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Hawaii TDI-45: Claim for Disability Benefit

Hawaii workers use the TDI-45 to claim Temporary Disability Insurance benefits for an off-the-job injury or sickness, including pregnancy. A clinician meets it when a patient brings the paper form from their employer and needs the disability certified in Part C. The completed claim goes to the employer's TDI insurance carrier, which notifies the employee whether benefits are payable.

Who completes it

The employee completes Part A (Claimant's Statement) and the employer completes Part B (Employer's Statement). A physician, physician assistant or advanced practice registered nurse certifies the disability in Part C, the Doctor's Statement.

Submitting and payment

How to submit it
The TDI-45 is not posted online: the employee gets it from the employer (or from the Disability Compensation Division if the employer has none), and the completed claim is mailed to the employer's TDI insurance carrier within 90 days of the start of the disability.

Good to know

  • A claim filed after the 90-day limit can lose part or all of its benefits unless good cause is shown, and a claim filed more than 26 weeks after the disability began pays nothing.
  • Under a statutory plan, benefits start on the eighth day of disability and last up to 26 weeks; a self-insured employer's plan can set its own terms.
  • Hawaii TDI covers only the worker's own non-work-related disability. The state has no paid family leave program; caregiving absences fall under the unpaid Hawaii Family Leave Law.
  • Related forms: TDI-46 is the carrier's notice of claim denial, and TDI-62 is completed only by TDI carriers, never by employees or clinicians.

Get the official form

Download the current version from the source each time; forms change without notice.

Claim for Disability Benefit

Official page

Fill it with Vero

If your copy of the form is a fillable PDF, upload it once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.

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How this list is checked

A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.

Vero is not affiliated with, or endorsed by, the agencies and insurers listed here. Read our editorial policy.

Frequently asked questions

Where can a patient get the Hawaii TDI-45 form?

The Disability Compensation Division does not publish the TDI-45 online. The employee asks their employer for the claim form, and if the employer does not have one, the employee contacts the Division. The clinician usually sees the form only after the patient has obtained it and started Part A.

Who can sign the doctor's statement on the TDI-45?

The Division's TDI page says a physician, physician assistant or advanced practice registered nurse certifies the disability in Part C, the Doctor's Statement. The certification supports the employee's claim that a non-work-related injury or sickness, which under Hawaii's TDI law includes pregnancy, keeps them from working.

What is the deadline to file a Hawaii TDI claim?

The claim must be filed within 90 days of the start of the disability period. Late claims may lose part or all of their benefits unless good cause is shown, and no benefits are paid on a claim filed more than 26 weeks after the disability began, so a prompt Part C matters.