HAWAII ADMINISTRATIVE RULES
TITLE 12DEPARTMENT OF LABOR AND INDUSTRIAL RELATIONSSUBTITLE 3
DISABILITY COMPENSATION DIVISION
CHAPTER 11
TEMPORARY DISABILITY INSURANCE

Subchapter lGeneral§l2-ll-lDefinitions§l2-ll-2
Special disability fund assessment§l2-ll-3
Financial solvency§l2-ll-4Filing date
§l2-ll-5
Oaths and subpoenas§§12-11-6 to l2-ll-l0 (Reserved)
Subchapter 2Plans§l2-ll-ll§l2-ll-l2§l2-ll-l3§l2-ll-l4§l2-ll-l5§l2-ll-l6§l2-ll-l7§l2-ll-l8§l2-ll-l9§l2-ll-20

Plans which were in existence June 30, l969
Existing plans which are extended or modified
Successor employers
Wage or salary continuance plans
Plans which were not in existence on June 30,l969
Existing and new plans
Method of evaluating benefits under plans
Wages to be used in determining benefit rate
Employees not covered under a plan
Benefits less favorable with respect to certain
employees eligible under a plan§l2-ll-2l
Procedure for obtaining acceptance of plans under
Section 392-4l (a)(4) and (5), HRS§l2-ll-22
Substitution of new carrier under a plan§l2-ll-23
Default in payment of assessments§l2-ll-24
Notices and reports required with respect to plans§l2-ll-25
Accepted plans§l2-ll-26
Reconsideration of denial of application for plan
acceptance; appeal§l2-ll-27
Minimum coverage standards for an association of
employers§§l2-ll-28 to l2-ll-34 (Reserved)
Subchapter 3

Benefits and Claims Procedures
DLIR 12-11 Page 1§l2-ll-35§l2-ll-36§l2-ll-37§l2-ll-38§l2-ll-39§l2-ll-40

Claim for disability benefits
Responsibility of employer to provide benefits
Part-time employment
Concurrent employment
Two-week period following termination of employment
Claim for reimbursement out of workers' compensation
benefits§12-ll-4l
Denial of claim§l2-ll-42
Disqualification for benefits§l2-ll-43
No waiting period required for benefits from special
fund§l2-ll-44
Disposition of accrued benefits upon death§l2-ll-45
Authorized physician, surgeon, dentist,
chiropractor, osteopath, naturopath, or equivalent§l2-ll-46
Average weekly wage
§l2-ll-47
Cash value of remuneration in kind§l2-ll-48
Change in average weekly wage
§l2-ll-49
Failure to provide coverage§l2-ll-50
Deductions greater than authorized§§l2-ll-5l to l2-ll-55 (Reserved)
Subchapter 4

Requirements for Insured Coverage§l2-ll-56§l2-ll-57§l2-1l-58§l2-ll-59

Posting of notice of coverage
The insurance contract
Cancellation of an insurance contract
Employee contributions toward the cost ofunder insurance contracts§l2-ll-60
Refusal to insure§§l2-ll-61 to l2-ll-65 (Reserved)
Subchapter 5

coverage

Requirements for Self-Insured Coverage§l2-ll-66§l2-ll-67§l2-ll-68§l2-ll-69§l2-ll-70§l2-ll-7l§l2-ll-72

Posting of notice of coverage
Application
Agreement
Requirements for self-insurance
Amount of securities or bond
Proof of ability to process claims
Termination of self-insurer's status and withdrawal
of security deposit§l2-ll-73
Self-insurance deposit credit§l2-ll-74
Obligations§l2-ll-75
Revocation of self-insurance status§l2-ll-76
Employee contributions towards the cost of coverage
by a self-insurer§12-11-77
Limitation of fund§§12-11-78 to 12-11-84 (Reserved)
DLIR 12-11 Page 2

Subchapter 6§l2-ll-85§l2-ll-86

Reports

Periodic reports
Other employer reports

Historical Note: Chapter ll of Title l2 is based substantially upon
Regulation XXXIV relating to Hawaii temporary disability insurance,
Department of Labor and Industrial Relations.
l2/25/69; am
l0/l4/7l; am 2/3/78; R 5/11/8]

SUBCHAPTER l
GENERAL§l2-ll-l Definitions. As used herein:"Benefits at least as favorable " means benefits under a plan
which meet the requirements of section l2-ll-l6. A plan shallprovide each employee, or each employee of the class or classes of
employees included under the plan, cash disability "benefits at leastas favorable" as the disability benefits under the law.
"Benefit year" shall be as defined in section 392-3, HRS.
A "class of employees" for whom benefits are provided under aplan that is submitted for acceptance under section 392-4l(a)(4) or(5), HRS, shall not be a class determined arbitrarily. In order toconstitute a class of employees within the provisions of thestatutes, there shall be a reasonable basis of classification
including, without limitation, type of work performed, work location,
salary or wage scale, seniority or length of service, or otherconditions pertaining to employment.
"Complete claims service office" means an office which receives
and processes temporary disability insurance claims and issues such
benefit payments.
"Contributions" shall be as defined in section 392-3, HRS.
"Current employment" includes the period any employee isreceiving workers' compensation benefits for temporary total
disability, vacation or sick leave pay, or temporary disability
insurance benefits.
"Department" means the department of labor and industrial
relations.
"Director" shall be as defined in section 392-3, HRS.
"Disability" shall be as defined in section 392-3, HRS.
"Disability during employment" means the total inability of an
employee, as a result of injury or sickness not arising out of and in
the course of the individual's employment, to perform the regular
DLIR 12-11 Page 3

duties of the individual's employment or the duties of any other
employment which the employer may offer the individual at theindividual's regular wages.
"Disability during unemployment" means the inability of aclaimant to qualify for benefits under chapters 383 and 384, HRS, asa result of injury or sickness not arising out of and in the courseof an employment.
"Domestic service in a private home" means service in or about
the home of the individual's employer.
"Employee" means any individual who performs services in
employment for an employer.
"Employer" shall be as defined in section 392-3, HRS.
"Employment" as defined in section 392-3, HRS, includes
services performed by an individual for wages or under any contractof hire irrespective of whether the common-law relationship of masterand servant exists unless and until it is shown to the satisfactionof the director that:(l) The individual has been and will continue to be free fromcontrol or direction over the performance of the service,
both under the individual's contract of hire and in fact;and(2) The service is either outside the usual course of thebusiness for which the service is performed or that theservice is performed outside of all the places of businessof the enterprise for which the service is performed; and(3) The individual is customarily engaged in an independently
established trade, occupation, profession, or business ofthe same nature as that involved in the contract ofservice.
"Injury or sickness" means accidental injury, disease,
infection, or illness. Sickness includes the total inability of an
employee to perform the duties of her or usual employment because of
pregnancy or the normal incidents of pregnancy or the termination
thereof.
"Insurer" as used in section 392-42.5, HRS, means any insurancecompany authorized by the insurance commissioner to underwrite, sell,or transact temporary disability insurance in the State of Hawaii andany employer or association of employers who has been granted
self-insured status under section 392-41, HRS, beginning January 1,
1992.
A "plan" includes any definitive insured or properly
self-insured program, effectively providing for employees cash
disability benefits that differ from the benefits required to beprovided under the statute, either as to rate, waiting period,
maximum or minimum benefits, duration of benefit period, or in any
other respect. A plan may provide benefits for all of the employeesof an employer, or for some class or classes of the employees of an
employer.
DLIR 12-11 Page 4

