Official Site of The State of New Jersey

Family Leave Insurance benefits can partially replace wages of workers who need to care for a seriously ill or injured family member, or bond with a newborn, newly adopted or newly placed foster child. The program complements the Temporary Disability Insurance program, which partially replaces wages during an employee’s own injury, illness, or other disability, including pregnancy. As of July 1, 2020, workers can collect Family Leave Insurance benefits for a maximum of twelve consecutive weeks in a 12-month period, or up to eight weeks (56 individual days) in a 12-month period, if taking leave in a non-continuous manner. 

Your role in the application process has changed. You may not be as involved as you were in the past in submitting your employee's application, but your role as a reliable resource is more important than ever!

We moved to an alternate way of calculating your employees' claims. Good news! It requires less effort from you on the front end, but we'll need you to keep a watchful eye on any benefits approved to your employees. 

As you report your employees' quarterly earnings to the state, we will use those reported earnings to qualify a claim and establish a weekly benefit amount. A claim will no longer be based on the weekly earnings immediately before their leave, but on the earnings you report for the previous calendar quarters. 

Employees who need leave from work in order to care for an ill family member or to bond with a new addition, should complete the first two sections of the application (Parts A & B.) They must include:

• The last day they physically worked 
• The first day their leave began
• If they are taking their leave in one continuous period or intermittently up to 56 individual days
• All employment from the past 6 months, with accurate dates and work locations
• Dates of any paid time off or other benefits received after the last day they worked

Since the work history and wages are based solely on your employee's statement and wage record, we need you to oversee this process and assist your employees as needed. You can do this by paying close attention to the form (D20) Notice of Eligible Determinations. This form notifies you that your employee’s Family Leave application has been approved. The front of the form has important information about the employee’s benefits. The back lists the payment schedule, taxes, and reasons benefits could be reduced.

This means we will rely on you to check the time frame we issued benefits and compare it to the days they reported to work or received paid time off. Any incorrect payments should be reported to the Division immediately by calling our Customer Service Line (609) 292-7060 or by faxing a corrected statement (along with the employee's Social Security number) to (609) 984-4138.

In the event that we do not have enough information to approve a claim based on the reported calendar earnings and the employee's statement, you may be required to provide wage information. In these cases, you will receive in the mail a request for information (form E-10) or request for additional wage information (form E-20). The wage and employment information you provide is required to determine their claim, so please complete and return this form promptly. Failure to do so can result in a denial of benefits and a monetary penalty.

When your employee's claim is under review, we consider the gross earnings reported for the 5 completed quarters prior to the week their leave began. The first 4 quarters of that time frame is the newly defined base year. 

 To qualify in 2020, they must have worked 20 weeks earning at least $200 weekly, or have earned a combined total of $10,000 in those four quarters (the base year). 

 To qualify in 2021, they must have worked 20 weeks earning at least $220 weekly, or have earned a combined total of $11,000 in those four quarters (the base year). 

1. First, we calculate the average weekly wage. We do this by dividing the employee's base year earnings by the number of base weeks. 
   In 2020, a "base week" is any week they earn $200 or more.
   In 2021, a "base week" is any week they earn $220 or more.
   
   
2. Now, we can determine the 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 2020, the maximum weekly benefit rate is $881 per week.
   In 2021, the maximum weekly benefit rate is $903 per week. 

For example, let’s say Steve's first day of disability is Friday, March 5, 2021. To see how much he would receive weekly on Temporary Disability Insurance, we look at the wages you reported for the first four of the last five completed quarters: 

Quarters 1 through 4 are the regular base year and the time frame 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.

If Steve is taking his leave on a day to day basis, he will receive 1/7 of his weekly benefit rate for each day he claims: $49 per day.

The family leave program is financed 100% by worker payroll deductions. Employers do not contribute to the program.

For 2020, workers contribute 0.16% of the first $134,900 (wage cap) in covered wages earned during this calendar year. The maximum worker contribution for 2020 is $215.84.

For 2021, workers contribute 0.28% on the first $138,200 (wage cap) in covered wages earned during this calendar year. The maximum worker contribution for 2021 is $386.96. 

The taxable wage cap changes each year.

Individuals may be eligible for Family Leave Insurance benefits to bond with a child during the first 12 months after the child’s birth, adoption, or placement. To bond with a newborn, your employee must be the baby’s biological parent, or the biological parent’s domestic partner or civil union partner. Family Leave benefit days can be taken in one continuous period of twelve consecutive weeks or on a day to day basis up to eight weeks (56 individual days) to suit the employee's needs. They can claim Family Leave Insurance benefits to bond for as many or as few days at a time, up to the maximum days available. Medical documentation is not required for bonding claims.

