Temporary Disability Income (TDI) Claims

(Hawaii ONLY)

A TDI claim must be filed within 90 days after commencement of the disability period.

Complete the Employer's Statement section of the claim form. Provide the claim form and Consumer Privacy Notice to the employee.

Form NameForm Number

Claim form for Hawaii employees

TDI-45 (rev 2/06)

Consumer Privacy Notice

47316c (116249)

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