"Purchase of insurance" means the acceptance as of a specificdate of approval of an employer's temporary disability insurance
application by an insurance company licensed to sell temporary
disability insurance in Hawaii.
"Regular wages" means the wages that the employee would haveearned if the disability had not prevented the employee from working.
"Statute" means chapter 392, HRS, entitled temporary disability
insurance law.
"Wages" shall be as defined in section 392-3, HRS.
"Week" means a period of seven consecutive days.
"Weekly benefit amount" shall be as defined in section 392-3,
HRS. [Eff 5/11/81; am 1/13/92; am 1/16/93; am and ] (Auth: HRS§392-9l) (Imp: HRS §§392-l, 392-3, 392-5, 392-6, 392-4l, 392-42.5)§l2-ll-2 Special disability fund assessment. When a special
fund assessment is made, refunds due to an insurance carrier's orself-insured employer's computational errors shall not be made unlessan application is filed with the director within ninety days from thedate of payment. [Eff 5/11/81] (Auth: HRS §392-9l) (Imp: HRS§392-67)§l2-ll-3 Financial solvency. Financial statements required bysection 392-41, HRS, shall be filed annually not later than threemonths after the close of the self-insurer's fiscal year, or as
requested by the director. [Eff 5/11/81] (Auth: HRS §392-9l)(Imp: HRS §392-4l)§l2-ll-4 Filing date. If not mailed, the filing date shall be
the date the document is received by the addressee; or, if mailed,
the postmark date unless another date is specified in the statutes orthis chapter. [Eff 5/11/81] (Auth: HRS §392-9l) (Imp: HRS§§392-26, 392-42, 392-45)§12-11-5 Oaths and subpoenas. The director or the director's
authorized representative may administer oaths, take or cause to betaken the depositions of witnesses, and require the attendance andproduction of all books, records, and other evidence relative to any
matter under investigation or audit. The subpoena shall be signed
and issued by the director or director's authorized representative.
In case of failure of any person to comply with any subpoena lawfully
issued under this section, the circuit court of any circuit, upon
application by the director or the director's representative, shallhave the power to enforce by proper proceedings the attendance andtestimony of any witness so subpoenaed. [Eff 11/3/89] (Auth: HRS§392-91) (Imp: HRS §392-91)§§l2-ll-6 to l2-ll-l0 (Reserved)
DLIR 12-11 Page 5

SUBCHAPTER 2
PLANS§l2-ll-ll Plans which were in existence June 30, 1969. A plan
which was in existence on June 30, l969 and which continues inexistence on January l, l970 is an existing plan and shall be
accepted by the director as complying with the obligation of theemployer to provide disability benefits for the employees, or for theclass or classes of employees entitled to benefits under the plan,
provided:(l) The employer was on June 30, l969 obligated not todiscontinue the provisions of the plan or the contribution
toward its cost during some period of time after June 30,l969, provided that the acceptance of the plan shall belimited to the period of the obligation; or(2) That if the plan is one under which the employer is not
obligated, as of June 30, l969, to continue the provisionsof the plan or the contribution toward its cost duringsome period after June 30, l969, the plan either(A) Has been found by the director to meet therequirements of section l2-ll-l6 and the employer hasentered into the required agreements and otherwise
complied with section l2-ll-2l the period for which
the plan may be accepted shall be limited to theperiod provided in section l2-ll-2l(3); or(B) Has been agreed to by an association of employees or
through collective bargaining and the employer has,prior to January l, l970, entered into the required
agreements and otherwise complied with section
l2-ll-2l the period for which such plan may be
accepted shall be the term of the plan as so agreed.
[Eff 5/11/81] (Auth: HRS §392-9l) (Imp: HRS§392-4l)§l2-ll-l2 Existing plans which are extended or modified. (a)An existing plan may, after June 30, l969, be extended with orwithout modification, or modified with or without extension, byagreement with an association of employees or through collective
bargaining and, as so extended or modified, the plan during theperiod of the extension or modification shall continue to be accepted
as complying provided that benefits are at least as favorable as
required under section 392-4l, HRS. If the extension or modification
is not effective prior to the expiration of the period during which
the employer is obligated not to discontinue the plan or thecontribution to its cost, the employer shall be required to makeprovision of benefits between the expiration of the period and the
DLIR 12-11 Page 6

day when the agreement of extension or modification is made andbecomes effective; but when so extended or modified, the plan shallcontinue to be accepted as complying provided benefits are at leastas favorable as required under section 392-4l, HRS, during the periodof the extension or modification.
(b) An existing plan that, after June 30, l969, is extended byan employer with or without modification, or modified with or without
extension, other than by agreement with an association of employeesor through collective bargaining, may be continued as an existingplan and may be accepted as complying with the obligation of theemployer under section 392-4l, HRS, during the period of extension or
modification only if the plan, as so extended or modified, is foundby the director to meet the requirements of section l2-ll-l6. [Eff5/11/81] (Auth: HRS §392-9l) (Imp: HRS §392-4l)§l2-ll-l3 Successor employers. An existing plan shall bedeemed continued and may be accepted as the plan of an employer who,
after June 30, l969, has acquired all or substantially all, or an
identifiable portion, of the assets or employment and has assumed
liabilities, including liabilities under the plan, of an employer who
immediately preceding such acquisition had an acceptable existingplan. [Eff 5/11/81] (Auth: HRS §392-9l) (Imp: HRS §392-4l)§l2-ll-l4 Wage or salary continuance plans. (a) Arrangements
for wage or salary continuance during disability in effect on June
30, l969 may be accepted as an existing plan, provided the plan
formed part of the employer's regular contract of hiring, either
under written agreement or by established custom and practice.
(b) A wage or salary continuance plan in effect on June 30,l969, but not then under written agreement, may be accepted as a plan
if it is reduced to a written agreement and if proof satisfactory to
the director is submitted that the plan was actually in existence onJune 30, l969 as the employer's established custom and practice.
(c) Wage and salary continuance may be offered by an employer
as the employer's plan and, if found to be "at least as favorable" asthe statutory benefits schedule, the plan may be accepted as theemployer's compliance with the benefit provisions of the law for theclass or classes of employees covered by the plan. In such case, theemployer may insure or have approved self-insurance for disability
benefits, paying the excess over the benefits under the employer's
continuance agreement as wages or salary or the employer may continue
wages or salary and provide, through insurance or approved
self-insurance, for benefits to commence on the first day of
disability following the last day to which wages or salary arecontinued. [Eff 5/11/81;] (Auth: HRS §392-9l) (Imp: HRS §392-4l)§l2-ll-l5 Plans which were not in existence on June 30, 1969.
Any plan which was not in existence on June 30, l969, but which is in
DLIR 12-11 Page 7

