Temporary Disability Insurance
Contact a Customer Service Representative at 609-292-7060
Call Center Agents are available the following hours:
8:00am - 7:00pm Monday – Friday (except holidays)
File A Claim
Health Care Provider
Click HERE to file an online claim for Temporary Disability Insurance Benefits...
If your own illness, injury or pregnancy:
- prevents you from working
- and was not caused by your job
File online because:
- You will get your benefits faster!
- You will 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.
Important Information About the Application Process:
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 health care provider 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 online, bring your health care provider and employer(s) 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 and Family Leave Insurance from the left navigation bar, and then choosing either the Health Care Provider or Employer button in the window.
Before you file your claim online, please have the following information:
- Name, address, and phone number of the health care provider treating you within 10 days of the first day you were unable to work.
- Dates of any emergency/urgent care treatment or hospitalization.
- Dates you worked for any employers in the last year, the employers’ addresses/phone numbers and the address where you worked. If you are applying online, you will need to know the dates of any paid time off you 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.
The online claim application may prompt you to print out a form, so you may need access to a printer.
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.
If you submit your claim online, do not mail or fax a paper application.
If you submit duplicate forms, payment of your benefits will be delayed.
Don’t want to file your Temporary Disability Insurance claim online?
Download and Print out a claim form to fax or mail in to apply for temporary disability insurance benefits.
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.
Filing your Medical Certification - your guide to the online application process
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.
Filing your Employer Statement - Your guide to the online application process
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 claim.
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 started your application before your first day of disability, use this link to complete and submit the claim once you become unable to work.
- 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 - Click here to change your name and/or address on your most recent Temporary Disability claim. 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.