Family Leave Insurance
File A Claim
Health Care Provider
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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 Claim for Family Leave Insurance benefits online (WFL1) If you are filing for a New Mother/Bonding claim, use the link below.
You will need a printer or the ability to save forms to your personal computer to use this application. There are forms that must be given to your employer and your care recipient's health care provider (care claim only) to complete.
If you submit your claim through the online application, do not also submit an application by mail. Doing so will delay the processing of your claim.
Advantages of Filing Online
- Reduces overall claim processing time
- Immediate confirmation that application has been received
- Safe and secure
- If your health care provider or employer submit their part of the application online you will be able to view the information they submitted through "Print Forms" on the Web Services tab.
- Able to add out of state employment information, avoiding additional forms to complete.
If you file online you may start an application up to 14 days in advance. Complete and submit the claim online after your first day of family leave.
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.
- 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.
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.
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.
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)