Disability policies have two different protection features that are important to understand:
In addition to the traditional disability policies, there are several options you should consider when purchasing a policy:
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(For other FAQs, see Workers’ Comp or Prepaid Health Care) Employee’s section Employer’s section Insurance Carrier’s Section 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:
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:
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:
If your employer has a plan that differs from statutory benefits and has been approved by this Division, 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:
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? A work-related disability is covered under the workers’ compensation law, while a nonwork-related disability should be filed as a TDI claim. Occasionally, there may be doubt as to whether an injury or sickness had anything to do with work. 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 for TDI benefits. If you are later awarded workers’ compensation benefits for the same disability, your employer or the TDI insurance carrier has the right to be paid back the amount of TDI benefits that were paid to you. This amount can be taken from your workers’ compensation benefits. 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? The TDI Special Fund pays benefits to:
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 the Denial of Claim for Disability Benefits 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 then send two copies to this Division in Honolulu or to 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 submit your written appeal to the Honolulu office or 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 (808) 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. Back to top If I am a State or County employee, am I entitled to receive TDI benefits? 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. Contact your personnel office to file a claim. Who is required to provide TDI coverage? Other than those excluded (refer to section 392-5 of the Hawaii Revised Statutes for exclusions), every employer is required to provide TDI when its eligible employees are unable to work because of a nonwork-related illness or injury. The State does not pay TDI benefits; instead, it requires every employer covered by the law to provide 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 set annually by this Division, which is $5.51 per week during 2021. (Please refer to the Maximum Weekly Wage Base and Maximum Weekly Benefit Amount). Example: An employee’s weekly wage is $300. The premium cost is 80 cents per $100 of covered wages, or $2.40 for this employee. Since the employer cannot charge the employee more than one-half the premium cost, the employee’s share could be up to $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:
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:
Back to top My accounting service is withholding money from the employees’ paychecks for state disability. How do I submit the state disability insurance tax payment to Hawaii? Do not submit payment to the State. The State of Hawaii does not assess a disability tax (SDI) and does not collect a disability tax payment since employers are required to obtain coverage. If the employer chooses to take a deduction from employees’ paychecks, the employer uses that amount to pay for part of the cost of the TDI coverage. If you have chosen to share the cost with the employee, verify that the deduction taken by the accounting service meets the following requirements. The employer may pay for the entire cost of providing TDI coverage, 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 set annually by this Division ($5.51 per week during 2021. Refer to the Maximum Weekly Wage Base and Maximum Weekly Benefit Amount for the current maximum). Example: An employee’s weekly wage is $300. The premium cost is 80 cents per $100 of covered wages, or $2.40 for this employee. Since the employer cannot charge the employee more than one-half the premium cost, the employee’s share could be up to $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 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:
The Certification of Issuance must be submitted to this Division within thirty days after purchase of insurance. It must signed by an officer of the insurance carrier or its authorized representative. The carrier will be notified if the Certificate of Issuance is accepted. When canceling an insurance policy, the following guidelines should be observed:
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 |