If you suffer a temporary illness or injury while being an employee, but your medical condition wasn't due to your job, you may be eligible for disability benefits through New Jersey’s State Temporary Disability Insurance (TDI) program.
What Are the Requirements to be Eligible for Benefits?
First, you must have a non-work related illness or injury that keeps you from working and be under medical care for treatment of the disabling condition. Second, you must have worked for at least 20 calendar weeks earning at least $145 per week for a covered New Jersey employer. Alternatively, you must have earned $7,300 or more during your “base year.” Your base year is defined as the 52-week time period immediately prior to the week your disability started.
What Can Make You Ineligible for TDI Benefits?
Even if you meet the medical and earnings requirement, you cannot get benefits in the following situations.
- Your medical condition doesn't last more than seven days.
- Your medical condition started more than 14 days after your last day of employment with a covered New Jersey employer (see below for a brief discussion on the Disability During Unemployment Program.)
- You aren't getting treatment for your condition by a medical provider (licensed physician, dentist, optometrist, practicing psychologist, advanced practice nurse, certified nurse midwife, or chiropractor.)
- Your medical condition was caused during the commission of a crime.
- Your medical condition was self-inflicted.
- Your most recent employer fired you for gross misconduct on the job, if your conduct was a crime.
- You got paid for working after you became disabled.
- You became disabled during a labor dispute with your most recent employer.
- You still get paid by your employer, and your pay and TDI combined would be more than what you were earning before you became disabled.
- You are a government worker who is eligible for sick leave, and you have not yet used all of the sick leave available to you.
Also, in most cases, you cannot get temporary disability benefits if you are getting payments from other programs such as unemployment of workers’ compensation.
If you are not sure whether you qualify for TDI, contact New Jersey's State Plan Operations.
How Much Can I Get in Benefits?
You weekly benefit rate (WBR) is determined using the average of the last eight weeks of your earnings. Your WBR is 2/3 of this average. For 2013, the most you can get is $584 per week, and part of the payment is taxable. Here is an example:
You earned $600 per week during five of the last eight weeks, and you earned $200 per week for the remaining three weeks. Your total wages for the eight weeks is $3,600. Your average weekly wage is $3,600 divided by eight, or $450. Your benefit amount is 2/3 of $450, or $300.
You can get benefits for up to 26 weeks. This means that even if your injury or illness lasts more than 26 weeks, your benefits will stop. However, if you suffer a new disabling medical condition and apply for TDI, the 26 weeks will start again.
Keep in mind that the most you can get for each period of disability is 1/3 of your total wages earned in your base year or 26 times your benefit amount, whichever is smaller.
How Do I Apply for Benefits?
You need to complete Form DS-1, Claim for Disability Benefits, to apply for benefits. There are three parts to the form that need to be completed: one for you, your employer, and your doctor. Make sure all three parts are filled out entirely so that your claim can be processed quickly. Once it is completed, send the form to:
Division of Temporary Disability Insurance
Department of Labor and Workforce Development
P.O. Box 387
Trenton, NJ 08625
Here are the phone and fax numbers:
Make sure that everything you send to the Division of TDI has your name and Social Security number on it.
When Do I Have to File My Claim?
You must file your claim within 30 days from the first day you become disabled. If you file later than this, you will have to show "good cause" for why you didn't file the claim on time. To do this, attach an explanation of why the filing was delayed to your claim form. If good cause isn't shown, you may be ineligible for benefits, or your benefits may be reduced.
Note that you cannot file your claim before you become disabled even if you know, for example, the date of the disabling event (like surgery) that will prevent you from working.
What If Am Denied Benefits or the Benefit Amount Is Wrong?
You can appeal a decision by the Division of TDI if you think it is wrong. Your appeal must be in writing and contain an explanation of why you disagree with the decision. It has to be received by or postmarked within seven days of getting your letter of determination, or within ten days from the date the letter was mailed to you. You can also fax your appeal or submit it online.
Once your appeal is received, you'll get a letter that advises you of the date, time, and location of the appeal hearing. An Appeal Tribunal examiner will conduct the hearing, and you must be present for it. You don’t need an attorney, but you can bring an attorney or a friend or relative with you. The examiner's decision will be sent to you by mail.
If you'd like legal representation at the hearing, contact a disability lawyer in your area.