reglab/statecodes huggingface dataset:
New Jersey Administrative Code › Title 12 - LABOR AND WORKFORCE DEVELOPMENT › Chapter 18 - TEMPORARY DISABILITY BENEFITS › Subchapter 1 - GENERAL PROVISIONS › Section 12:18-1.8 - Payment of Benefits

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The Division (for State plan and disability during unemployment) or the insurer (for private plan), shall make all temporary disability benefit checks payable to the claimant, except under the following circumstances:
1. As prescribed under 43:21-42(b), relative to the payment of benefits due a deceased claimant;
2. As prescribed under 43:21-42(c), relative to the payment of benefits due a minor; or
3. As prescribed under 43:21-42(d), relative to the payment of benefits due an individual for whom the Director has appointed a representative as disability benefit beneficiary.
New Jersey Administrative Code › Title 12 - LABOR AND WORKFORCE DEVELOPMENT › Chapter 18 - TEMPORARY DISABILITY BENEFITS › Subchapter 2 - PRIVATE PLANS › Section 12:18-2.1 - Extent of coverage

Current through Register Vol. 56, No. 14, July 15, 2024
(a) All employees of the employer shall be covered by one or more private plans, without restrictions or exclusions, except that, subject to the approval of the Division, any private plan may exclude employees of a separate unit, craft, organization, plant, department or establishment, or other class or classes of employees. Application for such exclusion shall be submitted on a form and in a manner prescribed by the Director. The Division may not approve the exclusion of a class or classes of employees determined by the age, sex or race of the employees or by the wages paid such employees, if, in the opinion of the Division, such exclusion would result in a substantial selection of risk adverse to the State plan. For the purposes of this regulation, the employees of an employing unit (not a subject employer) performing services for an employer, as defined in 43:21-19(g)  shall be considered a class of employees which may be excluded.
(b) Employees excluded from a private plan shall be covered under the State plan and the employer shall be liable for the deduction and payment of workers' contributions and employer's contributions, as required by 43:21-7.
(c) All proposed private plans shall be submitted for review and approval by the Division. An employer failing to secure the approval of a private plan shall be deemed to be covered under the State plan and the employer shall be liable for the deduction of workers' contributions and payments of workers' and employer's contributions to the Fund as required by 43:21-7 until such date as a private plan is effective.
(d) An employee who ceases to be covered by a private plan, whether by termination of the plan, changing employers or for any other reason, shall, if otherwise eligible, become entitled to disability benefits from the Fund.
(e) The responsibility for coverage shall be established by the covered individual's last employer. The application for benefits shall be processed by the insurer, if the employer has an approved private plan and the individual is covered by that plan, or the State plan if the employer has State plan coverage. However, claims coming within the purview of 12:18-1.5, 2.10 or 3.5 shall be governed thereby.
New Jersey Administrative Code › Title 12 - LABOR AND WORKFORCE DEVELOPMENT › Chapter 18 - TEMPORARY DISABILITY BENEFITS › Subchapter 2 - PRIVATE PLANS › Section 12:18-2.2 - Benefits

Current through Register Vol. 56, No. 14, July 15, 2024
(a) An employee shall not be entitled to any benefits from the Fund with respect to any period of disability commencing while he or she is covered under a private plan.
(b) An employee shall not be paid any benefits for disability during unemployment (43:21-3, 4) for any period of disability commencing while he or she is a "covered individual" as defined in 43:21-27(b).
(c) The benefits provided by a private plan shall be set forth in the plan both as to eligibility requirements and amounts payable.
(d) If application for benefits is made under the State plan or Disability During Unemployment and it is determined that the claim should have been made under a private plan, an employee shall not be deprived of benefits under the private plan for failure to give timely notice and proof of disability provided that:
1. The application to the State plan would have been timely notice to the private plan if it had been then made; and
2. Proof of disability is furnished under such private plan within the period required therein or within 30 days after the employee has notice that the claim should have been made thereunder.
New Jersey Administrative Code › Title 12 - LABOR AND WORKFORCE DEVELOPMENT › Chapter 18 - TEMPORARY DISABILITY BENEFITS › Subchapter 2 - PRIVATE PLANS › Section 12:18-2.3 - Proof of coverage

