About Temporary Disability Insurance
The Hawaii Temporary Disability Insurance (TDI) law was enacted in 1969, which requires employers to provide partial “wage replacement” insurance coverage to their eligible employees for nonwork-related injury or sickness, including pregnancy. This means that if an employee is unable to work because of an off-the-job injury or sickness and the employee meets the qualifying conditions of the law, the disabled employee will be paid disability or sick leave benefits to partially replace the wages lost. TDI, however, does not include medical care.
To be eligible for TDI benefits, an employee must have at least 14 weeks of Hawaii employment during each of which the employee was 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. The employee must also be in current employment to be eligible.
Some employees are excluded from coverage 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. Refer to sections 392-5 and 392-27 of the law for exclusions and ineligibility for benefits.
An employer may adopt one or more of the following methods of providing TDI benefits:
- By purchasing insurance, called an “insured” plan, from an authorized insurance carrier. To purchase a TDI policy, refer to the list of Authorized TDI Insurance Carriers.
- 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,
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 self-insured plans must be submitted (FormTDI-15) to this Division for review and approval before they can be put into effect.
The employer’s plan determines how much benefit the employee will receive each week, how long the employee will be paid and whether the employee has to serve a waiting period.
- If the employer has a statutory plan, i.e. a plan that provides benefits according to the minimum benefit standards as required by law, the employee is entitled to disability benefits, from the eighth day of disability for a maximum of 26 weeks, at 58% of the employee’s average weekly wages up to the maximum weekly benefit amount annually set by this Division.
- If the 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, the 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.
The employer may pay for the entire cost of providing TDI coverage, or the employer may share the cost equally with the employees eligible for coverage. However, the employee’s contribution cannot exceed 0.5% of the employee’s weekly wages, nor the maximum weekly deduction. An example of the deduction limits is available in the Highlights of the Hawaii Temporary Disability Insurance Law publication.
To file a TDI claim, the employee should follow the procedures described below:
- Notify the employer immediately of the disability.
- Ask for Form TDI-45, Claim for TDI Benefits, from the employer. A TDI claim must be filed within 90 days of the start of the disability period.
- Complete Part A, Claimant’s Statement, of the claim form.
- Take the form to the physician to have disability certified on Part C, Doctor’s Statement.
- Have the employer complete Part B, Employer’s Statement.
- Mail the form to employer’s TDI insurance company if the employer is not self-insured.
- The employer or the insurance carrier will notify the employee of his or her entitlement to benefits.
The law requires that a claim be filed within 90 days from the date of disability. If the claim is filed after 90 days, the employee may lose part or all of the benefits unless good cause can be shown. If claim filed more than 26 weeks after disability, the employee will not be entitled to any benefits. To avoid partial or complete loss of benefits, file the claim within 90 days.
An employer or insurance carrier is required to send the employee a written notice (three copies of Form TDI-46) if the claim is denied. If the employee disagrees with the denial, the employee may appeal by explaining why he or she disagrees on the notice and send two copies to this Division in Honolulu or the nearest Department of Labor & Industrial Relations District Office. The employee has twenty calendar days from the mailing date of the denial notice to appeal.
An employee who disagrees with the amount of benefits paid by the employer or the TDI insurance carrier may appeal to this Division in Honolulu or to the Department of Labor and Industrial Relations District Office nearest the employee. The employee should submit evidence such as copies of pay slips or check stubs as proof for more benefits. This Division will notify the employee of the time and place of the appeal hearing. An impartial referee will hear the case.
If an employer does not have a TDI policy for the employees, the disabled employee may contact the Investigation Section in Honolulu or on the neighbor-island, the Department of Labor and Industrial Relations District Office nearest the employee for assistance.
For additional TDI information see the Highlights of the Hawaii Temporary Disability Insurance Law and Frequently Asked Questions.