What is the role of the medical provider in applications for Temporary Disability Insurance and Family Leave Insurance?

For Temporary Disability Insurance, your patient applies for benefits; for Family Leave Insurance, your patient's caregiver is applying for benefits. Online applicants are responsible for providing you with their identification form after completing their part. Once you receive the identification form, it is your responsibility to complete the online medical section that certifies your disability or need for care. Paper applicants must hand their application to you to complete your part. You or the applicant can send us the completed application by fax or mail.

Forms completed by a PA-C must be certified/signed by the supervising physician.

We encourage online applications, but may not be possible for some applicants. Please consider printing applications for those who need them at: myleavebenefits.nj.gov/paperapp.

When should I deliver the medical part?

Once the applicant provides you with the online identification form, submit the medical section within 14 days of the application, or the processing of the application could be significantly delayed for your patient or their caregiver.

 Applicants who apply online can start their application 60 days before the benefit period.

What information must I provide, as a provider of medical services?

Complete the medical section form in its entirety, including:

• Dates the patient is under medical supervision
• First day of disability or date the patient needs care
• Discovery
• forecast date
• Pregnancies: date of delivery, date of birth and complications during pregnancy (if applicable)
• Signature and date
• Your medical license number 

If any information is missing or illegible, we will send the applicant another form requesting that information . This could delay the processing of the application by 4 to 6 weeks or prevent the benefits from being granted.

Be sure to include an exact date for the forecast. “TBD, unknown” or leaving it blank could result in a shorter duration of approved benefits. If you are not sure, estimate the date or provide the date of the patient's next scheduled visit.

Can I charge my patients or their caregivers to fill out their medical forms?

No. NJSA 12:18-1.6 prohibits health care providers from charging for filling out Temporary Disability Insurance or Family Leave forms.

Is the online application secure?

Yes, the information it sends is encrypted and the system complies with all security standards required by the State.

It is recommended that medical certificates be submitted online, but a paper medical section may also be submitted to the Division by mail or fax.

Benefits for new and expectant parents

Temporary Disability Insurance can provide financial benefits to expectant parents when they need to stop working before giving birth and while they recover. Parents who give birth can move directly into Family Leave Insurance for their newborn baby. Family Leave Insurance is also available for parents who have not given birth to bond with their newborn, adopted, or newly placed foster child in the first year after birth or placement.

Benefits related to COVID-19

Your patient may be eligible for Temporary Disability Insurance benefits if you certify that they are unable to work because they have been diagnosed with COVID-19 or are at high risk of COVID-19 due to an underlying condition. In addition, a patient's caregiver may be eligible for Family Leave Insurance benefits if you certify that they need care due to COVID-XNUMX.

Do these programs provide employment protection?

These are wage replacement programs and do not protect employment. However, patients and caregivers may be covered separately under the Federal Family and Medical Leave Act (FMLA), the New Jersey Family Leave Act (NJFLA), the New Jersey Security and Financial Empowerment Act (SAFE), and/or COVID-19-related job protection during the public health emergency. Learn more at myleavebenefits.nj.gov/jobprotection.