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How does an employee file a New Jersey Temporary Disability Benefits (TDB) claim?

If the non-work related disability begins while the employee is working, or within fourteen days of the last day worked, the employee should file a completed DS1 claim form (Español aqui) within 30 days.
PART A is the Claimant's information and is for the employee to fully complete and sign.
PART B is the Claimant's employment information. The employee must complete this section for all employers they have worked for within the past six months.
Once all sections are complete you or your employee can submit the claim to us by:
Phone:
(800) 401-2691
Fax:
(800) 728-7028
Email:
StandardSecurityNJTDB@absencesolved.com
Mail:
Standard Security Life Ins. Co. of NY
c/o Absolve Leave Administration
PO Box 1328
Mt. Laurel, NJ 08054

About the program

The Temporary Disability Benefits Law allows employers the option of choosing to establish a private plan for the payment of temporary disability benefits in place of paying benefits under the State Plan. All private plans must be approved by the Division of Temporary Disability Insurance before they become effective. Private Plan Operations is responsible for the approval process. This office also oversees the administration of private plan policies and the processing and payment of private plan benefits.
At a minimum, approved private plans must meet the basic provisions required of State Plan. Under a private plan:
  • Benefits paid must be at least equal to the amount that would be paid on a State Plan claim.
  • Eligibility requirements cannot be more restrictive than they would be for a State Plan claim.
  • Coverage must be at least equal to that offered by the State Plan.
  • Neither the employer, nor their workers are required to contribute to the State's Temporary Disability Insurance Trust Fund while the private plan remains in existence. The cost to the worker for the private plan cannot be more than it would be under State Plan.
  • A written election must be held, unless waived, if the plan is contributory and covers members of a Collective Bargaining Agreement.  A majority of employees must agree to the plan prior to the effective date of the plan.

Plan approval

Private plans can be established in three ways:

  1. Through an insurance company. All insurance companies must be approved by the New Jersey Department of Banking and Insurance and Private Plan Operations to provide coverage for temporary disability insurance before they can write private plan policies. Information for New Insurers 
  2. By establishing a self-insured plan. The employer is responsible for administering the plan and paying benefits. 
  3. Through a union welfare fund. The union welfare fund is responsible for administering the plan and paying benefits.

Modifying An Approved Private Plan

Once a private plan has been approved, it is possible to make changes through the modification process. All modifications must be approved by Private Plan Operations before they can take effect.

The plan must go through the modification process if:

  • You decide to change insurance carriers.
  • There is a change in the class of employees covered by the plan.
  • There are any changes made to the eligibility requirements.
  • There are any changes made in benefits.

This is a general list of possible modifications. It is not all inclusive. If you have any questions about changes that may require modifying a private plan, contact the Private Plan Unit.

How To Terminate An Existing Private Plan

A private plan can be terminated by:

  • The employer.

    To have an approved private plan terminated, the employer must request termination of the plan in writing. The effective date of the termination will be 30 days after the postmark date of the letter. If the employer would like to request a specific termination date they may do so, but the termination request must be postmarked at least 30 days prior to the termination date. The termination request must state how and when the employees affected were notified that the plan would be terminated, include the NJ Employer Identification Number and be signed by a corporate officer. Mail the termination request to the Private Plan Compliance Section, Plan Approval Unit, PO Box 957, Trenton, NJ 08625.

    Additional information regarding this termination process can be directed to the Plan Approval Unit at (609) 292-2720.

    Once the plan is terminated, the employer and insurer will receive a "Certificate of Withdrawal" of the private plan and the employer will automatically be put back into the State Plan for disability coverage.

    Information pertaining to the employer's cost under the State Plan can be found on the Department's website at Employer Accounts or by calling Employer Accounts at (609) 633-6400.

  • The insurer.
    If the plan is being terminated due to nonpayment of the premium, notification to Private Plan Operations must be made in writing at least 15 days before the effective date of the termination.

    If termination by the insurer is for any other reason, written notice must be submitted to Private Plan Operations at least 60 days prior to the effective date of the termination. However, if the termination is due to a change of insurer, the 60 day requirement may be waived.
  • The workers covered by plan.
    This requires a petition signed by at least 10 percent of the employees covered by the private plan. Private Plan Operations would then oversee an election in which the covered employees would vote on terminating the plan. The plan will be terminated if a simple majority of the workers covered by the plan vote for its discontinuance.
  • The Division of Temporary Disability Insurance.
    Should Private Plan Operations determine that there is just cause to terminate a private plan, that plan may be terminated immediately. Should this occur, all parties would be given notice of the termination.

