Family Leave Insurance
CUSTOMER SERVICE: 609-292-7060
Due to the high volume of calls, we've temporarily
extended our Customer Service hours.
Agents are now available from: 8:00am - 5:30pm Monday – Friday (except holidays)
8:00am - 1:00pm Saturday
ATTENTION: Due to a scheduled maintenance, the online application will not be available
Tuesday, January 24, 2017 from 9:00am to 11:00am.
File A Claim
Health Care Provider
File online because
- you'll get your benefits faster!
- you’ll get immediate confirmation that we received your claim.
- it’s safe and secure.
- you’ll be able to see the information your employer and your family member's health care provider submit (Under the Web Services tab, choose Print Forms.)
- You can start an online application up to 14 days in advance of your first day of leave, then complete and submit the claim online after your first day of leave.
Before you file
Please have handy:
- dates you worked for any employers in the last 52 weeks, and the employers’ addresses. If you are applying online, you will need to know the dates of any paid time off received after the first day of leave.
- dates of any intermittent weeks (for a bonding claim) or intermittent days (for a care claim) for which you have taken leave.
- the name, address and date of birth of the child you are bonding with or the family member for which you are caring.
- date you want your benefits to end.
If you file online and do not complete the application on your first attempt, you can return to complete the form. Your information will be saved up to the last full page you completed. In certain situations the application program may prompt you to print out a form, so you may need access to a printer.
If you submit your claim online, do not also mail or fax a paper application.
If you submit duplicate forms, payment of your benefits will be delayed.
Family Leave claims require information from you, your employer, and your family member's health care provider, if this is a care claim. All parts can be completed online. After you complete your part of the application, it is your responsibility to make sure
1)any employer(s) you worked for in the last 6 months submit an employer statement
2)Your family member's health care provider submits the medical certification.
When you have completed your part, bring your employer and your family member's health care provider (for a care claim only) the instructions for them to complete their portion online with their unique "Online Form ID". They will complete their parts by going to www.nj.gov/labor, choosing Family Leave from the left navigation bar, then choosing Health Care Provider or Employer from the tabs in the window.
File a New Mother/Bonding Claim (FL2)
If you are receiving State Plan Temporary Disability benefits for a pregnancy-related disability, instructions for claiming Family Leave Insurance benefits for bonding with your newborn child will automatically be sent to you 35 days after your date of delivery. Once you have recovered from the delivery, use the "FLI Claim ID No." in Item 8 of the FL2 notice to file your Family Leave Insurance New Mother/Bonding Claim using this link.
Complete the Medical Certificate (M01) online If you submit your information online, do not send the form by mail. Doing so will delay the processing of the claim.
Submit your patient's medical information securely. Your patient's caregiver will provide you with the unique identification number associated with their claim.
Guide to Family Leave Insurance for Medical Providers (PR-118W)
Complete the Employer Statement (E01-FLI) online If you submit your information online, do not send the form by mail. Doing so will delay the processing of the claim.
Need to change your name or address? Now you can do it online here.
Under the Family Leave Insurance provision of the New Jersey Temporary Disability Benefits Law, cash benefits may be payable for up to six (6) weeks to bond with a newborn or newly adopted child or to provide care for a seriously ill family member.
Information on the following topics can be found by clicking on the links below:
Bonding with a Newborn or Newly Adopted Child - This page provides information on bonding claims.
Care of a Seriously Ill Family Member - This page provides information on claims for care of a family member.
Most workers who take family leave within 14 days of their last day of work in covered New Jersey employment are covered for family leave insurance under the State Plan or an approved Private Plan. If you are not sure of your coverage you should ask your employer.
If your family leave begins more than 14 days after your last day of work in covered New Jersey employment, your claim will be fowarded to our Family Leave During Unemployment section.
For additional information on any of the program areas, click on the link below.
File a New Mother/Bonding Claim (FL2) If you are receiving State Plan Temporary Disability benefits for a pregnancy-related disability, instructions for claiming Family Leave Insurance benefits for bonding with your newborn child will automatically be sent to you 35 days after your date of delivery. Once you have recovered from the delivery, use the "FLI Claim ID No." in Item 8 of the FL2 notice to file your Family Leave Insurance New Mother/Bonding Claim using this link.
- Web Inquiry If you have filed a claim for Family Leave Insurance you will be able to view and print basic claim information for any claim you filed in the past 1,000 days.
- Complete a Claim If you began your application online prior to your first day of family leave, use this application to complete and submit the claim on or after your first day of family leave.
- Print Forms Reprint any forms required at the initial online filing of your family leave claim. View or print any health care provider or employer statement submitted through the online application.
Note: The Family Leave Insurance Continued Claim Certification (FL3) is not currently available online.
Address Change - Change your name and/or address on your most recent Family Leave claim through this application. If you are doing a name change, remember to also edit your Department of Labor and Workforce Development Logon ID with your changes through LWD Profile.
These applications are best viewed using Internet Explorer and do not support viewing in the Opera Web Browser.
If you encounter problems using any of these options, please contact our Customer Service Section at (609) 292-7060.
Health Care Providers - Select Health Care Provider tab to submit your information online.
Employers - Select Employer tab to submit your information online.
Debit Card Information
FAQs (Frequently Asked Questions)
Other Government Assistance
FLI Law and Regulations
Family Leave Brochures
Repayment of Overpaid Benefits
To obtain information on how to contact the offices within the Division of Temporary Disability Insurance - Family Leave Units, click on the link provided.