Current through Register Vol. 56, No. 14, July 15, 2024
Notice, in a form approved by the Director, of the benefits provided by the private plan shall be furnished to the covered employees either by individual certificates or other direct notification at the time of coverage, or by conspicuous and continuing posting at the place of employment. This notice shall reflect current rates, eligibility requirements, benefit entitlements, and appeal rights to the Division as specified in 12:18-2.6. This notice shall be available for inspection at the work site. A copy of the notice shall be submitted annually to the Division.
New Jersey Administrative Code › Title 12 - LABOR AND WORKFORCE DEVELOPMENT › Chapter 18 - TEMPORARY DISABILITY BENEFITS › Subchapter 2 - PRIVATE PLANS › Section 12:18-2.4 - Choice of doctor

Current through Register Vol. 56, No. 14, July 15, 2024
(a) An employee covered under a private plan shall have the right to choose his or her own attending licensed medical practitioner, but he or she may be required to submit, not more often than once a week, to an examination by a licensed medical practitioner designated by the employer, insurer or organization paying benefits.
(b) Where a covered employee has utilized a licensed medical practitioner, and that licensed medical practitioner has examined the covered employee and has diagnosed him or her with a disabling condition, and where the licensed medical practitioner has certified that the employee's condition renders him or her unable to perform the duties of his or her employment for a given period of time, the employer, insurer or organization paying benefits may only deny benefits to the covered employee during that period so certified where:
1. The employer, insurer or organization paying benefits has contacted the covered employee's personal licensed medical practitioner and has reached a mutual agreement therewith as to a change in the period of the covered employee's disability;
2. A licensed medical practitioner designated by the employer, insurer or organization paying benefits has examined the covered employee and has determined that the covered employee is no longer disabled. Where such a determination has been made, benefits shall not be paid beyond the date of the examination;
3. A covered employee refuses to submit to or fails to attend an examination conducted by a licensed medical practitioner designated by the employer, insurer or organization paying benefits, in which case the covered employee shall be disqualified from receiving all benefits for the period of disability in question, except as to benefits already paid; or
4. The employer, insurer or organization paying benefits has obtained credible factual evidence showing that the covered employee is performing activities that demonstrate that he or she is able to perform the duties of his or her regular employment. In such instances, benefits shall not be paid beyond the date that such factual evidence is obtained.
New Jersey Administrative Code › Title 12 - LABOR AND WORKFORCE DEVELOPMENT › Chapter 18 - TEMPORARY DISABILITY BENEFITS › Subchapter 2 - PRIVATE PLANS › Section 12:18-2.5 - Nonprofit provision

Current through Register Vol. 56, No. 14, July 15, 2024
No employer, union or association representing employees and no person acting in behalf of any of the foregoing shall so administer or apply the provisions of a private plan as to derive any profit therefrom.
New Jersey Administrative Code › Title 12 - LABOR AND WORKFORCE DEVELOPMENT › Chapter 18 - TEMPORARY DISABILITY BENEFITS › Subchapter 2 - PRIVATE PLANS › Section 12:18-2.6 - Appeals

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The appeal procedures for private plan temporary disability cases are found at N.J.A.C. 1:12A and are appendixed at the end of this chapter.
(b) If an employee covered under a private plan is denied benefits by the insurer for any period of disability or he or she disagrees with a determination of benefits made by the insurer, he or she has the right to appeal the determination or denial.
(c) The appeal or complaint shall be filed with the Division within one year after the beginning of the period for which benefits are claimed. Such appeal or complaint shall be filed, either personally or by mail, by the employee or his or her representative. A late appeal shall be considered on its merits if it is determined that the appeal was delayed for good cause. Good cause exists in circumstances where it is shown that:
1. The delay in filing the appeal was due to circumstances beyond the control of the appellant; or
2. The appellant delayed filing the appeal for circumstances which could not have been reasonably foreseen or prevented.
New Jersey Administrative Code › Title 12 - LABOR AND WORKFORCE DEVELOPMENT › Chapter 18 - TEMPORARY DISABILITY BENEFITS › Subchapter 2 - PRIVATE PLANS › Section 12:18-2.7 - Review

