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 Name Form Number

Claim form for Hawaii employees


Consumer Privacy Notice

47316c (116249) (rev 5/01/14)

Voya™ Employee Benefits insurance products and services in the U.S. are provided by ReliaStar Life Insurance Company (Minneapolis, MN) and ReliaStar Life Insurance Company of New York (Woodbury, NY). Within the State of New York, only ReliaStar Life Insurance Company of New York is admitted, and its products issued. Both are members of the Voya™ family of companies. Product availability and specific provisions may vary by state. Each insurer is solely responsible for the financial obligations under the policies or contracts it issues.