Individuals may be eligible for Family Leave Insurance benefits to care for a family member with a serious health condition. A health care provider must certify the condition and that the patient requires care. Family caregivers may take leave in one continuous twelve week period, or on a day to day basis up to 56 individual days to suit their needs. That means your employees can take as many or as few days at a time, up to the maximum available, during the 12-month period starting with the first date of leave.

“Family member” means:

• parents
• spouse
• children of any age
• parents-in-law
• siblings
• grandparents
• grandchildren
• domestic partners
• any other individuals related by blood
• any other individuals with whom the employee considers to be family

A “serious health condition” means an illness, injury, impairment, or physical or mental condition that requires inpatient care in a hospital, hospice, or residential health care facility, or continuing treatment or continuing supervision by a health care provider.

The health care provider determines whether the patient’s physical or mental health condition requires physical care or emotional support from a family member. In some cases, more than one person may receive Family Leave Insurance benefits to care for the same family member.

When patients sign a Family Leave Insurance benefits application, they authorize their doctor to share their medical information with their caregivers and the Division of Temporary Disability Insurance. We cannot discuss your employee’s family member’s condition without express written authorization. The Division of Temporary Disability & Family Leave Insurance is not a “covered entity” under the federal Health Information Portability & Accountability Act (HIPAA).

All of a patient’s medical records, except to the extent necessary to administer the Temporary Disability Benefits Law, are confidential and are not open to public inspection. We protect all records that may reveal the identity of the patient.

To protect the integrity of the family leave benefits fund, we verify claims and review diagnosis (ICD) codes and the care recipient’s estimated date of recovery. We use this information to determine whether it is consistent with the normal anticipated duration of the claimed illness, injury, or other disability.

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.
• If employees are to be required to contribute toward the cost of the plan, a written election must be held and a majority of employees must agree to the plan prior to the effective date of the plan.

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.

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. 

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.

The following is a list of insurance companies currently licensed to provide short-term group temporary disability coverage in New Jersey. These companies may be used to insure approved Private Plans for your New Jersey employees. The publication of this list is for informational purposes only, and is not an endorsement by Private Plan Operations of the companies on the list.

Aetna Life Insurance Company
Arch Insurance Group Inc
Dearborn National Life Insurance Company
Guardian Life Insurance Company of America
Hartford Fire Insurance Company
Hartford Life Insurance Company
Hartford Life Group Insurance Company
Liberty Life Assurance Company of Boston
Life Insurance Company of North America
Lincoln Life & Annuity Company of New York
Lincoln National Life Insurance Company
Metropolitan Life Insurance Company
Mutual of New York Life Insurance Company of America
Nationwide Life Insurance Company
Paul Revere Life Insurance Company
Principal Life Insurance Company
Provident Life and Accident Insurance Company
Prudential Insurance Company of America
Reliance Standard Life Insurance Company
Reliastar Life Insurance Company
Renaissance Life & Health Insurance Company of America
Shelterpoint Life Insurance Company
Standard Insurance Company
Sun Life Assurance Co of Canada
Sun Life & Health Ins Company
Symetra Life Insurance Company
Trustmark Insurance Company
UniCare Life and Health Insurance Company
Union Labor Life Insurance Company
Union Security Insurance Company
United of Omaha Life Insurance Company
United States Life Insurance Company in the City of New York
UNUM Life Insurance Company of America
Wesco Insurance Company (formerly National Benefit Life Insurance Company)
Zurich American Life Insurance Company

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. 

Click here to download a printable PDF copy of the 2020A Private Plan Claims Manual, a guide to processing Temporary Disability Insurance benefits on claims dated up to, and including, June 30, 2020 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.

You may request a visit to our office. Our representative will meet with you to discuss claims procedures, as well as your Private Plan(s) and the Law, and answer your questions. To request a visit, please contact our office at:

Division of Temporary Disability Insurance
Private Plan Operations
Claims Review Unit
PO Box 957
Trenton, NJ 08625-0957

Telephone: (609) 292-2720
FAX: (609) 292-2537

Division of Temporary Disability Insurance
Private Plan Operations
PO Box 957
Trenton, NJ 08625-0957

Telephone: (609) 292-2720
FAX: (609) 292-2537

To request a Private Plan application click here.