The NJ M-10 form is a Request for Medical Information that the New Jersey Division of Temporary Disability Insurance mails out when a disability claim is missing medical details, when the medical statement needs clarification, or when what you reported doesn’t match what your healthcare provider reported.1Division of Temporary Disability and Family Leave Insurance. About the Program It is not the application itself. Your initial application is the DS-1; the M-10 shows up afterward, when something in the medical certification needs to be fixed before the state can approve your benefits. The faster your provider completes and returns it, the faster your claim moves.
Why You Received an M-10
The state sends an M-10 for one of three reasons: the application was filed without complete medical documentation, the medical statement your provider submitted raised questions, or something you reported on your part of the application contradicts what your provider reported on theirs.1Division of Temporary Disability and Family Leave Insurance. About the Program
A common trigger is a vague or missing estimated return-to-work date on the initial certification. Another is a mismatch between the date you said you stopped working and the date your doctor listed as the start of the disability. The form itself tells you what the state still needs, so read it carefully before handing it to your provider.
What Your Provider Needs to Fill In
The M-10 covers the same medical ground as Part C of the DS-1 application, with the state often flagging the specific items that need clarification. Your provider should be ready to document:
- The first date of treatment, the most recent visit, and how often they have been seeing you.
- The specific calendar date your condition prevented you from performing your regular job duties.
- A written diagnosis along with the ICD-10 code.
- Whether you have recovered, and if not, the estimated date you can return to work.
- Whether you are mentally capable of managing your own affairs, including the use of benefits.
- Dates of any emergency room visits, hospital stays, or surgeries, including whether any surgery was cosmetic.
- For pregnancy claims: estimated delivery date, actual delivery date, type of delivery, and any pre-term or postpartum complications.2State of New Jersey Department of Labor and Workforce Development. New Jersey Temporary Disability Benefits Application
Your provider also needs to sign and date the form, print their name, and include their license number and state of licensure. Blank fields, a missing signature, or dates that contradict what you reported in your part of the application can prompt another request from the state or an outright denial.
Pregnancy Recovery Periods
For pregnancy claims, New Jersey recognizes standard disability periods of six weeks after a vaginal delivery and eight weeks after a cesarean section.3State of New Jersey Department of Labor and Workforce Development. Temporary Disability Insurance: Information for Medical Professionals A provider can certify a longer or shorter period based on your condition, but certifications that deviate significantly from those windows without a clear medical explanation tend to draw extra scrutiny, which is often what prompts an M-10 in the first place.
A Note on the Waiting Week
Benefits do not start on the first day of disability. The program includes a seven-day unpaid waiting period, with payments beginning on the eighth day. If your leave lasts 22 days or longer, the state pays you retroactively for that initial waiting week.4Division of Temporary Disability and Family Leave Insurance. The Waiting Week for Temporary Disability, Explained If your return-to-work date on the M-10 is close to that 22-day threshold, getting the dates right can mean an extra week of benefits.
Who Can Sign the M-10
Not every healthcare professional qualifies to certify a Temporary Disability claim. The state’s approved list includes:
- Medical Doctor
- Osteopath
- Chiropractor
- Dentist
- Podiatrist
- Optometrist
- Psychologist
- Advanced Practice Nurse or Advanced Practice Registered Nurse
- Certified Nurse Practitioner
- Clinical Nurse Specialist
- Certified Nurse Midwife
Physician Assistants and Certified Professional Midwives may also sign, but only under the supervision of a licensed physician.5Division of Temporary Disability and Family Leave Insurance. Approved Medical Practitioners and Healthcare Providers
Providers are also limited to certifying conditions within their scope of practice. A chiropractor cannot certify a psychiatric disability, for example; you would need a referral to an approved provider who specializes in that area.6Division of Temporary Disability and Family Leave Insurance. Information for Healthcare Providers If an unqualified provider signed the original certification, that alone can be what triggered the M-10.
How and Where to Submit the M-10
Online is faster. If your original application was filed online, your provider can log into the state’s secure system using the Online Form ID from your application and complete the medical certification electronically. They receive immediate confirmation that the state got the submission.7New Jersey Division of Temporary Disability and Family Leave Insurance. Submit a Medical Certification The state will not notify your provider automatically; passing along the Form ID is your responsibility.
If your original claim was on paper, or if your provider prefers paper, the completed form can be faxed to 609-984-4138 or mailed to:
Division of Temporary Disability Insurance
PO Box 387
Trenton, NJ 08625-03876Division of Temporary Disability and Family Leave Insurance. Information for Healthcare Providers
If you mail a paper response, use a tracked delivery method and keep a copy.
How Quickly to Respond
The M-10 itself will note any specific deadline the state has set. In general, delays at this stage directly delay your benefits, so your provider should treat it with the same 14-day urgency the state applies to initial medical certifications.6Division of Temporary Disability and Family Leave Insurance. Information for Healthcare Providers Hand the form over as soon as you receive it, confirm your provider has your Online Form ID, and ask them to submit online when possible.
What Happens After You Send It Back
Your claim status is visible online once your application is in the system. Log in at myleavebenefits.nj.gov to check it. If you do not see a status update two weeks after submitting, call 609-292-7060 or send a message through the state’s contact form.8Division of Temporary Disability and Family Leave Insurance. What Happens After I Apply?
Once approved, benefits arrive on a Money Network/My Banking Direct prepaid Visa debit card mailed from Omaha, Nebraska in a plain envelope. Funds are available within three business days of each payment date, and you can use the card anywhere Visa debit is accepted, withdraw cash at ATMs, or transfer money to your personal bank account through the Money Network mobile app or the My Banking Direct website.9Division of Temporary Disability and Family Leave Insurance. How You’ll Get Your Money
If the Claim Is Denied Anyway
If your claim is denied, whether because of an unresolved M-10 issue or any other reason, you have 21 calendar days from the mailing date on the denial notice to file an appeal.10My Leave Benefits. Appealing a Decision Late appeals are not rejected automatically, but you must explain the delay, and an appeals examiner decides whether to proceed.
The Appeal Tribunal schedules a hearing by telephone or in person. You may bring witnesses and hire an attorney at your own expense, and free legal advisory services are available for claimants who cannot afford counsel.11New Jersey Department of Labor and Workforce Development. About the Appeal Tribunal If you need to postpone, request it at least three days before the hearing; postponements are granted only for substantial reasons, and failing to appear or be available for a scheduled telephone hearing can result in dismissal.