Official Site of The State of New Jersey

If you haven't created an account with us yet, you will need to do so in order to start a new application, or check on an existing claim.

Some problems that can cause error messages include:

Incorrectly formatting identifying information (Social Security number, date of birth, phone number).

• Social Security numbers must be entered with the dashes (XXX-XX-XXXX).
• Date of birth must be entered as a two-digit month, two-digit day, and four-digit year (mm-dd-yyyy).
• Phone number must be entered with the area code and dashes, no parentheses (XXX-XXX-XXXX)

Incorrectly entering the security code (unique image of numbers and letters at the bottom of the create and account page). 

• This code is case sensitive. Look carefully at the image before typing the characters in the box.

If you click a link to check your claim status or complete an application and the new page that loads is completely blank, try quitting your browser application. Use the X at the top right of your screen to close all browser windows. Then re-open the browser application and try again.

If you start to fill out an online application but close your browser or quit the application before completing it, the partially completed application should be saved so you can use your username and password to return to it later. 

We only keep incomplete applications in our system for 14 days. After that time, you will need to restart and complete a new application.

Make sure that you have answered all required questions (marked with a red asterisk). Carefully read any error messages that are displayed. They will tell you what information is missing or needs to be changed.

There are various reasons the online medical application may not allow you to proceed.

You should be aware that you may only complete your patient’s medical statement online while the claim is "undetermined" or "ineligible." Once an application for Temporary Disability benefits is approved, subsequent medical information can be submitted through the Medical Extension (M-03) application. Once an application for Family Leave benefits is approved, additional medical information can be provided on the Family Leave Insurance Continued Claim Certification (form FL-3). The claimant will be sent this form in the mail if they have additional Family Leave benefits to claim. If the claim is for caregiving leave, you may need to complete Part B of the form. Once completed, the form can be faxed or mailed to the Division. 

Another reason you may have trouble accessing the online medical application is that the claimant may have provided you the incorrect Form ID. If the Form ID you have does not work, reach out to your patient to confirm. Currently our online medical application works best by using the Internet Explorer web browser. If you’re using a different browser, such as Firefox or Google Chrome, you may also experience difficulties. 

If you are still having trouble submitting online information, you may mail or fax the Division a paper application (Part C) for Temporary Disability claims, or a paper application (Part C) for Family Leave Insurance claims.