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TEMPORARY DISABILITY INSURANCE (TDI)
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 sickness or injury (including pregnancy).
This means that if an employee is unable to work because of an off-the-job
sickness or injury and that 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:
a. 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:
- 1. 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,
- 2. Depositing securities, or
- 3. Posting surety bonds in an amount determined pursuant to sections 12-11-69 and 12-11-70 ,
Hawaii Administrative Rules.
c. 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-13 and FormTDI-15)
to this Division for review and approval before they can be put into effect.
As for the benefits, 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.
a. If the employer has a statutory plan, i.e. a plan thatprovides
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.
b. 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.
As for the cost of providing TDI coverage, the employer may pay for the entire
cost or share the cost equally with the employees eligible for coverage.
To file a TDI claim, the employee should follow the procedures described below:
a. Notify the employer immediately of the disability.
b. Ask for Form TDI-45, Claim for TDI Benefits, from the employer. A TDI claim
must be filed within 90 days after commencement of the disability period.
c. Complete Part A, Claimant's Statement, of the claim form.
d. Take the form to the physician to have disability certified on Part C,
Doctor's Statement.
e. Have the employer complete Part B, Employer's Statement.
f. Mail the form to employer's TDI insurance company if the employer is not
self-insured.
g. 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 claim filed after 90 days, the employee may lose part 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 Department of Labor & Industrial Relations field office nearest
you. The employee has twenty calendar days from the mailing date of the denial
notice to appeal.
An employee may also appeal to this Division or on the neighbor-island, the
Department of Labor and Industrial Relations District Office nearest you if
the employee disagrees with the amount of benefits paid by the employer or
the TDI insurance carrier. Bring evidence such as 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 RelationsDistrict Office
nearest you for assistance.
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