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.

Visit My Leave Benefits at nj.gov