Disability Application

Do you need us to complete and submit an application for your disability benefits?

Simply fill out the patient/caregiver sections of your form(s) and upload the form(s) below. You may upload multiple forms. You will receive a confirmation email once we receive your form(s). After we submit the form(s) on your behalf, you will receive an email notification and a copy of the completed form(s) from us.

If you have any questions regarding your disability application, feel free to contact us at disability@altairhealth.com.


If you are filing a claim with the state of New Jersey and do not have the forms, you may obtain them by visiting the Division of Temporary Disability and Family Leave Insurance.