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Statutory Benefits

NJ Temporary Disability Insurance:
Benefits

NJ Temporary Disability Insurance: Benefits
At-A-Glance Cost

Temporary Disability Insurance in NJ provides covered employees with up to 26 weeks of partially-paid time off due to a non-work-related illness or disability, including mental conditions, as well as childbirth and pregnancy-related complications, such as bedrest.

 

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NJ TDI Maximum Benefit Amount and Duration

The benefit is based on  an employee’s average weekly wage, capped at a maximum amount, which is set by the state for each calendar year.  In 2022, TDI benefits pay 85% of the average weekly wage, to a maximum of $993 per week.

Benefit
effective date

Jan. 1,
2022


Maximum length of paid leave

26 WEEKS

 


Weekly benefit amount 

85
of average weekly wage,
to a max of
$993

Waiting period 


7  DAYS*




 


*The 7-day waiting period is covered after 22 consecutive days of disability; there is no waiting period for organ or bone donations.


How to Calculate The Benefit for Temporary Disability Insurance


  1. Determine the employee’s average weekly wage (AWW):

    • Count back over the last 5 completed quarters (see next section for details on how to count back).

    • Select the first 4 quarters. Add up the earnings over that time period and divide that total amount by the number of base weeks.


      Let’s look at an example: If the first day of the qualifying condition was  April 13, 2022, it would be calculated as follows:
      Previous, Completed Quarters Total Earnings  Number of Base Weeks AWW
      Q5 (1/1/22-3/31/22)  $9,500 13 base weeks
      Q4 (10/1/21-12/31/21) $9,500 13 base weeks
      Q3 (7/1/21-9/30/21) $7,000 12 base weeks
      Q2 (4/1/21-6/30/21) $7,000 12 base weeks
      Q1 (1/1/21-3/31/21) $7,000 10 base weeks
      1st 4 Completed Quarters $30,500 47 base weeks $648.94
      The AWW would be $30,500/47 base weeks = $648.94,

  2. Apply the 85% benefit factor:
    $648.94 * 85% = $551.60, the benefit payment would be $551

  3. Check if it falls within the maximum weekly benefit of $993:
    The cap would not apply in this case since $551 is well below $993.
    Now, if 85% of the AWW came out to more than the cap, the benefit amount would be $993.

    Let’s look an example for this scenario:
  4. If the employee earned $75,000 over the first 4 completed quarters, then the average weekly wage would be $1,596; times the 85% factor equals $1,356. In this case, the weekly benefit limit applies, providing $993 per week.



How to Calculate The Base Year and Minimum Gross Earnings Requirements for NJ TDI

To determine the base year earnings, count back from the date the claim began to the prior 4 out of 5 completed quarters. Here is a handy chart to figure identify the 4 quarters based on the claim filing date:

If the claim began in. . . . . . you would use the average weekly wage from this period:
Q1 (1/01-3/31/22) October 1, 2020 to September 30, 2021
Q2 (4/1-6/30/22) January 1, 2021 to December 31, 2021
Q3 (7/1-9/30/22)
April 1, 2021 to March 31, 2022
Q4 (10/1-12/31/22)
July 1, 2021 to June 30, 2022
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Minimum Gross Earnings Requirements: 

The employee needs to have worked 20 weeks for a minimum of $240 per week in 2022, totaling $12,000 in the base year (first 4 completed quarters). This determines the amount of weekly benefits they may receive with their claim application.  

If the TDI coverage is through ShelterPoint and the employee doesn’t have a standard base year, please let us know. We may be able to use an alternate method of calculating the base year earnings.


Temporary Disability Insurance & COVID-19

According to NJ state law, employees may be eligible for TDI benefits if their healthcare provider certifies that they are unable to work because they were diagnosed with COVID-19 or are at high risk for COVID-19 due to an underlying health condition.  Please visit our TDI Frequently Asked Questions for more information on filing a COVID-19 claim.

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TDI Frequently Asked Questions

 

What if the benefits were filed late?

