This page provides an overview of disability forms and documents to help members and employers understand the process and what information is needed to apply for disability benefits.
Members of the Teachers and State Employees' Retirement System or are ORP members may apply for disability with the Disability Income Plan of North Carolina (DIPNC). If members of the Local Governmental Employees', Consolidate Judicial and Legislative Retirement Systems begin receiving a disability benefit, they are considered retired.
You should talk to your employer, review the guides on the applicable disability forms, and submit a complete disability application package to the Retirement Systems Division if you are applying for DIPNC preliminary long-term, DIPNC extended short-term, or DIPNC long-term benefits. If you are applying for DIPNC short-term benefits, you should submit the package to your employer since the employer will pay your short-term benefits. Forms can be mailed to the Retirement Systems or faxed to (919) 855-5800.
| A complete DIPNC short-term and/or preliminary long-term application package includes: |
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| Form 701 - Requesting Short-Term Benefits Through the Disability Income Plan of North Carolina (you complete this form) |
| Form 700 - Requesting Employer Information Required for Member Disability Income Plan Benefits (your employer completes this form) |
| Job Description (Provided by employer) |
| Form 703 - Reporting Earnings for Short-Term Disability Benefits and Medical Report for Eligibility Review (you and a licensed physician complete this form) |
| Form 7A - Medical Report for Eligibility Review (a licensed physician completes this form) |
| Supporting medical documentation within six months |
| A complete DIPNC extended short-term or long-term application package includes: |
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| Form 704 - Requesting Additional Benefits Through DIPNC (you complete this form) |
| Form 701 - Requesting Short-Term Benefits Through the Disability Income Plan of North Carolina (you complete this form) |
| Form 700 - Requesting Employer Information Required for Member Disability Income Plan Benefits (your employer completes this form) |
| Job Description (Provided by employer) |
| Form 703 - Reporting Earnings for Short-Term Disability Benefits and Medical Report for Eligibility Review (you and a licensed physician complete this form) |
| Form 7A - Medical Report for Eligibility Review (a licensed physician completes this form) |
| Form 711 - Determining and Recording Short-Term Disability Benefits (your employer completes this form) |
| Supporting medical documentation within six months |
The Disability Income Plan of North Carolina (DIPNC) benefits handbook provides TSERS and ORP members with a description of the benefits available under DIPNC. It includes DIPNC eligibility requirements and examples of how DIPNC benefits are calculated. This handbook also includes a section describing how to apply for DIPNC benefits.