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How to File a Claim - Disability During Unemployment

If you become disabled more than 14 days after your last day of employment, your disability claim is processed under the Disability During Unemployment Program. This program is also known as 4(f) since it was established under Section 4(f) of the Unemployment Law. Claims filed under this program are governed by both the Unemployment Compensation and Disability Benefits Laws. To qualify for benefits under this program, you must meet all the requirements of the Unemployment Compensation Law with the exception of ability to work. You must also be totally disabled and be under the care of a legally licensed physician, dentist, podiatrist, optometrist, chiropractor, psychologist or advanced practice nurse.

Disability insurance is designed to serve you by mail. You need not leave your home or the hospital to apply for benefits. Claims for Disability During Unemployment are filed by mailing the Application for Benefits, form DS-1, to the Disability Insurance Office in Trenton. The DS-1 form can be obtained through this site or by writing or telephoning your union, employers, or the Division of Temporary Disability Insurance, PO Box 387, Trenton, New Jersey 08625-0387, (609) 292-7060.

Complete Part A, Claimant's Statement of the Application for Benefits. Be sure to give your correct social security number and to sign the form.

Part B, Medical Certification, must be completed by your doctor.

Leave Part C, Employer Statement, blank. Submit the completed application to the address shown on the form.

File your claim for disability benefits within 30 days of the start of your disability. Late filing, without good cause, may result in a reduction of benefits payable.

Download an Application