existence on or after January l, l970, is a new plan and, if thebenefits provided meet the requirements of section l2-ll-l6, may be
accepted by the director under section 392-4l, HRS, provided:(l) The benefits are to be provided under the plan for a fixed
term; the acceptable period of the plan shall be suchterm; or(2) The employer has filed with the director the required
agreements and otherwise complied with section l2-ll-2l;
the acceptable period of the plan shall be limited to theperiod provided in section l2-ll-2l(3). [Eff 5/11/81](Auth: HRS §392-9l) (Imp: HRS §392-4l)§l2-ll-l6 Existing and new plans. (a) Benefits under any plan
shall, in the aggregate, be deemed to be "at least as favorable" only
if:(l) A waiting period of no more than seven days is required;and(2) The aggregate actuarial value, as determined under section
l2-ll-l7, of the cash disability benefits for each
employee is equivalent to the aggregate actuarial value,as determined under section l2-ll-l7, of the disability
benefits under section 392-4l, HRS; and(3) Cash disability payments are payable at the rate of l00
per cent of wages and for at least three weeks in abenefit year under a plan with no waiting period, and cash
disability payments are payable for at least fifteen weeks
in a benefit year under a plan with a two-day waiting
period which provides cash disability payments at the rateof 58 per cent of wages. [Eff 5/11/81; am 1/16/93](Auth: HRS §392-9l) (Imp: HRS §§ºº392-22, 392-4l)§l2-ll-l7 Method of evaluating benefits under plans. (a)Benefits provided under a plan which meets the minimum requirementsof section l2-ll-l6 will be evaluated, to assist in determining
whether the plan benefits are "at least as favorable" as the benefits
provided by law, by the use of tables established by the insurance
commissioner which reflect the actuarial relationship between
different types and amounts of benefits.
(b) In evaluating weekly cash disability benefits, thefollowing will be considered:(l) Maximum period during which benefits are payable during
fifty-two consecutive weeks or during a single period of
disability.
(2) Non-compensable waiting period after disability forillness and for accident commences before benefits arepayable.
(3) Benefit rate, which for evaluation purposes will be thepercentage obtained by dividing the weekly benefit by the
DLIR 12-11 Page 8

weekly wage as defined in section l2-ll-l8. [Eff5/11/81;] (Auth: HRS §392-9l) (Imp: HRS §392-41)§l2-ll-l8 Wages to be used in determining benefit rate. (a)In determining the benefit rate for plan evaluation, the normal
weekly earnings paid under regular employment practices will
generally be used as "weekly wages". However, I for any extended
period of time employees regularly receive extra wages including,
without limitation, overtime or premium pay, it may be required that
benefits be determined on the total of normal and such extra wages.
(b) If, under a plan, benefits are to be provided in accordancewith classification will generally be used as the weekly wage indetermining the benefit rate for plan evaluation. For those
employees whose average weekly wages is $20 or more and less than $40
per week, the benefit rate for plan evaluation will be computed by
dividing the actual cash benefit to which the employee is entitled by$40. If the employer submits a wage schedule showing for each wage
classification a distribution of employees by wages (up to weekly
wages equal to the maximum weekly wage base), the weekly wage to be
used for plan evaluation will be the average wage of the employees
included in the classification, but not less than $5 under the
maximum wage of the classification. [Eff 5/11/81] (Auth: HRS§392-91)(Imp: HRS §392-22)§12-11-19 Employees not covered under a plan. If an employee
who is eligible for benefits under the statute is not eligible forbenefits under the plan for any of the following reasons:(1) The eligibility or probationary period under the plan islonger than that provided by law; or(2) There is an eligibility or probationary period under theplan for employees who are entitled by law to immediate
coverage; or(3) The plan does not provide for payment of benefits fordisability occurring while the person is an "individual incurrent employment" as that term is defined in section
392-6, HRS; or(4) The employee is not of the class or any of the classes of
employees entitled to benefits under the plan; then, andin any one or more of the foregoing circumstances, theemployer shall be required to provide for the payment ofbenefits to the employee in one or more of the ways set
forth in section 392-41, HRS. The employer, may, however,modify the plan so as to extend the plan benefits for the
statutory periods referred to in paragraphs (l), (2), and(3) above, and the extension shall not be deemed amaterial modification of the plan. [Eff 5/11/81] (Auth:
HRS §392-91) (Imp: HRS §392-41)

DLIR 12-11 Page 9§l2-ll-20 Benefits less favorable with respect to certain
employees eligible under a plan. If the benefits under a plan, otherthan a plan under section l2-ll-ll(l) or l2-ll-ll(2) (B), do not meetthe requirements of section l2-ll-l6 as to any class of employees
eligible for the benefits, but do meet such requirements as toanother class or other classes of employees, the plan may be accepted
under section 392-4l, HRS, with respect to the class or classes of
employees as to whom the benefits provided do meet the requirementsof section l2-ll-l6. The employer may provide statutory benefits forthe class or classes of employees for whom the plan benefits do notmeet the requirements of section l2-ll-l6 or may supplement the plan
benefits by another plan, in order that the total benefits provided
for all employees entitled to benefits under the plan shall meet therequirements of section l2-ll-l6. [Eff 5/11/81] (Auth: HRS§392-9l) (Imp: HRS §392-4l)§l2-ll-2l Procedure for obtaining acceptance of plans under
section 392-41(a)(4) and (5), HRS. An employer who has an existingplan or a new plan, and who desires to be permitted to provide
benefits thereunder in lieu of the statutory benefits for a class orclasses of employees, shall apply in writing to the director to havethe plan accepted. The employer shall, as a part of the application,and in a form prescribed by the director, file with the director:(l) A statement setting forth the provisions of the plan and,if required by the director, a copy of the plan.
(2) An agreement with the director to pay assessments for the
special disability fund by the employer or the employer's
carrier as the case may be pursuant to section 392-67(a)or (b), HRS.
(3) A written agreement, satisfactory to the director, if theplan is one that under section 12-l1-ll(2), l2-ll-l2(b),or l2-ll-l5 requires an agreement, that the benefits under
the plan will be continued with respect to all employees
included under the plan for disabilities occurring prior
to the date the employer files with the director written
notice of termination of the plan.
(4) Evidence satisfactory to the director that the obligation
to pay benefits under the plan has been insured and is
kept insured with an insurer duly authorized to transact
the business of accident and health insurance in thisState or proof satisfactory to the director of thefinancial ability to pay the benefits and otherwise
complying with section 392-4l(a)(2) and (3), HRS. [Eff5/11/81;](Auth: HRS §392-9l) (Imp: HRS §§392-4l,
392-67)§l2-ll-22 Substitution of new carrier under a plan. If theagreement filed with the director under section l2-ll-2l(2) is the
DLIR 12-11 Page 10

