Frequently Asked Questions - New Jersey Temporary Disability Insurance
How do I file a claim?
Is there a time limit for filing a disability claim?
I know the date of my surgery, can I file a disability claim before I stop working?
How often do I need to see my medical practitioner in order to receive disability benefits?
What will I receive in temporary disability benefits per week? How is my maximum benefit amount calculated?
When do my benefits begin?
I returned to work (or) recovered from my disability. What should I do?
I lost or did not receive a form. How do I get another one?
My address changed, or the address you have on record is incorrect. How do I get it corrected?
Can I have more than one (1) disability claim during a year?
How long does it take to get a decision after a claim is filed?
I was collecting unemployment benefits and then became disabled. Can I file a claim for temporary disability benefits?
Can I collect temporary disability benefits if I was injured on the job?
Can I collect disability benefits while involved in a strike?
Can I collect disability benefits for alcoholism and alcohol-related disabilities?
Can I collect disability benefits for a disability related to substance abuse?
I exhausted my disability benefits under my employer's approved Private Plan, but I am still disabled. Can I now collect State Plan benefits?
I received a notice to report to a doctor for an impartial medical examination. Am I required to go even though I have my own doctor?
I disagree with the decision made on my State Plan claim. Can I file an appeal?
I am covered by my employer's Private Plan, and I disagree with the decision made on my Private Plan claim. Can I file an appeal?
How much does it cost me each year for New Jersey's temporary disability insurance coverage?
Are disability benefits taxable?
What can I do if I know someone is working while collecting disability benefits?
Can I collect disability benefits due to pregnancy?
When should I file a disability claim due to pregnancy?
How long can I collect benefits for my pregnancy?
If I work until my delivery, can I collect benefits for a longer period of time after the birth?
If I deliver my baby early, will I receive the same amount of benefits as a woman who delivers on her due date?
Is my employer required to hold my job for me if I stop working due to pregnancy?
Can I collect disability benefits if my doctor determines that my job environment is potentially harmful to my baby?
To protect my benefit rights, should I ask my employer for a leave of absence rather than quit outright?
Can I collect disability benefits if my baby is sick?
What is a base year?
How do I, as an employer, report money that is paid to the claimant after a disability claim has been filed?
Why am I the chargeable employer on my employee's disability claim?
Can I refuse to provide wage information? Are there penalties for not complying with a wage request?
Can an employer request an independent medical examination?
How is a Private Plan established?
Must all Private Plans be written by an insurance company?
Can employees be required to contribute to the cost of a Private Plan?
Can an employer insure some employees through a Private Plan, and others through the State Plan?
Does the Division of Temporary Disability Insurance have to be notified if Private Plan benefits are denied?
No. Where you live has no bearing on whether you can receive disability benefits. The most important eligibility requirement is that you worked in New Jersey for a New Jersey covered employer.
You can file a claim online or complete a paper application (form DS-1) Click on the "File a Claim" tab.
Yes. You have 30 days from the first day of disability to file your claim. If your claim is received more than 30 days from the start of the disability, you must show good cause why the claim was not filed in time. You can attach a statement to the claim form (DS-1) explaining why your claim is late. If the reason is determined to not be good cause, benefits may be reduced or denied.
No. A disability claim cannot be filed until your period of disability actually begins. However, you may initiate your claim up to 14 days before your expected surgery by filling out your portion of the online application. (The medical and employer segments cannot be completed until the disability period actually begins.) Your information will be stored for up to 14 days after your expected first day of disablity. You may return to the application after you become disabled, confirm all the information and submit your claim for benefits. Be sure to return through the Complete a Claim link. If you wait longer than 14 days after your expected date of disability the claim will not be retrievable and you will have to begin again.
Medical care must be received within 10 days of the first date you became disabled. After initially being treated, there is no set requirement as to how often you must see your medical practitioner. However, to continue receiving benefits you must be under the continued care of a medical practitioner who certifies you are unable to work. Periodically, a form will be mailed to you to gather this medical information. The form must be completed by you and your medical practitioner and returned to this Division.
For detailed information on benefit calculations, see Benefit Calculations.
Benefits are payable on the eighth consecutive day of your disability. The first seven days of disability are called the waiting week. If your disability continues for three consecutive weeks, only then will you receive benefits for the waiting week. For example: If you became disabled on August 9 and were found to be eligible, you would begin receiving benefits from August 16. If you are still disabled on August 30, the first 7 days (August 9 - 15) would then be paid.
