The State of Hawaii requires employers to provide temporary disability insurance (TDI) or payments to workers who suffer short-term, non-work related illness or injuries, including pregnancy. The goal of the requirement is to provide workers with partial wages while they can’t work.
How Do I Qualify for TDI Benefits?
To be eligible for TDI benefits, you must be currently employed in the state of Hawaii and:
- have worked at least 14 weeks in the state of Hawaii
- have been paid for at least 20 hours of work during each of the weeks, and
- have earned at least $400 dollars from working during the 52 weeks before the day you became disabled.
It doesn’t matter if you didn’t work the 14 weeks consecutively or if you had multiple employers.
If you meet the basic requirements above, you must also:
- experience an injury or an illness that was not a result of your job
- be unable to work your regular job because of the injury or illness
- have your medical provider certify your disability (this can be a licensed physician, surgeon, dentist, chiropractor, osteopath, naturopath, or accredited practitioner of a faith-based healing group), and
- have worked within two weeks of when you suffered your injury or illness.
Who Doesn't Qualify for Benefits?
Not all workers in Hawaii can get TDI benefits. Here are some reasons you may not be eligible for TDI:
- You stopped working because of a labor dispute.
- Your injury or illness was intentionally self-inflicted.
- You were injured while committing a crime, or
- You worked for pay even one day during the time period you claim you are disabled.
In addition, here are some examples of workers who are ineligible:
- federal employees
- commissionbased real estate or insurance agents
- newspaper delivery people who are under the age of 18, and
- student nurses and other interns.
Also, if you provide false information about your illness or injury, or if you leave out material evidence about your disability, you will not be able to get benefits for the period of time to which the statements pertained.
Is There a Deadline for Filing My Claim?
You must file your claim within 90 days of the date you became disabled. If you file after that time, you must show that there was a good cause for the delay. A late filing may result in a denial of benefits or a reduction in the amount you can get. If you file your claim more than 26 weeks after the date you became disabled, you will not be entitled to benefits at all.
What Will My Benefit Amount Be?
If your employer follows the guidelines established by Hawaii’s legislation, your benefits amount will be 58% of your average weekly wages, rounded to the next highest dollar. But the maximum amount you can get is limited by a dollar amount that is established each year by the Disability Compensation Division (DCD). For 2013, the most you can get per week is $534.63.
If your employer has developed its own temporary disability payment plan (called "self-insuring," it must provide better benefits than the ones established by law. You should speak to your employer if you have questions about the specifics of its temporary disability insurance plan.
Are There Limits on TDI Benefits?
Benefits won't begin until the eighth day of your disability, and you cannot get more than 26 weeks of benefits a year.
You also cannot get “duplicate” benefits. This means if you get other temporary disability benefits, such as worker’s compensation, you cannot also collect TDI benefits.
How Do I Apply for TDI?
If you develop an illness, suffer an injury, or are pregnant and are unable to work, you must follow these steps to apply for benefits.
- Tell your employer right away about your disability.
- Ask your employer for Form TDI-45.
- Fill out Part A (Claimant’s Statement) of Form TDI-45.
- Ask your doctor to fill our Part C (Doctor’s Statement) certifying that you are disabled.
- Ask your employer to fill out Part B (Employer’s Statement).
- Mail the completed form to your employer’s TDI insurance carrier if your employer isn’t self-insured.
Remember that you must file your claim within 90 days to avoid losing eligibility for benefits or a reduction in your benefit amount.
Can I Appeal a Denial of TDI or My Benefit Amount?
If the insurance company denies your claim, or provides a benefit amount you disagree with, you can file an appeal within 20 days of getting the notice from your employer or its insurance carrier. To appeal, write an explanation of why you think the decision is wrong. Make sure you provide all the necessary evidence to support your appeal, including evidence of how much you were paid by your employer.
Send two copies of your letter to the Disability Compensation Division (DCD) in Honolulu. You can also send the appeal to the Department of Labor & Industrial Relations office closest to you.
Here is the DCD’s contact information:
830 Punchbowl Street, Room 209
Honolulu, HI 96813
P.O. Box 3769
Honolulu, HI 96812-3769
Telephone: (808) 586-9188
To decide the appeal, the DCD will hold a hearing, which will be presided over by a neutral referee. If you'd like legal representation at the hearing, contact a disability lawyer in your area.