Private Plan Claims Processing
The Division of Temporary Disability Insurance oversees the handling of private plan claims through the Claims Review Unit of Private Plan Operations. All claimants who are denied private plan benefits must be notified of the denial in writing by the insurer, self-insured employer or union welfare fund. The notification must state the reason for denial, and must advise the claimant of his or her right of appeal. A copy of the denial, together with a copy of the claim file, must be submitted to Private Plan Operations.
Under the Law, the claimant may appeal the denial of a private plan claim within one year from the date of the beginning of disability. Appeals are heard by the Private Plan Hearing Officer, whose decision is binding. Further appeals must be presented to the New Jersey Superior Court.
The Claims Review Unit also resolves claim discrepancies, handles claimant complaints and provides assistance and information to all private plan employers, insurers and claimants. To submit copies of denials or to obtain claims assistance, contact:
Division of Temporary Disability Insurance
Private Plan Operations
Claims Review Unit
PO Box 957
Trenton, NJ 08625-0957
Telephone: (609) 292-6135
FAX: (609) 292-2537
