Q. What is the base-year period used to establish a disability claim?A. The regular base-year of a Disability During Unemployment claim consists of the first four of the last five completed quarters preceding the date of the claim. Alternative base-year periods consist of the four most recently completed calendar quarters preceding the date of the claim and the three most recently completed calendar quarters preceding the date of the claim and the weeks in the filing quarter up to the date of claim. In State Plan disability, the base year consists of the 52 calendar weeks immediately preceding the week in which the claimant is disabled. When a claimant files a claim, the weeks and wages in the appropriate base-year period are counted to determine the validity of the claim.
Q. When does the waiting week become payable?A. The waiting week on a State Plan claim becomes compensable when disability benefits have been paid for all or some part of each of the three weeks immediately following the waiting week. The Disability During Unemployment program is similar to the Unemployment Insurance program in that a waiting week is not required before benefits are issued.
Q. Can a claimant receive disability benefits while involved in a labor dispute?A. If the claimant’s period of disability commences on or after the start of a labor dispute and the claimant is a participant, no disability benefits can be paid for the duration of the labor dispute. If the claimant is still disabled after the labor dispute is over, benefits can be paid following the end of the labor dispute.
However, if an individual becomes disabled prior to a labor dispute, benefits may be paid during the labor dispute period.
Q. Do I have to rehire the claimant once the disability is over?A. There is no provision in the Temporary Disability Benefits Law that requires an employer to rehire a claimant once the disability is over. However, employment rights provided by state or federal Civil Rights legislation still apply.
A. The claimant has 30 days from the first day of disability in which to file a claim. It is the claimant’s responsibility to obtain and file the DS-1. If the claim is received more than 30 days after the first day of disability, the individual must show good cause why the claim was not filed timely. If not, benefits may be reduced or denied.
Q. Is there a time limit for filing a DS-1
, “Claim for Disability Benefits”?
Q. Can a disability insurance claim form be filed before the last day of work?A. A disability claim should not be filed until the period of disability begins. Even though there may be a scheduled date for surgery, a claim must not be submitted until the individual has actually stopped working.
Q. Can part-time employees collect disability benefits?A. Yes, wages earned by individuals employed on a part-time basis can be used to establish eligibility. Of course, to qualify for benefits, the individual would have to be unable to perform the duties of the part-time employment and be under the care of a licensed physician.
Q. What can I do if I know that a claimant is working while receiving disability benefits?A. An employer who knows or has reason to suspect that a claimant is working and collecting disability benefits should notify the Division of Temporary Disability Insurance as soon as possible. You can report suspected fraud by calling our fraud hotline (609-984-4540) or submitting information online. If possible, supply the name and/or address of the business suspected of employing the claimant.
Q. Are disability benefits taxable? A. Disability benefits are taxable under federal income tax and FICA (Social Security). The portion of the benefit payment that is taxable is that portion attributable to the employer’s disability contribution rate. The employer is also liable for the employer’s share of FICA. Disability benefits are not taxable under the New Jersey state income tax.
Q. How do I know how much FICA tax has been deducted from the claimant’s disability benefits? Also, if the claimant has paid his maximum FICA tax, should I advise the Disability Office?A. The employer is notified of the FICA deduction on the DS-7C charge notice, which is mailed each time a check is sent to the claimant. If you are aware that the claimant has paid his maximum yearly FICA tax, you should notify the Division of Temporary Disability Insurance, and FICA deductions will cease.
Q. Are alcoholism and alcoholism-related disabilities payable under the New Jersey Temporary Disability Insurance Program?A. Yes, a claimant disabled due to alcoholism or an alcoholism-related condition can be paid disability benefits as long as he/she is under the care of a licensed physician and meets all other eligibility requirements.
Q. Can an employee who has a drug problem collect disability benefits?A. Yes, as long as they are no longer using illegal drugs and they are being treated for their substance abuse. As soon as they undergo treatment for substance abuse in a program with a licensed physician, they are immediately eligible for disability if certified by their doctor and meet all other eligibility requirements.
Q. Why is the last employer the only chargeable employer on a disability claim?A. The type of coverage of the individual’s most recent employer determines whether the individual receives benefits under the state or private plan. If that employer is covered by a private plan, the plan assumes full responsibility for paying benefits. Conversely, if the last employer is covered under the State Plan, State Plan Operations in the Division of Temporary Disability Insurance assumes the responsibility.
Under the Unemployment Compensation Law, all covered employers in the base year share the benefit charge associated with a UI claim on a proportional basis. This is not possible under the Disability Insurance Program since there is both private and state plan coverage. If a claim was filed and there were private and State Plan employers in the base year, there would be no way to charge the private plan employer since, in effect, they pay no contributions to the Temporary Disability Fund. However, there are no benefit charges to the employer for claims paid under the Disability During Unemployment Program.
Q. Must an employer with a private plan complete information request forms on State Plan disability claims?A. Yes. Many individuals have more than one employer and the law requires that wages from all base-year employers be used to calculate the benefit amount, even if they are not the individual’s last employer.