When you receive a Form P30, "Request to Claimant for Continued Claim Information", indicate the date you recovered or returned to work, have your doctor confirm any care not previously reported, and mail the completed form to this office, immediately. You may also use form C05 "Notice to Claimant of Receipt of Claim" to report your recovery or return to work. If you recovered earlier than expected, call this office immediately at (609) 292-7060 to report your recovery or return to work date and prevent an overpayment of benefits.
If you lost or did not receive a C10 "Request to Claimant for Disability Information", M10 "Request for Medical Information", P30 "Request to Claimant for Continued Claim Information", or D10/D30 "Notice of Eligible/Ineligible Determination" you can call this office at (609) 292-7060 to request the lost or missing form. We will regenerate the form through our computer system and sent it out to you immediately.
You can change your address in our records by using the Address Change application. Otherwise, you must notify us in writing of a new or corrected address. Be sure your letter includes your full name, your former address, your new complete address, and your Social Security number. We cannot identify your claim without the Social Security number. Sign and date the letter. Send your letter to Division of Temporary Disability Insurance, PO Box 387, Trenton, NJ 08625- 0387.
Yes. You can have multiple disability claims during the year. You must meet the eligibility requirements and have medical documentation for each new claim.
Claims are processed in the order in which they are received in Trenton. However, if your claim does not contain all the required information, it will take much longer to process. It is important that you answer every question on your portion of the form. It is also important that you make sure your employer and your physician answer every question before you submit the application to us.
Yes. If you are collecting unemployment benefits and become disabled, notify the Division of Unemployment Insurance immediately, so they can suspend your unemployment claim while you are unable to work. Click on "File a Claim" on the side bar to apply for disability benefits.
Work-related injuries or illnesses are not compensable under the Temporary Disability Benefits Law. However, if you file a claim for workers' compensation benefits and it is contested by the workers' compensation insurance carrier, you may be eligible for temporary disability benefits while the workers' compensation issues are being resolved. To protect our subrogation rights, we would file a lien against any subsequent workers' compensation award. For additional information, see Work Related Disabilities.
If your disability begins on or after the start of the labor dispute in which you are a participant, disability benefits will not be paid for the duration of the dispute. If you are still disabled after the labor dispute is over, benefits can be paid for the period following the ending date of the labor dispute.
Yes. If you are disabled due to alcoholism or alcohol-related illnesses, you may collect disability benefits as long as you are under the care of a licensed medical practitioner and meet all other eligibility requirements.
Yes. As long as you are no longer using illegal drugs and you are being treated for the substance abuse in a program with a licensed physician, you may collect disability benefits. Your physician must certify that you are disabled, and you must meet all other eligibility requirements.
No. Coverage under an approved Private Plan replaces State Plan coverage. Since you are not covered by the State Plan, you cannot be paid State Plan benefits, even if you continued to be disabled. Contact your local Social Security office to inquire about Social Security Disability benefits.
Yes. During your period of disability you may be required to go to a doctor for an independent medical examination. Failure to keep the appointment could result in your disability benefits being discontinued. For more information see Independent Medical Examinations.
Yes. The determination you received has a written statement explaining your appeal rights. For further information on appeals see Appeals.
Yes. You may file an appeal with the Private Plan Compliance Section, Claims Review Unit. For further information see Appeals.
Yes. A portion of disability benefits is considered taxable income for both the Federal Income Tax and FICA (Social Security). Federal income tax is not withheld from your benefit payment each week unless you request it to be withheld using a W-4S form from the IRS or your employer. (Information about Form W-4S is available at www.irs.gov/w4s.) The portion of the benefit payments that is taxable is that portion attributable to the employer's disability contribution. In January of the year following your receipt of benefits, the amount of your benefits that is taxable will be reported to your employer who will include that amount on your W-2 annual earnings statement.
Your share of FICA is automatically deducted from your State Plan benefit payments. The employer is liable for the employer's share of FICA.
If you know or have reason to suspect that someone is working and collecting disability benefits notify this Division as soon as possible. Click here to Report Fraud. Or, call our fraud hot-line at (609) 984-4540.