agreement of a carrier and not of the employer, acceptance of theplan shall terminate forthwith whenever the carrier's obligation to
pay benefits shall terminate, unless prior thereto an acceptable newcarrier, assuming fully the obligations of the employer under theplan, has duly filed with the director notice thereof and has filed
also the agreement with the director required under section l2-ll-2l.
[Eff 5/11/81;
comp] (Auth: HRS §392-9l) (Imp: HRS §392-4l)§l2-ll-23 Default in payment of assessments. If the agreement
filed with the director under section l2-ll-2l(2) is the agreement ofan employer, or of an association of employers, or an association of
employees authorized to pay benefits, or a trust or trustee under aplan paying benefits, the acceptance of the plan shall terminate
forthwith on default, after notice, in any payment required to bemade to the director in accordance with section 392-47 or 392-67,
HRS. [Eff 5/11/81;] (Auth: HRS §392-9l) (Imp: HRS §392-67)§l2-ll-24 Notices and reports required with respect to plans.
(a) Whenever a plan accepted by the director shall thereafter be
modified or extended, written notice of the modification or
extension, in form approved by the director, shall be filed forthwith
with the director, and except as to modifications which are notmaterial modifications and except for the extension of a new plan
without material modification for a fixed period of time specified in
the agreement of extension, no such modification shall be effective
until it has been accepted by the director, and when accepted shallbe effective as of the date requested, and no extension shall beeffective until notice of extension has been filed with the director.
(b) A material modification of a plan shall be effective on
acceptance by the director, and, without limitation, any modification
which reduces the class or classes of employees to which the plan isapplicable or the rate of weekly benefits or the period during which
benefits are payable, or which increases the waiting period or thecontribution of employees to the cost of benefits, shall be deemed amaterial modification. [Eff 5/11/81;] (Auth: HRS §392-9l) (Imp:
HRS §392-4l)§l2-ll-25 Accepted plans. The director shall give to theemployer or association of employers or association of employees bywhom the application for acceptance was filed, and also to theapplicant, written notice that the plan is accepted as satisfying theobligation of the employer or employers to provide for the payment ofbenefits, or that it is not accepted. From and after the effective
date of notice of acceptance, the provision for benefits and employee
contributions under the plan shall be effective for the employees, orthe class or classes of employees, entitled to benefits under the
DLIR 12-11 Page 11

plan, in lieu of the provisions for benefits under the statute, andfor employee contributions under section 392-43, HRS. [Eff 5/11/81;](Auth: HRS §392-9l) (Imp: HRS §§392-4l, 392-43)§l2-ll-26 Reconsideration of denial of application for plan
acceptance; appeal. (a) When an application for acceptance of a plan
has been denied on the ground that the benefits under the plan do notmeet the requirements of section l2-ll-l6, the applicant, within
fifteen days after notice of denial has been given, may apply in
writing to the director for reconsideration. In support of theemployer's application for reconsideration, and as a part of theapplication, the applicant shall submit a memorandum of the facts on
the basis of which applicant contends that the benefits provided
under the plan are at least as favorable as the disability benefits
under the statute.
(b) The director, or an officer or employee designated by the
director for that purpose, shall reconsider the application and plan,and the director may direct that a hearing be held for the taking ofevidence and for any other consideration as the proofs warrant toconform with the purpose and intent of the statute.
(c) The filing of an application for reconsideration or an
appeal of the decision upon reconsideration shall not relieve theapplicant, or any employer if the applicant is an association of
employers or employees, of its responsibility to provide statutory
benefits as required by the law pending a final decision thereon.
[Eff 5/11/81;] (Auth: HRS §392-9l) (Imp: HRS §392-4l)§l2-ll-27 Minimum coverage standards for an association of
employers. (a) The minimum standards which an insured association of
employers shall meet to qualify its members for obtaining temporary
disability insurance coverage are:(l) The association must be a bona fide organization acharter, constitution, and by-laws or other documentation
identifying its purpose, scope, and function. It musthave a stable roster of members and assured continuity ofoperation.
(2) The association's membership must be in the same or aclosely related industry or have some common interest
binding the membership. It must have been formed for a
purpose other than obtaining coverage under the statute.
(3) The association shall submit a certification in the format
prescribed by the department.
(b) The minimum standards which a self-insured association of
employers shall meet to qualify its members for temporary disability
insurance coverage are:(l) The association shall meet all requirements of section
l2-ll-27(a).
(2) The association shall establish a special temporary
DLIR 12-11 Page 12

disability insurance fund in its treasury from which
payments received from members for coverage shall bedeposited and disbursements paid out.
(3) The association shall have a central office staffed byassociation personnel to administer temporary disability
insurance functions such as: collect and remit premiums;
receive, process, and pay claims; and prepare reports tothe director.
(4) The association shall meet the self-insurance requirementsof section 392-4l, HRS, and this chapter.
(5) The association shall provide the name of its authorized
representatives to the director.
(c) Participation in any association plan does not release an
employer from any obligation under the statute. The association'splan of benefits shall be accepted as the employer's method ofproviding benefits. The association shall act as the employer's
agent only for those functions relating to the providing of benefits.
(d) There shall be no individual underwriting in an association
plan. [Eff 5/11/81] (Auth: HRS §392-9l) (Imp: HRS §§392-3,
392-4l)§§l2-ll-28 to l2-ll-34 (Reserved)

