The NJ C-10 form is a one-page follow-up notice from the New Jersey Division of Temporary Disability and Family Leave Insurance. It arrives when your disability application is missing information or when your answers don’t match what your doctor or employer reported. The form lists the specific questions you need to re-answer, and you must return it promptly. If you don’t, your claim can be denied.1Division of Temporary Disability and Family Leave Insurance. Why Did I Get This? – Form Look Up
Why the Division Sent You This Form
There are two triggers. Either a required field on your original claim (the DS-1) was left blank, or something you wrote conflicts with the medical certification your healthcare provider submitted or the information the Division received from your employer. The C-10 marks the specific questions that need attention, so you don’t have to guess what went wrong.1Division of Temporary Disability and Family Leave Insurance. Why Did I Get This? – Form Look Up
Typical mismatches include a disability start date that doesn’t line up with your doctor’s records, incomplete employer information, or a vague description of your medical condition. The Division cross-references what you wrote against what your provider submitted, and any inconsistency can prompt a C-10.
Important boundary: the C-10 goes to you, not your doctor. When the Division needs updated information from a healthcare provider, it sends a different form (the M-10) directly to the provider. If a doctor’s office tells you they received a form about your claim, that’s a separate request and doesn’t remove your responsibility to return the C-10.
How to Fill Out the C-10
Read the form carefully before writing anything. Only the questions the Division has flagged need new answers, so focus there. Vague or partial responses risk another round of follow-up or a denial.1Division of Temporary Disability and Family Leave Insurance. Why Did I Get This? – Form Look Up
Pull your medical records first. Discharge summaries, visit notes, anything recent from your treating physician. Because the most common problem is a mismatch between your account and your doctor’s, your answers should track the medical documentation rather than your memory. If your doctor described your condition or the timeline differently than you did originally, correct your answer to match the records.
Sign and date the form. An unsigned C-10 won’t be processed. Check that your name and claim identification number are legible. A smudged ID number can send your paperwork into limbo.
How to Send the Form Back
Fax is the fastest option. The Division’s fax line is 609-984-4138.2Division of Temporary Disability and Family Leave Insurance. Contact Us Keep the confirmation page with the date and time as proof of delivery.
If you can’t fax, mail the form to:
Division of Temporary Disability and Family Leave Insurance
PO Box 387
Trenton, NJ 08625-03872Division of Temporary Disability and Family Leave Insurance. Contact Us
Certified mail with a return receipt gives you a record of exactly when the form arrived. First-class mail works, but you lose that paper trail if a dispute comes up later.
If you’re attaching a supporting document, such as a medical record, convert phone photos into high-contrast black-and-white PDFs before faxing. Raw photos of documents often come through illegible.3Division of Temporary Disability and Family Leave Insurance. When You’re Sick, Injured, or Post-Surgery
What Happens Next
A claims examiner reviews your updated answers against the rest of your file. Allow at least 14 days for processing before contacting the Division about your claim status.4Division of Temporary Disability Insurance. Claim for Disability Benefits DS-1 You can check for updates through the online claims portal at secure.dol.state.nj.us.
If your responses clear up the discrepancy, benefits continue or resume without further action from you. If questions remain, the Division may send another form or call you. In some cases, the medical review unit will require an independent medical examination with an agency-approved provider. That request arrives on a separate form (the M-40) and lists the appointment date and location.1Division of Temporary Disability and Family Leave Insurance. Why Did I Get This? – Form Look Up The exam is free to you, and refusing to appear disqualifies you from benefits for the disability period in question, except for payments already made.5New Jersey Department of Labor and Workforce Development. New Jersey Temporary Disability Benefits Law
Ignoring the C-10 or sending it back incomplete puts your entire claim at risk. The Division can deny benefits if it doesn’t get the information it needs.
If the Division Denies Your Claim
You have 21 calendar days from the date on the denial letter to file an appeal. Appeals can be filed online, or in writing by fax or mail. A written appeal must include your name, Social Security number, address, and signature, sent to the same fax number (609-984-4138) or mailing address you used for the C-10.6Division of Temporary Disability and Family Leave Insurance. Appeals
After you file, the Division first checks whether the issue can be resolved without a hearing. A representative may call or send another form asking for clarification. If that doesn’t settle things, your appeal goes to an appeal tribunal for a telephone hearing. You’ll get a separate notice with hearing details, and you must register no later than 3 p.m. on the business day before the hearing.6Division of Temporary Disability and Family Leave Insurance. Appeals
Have your paperwork ready: medical records, copies of forms you submitted, and any correspondence from the Division. You can have an attorney or witnesses join the call. The tribunal mails its decision after the hearing, along with instructions for further appeal.
Missing the 21-day deadline doesn’t automatically end things. You can still file a late appeal, but you’ll need to explain the delay, and an appeals examiner decides whether to accept it.6Division of Temporary Disability and Family Leave Insurance. Appeals
How the C-10 Differs From Other Division Forms
The Division uses several follow-up forms while a claim is being processed, and they’re easy to confuse:
- M-10 (Request for Medical Information) goes to your healthcare provider, not to you. It asks for updated medical details such as diagnosis, treatment plan, or a revised return-to-work date. If your doctor mentions one, make sure they respond so your benefits aren’t held up.
- M-40 (Notice of Medical Examination Required) notifies you of a mandatory independent medical exam with a Division-approved provider. Attend on the date listed or your claim may be denied.1Division of Temporary Disability and Family Leave Insurance. Why Did I Get This? – Form Look Up
- P-60 (Demand for Refund) is sent when the Division determines you were overpaid. You have 24 calendar days from the mailing date to appeal.6Division of Temporary Disability and Family Leave Insurance. Appeals
If you’ve received a C-10, the action is on you: answer the flagged questions, align them with your medical records, sign the form, and get it back to the Division by fax or certified mail with a record of when it arrived.