TDB Process

TDB Claims are for accident or illness unrelated to the job

New Jersey Temporary Disability Benefits ("TDB") is a state disability insurance program designed to provide employees with some level of income replacement in case of disability caused off-the-job.

  Steps to take to determine employer's cost:
  1. Download an AC174 request form from here
  2. Place on letterhead, complete the detail in red, and scan back to us at
  3. We will contact the state with your letter
  4. We will market the results (see a sample) and present a quote from a private carrier
  5. Upon your approval of the quote, you will obtain 51% of your employees signatures on a consent form (see a sample) and submit that to us
  6. We will prepare a DP-1 (Application For Approval or Modification Of Insured Private Plan), signature ready (see a sample)
  7. You will sign 3 copies and mail them back (originals required)
  8. We will file the DP-1 with the state on your behalf
  9. Upon approval we will notify you and you will inform your payroll service provider to convert you to Private Plan
  10. We can talk to your PSP if you request it, to explain the change required
  11. Your payroll service provider should provide you with quarterly SUTA-base reporting to use in reconciling your premium bill
  12. You will be billed quarterly in arrears by the private carrier
  13. Failure to make timely payments may result in plan termination, state fines or other penalties
  For more information, contact us at:
(718) 535-7070 or