Yes. Eligibility for temporary disability benefits due to pregnancy is determined in the same manner as for any other disability. You must meet the wage requirements and your physician must certify that you are disabled. For more information, see our web page entitled Pregnancy-related disabilities.
When you have stopped working and your doctor certifies that you are disabled, complete the claim form (DS-1) and mail it to this Division or file online (See "File a Claim" on the side bar). Do not file the claim before you stop working or before your physician says you are disabled. If you file the claim while you are still working, or before the doctor certifies that you are disabled, your claim may be denied.
However, you may initiate your claim up to 14 days before you expect to be disabled because of pregnancy by filling out your portion of the online application. (The medical and employer segments cannot be completed until the disability period actually begins.) Your information will be stored for up to 14 days after your expected first day of disablity. You may return to the application after you become disabled, confirm all the information and submit your claim for benefits. Be sure to return through the Complete a Claim link. If you wait longer than 14 days after your expected date of disability the claim will not be retrievable and you will have to begin again.
For a normal pregnancy benefits are usually payable for up to four (4) weeks before the expected delivery date and up to six (6) weeks after the actual delivery date. Benefits may be payable for a longer period if your doctor certifies that you have a specific complication related to the pregnancy; you have a Cesarean section; or you have another simultaneous disability.
No. You may receive benefits only for the period of time that the doctor certifies you are physically unable to work.
Not necessarily. Benefits are payable only for the period your doctor certifies you are disabled. It cannot be adjusted because you delivered early.
The New Jersey Temporary Disability Insurance Law does not require an employer to hold a job for someone who is on disability. However, you may have job retention rights under other State or Federal Laws. For further information contact the nearest office of the New Jersey Division of Civil Rights.
If you are physically able to do your job, but you are exposed to environmental risks at the worksite (for example, x-rays, radiation, or chemicals) disability benefits are not payable because you are not disabled. In this situation, you may have benefit rights under the Unemployment Insurance program.Contact the Division of Unemployment Insurance for additional information.
No. You must be disabled to receive disability benefits. However, you may be eligible for Family Leave Insurance benefits.
For a State Plan claim, the base year is the 52 calendar weeks immediately preceding the week in which the claimant is disabled. For a Disability During Unemployment claim the base year is the first four of the last five completed quarters preceding the date of the claim.
If you pay the claimant money during a period of disability, the amount of benefits paid may be affected. To report the money paid to the claimant, you should notify this office in writing. Include the claimant's name, Social Security number, the type of payment, amount paid, and the period covered by those payments. For further information, see Continued Pay.
The most recent employer is the chargeable employer under New Jersey's Temporary Disability Insurance Law. Under the provisions of the New Jersey Unemployment Compensation Law, all covered base year employers proportionately share the benefit charge associated with a UI claim. But this is not possible under the Temporary Disability Insurance Program because it encompasses both State Plan and Private Plan coverage. If a disability claim were filed, and that claimant had both State Plan and Private Plan employers in the base year, there would be no way to charge the Private Plan employer since no contributions are paid to the TDI Trust Fund.
The type of disability coverage of the claimant's last employer determines who is responsible for processing the claim and paying benefits. If you have State Plan coverage for your employees, State Plan Operations is responsible for processing the claim and paying benefits. If you have Private Plan coverage, your Private Plan carrier assumes responsibility for the claim.
Under New Jersey Law, employers are required to provide all requested wage information. Failure to do so will result in penalties. If you have doubts about the authenticity of a disability claim, complete the wage request form and request an independent medical examination for the claimant at the same time.
Yes. As the employer, you have the right to request an exam. Make your request as soon as a problem with a claim is suspected. For information on how to make this request, see Independent Medical Examinations.
No. An employer may self-insure the Private Plan. Or, the Private Plan may be funded through a labor-management agreement.
Yes, but the cost can be no more than what they would have contributed for State Plan coverage. For further information, see our web page entitled Cost.
Yes, as long as the selection will not result in a substantial risk adverse to the State Plan. For example, production workers may be insured through a Private Plan and all other workers by the State Plan. Another example is to insure employees with less than a year of employment through the State Plan and all other employees under a Private Plan.
Yes. Copies of all denials of Private Plan benefits must be forwarded to the Private Plan Compliance Section, Claims Review Unit, Private Plan Operations, PO Box 957, Trenton, NJ 08625-0957. Denials must advise claimants of their appeal rights.