on each question to show the answer.
What is Temporary Disability Insurance (TDI)?
- TDI provides income support to individuals who are out of work because of a non-work related illness or injury. Rhode Island was the first state to establish a TDI program. It did so in 1942. In addition to Rhode Island, only California, Hawaii, New Jersey, New York and the Commonwealth of Puerto Rico have TDI programs.
- 2. What Are The Medical Eligibility Requirements For TDI?
- To be medically eligible for TDI benefits, a Qualified Healthcare Provider (QHP) or medical practitioner must certify the patient functionally unable to perform their customary and regular work duties and provide the length of time the patient is expected to be unable to work.
For eligibility to begin the first day he/she is disabled the patient must have an in-office examination by a licensed Qualified Healthcare Provider (QHP) that week, the week before or the week after, the disability began. A contact with the QHP via a telephone call is not acceptable by TDI law as a timely examination by a licensed QHP.
Additionally, the patient may be asked to make an appointment with an impartial medical examiner if we believe an exam is necessary. Benefits will be stopped if the claimant does not make or keep the appointment with the impartial medical examiner.
- 3. What Is A Qualified Healthcare Provider?
- As a result
of legislation enacted on July 7, 2004, Midwives, Nurse Practitioners,
Physician Assistants, Physicians, Psychologists and Psychiatric Clinical Nurse Specialists
are Qualified Healthcare Providers. Midwives, Nurse Practitioners, Physician
Assistants, Physicians and Psychiatric Clinical Nurse Specialists can
certify as to the inability of individuals to perform their regular or
customary work, due to sickness. On October 18, 2007 Rule number 3 of
the TDI program was amended to include Licensed Clinical Social Workers-(lcsw)
and Licensed Independent Clinical Social Workers-(licsw).
What Are My Responsibilities As A Qualified Healthcare Provider?
- Qualified Healthcare Providers are requested to provide medical certifications to determine if individuals are unable to work due to a non-work related illness or injury. If the individual is unable to work, the QHP certifies the number of weeks the individual is unable to work.
If My Patient Is Receiving TDI Can I Bill TDI For Medical Expenses For The Illness/Injury?
- TDI provides income support to individuals who are out of work because of a non-work related illness or injury. TDI does not pay for medical expenses for the illness or injury.
Can I Obtain Information On My Patient's TDI Claim?
- All information regarding a TDI claim is confidential.
Can My Patient Receive Both TDI and Workers' Compensation?
- An individual cannot receive TDI for any period that he or she receives Workers' Compensation (WC). If someone is injured on the job a claim for Workers' Compensation benefits must be filed. If this claim is contested a TDI claim can be filed. If the individual then receives Workers' Compensation benefits for any weeks that TDI benefits have been paid, the employer or the Workers' Compensation Insurance carrier must reimburse TDI for any weeks that TDI benefits have been paid.
Can My Patient Receive Both TDI and Unemployment Insurance?
- An individual cannot receive TDI and Unemployment Insurance (UI) benefits for the same weeks. To be eligible for TDI a qualified healthcare provider must certify that you are unable to work. To be eligible for UI an individual must be able and available for work and must be actively seeking work.
Does TDI Have Any Procedures for Preventing Fraud and the Misuse of Benefits?
- TDI is very proactive with respect to fraud and the misuse of benefits. By law, TDI can require individuals to be examined by an impartial qualified healthcare provider in order to determine continued disability and eligibility for benefits. The Medical Review Unit refers claims to the TDI Medical Consultant for further review and recommendation as needed. Medical duration guidelines (MDG) are used by the Medical Review Unit to determine disability durations. TDI has an internal program to determine if someone has received TDI benefits during a period when he or she was working. TDI is in constant contact with the Workers' Compensation Court and insurance carriers and with the Unemployment Insurance Division to determine if someone is receiving TDI benefits that he or she is not entitled to.
What Happens When A Disability Duration Exceeds The MDG?
- When a disability duration exceeds the medical duration guidelines (MDG) the claim is referred to the Claims Management Unit for further review. A Registered Nurse in the Unit will make an additional review of the claim and if necessary, will contact the Qualified Healthcare Provider and/or the TDI customer for additional information.
What If I Suspect That My Patient Is Receiving TDI and Shouldn't Be?
- If you suspect that one of your patients is receiving TDI benefits and should not be, you may contact the UI/TDI Fraud Unit at (401) 462-8419. Your call may be anonymous.
Is It Possible To Become An Impartial Qualified Healthcare Provider for TDI?
- TDI has a
database of impartial qualified healthcare providers for all medical specialties,
serving the entire state. TDI is constantly seeking to increase the number
of impartial qualified healthcare providers in order to better service
its customers. If you are interested in becoming an impartial examiner
you may contact TDI at (401) 462 - 8381 or e-mail TDI at email@example.com If you prefer, you may write to TDI at Temporary Disability Insurance,
P.O. Box 20100, Cranston, Rhode Island 02920-0941.
I have a patient who is requesting time out of work to take care of a sick relative and also wishes to apply for TDI; can I certify a person for TDI who is out of work on family medical leave?
- No. RI TDI only pays benefits to workers who are ill or injured and does not extend benefits to persons taking care of a sick relative while on family medical leave (FMLA). Anyone who receives Temporary Disability Insurance must be certified by a licensed Qualified Healthcare Practitioner that they are disabled and unable to work. The medical community and Qualified Healthcare Practitioners are integral partners with TDI in maintaining the integrity of the program.