Hawaii Temporary Disability Insurance

Quick Facts

• Benefit amount: 58% of average weekly wage, capped at $765 in 2025.
• Duration: Up to 26 weeks of benefits during a benefit year.
• Funding: Employers must provide coverage through insurance policies or approved self-insured plans. Employees can be required to contribute up to 0.5% of weekly wages, capped at $6.00 per week.
• Coverage: Applies to most private-sector employees who work at least 20 hours per week for six consecutive weeks.

Program Overview

Hawaii’s Temporary Disability Insurance (TDI) law requires employers to provide wage replacement when employees cannot work due to off-the-job sickness or injury, including pregnancy. The program, established in 1969, ensures most workers have short-term disability coverage. Unlike state-run systems funded entirely by employee contributions, Hawaii mandates employer-sponsored plans meeting statutory minimums. Employers can purchase insurance from private carriers, join a mutual association, or self-insure with state approval.

Benefits assist workers recovering from surgeries, illnesses, or pregnancy complications. TDI works alongside Hawaii Family Leave, Paid Family Leave pilot programs, and employer-provided benefits. Because coverage varies by insurer, employees should review their employer’s TDI plan for specific procedures, though all plans must meet statutory minimums.

Eligibility Requirements

1. Covered employment: You must have worked at least 14 weeks for one or more Hawaii employers, with a minimum of 20 hours per week and earning at least $400 in each of those weeks.
2. Disability certification: A licensed physician, advanced practice registered nurse, osteopath, naturopath, chiropractor, dentist, or accredited practitioner must certify you are unable to work.
3. Waiting period: Benefits begin after a seven-day waiting period, unless the plan provides more generous coverage.
4. Timely filing: Claims must be filed within 90 days after the disability begins. Late filing may be excused for good cause but can reduce benefits.

Benefit Calculation

• Average weekly wage (AWW): Determined using wages from the highest paid months preceding disability.
• Weekly benefit: 58% of AWW, up to the statutory maximum ($765 in 2025). Employers may offer higher benefits.
• Duration: Up to 26 weeks of benefits within a benefit year. Multiple disabilities within the year share the 26-week cap.
• Offsets: Benefits are reduced by wages earned during disability or by Paid Family Leave benefits for the same period.

Application Process

1. Notify employer promptly. Provide medical documentation and the date you stopped working. Employers supply claim forms (TDI-45 or carrier-specific forms).
2. Complete employee section. Include personal information, employment history, and disability dates.
3. Medical certification. Your healthcare provider completes the physician’s statement, detailing diagnosis, treatment, and expected recovery.
4. Employer verification. Employers submit wage and employment information to the insurer.
5. Submit claim. Send the completed forms to the insurance carrier or employer’s TDI administrator within 90 days.
6. Receive determination. Insurers must approve or deny claims promptly, typically within two weeks. Payments are issued weekly via check or direct deposit.

Required Documentation

• Completed TDI claim form with employer and physician sections.
• Medical records, surgical reports, or hospital discharge summaries if requested.
• Proof of pregnancy (estimated due date, delivery confirmation) for maternity claims.
• Wage statements if there is a dispute about earnings.

Coordination with Other Benefits

• Hawaii Family Leave: Provides up to four weeks of job-protected leave for family caregiving or bonding. It does not include pay, so TDI may cover pregnancy-related disability while Family Leave covers caregiving.
• Workers’ compensation: TDI does not cover work-related injuries. If a workers’ comp claim is denied, you may file TDI while appealing.
• Unemployment insurance: Not available while receiving TDI.
• Employer sick leave: Employers may require you to use accrued sick leave before TDI benefits begin if stated in policy.

Strategies to Maximize Benefits

1. Know your plan: Request a copy of the employer’s TDI policy. Some plans offer higher benefits or shorter waiting periods.
2. Coordinate with pregnancy leave: Typical maternity claims receive benefits for two weeks before birth and six weeks after vaginal delivery (eight weeks after cesarean). Complications can extend coverage; ensure your provider documents all complications.
3. File immediately: Even if you lack complete medical records, submit the claim within 90 days to preserve rights.
4. Maintain medical appointments: Insurers may require periodic updates. Keep records of visits and treatments.
5. Request tax withholding: Benefits are taxable at both federal and state levels. Elect withholding to avoid surprises.

Common Mistakes to Avoid

• Missing deadlines: Filing late without good cause can result in reduced or denied benefits.
• Incomplete forms: Ensure all sections are signed and dated by you, your employer, and your provider.
• Working without reporting: Report any part-time or light duty work; benefits may be reduced but failure to report can lead to overpayments.
• Assuming coverage while self-employed: Independent contractors are not automatically covered. Consider purchasing individual disability insurance.

Appeals Process

If denied, request a reconsideration from the insurer. If unresolved, file an appeal with the Hawaii Department of Labor and Industrial Relations Disability Compensation Division within 20 days. Hearings are conducted before a hearings officer. Further appeals can be made to state courts.

Example Scenarios

• Surgery recovery: Keoni had knee surgery and missed eight weeks of work. His orthopedic surgeon certified the disability, and he received $700 weekly TDI benefits after the waiting week.
• High-risk pregnancy: Malia experienced complications requiring bed rest. Her obstetrician extended TDI benefits for 12 weeks postpartum due to a cesarean and hypertension.
• Chronic illness flare: Jonah’s lupus caused severe fatigue. His rheumatologist certified disability for six weeks, with periodic updates allowing partial return to work.

Resources

• About TDI
• TDI FAQs
• TDI forms
• DLIR contact or call 808-586-9188

Advanced Tips

• Collective bargaining agreements: Many unions negotiate enhanced TDI benefits or supplemental pay. Review your contract.
• Vacation coordination: Some employers allow vacation to supplement TDI up to full wages. Confirm policy to avoid benefit reductions.
• Maintain insurance premiums: Arrange with HR to continue health insurance payments during leave.
• Plan return-to-work: Discuss transitional duties or schedule adjustments, especially if disability involves ongoing therapy.

Frequently Asked Questions

Does TDI cover elective procedures? Elective cosmetic procedures are not covered unless medically necessary to correct a condition affecting the ability to work. Always obtain pre-authorization.

Can I receive TDI during probationary employment? Yes, if you meet the 14-week and earnings thresholds. Employers cannot exclude new hires once they meet statutory criteria.

Are domestic workers covered? Household workers employed for at least 20 hours per week for six weeks qualify. Employers must secure coverage or join the Domestic Workers’ plan administered by DLIR.

What if my employer fails to provide coverage? Contact DLIR’s Disability Compensation Division. The state can impose penalties and may arrange benefits through the Special Compensation Fund.

Additional Planning Tips

• Document communication: Keep emails or letters sent to HR and the insurer. Documentation supports appeals if issues arise.
• Budgeting: Estimate reduced income and explore community resources such as Aloha United Way 211, Supplemental Nutrition Assistance Program, or county assistance.
• Coordinate with medical leave laws: Hawaii’s pregnancy disability leave allows reasonable leave for childbirth and related medical conditions. Use TDI to replace wages during this time.
• Prepare for hurricanes or emergencies: If storms disrupt mail or medical appointments, notify the insurer immediately to prevent interruptions in benefits.