SUBCHAPTER 3
BENEFITS AND CLAIMS PROCEDURES§l2-ll-35 Claim for disability benefits. (a) The employee
claiming for disability benefits or a person acting on the employee's
behalf shall file a claim for disability benefits with the employer
on a form prescribed by the director, or in the case where section
392-66, HRS, is applicable, with the director, within ninety days
after commencement of the period of disability or as soon thereafter
as is reasonably possible. Proof of disability shall be furnished tothe employer, or, in the case where section 392-66, HRS, isapplicable to the director, not later than ninety days after
commencement of the period of disability and thereafter from time totime as the employer or director may require, but not more often thanonce each week. In the event the claimant has a controverted
workers' compensation claim, the ninety-day filing period for
temporary disability insurance is waived if the employee gave noticeto the employer of a workers' compensation claim within ninety days
after the date on which disability commenced. In such event, thedate of notice of the workers' compensation claim shall be accepted
as the filing date under this section.
(b) The claim for disability benefits shall include statements
DLIR 12-11 Page 13

furnished by the claimant and the claimant's attending physician on aform prescribed for the purpose by the director. A carrier,employer, or the director may investigate a claim and for cause
require additional information.
(c) Failure to file a claim for disability benefits within thetime and in the manner above provided shall not invalidate the claim,
but no benefits shall be required to be paid for any period more thanfourteen days prior to the date on which the required claim fordisability benefits is filed. However, if it is shown not to havebeen reasonably possible for the claimant to file the claim within
the time above provided and that the claim was filed as soon
thereafter as reasonably possible, benefits may be payable for thefull period of disability, provided that no benefits shall be paid
unless the required claim is filed within twenty-six weeks after
commencement of the period of disability.
(d) In the case of an employer who has received approval fromthe department of its sick leave plan or a collective bargaining
agreement where either or both require further disability benefit
payments from an insurer upon the exhaustion of sick leave payments,
the employer shall initiate the filing of the claim for disability
benefits with the insurer within ninety days of the last date sickleave payments were made. [Eff 5/11/81; am 11/3/89] (Auth: HRS§392-9l) (Imp: HRS §392-25, 392-26, 392-27, 392-44)§l2-ll-36 Responsibility of employer to provide benefits. (a)An employer shall provide benefits for disabilities that occur during
the period of employment and while the employee is an "individual incurrent employment" as defined in section 392-6, HRS, provided that
if during the two-week period following termination of employment theemployee enters into new employment, the responsibility of the first
employer to provide benefits ceases on the first day of the new
employment if the new employer is subject to the statute.
Thereafter, the new employer shall be responsible for providing
benefits as required by the statute.
(b) An employer of an employee who is eligible shall provide
benefits for that employee for any disability which occurs during theperiod of continued eligibility whether the employment is on afull-time or part-time basis. [Eff 5/11/81] (Auth: HRS §392-9l)(Imp: HRS §§392-6, 392-4l)§l2-ll-37 Part-time employment. If an individual is employed
concurrently by more than one employer and is a part-time employee of
one or more of the employers, in order to be eligible for benefits
from employers for whom the individual is a part-time employee, theemployee must give written notice to all of the individual's
employers of other employment, giving sufficient details as will
enable the employers to ascertain whether the employee is in fact
eligible for benefits. [Eff 5/11/81] (Auth: HRS §392-9l) (Imp:
DLIR 12-11 Page 14

HRS §§392-3, 392-25)§l2-ll-38 Concurrent employment. (a) An employee is inconcurrent employment when the individual is regularly andcustomarily in the employ of more than one covered employer within
the same calendar week and is concurrently eligible for disability
benefits from each of the employments.
(b) Hours of employment with two or more employers,
concurrently, full-time or part-time, and wages earned therefrom,shall be aggregated for purposes of determining eligibility forbenefits. [Eff 5/11/81; comp] (Auth: HRS§392-9l) (Imp: HRS §§392-25, 392-43.5)§l2-ll-39 Two-week period following termination of employment.
The period of two consecutive weeks after termination of employment
shall end on the fourteenth consecutive calendar day following thelast day worked. [Eff 5/11/81] (Auth: HRS §392-9l) (Imp: HRS§392-6)§l2-ll-40 Claim for reimbursement out of workers' compensation
benefits. (a) If an employee who is eligible for benefits under the
statute is disabled and has claimed or subsequently claims benefits
under the workers' compensation law, and if the claim is denied by
the director on the ground that the employee's disability was notcaused by an accident that arose out of and in thecourse of theindividual's employment or by an occupational disease under theworkers' compensation law, the individual's employer or theemployer's disability benefits carrier or the director shallforthwith pay benefits under the statute to the employee for thedisability.
(b) If an employee who is eligible for benefits under the
statute has claimed or subsequently claims benefits for an alleged
disability under the statutes and under the workers' compensation
law, and if the claim is disputed on the ground that the employee was
not in fact disabled, the individual's employer or the employer's
disability benefits carrier or the director shall forthwith file astatement to this effect with the department. Whereupon the claims
under the statute and the workers' compensation law shall be combined
and considered jointly in all subsequent proceedings for the purposeof determining the fact of disability. [Eff 5/11/81] (Auth: HRS§392-9l) (Imp: HRS §392-4l)§l2-11-41 Denial of claim. (a) If an employee's claim forbenefits is denied in whole or in part by the employer or employer's
disability benefits carrier, a copy of the notice of denial, in theform prescribed by the director, shall be sent to the department.
The department shall review the denial within ten days of receipt andrequest the employer or insurer to reconsider the denial if it
DLIR 12-11 Page 15

considers it to be erroneous, without proper legal basis, or without
sufficient evidence. If the employer or insurer still decides todeny disability benefits, the employee and the department shall be so
notified.
(b) If an employee desires a review of any action of the claim
for benefits, the employee shall file with the director two copies of
the notice of denial, the employee's request for appeal, and astatement in duplicate giving specific reasons for the request. The
request for appeal shall be filed within twenty days from the datedenial was mailed to the claimant. The appeal shall be filed at theoffice of the department in the county in which the claimant resides
or in the county in which the claimant was employed prior to thedisability. The director shall forthwith notify the employer or theemployer's disability benefits carrier or the special fund fordisability benefits, as the case may be, of the claimant's request
for appeal, enclosing a copy of the claimant's statement of reasons
therefor. Determination of the appeal shall be made in accordancewith the provisions of Part V of chapter 392, Hawaii Revised
Statutes. [Eff 5/11/81] (Auth: HRS §392-9l) (Imp: HRS §392-44.5)§l2-ll-42 Disqualification for benefits. An individual shallbe disqualified for disability benefits under section 392-66, HRS,
during any period that the individual is disqualified for
unemployment insurance benefits under section 383-30, HRS. [Eff5/11/81] (Auth: HRS §392-9l) (Imp: HRS §§392-28, 392-66)§l2-ll-43 No waiting period required for benefits from specialfund. An individual who is eligible for disability benefits under
section 392-66, HRS, shall be paid the benefits without serving a
waiting period. [Eff 5/11/81] (Auth: HRS §392-9l) (Imp: HRS§392-66)§l2-ll-44 Disposition of accrued benefits upon death. If any
benefits due an employee are unpaid at the time of the employee's
death, the benefits shall be payable to the employee's estate or, atthe option of the carrier, may be paid to the surviving spouse,
parent, child, or children of the deceased employee. Benefits thatare due but are not so paid shall, after the expiration of one year
from the date of employee's death, be paid into the special fund fordisability benefits established pursuant to section 392-6l, HRS.
Upon making the payment into the special fund, the carrier shallimmediately and thereafter be held harmless from all liability to theextent of the payment, and any claim thereafter for the benefits
shall be filed with the director who shall determine the validity
thereof. [Eff 5/11/81] (Auth: HRS §392-9l) (Imp: HRS §392-6l)§l2-ll-45 Authorized physician, surgeon, dentist,
chiropractor, osteopath, naturopath, or equivalent. Pursuant to
DLIR 12-11 Page 16