Current through Register Vol. 56, No. 14, July 15, 2024
(a) All approved private plans shall be reviewed by the Division during their continuance to insure compliance with the law and regulations thereunder.
(b) Where a decision to accept or deny a claim is not made within 45 days of filing of claim, the insurer shall notify the Division of such fact giving the reasons therefor.
New Jersey Administrative Code › Title 12 - LABOR AND WORKFORCE DEVELOPMENT › Chapter 18 - TEMPORARY DISABILITY BENEFITS › Subchapter 2 - PRIVATE PLANS › Section 12:18-2.8 - Application for approval

Current through Register Vol. 56, No. 14, July 15, 2024
(a) An employer desiring to establish a private plan for the payment of benefits to employees, shall file an application on a form and in a manner prescribed by the Director. In requesting the form, the employer shall inform the Division whether the benefits will be provided by a contract of insurance, or by an agreement between the employer and a union or association representing the employees or by the employer as a self-insurer. (b) If two or more employers desire to have their private plans insured by a single policy of insurance, either by mutual agreement or by agreement as set forth in (a) above, each shall file an application for approval on a form and in a manner prescribed by the Director, designating a nominee, designee, trustee or one of them as the duly authorized agent for the purposes of this Act.
(c) All documents required by the Division for the completion of the approval process shall be submitted within 90 days of the date the application is received. A new application shall be filed if all such documents are not received within 90 days unless the employer can demonstrate good cause for the delay. For the purposes of this section, "good cause" means any situation over which the employer did not have control and which was so compelling as to prevent the employer from submitting the documents as required by the Division.
(d) An application submitted for approval of a private plan shall bear the signature of an authorized representative of the insuring organization, if the private plan is to be insured by an admitted insurer or union welfare fund, and:
1. A corporate officer if the employer is a corporation;
2. The owner if the employer is an individual; or
3. A partner if the employer is a partnership.
New Jersey Administrative Code › Title 12 - LABOR AND WORKFORCE DEVELOPMENT › Chapter 18 - TEMPORARY DISABILITY BENEFITS › Subchapter 2 - PRIVATE PLANS › Section 12:18-2.9 - Minimum plan requirements

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Each private plan, in order to secure Division approval, shall provide to the employees covered thereby rights equal at least to those set forth in 43:21-37 to 43:21-42 inclusive, by assuring that:
1. The private plan shall cover all employees, except as provided elsewhere in this chapter, for any disability commencing while the plan is in effect.
2. Eligibility requirements for benefits shall be no more restrictive than those requirements for benefits payable under the State plan.
3. Except as provided for in 12:18-2.1 0 (Concurrent coverage) of this chapter, the benefits payable to each employee covered thereunder shall be at least equal, in both weekly amount and duration, to those which would be payable to the employee under the State plan, but for his or her inclusion in the private plan.
New Jersey Administrative Code › Title 12 - LABOR AND WORKFORCE DEVELOPMENT › Chapter 18 - TEMPORARY DISABILITY BENEFITS › Subchapter 2 - PRIVATE PLANS › Section 12:18-2.10 - Concurrent coverage

Current through Register Vol. 56, No. 14, July 15, 2024
(a) A private plan shall not preclude simultaneous or concurrent coverage by reason of an individual's employment with two or more employers. Such employee shall receive not less than the benefits payable under the State plan both as to benefit amount and duration.
(b) A covered individual is in "concurrent employment" if he or she is in employment with two or more employers during the last calendar day of employment immediately preceding the period of disability. The term "concurrent employers" means the covered employers with whom an employee was employed on the last day of employment.
(c) If an employee is in concurrent employment and only one employer has a private plan, then the employee shall be entitled to receive benefits under that private plan, if otherwise eligible. Such benefits shall not be less than he or she would be eligible to receive under the State plan with respect to all employment, if he or she were covered under the State plan. No benefits shall be payable under the State plan for disability commencing while he or she is covered under such private plan.
(d) If an employee is in concurrent employment with two or more employers and more than one employer has a private plan, the employee shall be entitled to receive benefits under each private plan, if otherwise eligible. Each private plan shall pay not less than the full amount the employee would be eligible to receive if covered under the State plan. When determining the amount to be paid, the private plan may take into account coverage under other private plans and benefits may be apportioned among the plans in the same proportion that the employee earned wages with each employer in the last eight calendar weeks immediately preceding the period of disability. In no event shall the employee receive less than the benefits to which he or she would be entitled under the most favorable plan, both as to weekly amount and duration.
New Jersey Administrative Code › Title 12 - LABOR AND WORKFORCE DEVELOPMENT › Chapter 18 - TEMPORARY DISABILITY BENEFITS › Subchapter 2 - PRIVATE PLANS › Section 12:18-2.11 - Employee consent

