How to apply for disability after surgery

Temporary Disability Insurance provides cash benefits to workers who suffer an illness, injury, or other disability that prevents them from working, and wasn’t caused by their job. In addition, if your healthcare provider certifies that you are unable to work because you were diagnosed with COVID-19 or are at high risk for COVID-19 due to an underlying health condition, you may be eligible for Temporary Disability benefits. Most employers in New Jersey are required to have Temporary Disability Insurance for their employees.

Employers may be able to require employees to take paid time off (PTO) before Temporary Disability benefits. It depends on how they meet the requirements of the NJ Earned Sick Leave law. This law requires employers of all sizes to provide full-time, part-time, and temporary employees with up to 40 hours of paid sick time per year so they can care for themselves or a loved one.

Employers who separate NJ Earned Sick Leave from their PTO policy can require employees to take PTO before claiming Temporary Disability Insurance benefits. Employers cannot require them to take time accrued under the NJ Earned Sick Leave law.

Some employers use their PTO policy to follow the NJ Earned Sick Leave law. In this case, the employer may not require an employee to utilize any of their PTO prior to Temporary Disability benefits.

Check with your employer or HR professional to find out how they follow the NJ Earned Sick Leave law. If you believe your employer violates the Earned Sick Leave law, you may file a complaint with the Wage and Hour Division at NJDOL. You may still file for Temporary Disability benefits.

This is explained in more detail on our employer information page here.

1. You can apply online, which is the easiest way to apply for benefits. Once you submit your application, you will get immediate confirmation that we received it.
2. You can download, print, and fill out a paper application (DS-1), and mail it to us at: Division of Temporary Disability Insurance, P.O. Box 387, Trenton, NJ 08625-0387, or fax it to 609-984-4138.

Any New Jersey worker who contributes to the state plan for Temporary Disability Insurance, or to an employer’s approved private plan, and meets the minimum gross earnings requirements, may be eligible. Check your pay stubs or ask your employer if you’re not sure about your coverage.

Your employer is required to report your wages to the state after each calendar quarter. When your claim is under review, we consider the earnings reported for the five completed quarters prior to the week your disability began. The first four quarters of that time frame is called the base year.  To qualify for Temporary Disability Insurance in 2022, you must have worked 20 weeks earning at least $240 weekly, or have earned a combined total of $12,000 in those four quarters (the base year). 

The wages earned during your base year will determine the amount of weekly benefits you may receive, and the total amount you can receive throughout the life of a claim.

For workers who don't qualify with a standard base year, we have other ways of calculating a base year.

You may be eligible to receive benefits if you work in New Jersey, regardless of where you live.

You may be eligible for Temporary Disability benefits. Your healthcare provider must certify that you are unable to work because you are at high risk for COVID-19 due to an underlying health condition.

You have 30 days from the first day of your disability to file your application. If your application is received more than 30 days from the first day of your disability, you must provide a reason why the claim was not filed on time. Benefits may be reduced or denied for late applications.

If planning ahead, you may start your online application up to 60 days in advance. To avoid deletion of your draft application: (1) within 14 days of starting the application, provide all information and confirm your claim; then (2) within 14 days of starting your leave, certify and file your claim. Starting an online application prior to your disability period simply helps you get the paperwork in motion before becoming disabled. Because planned surgeries may be cancelled or rescheduled, we do not process applications ahead of time. Applications are processed in the order in which they are received. 

Note: Starting an application prior to your disability period, can only be done using the online application. 

There is no limit to the number of times you may apply for and receive benefits, but you must meet the eligibility requirements and have medical documentation for each new claim.

If you have a work-related disability and you are denied benefits by your employer's workers' compensation carrier, you may apply for Temporary Disability Insurance benefits. For additional information, see Work-Related Disabilities.

Yes. If you have not worked within 14 days of when you became disabled, you may be eligible for Disability During Unemployment (DDU) benefits, a combination of the Temporary Disability and Unemployment Insurance programs. The best way to transition from Unemployment Insurance to DDU is to stop claiming weekly Unemployment benefits. You do not need to notify the Division of Unemployment Insurance that you are no longer collecting benefits from them; simply stop certifying weekly. Once you stop certifying for Unemployment, complete an application for Temporary Disability Insurance and submit it. Once we receive your application and see that you meet the criteria for Disability During Unemployment, your application will be temporarily denied. You may notice that your online claim status will read “Ineligible,” but don’t worry as this temporary denial is simply our internal process of reassigning your claim to the proper section of DDU and has no reflection on the content of your application. Once a Disability During Unemployment examiner receives your application, it will be reviewed for claim approval. The time between when you stop certifying for weekly Unemployment benefits and when DDU starts paying you will cause a temporary disruption in benefits as it will take time for your new application to make its way to DDU. You will be paid retroactively by Disability During Unemployment benefits for this period.

Applications are processed in the order in which they are received. However, if your application does not contain all the required information, it will take longer to process. It is important that you answer every question on your portion of the application. You also must have your medical provider submit their information as soon as possible to have your application processed and any benefits paid promptly.

We start paying benefits on the eighth consecutive day of your disability, due to a seven-day period called the waiting week. You will receive benefits for that week only if your disability continues for three or more consecutive weeks and you have not been paid by your employer.

1. First, we calculate your average weekly wage. We do this by dividing your base year earnings by the number of base weeks.  In 2022, a "base week" is any week you earn $240 or more.
2. Now, we can determine your weekly benefit rate. Claimants are paid 85% of their average weekly wage, up to the maximum weekly benefit rate set for that calendar year.