    With the exception of termination due to a change in insurer, the workers would automatically be covered by the state plan effective the day following termination. No application forms are required to begin state plan coverage. Liability for contributions to the New Jersey Temporary Disability Trust Fund would also begin immediately upon termination of the private plan.

Private Plan Claims Processing

The Division of Temporary Disability Insurance oversees the handling of private plan claims through the Claims Review Unit of Private Plan Operations. All claimants who are denied private plan benefits must be notified of the denial in writing by the insurer, self-insured employer or union welfare fund. The notification must state the reason for denial, and must advise the claimant of his or her right of appeal. A copy of the denial, together with a copy of the claim file, must be submitted to Private Plan Operations.

Under the Law, the claimant may appeal the denial of a private plan claim within one year from the date of the beginning of disability. Appeals are heard by the Private Plan Hearing Officer, whose decision is binding. Further appeals must be presented to the New Jersey Superior Court.

The Claims Review Unit also resolves claim discrepancies, handles claimant complaints and provides assistance and information to all private plan employers, insurers and claimants. To submit copies of denials or to obtain claims assistance, contact the Private Plan Unit.

Private Plan Claims Manual

Click here to download a printable PDF copy of the 2021 Private Plan Claims Manual, a guide to processing Temporary Disability Insurance benefits under an approved Private Plan.

This manual has been prepared by the New Jersey Department of Labor and Workforce Development, Private Plan Compliance Section, as a guide to the processing of New Jersey short-term non-work-related temporary disability claims.

It is intended for use by insurance companies, employers, union welfare funds, and claims consultants who process and pay New Jersey temporary disability claims under approved Private Plans.

This manual describes the benefits and eligibility conditions for approved Private Plans that are equal to the State Plan in every way. If a Private Plan is more liberal than the State Plan, the more liberal provisions in the Private Plan must be used to process actual claims.

The material in the manual is based on the New Jersey Temporary Disability Benefits Law (R.S. 43:21-25 through 43:21-56), the New Jersey Administrative Code (N.J.A.C. 12:18-1.1 through 12:18-3.9 and 1:12A-1.1 through 1:12A-15.2), and portions of the New Jersey Unemployment Compensation Law, Workers' Compensation Law, State Income Tax Law, and No-Fault Automobile Insurance Law. Decisions issued by the New Jersey Supreme Court and Superior Court, policies established by this Department, and our own experience in the area of short-term disability claims processing also served as a basis for this material.

This manual is published for informational purposes only, and does not have the effect of law, regulation, or ruling. For more information on the material in the manual, or for additional copies, please contact:

New Jersey Department of Labor and Workforce Development
Division of Temporary Disability Insurance
Private Plan Compliance Section
Claims Review Unit
PO Box 957
Trenton, NJ 08625-0957 or click here.

Can my client help their employees complete their application?

Yes, in fact it is encouraged. Their employees may be confused about some of the employment information that the state used to get from them. Their assistance will ensure claimants provide accurate information on both the claimant and employment related questions.

It may be a good idea for them to retain a copy of the claim filings (the employment section-Part B) for their records.

How does my client report incorrect information on an employee's claim?

If they notice benefits being issued for days that their employee may have:

  • worked
  • received vacation pay
  • received sick pay

we ask that they notify AbSolve immediately by calling our Customer Service Line (800) 401-2691.

Why do you need my client's Federal Employer Identification Number (FEIN)?

FICA and Medicare taxes are reported to the federal government on a quarterly basis. At year end, an 8922 is filed and, to ensure they get proper credit for taxes paid, we need their FEIN.

How do you report Temporary Disability Insurance benefits on employee’s W-2?

Your client has two options. First they can have us send a separate W-2 for these benefits to each of their employees. Second, a FICA report will be mailed/emailed to them by the 5th of January for the previous year. Those benefits can be added to the employee's W-2. Only a portion of the Temporary Disability Insurance benefits paid are taxable by the federal government (they are not taxed by the State of New Jersey). They are considered third-party sick pay or other wages.

How can I update policy information?

You can update policy name, address, billing address, policy status etc. by contacting your service representative, or by submitting the change request directly to Standard Security Life Insurance Company of New York at:

Email:
billing@relatedrisk.com
Fax:                        
(732) 360-9600                        
Mail:
Standard Security Life Ins. Co. of NY
c/o Related Risk Management
PO Box 60
Mendham, NJ 07945

Where can I get a copy of my client's policy?

You can download a copy of their policy by logging in here.

Where can I get an updated FICA report for my client?

FICA reports are mailed monthly but if you need access to one immediately, you can run one by logging in here.

Where can I get a copy of my client's bill?

You can download a blank bill/worksheet by logging in here.


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