section 392-26(a) and (b), HRS, an authorized physician, surgeon,
dentist, chiropractor, osteopath, or naturopath includes any person
duly licensed to practice medicine, surgery, dentistry, chiropractic,
osteopathy, or naturopathy in this State; or a duly authorized or
accredited practitioner or any group which depends for healing upon
prayer or other spiritual means. If a claimant is a bona fide
resident of another state, nation, or other recognized unit ofgovernment, or if a claimant is disabled while temporarily in anotherstate, nation, or other recognized unit of government, the medical
statement and necessary reports of the attending physician duly
licensed under its laws to practice medicine, surgery, dentistry,
chiropractic, osteopathy, or naturopathy may be accepted as proof of
disability. [Eff 5/11/81] (Auth: HRS §392-9l) (Imp: HRS §392-26)§l2-ll-46 Average weekly wage. (a) Except as otherwise
provided herein or when shown to be inappropriate or unfeasible, forthe purpose of computing the amount of disability benefits of anon-salaried employee during any period of disability, "average
weekly wage" shall be the amount determined by dividing the total
wages earned by the employee in the employment of the employee's last
employer for the eight weeks or portion thereof that the employee wasin the employment immediately preceding and including the employee's
last day worked prior to commencement of the disability, by the
number of weeks or portion thereof of the employment.
(b) If an employee's remuneration consists of commissions or
piece-work pay, the commissions or piece- work pay earned by theemployee during the fifty-two consecutive weeks immediately preceding
the date of the employee's disability shall be used in determining
the employee's average weekly wage. [Eff 5/11/81] (Auth: HRS§392-9l) (Imp: HRS §§392-3, 392-7)§l2-ll-47 Cash value of remuneration in kind. (a) Board,lodging, or any other payment in kind received by an employee fromthe individual's employer in addition to or in lieu of (rather thanas a deduction from) money wages shall be deemed to be wages paid by
the individual's employer.
(b) The reasonable cash value of such payments in kind, as
established by the department, shall be used in determining the wages
paid to the employee and in computing contributions due from theemployer and the employee.
(c) Where a money value for such payments in kind is agreed
upon in a contract of hire, the amount so agreed upon shall, if morethan the rates specifically determined by the department or the rates
prescribed herein, be deemed the cash value of such payment.
(d) Effective January l, l978 and until amendments to rule 2 ofRegulation I relating to the administration and enforcement of the
Hawaii employment security law are promulgated, board and lodging
DLIR 12-11 Page 17

furnished as payment in kind shall be deemed to have not less than
the following values:
Full board and room, weekly .........$28.00
Meals,
per week .................. l8.90
per day ................... 2.70
per meal ..................
.90
Lodging, per week .................. 9.l0
per day ................... 1.30(e) When amendments to rule 2 of Regulation I relating to theadministration and enforcement of the Hawaii employment security law
are promulgated, subsection (d) shall be deemed to have been amended
to reflect such change. [Eff 5/11/81] (Auth: HRS §392-9l) (Imp:
HRS §392-3)§12-11-48 Change in average weekly wage. In the event a
claimant is disabled at the end of a calendar year and the claimant's
disability continues into the next calendar year, the claimant's
disability payment shall be calculated on the basis of theestablished rate at the time the claimant's disability commenced.
[Eff 5/11/81] (Auth: HRS §393-91) (Imp: HRS §§392-21, 392-22)§12-11-49 Failure to provide coverage. Should an employer
fail to provide coverage after deducting and withholding
contributions from the individual employees, the employer shalldeposit such contributions not to exceed 0.5 per cent of theemployees' weekly wages, as determined pursuant to section 392-43,
HRS, into the special fund when ordered by the director.
Contributions in excess of 0.5 per cent of the employees' weekly
wages shall be refunded to the employees. The employer's compliancewith this section shall not hold the employer immune to therequirements of the statute. [Eff 5/11/81] (Auth: HRS §392-91)(Imp: HRS §§392-4l, 392-43, 392-6l)§12-11-50 Deductions greater than authorized. Pursuant tosection 392-43(f), HRS, contributions of those employees, deducted
and withheld in amounts greater than those authorized, who are nolonger with the employer and cannot be located, shall be deposited at
the end of each calendar year in the special fund for disability
benefits by the employer. The employer shall provide the director
with a list containing the employee's full name, social security
account number, last known address, the amount due, and any otherinformation requested by the director. The director shall endeavor
to locate such employees to return such deductions. If such
employees cannot be located for a period of two years from the dateof deposit, the director shall cause such monies to become a part ofthe special fund. [Eff 5/11/81] (Auth: HRS §392-91) (Imp: HRS
DLIR 12-11 Page 18

§§392-43, 392-61)§§12-11-51 to 12-11-55 (Reserved)

