North Carolina Disability Benefits

Member Information

This page provides an overview of disability forms, training documents and FAQs to help members understand the process and what information is needed to apply for disability benefits.

Frequently Asked Questions

DIPNC Overview for TSERS Members
Overview of short-term, extended short-term and long-term disability benefits for permanent employees who are members of the Teachers’ and State Employees’ Retirement System.

Training and Education Modules for TSERS members

Disability Process Checklist

To help guide you through the process, the following is a checklist of required forms listed in the order that they must be submitted. Click on the form number to retrieve the form. For assistance with completing the forms, please refer to the modules in the Training and Education section above.

For members of Local Governmental Employees' Retirement System (LGERS)
ü	Form 7 - Requesting Disability Retirement Benefits
ü	Form 7A - Medical Report for Eligibility Review
ü	Job Description (Provided by employer)
For members of Teachers' and State Employees' Retirement System (TSERS) vested on or before January 1, 1988
ü	Form 7- Requesting Disability Retirement Benefits
ü	Form 7A - Medical Report for Eligibility Review
ü	Job Description (Provided by employer)
For members of TSERS vested after January 1, 1988
DIPNC Short-term and/or Preliminary Long-Term application includes:
ü	Form 701 - Requesting Short-Term Benefits Through the Disability Income Plan of North Carolina
ü	Form 700 - Requesting Employer Information Required for Member Disability Income Plan Benefits
ü	Job Description (Provided by employer)
ü	Form 703 - Reporting Earnings for Short-Term Disability Benefits and Medical Report for Eligibility Review
ü	Form 7A - Medical Report for Eligibility Review
DIPNC Extended Short-term or Long-Term application includes:
ü	Form 704 - Requesting Additional Benefits Through DIPNC
ü	Form 701 - Requesting Short-Term Benefits Through the Disability Income Plan of North Carolina
ü	Form 700 - Requesting Employer Information Required for Member Disability Income Plan Benefits
ü	Job Description (Provided by employer)
ü	Form 703 - Reporting Earnings for Short-Term Disability Benefits and Medical Report for Eligibility Review
ü	Form 7A - Medical Report for Eligibility Review
ü	Form 711 - Determining and Recording Short-Term Disability Benefits

Contact Us: Members with questions regarding the forms or the disability process should contact the Division’s Member Services.