

Back to top

How much benefit am I entitled to receive?

Your employer’s plan determines how much benefit you will receive each week, how long you will be paid and whether you have to serve a waiting period.

If your employer has a statutory plan, i.e. a plan that provides benefits according to minimum benefit standards, you are entitled to:

  • Cash benefits of 58% of your average weekly wages rounded to the next higher dollar, but not more than the maximum weekly benefit amount annually set by the Disability Compensation Division. Example: The maximum weekly benefit for 2009 is $510. Based on 58% of your average weekly wage, your weekly benefit amount for 2009 will range from a minimum of $1 to a maximum of $510.
  • Benefits from the eighth day of disability; in other words, there is a seven-consecutive-day waiting period.
  • A maximum of 26 weeks of benefit payments during a benefit year.

If your employer has a sick leave plan which differs from statutory benefits and has been approved by this Division as an equivalent or better-than-statutory plan, your weekly benefit amount, duration of payments, and whether or not a waiting period is required will be determined by the plan. Ask your employer for details of the plan.

TDI benefits paid or payable to you are solely to partially replace the wage loss resulting from your inability to work. Your employer or insurance carrier is prohibited from receiving benefit assignments, in whole or in part, to pay for a debt or obligation you incurred. Benefits are also exempt from levy, execution, attachment, and garnishment except for child support with a Family Court order, as allowed under Section 571-52, HRS.

Back to top

How do I file a TDI claim?

If you suffered a nonwork-related sickness or injury, you should follow the procedures described below:

  1. Notify your employer immediately of your disability.
  2. Ask for Form TDI-45, Claim for TDI Benefits, from your employer.   Or contact us.  A TDI claim must be filed within 90 days after commencement of the disability period.
  3. Complete Part A, Claimant’s Statement, of the claim form.
  4. Take the form to your physician to certify your disability on Part C, Doctor’s Statement.
  5. Have your employer complete Part B, Employer’s Statement.
  6. Mail the form to your employer’s TDI insurance company if your employer is not self-insured.
  7. Your employer or the insurance carrier will notify you of your entitlement to benefits.

The law requires that you file your claim within 90 days from the date you were disabled. If you file your claim after 90 days, you may lose part of your benefits unless good cause can be shown. If you file your claim more than 26 weeks after your disability, you will not be entitled to any benefits. To avoid partial or complete loss of benefits, file your claim within 90 days.

Back to top

What are subrogation rights?

Occasionally, there may be doubt as to whether a disabling injury or sickness had anything to do with work. A work-related disability is covered under the workers’ compensation law, while a nonwork-related disability should be filed as a TDI claim.

If you filed a workers’ compensation claim and it is being denied or controverted, you can then file a TDI claim, and your employer or the insurance carrier must pay the TDI benefits first provided you meet the eligibility requirements as described above. If you were subsequently awarded workers’ compensation benefits for the same disability, your employer or the TDI insurance carrier has the right to subrogate your workers’ compensation benefits to the extent of the TDI benefits already paid to you earlier.

Subrogation may also extend to benefits resulting from a legal action on liability if such benefits are awarded subsequently for the same disability covering the same disability period. Here is an example of what subrogation is:

Suppose while walking in a restaurant, you slipped on wet pavement and suffered a broken ankle. During your disability, you received TDI benefits from your employer or the insurance carrier. As a result of a suit you filed against the restaurant or of an agreement concluded between you and the restaurant, you received a cash settlement, which compensated you for wages lost during your disability. Since your employer or the insurance carrier paid you TDI benefits to replace your lost wages, the employer or the insurance carrier has the right to claim from the cash settlement or to require reimbursement from you for the amount of TDI benefits paid you.

Back to top

What is the TDI Special Fund and who may file a claim against it?

A TDI Special Fund for disability benefits was established in 1969 through assessments imposed on all employers subject to the TDI Law. According to the law, this Fund can only be used to pay benefits to:

  • Employees whose employers have failed to provide TDI coverage or who have gone bankrupt.
  • Unemployed claimants who, while receiving unemployment insurance (UI) benefits, became disabled and were held ineligible for further UI benefits solely due to the disability.

If you fall in either one of the above categories at the time you became disabled, contact us.

Back to top

What is the timeframe for the employer to complete Part B of the claim form?

The Hawaii TDI law does not provide a specific timeframe within which the employer must complete Part B. If, however, your employer does not fill out Part B in a timely manner (for instance, within a week or so), you may contact the Investigation Section or the Department of Labor and Industrial Relations District Office nearest you for assistance.

Back to top

 What if I am denied benefits or disagree with my weekly benefit amount?

Your employer or insurance carrier is required to send you a written notice (three copies of Form TDI-46) if your claim is denied. If you disagree with the denial, you may appeal by explaining why you disagree on the notice and send two copies to this Division in Honolulu or the Department of Labor & Industrial Relations field office nearest you. You have 20 calendar days from the mailing date of the denial notice to appeal.

You may also appeal to this Division or on the neighbor-island, the Department of Labor and Industrial Relations District Office nearest you if you disagree with the amount of benefits paid you by your employer or the TDI insurance carrier. Bring evidence such as pay slips or check stubs to prove you are entitled to more benefits. This Division will notify you of the time and place of the appeal hearing. An impartial referee will hear your case.

Back to top

 While on TDI, can my employer terminate my employment?

The Hawaii TDI law does not specifically indicate that it is unlawful to suspend any employee solely because that employee has suffered a nonwork-related disability. However, you may contact the Civil Rights Commission at 586-8636 for more information.

If my employer does not have a TDI policy for the employees, what recourse do I have?

You may contact the Investigation Section in Honolulu or on the neighbor-island, the Department of Labor and Industrial Relations District Office nearest you for assistance.

If I am a State or County employee, am I entitled to receive TDI benefits?

Basically, the sick leave provided by the employer is the TDI benefits for a state or county employee.  However, if your combined total of used and unused sick leave credits within a benefit year is less than three weeks prior to the disability, you may be entitled to additional TDI benefits.

Back to top

What is a TDI policy?

Every TDI policy issued by an authorized TDI insurance carrier covers the entire liability of the employer to its employees. The classes of employees covered must be specifically indicated in the policy and the Certification of Issuance (Form TDI-62) shall contain the following information:

  1. Insurer’s name
  2. Employer’s (insured) name
  3. Employer’s business name (d.b.a.) if different from above
  4. Department of Labor (DOL) account number of insured
  5. Policy or rider form number
  6. Effective date of coverage
  7. Classes of employees covered or excluded
  8. Benefits provided

The Form TDI-62 should be submitted within thirty days after purchase of insurance to this Division in triplicate, signed by an officer of the insurance carrier or its authorized representative. If accepted, two copies of the Form TDI-62 will be stamped “Accepted” and returned to the carrier, who will forward one copy to the policyholder.

When canceling an insurance policy, the following guidelines should be observed:

  1. A minimum 10-day notice of intent to cancel on a specified date and the reason therefor must be filed with and served on this Division and the employer.
  2. If the reason for cancellation is “coverage provided by a new carrier,” cancellation date can be the effective date of the new policy provided the new carrier has already filed a TDI-62 with this Division.

A self-insurer who terminates self-insured status with the approval of this Division may have the security deposit returned after 24 months from termination as specified in Section 12-11-72 of the Hawaii Administrative Rules.

Back to top