SUBCHAPTER 4REQUIREMENTS FOR INSURED COVERAGE§12-11-56 Posting of notice of coverage. Each employer shallpost and maintain in a conspicuous place or places in and about theemployer's places of business typewritten or printed notices statingthat the employer has obtained insurance to provide for the payment
of disability benefits required by law, in the form as may beprescribed by the director. [Eff 5/11/81] (Auth: HRS §392-91)(Imp: HRS §392-91)§12-11-57 The insurance contract. (a) Every contract of
insurance, including any amendment, endorsement, or rider to acontract of insurance, which provides for employee benefits under the
statute shall be approved by the insurance commissioner.
(b) Nothing in the statute or in this chapter is intended toamend, modify, or change any policy form approval requirements
prescribed in the State insurance law. [Eff 5/11/81] (Auth: HRS§392-91) (Imp: HRS §392-48)§12-11-58 Cancellation of an insurance contract. (a) No
insurer shall cancel a contract of insurance providing in whole or inpart for disability benefits required by the statute prior to the
expiration date of the contract unless notice of intention to cancel
on a specified date has been filed with and served on the employer
and the director at least ten days prior to the specified
cancellation date.
(b) The ten-day advance notice requirement in subsection (a)need not be complied with when a new insurer is substituted. In theevent of the substitution, the previous insurer shall immediately
file with and serve on the employer and the director notice that thecontract was cancelled as of a specified date because the obligation
to pay benefits for disabilities incurred after the date was assumed
by a new insurer which shall be specifically identified if its
identity is known by the previous insurer.
(c) The insurer need not file an additional notice of thetermination date prescribed in a contract of insurance, unless thedate was not shown in the notice of insurance filed with the director
pursuant to section 392-42, HRS.
(d) If a plan provides by its terms for an expiration date,acceptance of the plan by the director is notice thereof. Additional
DLIR 12-11 Page 19

notice by the insurer of cancellation of the insurance contract as ofthe expiration date of the plan is not necessary. [Eff 5/11/81](Auth: HRS §392-91) (Imp: HRS §§392-42, 392-50)§12-11-59 Employee contributions toward the cost of coverage
under insurance contracts. (a) If an employer provides fordisability benefits under the statute by a contract of insurance, thepremium charged therefor shall represent the cost of providing thebenefits. The employees' contributions shall not exceed one-half ofthe cost but not more than 0.5 per cent of the employees' weekly wage
as determined pursuant to section 392-43, HRS.
(b) If, after the end of a policy year, the employer receives
an experience rating credit or a dividend back from the insurer, theemployees' share of the experience rating credit or dividend shall be
refunded or credited to the employees by the employer. "Employees'
share" means one-half of the excess remaining, if any, after theemployer has deducted (1) any expenses of the employer directly
allocable to the cost of administering the insurance contract, and(2) the amount, if any, by which the employer's contribution to thepremium charged during the prior policy years exceeded the employees'
contributions. At the employer's option, the employer may refund incash each employee's proportionate share of the employees' share, or
may credit the total employees' share of the experience rating credit
or dividend from the prior policy year against the total amountcontributable by the employees during the current policy year.
(c) The applicable provisions of a collectively bargained
agreement shall prevail in the event of a conflict between those
provisions and this chapter. [Eff 5/11/81] (Auth: HRS §392-91)(Imp: HRS §§392-43, 392-6l)§12-11-60 Refusal to insure. If an insurance company refuses
to cover any employer-applicant, the insurance company shall notify
the employer-applicant in writing of the name and address of the pool
manager of the Hawaii temporary disability insurance risk spreadingplan. A copy of the letter shall be kept in a separate file at theinsurance company for the department's reference. [Eff 5/11/81](Auth: HRS §392-91) (Imp: HRS §392-41)§§12-11-61 to 12-11-65 (Reserved)

SUBCHAPTER 5REQUIREMENTS FOR SELF-INSURED COVERAGE§12-11-66 Posting of notice of coverage. Each employer who has
been granted self-insured status pursuant to the statute and thisDLIR 12-11 Page 20

chapter shall post and maintain in a conspicuous place or places inand about the employer's places of business typewritten or printed
notices stating that the employer is providing directly for thepayment of disability benefits required by law, in the form
prescribed by the director. [Eff 5/11/81] (Auth: HRS §392-91)(Imp: HRS §392-91)§12-11-67 Application. (a) Every employer and every
association of employers, or trustee or trustees paying benefits
under a plan or agreement authorized under section 392-41, HRS,
desiring to provide for the payment of benefits through approved
self-insurance, shall apply to the director to become a self-insurer.
The application shall be in the form prescribed by the director.
(b) If the applicant is an association of employers or of
employees, or a trustee or trustees, each employer of employees forwhom benefits under a plan pursuant to section 392-41, HRS, are to beprovided by the applicant shall apply, on a form prescribed by the
director, for acceptance of the plan of the association of employers
or employees, trustee or trustees, as the plan of the employer.
(c) If the director is satisfied as to the financial andadministrative ability of the applicant to make payment of thebenefits provided and that the applicant's tangible assets makereasonably certain the payment of all obligations that may arise
under the law, the application may be granted on the conditions
herein provided and such other conditions as, in the discretion of
the director, may be necessary or desirable in any case. [Eff5/11/81] (Auth: HRS §392-91) (Imp: HRS §392-4l)§12-11-68 Agreement. Each applicant for self-insurance shall
execute and file with the director an agreement, on a form prescribedby the director,:(1) To pay benefits to employees eligible under the law:(A) As provided in the statute, if there is no plan
applicable to the employees;(B) As provided by a plan qualifying under section
392-41, HRS, for employees covered by the plan.
(2) To pay all obligations, including benefits, fines,
expenses, and assessments imposed pursuant to the statute.
(3) To permit the director's authorized representative accessto the premises of applicant and of each employer, for the
purpose of examining operations and records pertaining tofinancial conditions and all obligations under the
statutes(4) To authorize the director in the event of neglect orrefusal of the self-insurer to pay any obligation,
including benefits, fines, expenses and assessments, tosell without notice all or any part of the deposited
securities or require the surety to pay forthwith to the
DLIR 12-11 Page 21