Current through Register Vol. 56, No. 14, July 15, 2024
(a) If employees who are subject to the provisions of a collective bargaining agreement are required to contribute toward the cost of benefits under a private plan, such plan shall not become effective, unless prior to the effective date, a majority of the employees in the class or classes to be covered by the private plan have agreed to the private plan by written election, unless the collective bargaining agreement expressly waives the employees' right to a majority election as a condition for the private plan.
(b) In the case of employees not subject to a collective bargaining agreement, no employee consent or written election is required for the withdrawal from the State plan or the establishment of a private plan.
(c) Written elections held pursuant to this section may be conducted by electronic communications evidenced by the electronic signature of the employee, as the term electronic signature is defined at N.J.S.A. 12A:12-2, but shall not be conducted in a manner inconsistent with any applicable terms of a collective bargaining agreement.
New Jersey Administrative Code › Title 12 - LABOR AND WORKFORCE DEVELOPMENT › Chapter 18 - TEMPORARY DISABILITY BENEFITS › Subchapter 2 - PRIVATE PLANS › Section 12:18-2.12 - Evidence of consent

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Where employee consent is required pursuant to N.J.A.C. 12:18-2.11, there shall be submitted on the application for approval a statement showing the total number of eligible employees in employment by the employer and the number of employees who agreed to the plan, together with the individual ballots or documents bearing the employees' signatures of consent. The ballots or documents of consent, after review by the Division, shall be returned to the employer.
(b) The results of such election shall be posted promptly and the records pertaining thereto shall be maintained by the employer and be available for inspection by Division representatives during the existence of the private plan.
New Jersey Administrative Code › Title 12 - LABOR AND WORKFORCE DEVELOPMENT › Chapter 18 - TEMPORARY DISABILITY BENEFITS › Subchapter 2 - PRIVATE PLANS › Section 12:18-2.13 - Certificate of approval; effective date

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The Division shall issue a "Certificate of Approval of Private Plan" which shall constitute evidence of approval of the plan by the Division.
(b) Each such private plan shall be submitted in detail to the Division and shall be approved by the Division to take effect as of the first day of the calendar quarter next following the submission date, or as of an earlier date if requested by the employer and approved by the Division. Grounds for approval of an earlier effective date include but are not limited to, whether the plan:
1. Is the result of an agreement contained in a labor-management contract; or
2. Covers a newly formed subsidiary of an employer with an existing private plan; or
3. Is the result of a succession from an employer with an existing private plan. As provided in 43:21-7(c)(7)(A), a successor in interest is an entity that acquires the organization, trade, or business, or substantially all the assets of an employer, whether by merger, consolidation, sale, transfer, descent, or otherwise.
New Jersey Administrative Code › Title 12 - LABOR AND WORKFORCE DEVELOPMENT › Chapter 18 - TEMPORARY DISABILITY BENEFITS › Subchapter 2 - PRIVATE PLANS › Section 12:18-2.14 - Withdrawal of certificate of approval

Current through Register Vol. 56, No. 14, July 15, 2024
(a) A certificate of approval may be withdrawn or revoked upon notice and opportunity for hearing if the Division finds:
1. That there is danger that benefits accrued or to accrue will not be paid; or
2. That the security for such payment is insufficient; or
3. That there has been a failure to comply with the terms and conditions of the plan; or
4. That there has been a failure to pay benefits to eligible claimants promptly; or
5. That in the case of an insured private plan, the insurance company has given notice of the cancellation of the policy of insurance thereunder; or
6. That the employer, his or her duly authorized agent, the union or association representing the employees or any person acting in behalf of any of the foregoing are deriving a profit in instituting or administering the plan; or
7. That the employer, or insurer or any other party responsible for the payment of benefits, as the case may be, has failed to comply with the Act and regulations; or
8. Other good cause.
New Jersey Administrative Code › Title 12 - LABOR AND WORKFORCE DEVELOPMENT › Chapter 18 - TEMPORARY DISABILITY BENEFITS › Subchapter 2 - PRIVATE PLANS › Section 12:18-2.15 - Termination on petition by employees