Q. If the employer advances the claimant’s full salary during the period of disability, can the employer receive the claimant’s disability check?A. If the intent of the employer is to pay the difference between full salary and disability benefits, an agreement can be made with the employee to have the check mailed to the employer. The claimant must submit a properly signed authorization to the Division of Temporary Disability Insurance so that the check will be sent to the employer. However, the benefit check will be prepared in the name of the claimant.
The employer should make sure that the proper block on the back of the DS-1 claim form is checked to identify the continued pay as the difference between the claimant’s regular weekly wage and the disability weekly benefit rate.
Q. How do I report any money that might be paid to the claimant after a claim has been filed?A. If you pay the claimant money during a period of disability, the amount of benefits paid may be affected. In such cases, you should notify the Division of Temporary Disability Insurance in writing as soon as possible. The information should include the claimant’s name, Social Security number, type of payment, the amount paid, and the period to which the payments apply.
Q. How do I request an independent medical examination?A. You may request an independent medical examination by contacting the Division of Temporary Disability Insurance after a disability claim has been filed. Submit an online form or call (609) 633-8718. Request the exam as soon as you suspect a problem with the claim. All correspondence must include the claimant’s Social Security number. There is no cost to the claimant or employer for the exam.
Q. May a worker who was injured on the job collect disability benefits?A. Work-connected injuries or illnesses are not compensable under the Temporary Disability Benefits Law. However, if an individual claims Workers’ Compensation benefits and the claim is contested by the Workers’ Compensation carrier, the law allows temporary disability to be paid pending resolution of the Workers’ Compensation claim. A lien is filed and the Division of Temporary Disability Insurance will have subrogation rights against any subsequent Workers’ Compensation award.
Q. Can a corporate officer/owner collect disability benefits?A. While a corporate officer/owner of an active corporation may not receive unemployment benefits during an off-season, such individuals who become disabled may be eligible to receive temporary disability benefits under the State Plan.
Q. How can I reduce unemployment and disability insurance costs?A. Avoid fines by submitting all reports accurately and on time. Provide information about separations when they are for reasons other than lack of work. Avoid unnecessary charges by reviewing determinations, appeal decisions and charge notices for accuracy. Make timely appeals from determinations, appeal decisions and charge notices that you believe are wrong. Attend appeal hearings. Report claimants who refuse work. Report fraud. Lower your experience rating by making voluntary contributions. Use the exception address file to have forms sent to the proper company location.
Q. Can an individual who is unemployed collect disability benefits?A. That individual may file for benefits under the Disability During Unemployment (DDU) program. If the individual is currently receiving Unemployment Insurance (UI) benefits, his/her claim will be transferred to the DDU Section for an eligibility review. Whether or not the individual is currently receiving UI benefits, he/she should file a disability claim (Form DS-1). An eligibility review will determine if the individual has sufficient earnings and meets the requirements to qualify for the program. No charges accrue to employers for claims paid under the DDU program.
Q. How is a private plan set up?A. All private plans must be approved by the Division of Temporary Disability Insurance. Request application forms and full information from the Private Plan Compliance Section, Plan Approval Unit, PO Box 957, Trenton, NJ 08625-0957.
Q. Must all private plans be written by an insurance company?A. No. An employer may self-insure a private plan. A private plan also may be established through a labor-management agreement.
Q. Can benefits provided to a claimant under an approved private plan be less than benefits provided by the State Plan?A. No. An approved private plan must offer disability benefits at least equal to benefits provided by the State Plan; a private plan with more generous benefits is allowed. Also, eligibility conditions imposed by the private plan cannot be more restrictive than those established under the State Plan.
Q. Can an employer insure some employees through a private plan and others through the State Plan?A. Yes, as long as the selection will not result in a substantial risk adverse to the State Plan. For an example of combined coverage, production workers may be insured through a private plan and all other workers by the State Plan. As another example, some employers insure individuals with less than six months’ or a year’s employment through the State Plan and all others under a private plan.
Q. Can a claimant who remains disabled after his/her approved private plan benefits are exhausted then begin to receive State Plan benefits?A. Coverage under an approved private plan replaces State Plan coverage. Therefore, a claimant who is not covered by the State Plan cannot be paid State Plan benefits, even if he/she continues to be disabled. The claimant should contact the local Social Security office (listed in the blue pages of the telephone directory or online here) to inquire about Social Security disability benefits.
Q. If a private plan insurance carrier denies a claim, does the Division of Temporary Disability Insurance have to be notified?A. Copies of all denials of private plan claims must be forwarded to the Private Plan Compliance Section, Claims Review Unit, PO Box 957, Trenton, NJ 08625-0957. Denials must advise claimants of their appeal rights under the law.
Q. Can an employer with a private plan switch to the State Plan?A. Yes. Employers who want to terminate private plan coverage must give 30 days’ notice in writing to the Private Plan Compliance Section, Plan Approval Unit, PO Box 957, Trenton, New Jersey 08625-0957. Benefits must be paid by the private plan throughout any disability that starts before the approved termination date, even though the disability may extend beyond the termination date of the private plan.