(5)director the penal sum of the bond.
Beginning January 1, 1992, to maintain a complete claims
service office or engage an independent claims adjusting
service as a claims agent in the State of Hawaii withdraft authority for the processing of temporary disability
insurance payments. [Eff 5/11/81; am 1/13/92] (Auth: HRS§392-91) (Imp: HRS §§392-41, 392-42.5)§12-11-69 Requirements for self-insurance. An applicant for
self-insurance shall:(1) Deposit with the State director of finance, and keep on
deposit, securities which are obligations of the UnitedStates, or any other state, Hawaii or any of its counties,
provided that the securities were issued pursuant to law
and the faith and credit of the issuing governmental
agency is pledged for their payment, in an amountacceptable to the director, but in no event less than
$2,000. Securities deposited shall be registered in thename of "Director of Labor and Industrial Relations, Stateof Hawaii". Interest paid on securities deposited withthe director of finance will be remitted to the applicant
for whose account they are deposited, as long as theapplicant complies with the law and with this chapter; or,(2) In lieu of securities and at the discretion of thedirector, file with the director of finance the bond of asurety company authorized to do business in this State, ina manner and penal sum acceptable to the director. Eachsurety bond shall be undertaken and may be enforced in thename of "Director of Labor and Industrial Relations, Stateof Hawaii", or(3) Upon furnishing satisfactory proof to the director of theemployer's solvency and financial ability to pay the
temporary disability benefits herein provided, noinsurance or security or surety bond shall be required,
and the employer shall make payments directly to theindividual employees, as they become entitled to receive
the same under the terms and conditions of the statute.
[Eff 5/11/81] (Auth: HRS §392-91) (Imp: HRS §392-41)§12-11-70 Amount of securities or bond. The amount of
securities or of the penal sum of the surety bond which a
self-insurer is required to deposit pursuant to section 12-11-69
shall be determined by the director. The number of employees
involved, the exposure, the financial standing of the applicant, andother factors which the director may deem proper shall be given
effect in fixing the amount. In the director's discretion, a depositin excess of the minimum under section 12-11-69 may be required.
[Eff 5/11/81] (Auth: HRS §392-91) (Imp: HRS §392-41)
DLIR 12-11 Page 22§12-11-71 Proof of ability to process claims. Each applicant
shall submit proof satisfactory to the director that adequate
provision has been made by the applicant, and by each employer, tocomply with the obligation to pay benefits, and from time to time,upon request, shall satisfy the director that the provision is kept
effective. [Eff 5/11/81] (Auth: HRS §392-91) (Imp: HRS §392-41)§12-11-72 Termination of self-insurer's status and withdrawal
of security deposit. (a) A self-insurer who has terminatedself-insured status, or as to whom approval for self-insurance has
been revoked, may apply to the director for return of the security
deposit or cancellation of the surety bond.
(b) After the lapse of twenty-four months from termination ofself-insurer status and proof satisfactory to the director that all
claims have been finally adjudicated and paid, that all fines,
penalties, expenses, and assessments have been paid, and satisfactory
disposition made of the balance of employee contributions, andotherwise complying with the applicable provisions of law, thischapter, and provisions of the self-insurer's agreement, the director
may release the securities deposited or permit cancellation of thesurety bond. [Eff 5/11/81] (Auth: HRS §392-91) (Imp: HRS §392-41)§12-11-73 Self-insurance deposit credit. If an employer has
deposited securities under the workers' compensation law, thedirector in his discretion may reduce the amount of deposit required
under the statute provided the employer has, by agreement
satisfactory to the director, made available all deposited securities
for all obligations of the employer under both laws. [Eff 5/11/81](Auth: HRS §392-91) (Imp: HRS §392-41)§12-11-74 Obligations. The obligations of a self-insurer shall
include all obligations and those of each and every employer withrespect to those employees for whom the self-insurer provides
benefits under the statute. [Eff 5/11/81] (Auth: HRS §392-91) (Imp:
HRS §392-41)§12-11-75 Revocation of self-insurance status. The director
may revoke the approval to self-insure at any time for good cause.
Failure to comply with this chapter, or with any award, order, or
directive of the director, either by the self-insurer or an employer
or employers for whose employees benefits are provided by the
self-insurer, is cause for revocation. [Eff 5/11/81] (Auth: HRS§392-91) (Imp: HRS §392-91)§12-11-76 Employee contributions towards the cost of coverage
by a self-insurer. (a) If an employer provides for disability
benefits under the statute through self-insurance, the cost of thebenefits shall include any expenses of the employer directly
DLIR 12-11 Page 23

allocable to the cost of administering and providing the benefits.
The employees' contributions shall not exceed one-half the cost but
not more than 0.5 per cent of the employees' weekly wage as
determined pursuant to section 392-43, HRS.
(b) If, at the end of a calendar year, the self-insurer
determines that an amount in excess of one-half the cost has been
contributed by employees, the excess shall be refunded or credited tothe employees by the self-insurer. At its option, the self-insurer
may refund in cash to each employee the proportionate share of theexcess or may credit the excess from the prior year to the total
amount contributable by employees during the current year.
(c) The applicable provisions of a collectively bargained
agreement shall prevail in the event of a conflict between those
provisions and this section.
(d) Employees' contributions shall be kept in a separate fundmaintained by the employer. [Eff 5/11/81] (Auth: HRS §392-91) (Imp:
HRS §§392-43, 392-61)§12-11-77 Limitation of fund. The separate fund provided bysection 12-11-76 shall not exceed five per cent of the employer's
highest monthly payroll in the last twelve completed calendar months.
No further deductions shall be made from employees until the fund
falls below the five per½cent indicated above. The additional
withholdings plus the fund balance shall not exceed five per cent of
the employer's highest payroll in the last twelve completed calendar
months. The director may, based on the actuarial experience of an
employer or group of employers, reduce the limitation prescribed bythis section. [Eff 5/11/81] (Auth: HRS §392-91) (Imp: HRS §392-67)§§12-11-78 to 12-11-84 (Reserved)

SUBCHAPTER 6
REPORTS§12-11-85 Periodic reports. (a) On March 1 of each year, theemployer's insurance carrier, self-insured employers, employers withcollective bargaining agreements, or an association of employers
shall file an annual report covering the most recently completed
calendar year in a form prescribed by the director for each employer
and for each plan, furnishing the following information:(1) Number of covered employees for each month of the year
(number of individuals employed during the pay period
including the 12th day of the month).
(2) Amount of total wages paid in the year.
(3) Amount of taxable wages paid in the year.
(4) Amount of employer contributions paid in the year, if
DLIR 12-11 Page 24

applicable.
Amount of employee contributions paid in the year, if
applicable.
(6) Amount of benefits paid in the year.
(7) Number of different persons paid disability benefits
during the year.
(8) Number of weeks for which benefits were paid.
(9) Number of separate periods of disability for which
benefits were paid.
(10) Number of claims denied.
(11) Amount of subrogated payments received.
(b) On March 1 of each year, the employer's insurance carrier,self-insured employers, employers with collective bargaining
agreements, or an association of employers shall file an annual
report for each employer and for each plan the information listed insubsection (a) and, in addition, furnish by sex, information listed
in items (1) and (6) through (10) of subsection (a) covering the mostrecently completed calendar year in a form prescribed by the
director. [Eff 5/11/81](Auth: HRS §392-91) (Imp: HRS §392-91)(5)§12-11-86 Other employer reports. Every employer for whom
services are performed in employment shall file a report on a form
prescribed by the director to determine liability for coverage withinten days after being mailed by the department. This report shallprovide information such as: Under an insured plan, the insurance
carrier name, number of employees covered, effective date ofcoverage, and the amount, if there is any employee contributions
toward premium payments; under a self-insured plan, furnishing copiesof the plan and financial statement, effective date of plan, number
and classes of employees covered, and the amount, if there is any
employee contributions toward premium payments; under a sick leaveplan covered under an employer-employee collective bargaining
agreement, the name of union, copy of agreement, effective andexpiration date of agreement, and number and classes of employees
covered. [Eff 5/11/8l] (Auth: HRS §392-91) (Imp: HRS §392-91)

DLIR 12-11 Page 25