The NJ M-01 medical certificate is the form your treating healthcare provider completes and sends to the New Jersey Division of Temporary Disability and Family Leave Insurance to certify that a non-work-related illness, injury, or pregnancy is keeping you from doing your job. It is the clinical half of a Temporary Disability Insurance claim: your application tells the Division who you are and what you earn, and the M-01 tells the Division why you cannot work. Your provider handles almost all of the completion and submission. Your job is to get the form in front of them quickly and confirm it went out.
When You Need an M-01
Every initial Temporary Disability Insurance claim needs one. Without the medical certification, the Division has no clinical basis to approve benefits, and your claim will sit.
Two situations do not use the M-01. If your injury or illness is work-related, workers’ compensation applies instead. And if you are a public employee applying for pension disability retirement through the Division of Pensions and Benefits, that program uses its own medical examination form and a separate application; the M-01 has no role there.1New Jersey Division of Pensions and Benefits. Forms and Publications
What Your Provider Has to Put on the Form
The M-01 is designed for the treating provider, not the patient. The clinical information the Division relies on to evaluate the claim includes a specific diagnosis coded with a current ICD code and the applicant’s estimated date of recovery.2New Jersey Division of Temporary Disability and Family Leave Insurance. Information for Healthcare Providers A complete certification typically documents:
- Your name, date of birth, and Social Security number, so the certification is linked to the right claim.
- A specific diagnosis with an ICD code. Vague or unspecified codes tend to trigger follow-up requests from the Division.
- The onset date and clinical history that ties the condition to your inability to perform your job.
- The functional limitations — what you cannot do, and why that keeps you out of work.
- An estimated recovery date. This date sets the initial benefit period the Division authorizes.
- The provider’s name, license number, and contact information, plus a signature. If a certified physician assistant (PA-C) completes the form, the supervising physician’s name and medical license number must also appear.2New Jersey Division of Temporary Disability and Family Leave Insurance. Information for Healthcare Providers
An unsigned or incomplete form will not be accepted, and the claim stalls until a corrected version arrives.
How the M-01 Gets Submitted
Providers can file the medical statement online through the Division’s provider portal at myleavebenefits.nj.gov, which is the faster route and gives immediate confirmation of receipt.3New Jersey Division of Temporary Disability and Family Leave Insurance. Medical Certifications Paper submissions go by mail to the Division of Temporary Disability and Family Leave Insurance. Do not send the M-01 to the Division of Pensions and Benefits; that agency runs a different program.
Your role is short but important. Bring the form (or the portal information) to the appointment where you discuss being out of work, hand it to the provider directly, and follow up within a few days to confirm it was actually submitted. The most common reason claims drag is a doctor’s office that treats the M-01 as low priority while the patient waits weeks for benefits to begin.
What the Division Does With It
Once the Division has both your claim application and the M-01, it reviews the diagnosis codes and the estimated recovery date to determine whether you qualify and for how long.2New Jersey Division of Temporary Disability and Family Leave Insurance. Information for Healthcare Providers If something looks off — say, a diagnosis code that does not line up with the limitations described — the Division will ask for more information before deciding.
Approved Temporary Disability Insurance benefits replace a portion of your average weekly wages for up to 26 weeks. There is a waiting period before payments begin, so benefits do not start on your first day out of work. You can track the claim’s status through the Division’s website.
If You Need More Time Than Your Provider Estimated
If your disability lasts longer than the recovery date on your original M-01, do not submit a second M-01. Your provider files Form M-03, the medical extension, to certify that the disability continues and to update the recovery date.3New Jersey Division of Temporary Disability and Family Leave Insurance. Medical Certifications The M-03 uses the same submission channels as the M-01. File it before the original certification period ends; a gap in medical documentation can interrupt your payments.
Mistakes That Delay Payment
A handful of preventable problems account for most M-01 delays:
- Missing or vague ICD codes. A narrative diagnosis without a specific code forces the Division to follow up. “Unspecified” codes invite more scrutiny than codes that name the actual condition.
- No estimated recovery date. Leaving the field blank means the Division cannot set a benefit period. Even chronic conditions need an estimate of when some return to work is possible.
- A PA-C filing without the supervising physician’s name and license number. The certification will be returned.
- Sending the form to the wrong agency. The M-01 belongs with the Division of Temporary Disability and Family Leave Insurance, not the Division of Pensions and Benefits.
- Waiting too long. The larger the gap between your last day of work and the medical certification, the longer you wait for benefits.
Get the form to your provider at the first appointment where work capacity comes up, ask them to file through the online portal, and check back within a few days. That single follow-up is usually what separates a claim that pays on time from one that does not.