   In 2021, the maximum weekly benefit rate is $903 per week.

   In 2022, the maximum weekly benefit rate is $993 per week. 

   For example, let’s say Steve's first day of disability is Friday, March 4, 2022. To see how much he would receive weekly on Temporary Disability Insurance, we look at his reported wages for the first four of the last five completed quarters: 

   Previous Completed Quarters	Timeframe Covered	Total Earnings	Number of Base Weeks
   Quarter 5	10/1/21 - 12/31/21	$5,500	13 base weeks
   Quarter 4	7/1/21 - 9/30/21	$5,000	12 base weeks
   Quarter 3	4/1/21 - 6/30/21	$5,000	12 base weeks
   Quarter 2	1/1/21 - 3/31/21	$4,000	10 base weeks
   Quarter 1	10/1/20 - 12/31/20	$4,200	11 base weeks

   
   Quarters 1 through 4 are the regular base year and the timeframe used to calculate his benefits.

   Total base year earnings: $18,200 which we divide by 45 (the number of base weeks)

   This gives us an average weekly wage of $404.

   Steve’s weekly benefit rate is 85 % of his average weekly wage: $343.

You can change your address online by clicking here, or you can let us know in writing by mail or fax. Be sure to include your full name, your old address, your new address, your Social Security number, and sign and date the letter. Fax it to 609-984-4138, or mail to: Division of Temporary Disability Insurance P.O. Box 387, Trenton, NJ 08625-0387. Our customer service agents cannot accept address changes over the phone.

If you filed online, you can access some forms online by clicking here and logging in to your account. For everything else, call us at 609-292-7060 so our computer system can generate a new form to be sent to you.

You must be under the care of a medical provider within 10 days of the date you first became disabled. After this initial treatment, there is no set requirement for how often you must see your medical provider. However, in order to keep receiving benefits, we may ask for proof from your doctor that you are still unable to work and under continuous medical care. We will send you a form in the mail (P-30, Request to Claimant For Continued Claim Information) with instructions on how to submit this information to us.

In the unfortunate event that the person who applied for Temporary Disability has passed away we will send a form P40 "Instructions for Claiming Benefits Due to a Deceased Person" to the address on file.  It explains how that person’s estate can claim any benefits to which it may be entitled. 

What do I do with this form?

We need notarized copies of the following documents to issue benefits to an estate:

• the claimant’s death certificate, and
• an affidavit issued by the Surrogate of the county in which the claimant resided, and
• the signed affidavit (Form P40) provided by this agency.

Send these notarized documents and the completed Instructions for Claiming Benefits Due to a Deceased Person (P40) form you received to: Division of Temporary Disability Insurance, PO Box 387, Trenton, NJ 08625-0387.

We send you forms in case you need to update any of your information, provide medical proof to continue receiving benefits, or let us know you recovered and returned to work. For more information about specific forms, see our Form Lookup page.

The decision you receive in the mail comes with a written statement explaining your appeal rights. For more information, see Appeals.

This exam is a routine procedure to make sure benefits are paid properly. It does not affect the relationship between you and your doctor. There is no charge to you for the exam and the results will be kept confidential. You will be referred to a doctor located as close as possible to your home. Failure to keep the appointment could cause your benefit payments to be stopped.

Temporary Disability Insurance benefits are considered taxable income for purposes of both the federal income tax and FICA (Social Security). Federal income tax will not be withheld from your benefit payment each week unless you request it when you file, or submit IRS form W-4S to us (for state plan claims) or your employer (for private plan claims). Your share of FICA and medicare is automatically deducted from state plan benefit payments. Garnishments and any refunds owed from a previous disability or family leave claim will also be withheld from your benefit payments. 

The amount of your benefits that is taxable will be reported to your employer in January of the year following the receipt of your benefits. Your employer will include that information on your W-2 annual earnings statement. The amount of your benefits that is taxable will be reported to your employer in January of the year following the receipt of your benefits. Your employer will include that information on your W-2 annual earnings statement, often listed as "third party sick pay" or "other wages." Keep in mind, benefits are federally taxable during the year that payments are issued, which may not always match up with when your leave occurred. 

If your Temporary Disability benefits are not reported on your W-2, contact your employer directly to have it corrected. If needed, let your employer know they can download their year-end tax statement here. For additional information on incorrect W-2s, go to: Internal Revenue Service (IRS).

If you have received your maximum benefit amount but are still unable to return to work, click here to see other programs that may be of assistance to you.

Eligibility for Temporary Disability Insurance benefits due to pregnancy is determined in the same way as any other disability. You must meet the wage requirements, and your physician must certify that you are disabled and unable to work due to your pregnancy. For more information, see our Maternity Coverage page.

If planning ahead, you may start your online application up to 60 days in advance. To avoid deletion of your draft application: (1) within 14 days of starting the application, provide all information and confirm your claim; then (2) within 14 days of starting your leave, certify and file your claim. If applying after disability period begins, you have 30 days from your first day of disability to file your application. 

Benefits are usually payable up to four weeks before the expected date of delivery, and six to eight weeks after you give birth, depending on how you delivered. If your doctor certifies that complications exist more than four weeks before your expected delivery date or longer than eight weeks after the birth, benefits may be payable for a longer period.

If you are physically able to do your job, but you are exposed to environmental risks at the worksite (for example, X-rays, radiation, or chemicals) Temporary Disability Insurance benefits are not payable because you are not disabled. In this situation, you may qualify for Unemployment Insurance benefits.

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