There is a 30-day timeframe to file a claim once an employee is out on temporary disability. Thereafter, a valid reason for filing late is needed – but the benefit may be reduced or denied.

How does the 7-Day Waiting Period work?

During the first week an employee is out due to a qualified condition, they don’t receive benefits – unless the disability extends through more than 22 days, in which case they may receive a retro payment for the first 7 days.
Additionally, if the employee applied for disability due to an organ or bone marrow donation, the waiting period is waived, i.e., benefits would begin from day 1.

Is TDI only for residents of New Jersey?

No, the rule of thumb is that employees have to work in New Jersey to qualify for TDI benefits. So, it’s based on where someone works, not lives.

Does Temporary Disability Insurance provide job protection or anti-retaliatory provisions?

While TDI doesn’t provide job protection, employees may have job protection under the federal Family Medical Leave Act (FMLA).

Is pregnancy covered under Temporary Disability Insurance?

Yes, but the doctor will be required to certify that the employee is disabled and unable to work due to her pregnancy. Usually, the birth mother may receive benefits up to 4 weeks before the expected date of delivery, and 6 to 8 weeks after childbirth, depending on how the baby is delivered. The doctor would need to certify that there were complications more than 4 weeks before the expected delivery date or longer than 8 weeks after childbirth to request benefits for a longer period of time.

How do you file a COVID-19 claim?

If ShelterPoint provides the TDI benefits, follow the steps outlined in the next question and download the NJ TDI claim form here or right below in the Download Center module on this page. The healthcare provider needs to complete Part B (Medical Certificate); the employer needs to complete Part C.
If the state provides TDI benefits, please visit the state’s TDI webpage.
If another approved private plan provides the TDI benefits, please reach out the other insurance carrier who provides the coverage.

ShelterPoint provides Temporary Disability Insurance benefits at our business. Where do we file a claim?

There are 4 ways you can file a claim with ShelterPoint Life Insurance Company:
  1. By email:
    claims@shelterpoint.com
  2. By mail:
    ShelterPoint Life Insurance Company
    Attn: NJ TDI Claims
    1225 Franklin Avenue, Suite 475
    Garden City, NY 11530
  3. By fax:
    Fax 516-504-6414
  4. By upload of the claim package directly on our website
    Please send your completed claim package through one method only once, or it will be separated from processing to determine which package you submitted is the most complete, which may delay your claim.

NJ Temporary Disability Insurance Download Center


 

Looking for a TDI-related form, whether application or claim?


Visit our Download Center for forms such as the DP-1 Application form or Temporary Disability Claim Form.

Go Now 



Learn More About NJ Temporary Disability Insurance

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*The ShelterPoint family of companies operates under the “ShelterPoint” name strictly as a marketing name, and no legal significance is expressed or implied. The ShelterPoint family of companies consists of ShelterPoint Life Insurance Company, a NY-domiciled carrier, and its wholly-owned subsidiary ShelterPoint Insurance Company, a FL-domiciled carrier, depending on the state. ShelterPoint is a registered service mark.

Underwritten by: ShelterPoint Life Insurance Company (principal office in Garden City, NY) in: NJ (form# TDB-P-NJ)

This page is for informational purposes only and is not intended to provide legal counsel. Please consult with an appropriate professional for legal and compliance advice.

The information on this page is not intended as an offer of coverage (“Invitation to Contract”). It is for illustrative purposes only, providing a general overview of the services descried. It is not a contract. Available in NJ only. The Temporary Disability Benefits (TDB) Law (Temporary Disability Benefits law (P.L.1948, c.110 (C:43-21-25 et seq.) governs this private plan and its interpretation and administration. All coverage extends up to TDB Law limits reflected in this policy. Please refer to the policy and TDB law for coverage details, a complete listing of covered services, provisions, conditions, exclusions, and terms under which the policy may be continued or cancelled. In the event of conflicting information with the policy and applicable TDB Law, the policy and TDB Law will take precedence over what is shown in this material. Claim payment is not guaranteed; benefit amount depends on wages. Policies have a statutory 7-day waiting period.

 

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