Temporary Disability Insurance
File A Claim
Health Care Provider
Due to the high volume of calls, our Customer Service Section hours have temporarily been extended.
Agents are now available from 8:00am - 5:30pm, Monday – Friday (except holidays).
For more information please visit our Contact Us page on the Quick Links Tab.
NEW! You can now change your name and/or address online on your most recent claim. Go to our Web Services tab and select Address Change.
Most workers who become disabled within 14 days of their last day of work in covered New Jersey employment are covered for disability insurance under the State Plan or an approved Private Plan. If you are not sure of your coverage you should ask your employer.
If your disability begins more than 14 days after your last day of work in covered New Jersey employment, your claim will be fowarded to our Disability During Unemployment section.
For additional information on a program area, please click on the link below.
State Plan Disability Program
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 if the workers' compensation carrier stops benefit payments, you may file a claim with the Division of Temporary Disability Insurance. See the Work-related Disabilities page for more information.
You may need a printer or the ability to save forms to your personal computer if you file online and additional information is needed. The forms that must be completed by your doctor and employer can also be completed online. Simply give each their unique Form Identification Number and direct them to our website.
If you submit your claim online, do not mail or fax a paper application. Duplicate forms only delay the processing of your claim.
- Safe and secure.
- Immediate electronic confirmation that your claim was received.
- Faster claim processing time.
- See the information your health care provider or employer submits online through "Print Forms" on the Web Services tab.
- START EARLY! You can start an application up to 14 days in advance if you will be disabled due to pregnancy or an anticipated surgery. Complete and submit the claim online after you become disabled and can not work.
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.
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
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.