Temporary Disability 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 health care provider and employer submit (Under the Web Services tab, choose Print Forms.)
- if you will be unable to work due to pregnancy or a scheduled surgery, you can start the claim process early. You can start an online application up to 14 days in advance, then complete and submit the claim online when you become unable to work.
Before you file
Please have handy:
• name, address, and phone number of the physician treating you.
• dates of any emergency/urgent care treatment or hospitalization.
• 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 disability.
• date you recovered (if you have recovered already) or estimate of when you expect to return to work.
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 disability 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.
Disability claims require information from you, your doctor and your employer. All parts can be completed online. After you complete your part of the application, it is your responsibility to make sure
1)your doctor submits the medical certification, and
2)any employer(s) you worked for in the last 6 months submit an employer statement
When you have completed your part, bring your doctor and employer 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 Temporary Disability from the left navigation bar, then choosing Health Care Provider or Employer from the tabs in the window.
Complete Medical Certificate (M01) online If you submit your information online, do not also mail the form. Doing so will delay the processing of the claim.
Submit your patient's medical information securely.
Complete Employer Statement (E01) Online If you submit your information online, do not also mail the form. Doing so will delay the processing of the claim.
Instructions for submitting Wage Information For Claims (DS1 - Part C or E15 form)
Information for employers and insurers about the programs administered by the Division of Temporary Disability Insurance.
State Plan Disability Program
Private Plan Disability Program
Disability During Unemployment Program
Need to change your name or address? Now you can do it online here.
Most employers in New Jersey are required to have temporary disability insurance (TDI) for their employees.
TDI insures workers in case they suffer an illness or disability that
• prevents them from working, and
• is not related to their work.
Employers may choose an insurance plan offered by the state or by a private insurance company. If
you become disabled while you are employed or within 14 days of your last day of work, ask your
employer whether their disability insurance is through a “state plan” or “private plan.” If they
have a state plan, file your claim for temporary disability benefits here. If they use a private insurance
company, you will file a claim through that company. Your employer can tell you how.
To learn about the types of disability benefits, click on a link below
State Plan Disability
Private Plan Disability
Disability During Unemployment If you become disabled more than 14 days after your last day of work, our Disability During Unemployment section will take care of your cliam.
If you have become disabled due to injury or illness that is job related, contact the Division of Workers' Compensation
If your disability is work related and your employer's workers' compensation carrier
-denies you benefits or
-stops benefit payments
you may file a claim with the Division of Temporary Disability Insurance. See the Work-related Disabilities page for more information.
Health Care Provider - Please use health care provider tab to complete an M01 online.
Employer - Please use the employer tab to complete an E01 online.
- Web Inquiry- If you have filed a claim for State Plan Temporary Disability you will be able to view and print basic claim and payment information for any claim you filed in the past 1,000 days.
- Complete a Claim - If you began your application prior to your first day of disability, use this application to complete and submit the claim on or after your first day of disability.
- Print Forms - If you filed a claim online, reprint any of the forms required at the initial filing of your claim. View or print any health care provider or employer statement submitted through the web application.
Note: The Request to Claimant for Continued Claim Information (P30) is not currently available online.
Address Change - Change your name and/or address on your most recent Temporary Disability 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.