Current through Register Vol. 56, No. 14, July 15, 2024
Upon receipt by the Division of a petition to terminate a private plan, signed by not less than ten per cent of the employees covered by the private plan, the Division shall order an election, after 30 days' written notice to the employer. No such election shall be required more often than once in any 12 consecutive months. The Division shall, whenever it deems necessary, supervise such election.
New Jersey Administrative Code › Title 12 - LABOR AND WORKFORCE DEVELOPMENT › Chapter 18 - TEMPORARY DISABILITY BENEFITS › Subchapter 2 - PRIVATE PLANS › Section 12:18-2.16 - Eligibility to petition

Current through Register Vol. 56, No. 14, July 15, 2024
(a) An employee, to be eligible to sign any petition requesting an election to discontinue a private plan, shall be in the employ of the employer as of the date of the petition, and covered by the plan. The form of the petition requesting an election shall be prescribed by the Director.
(b) An employee, to be eligible to vote in any election to discontinue a private plan, shall be in the employ of the employer as of the date of the election and covered by the plan.
New Jersey Administrative Code › Title 12 - LABOR AND WORKFORCE DEVELOPMENT › Chapter 18 - TEMPORARY DISABILITY BENEFITS › Subchapter 2 - PRIVATE PLANS › Section 12:18-2.17 - Requirements of election

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Any election to discontinue a private plan shall be in accordance with this Subchapter. The election shall be by written ballot but the Director may order a secret ballot if the facts so warrant. The ballot shall be so worded as to give each employee voting an opportunity to vote for or against the discontinuance of the private plan. The time and place of the election shall be convenient to employees, and on not less than 30 days' written notice by the employer to the employees. The notice of the election and the results thereof shall be given to the employees affected by one of the following methods:
1. By posting on bulletin boards in the employer's establishment or place of business for a period of not less than 30 days;
2. By mail addressed to each employee;
3. By personal service.
New Jersey Administrative Code › Title 12 - LABOR AND WORKFORCE DEVELOPMENT › Chapter 18 - TEMPORARY DISABILITY BENEFITS › Subchapter 2 - PRIVATE PLANS › Section 12:18-2.18 - Retention of election records

Current through Register Vol. 56, No. 14, July 15, 2024
The records pertaining to any election to discontinue a private plan shall be retained by the employer and shall be available for inspection by the Division representatives for a one-year period from the date of termination.
New Jersey Administrative Code › Title 12 - LABOR AND WORKFORCE DEVELOPMENT › Chapter 18 - TEMPORARY DISABILITY BENEFITS › Subchapter 2 - PRIVATE PLANS › Section 12:18-2.19 - Certification of election results

Current through Register Vol. 56, No. 14, July 15, 2024
A statement shall be submitted forthwith by the employer to the Division showing the total number of employees eligible to vote, and the number of employees who voted for and against termination of the plan.
New Jersey Administrative Code › Title 12 - LABOR AND WORKFORCE DEVELOPMENT › Chapter 18 - TEMPORARY DISABILITY BENEFITS › Subchapter 2 - PRIVATE PLANS › Section 12:18-2.20 - Discontinuance

Current through Register Vol. 56, No. 14, July 15, 2024
(a) As provided in the Act, a private plan shall be discontinued when the Division withdraws its approval thereof upon being furnished satisfactory evidence that a majority of the covered employees have made election in writing to discontinue such plan.
(b) An employer may discontinue a private plan upon proper notice to the Division and to the covered employees.
New Jersey Administrative Code › Title 12 - LABOR AND WORKFORCE DEVELOPMENT › Chapter 18 - TEMPORARY DISABILITY BENEFITS › Subchapter 2 - PRIVATE PLANS › Section 12:18-2.21 - Responsibility of employer on withdrawal of certificate of approval

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The employer shall be liable for the deduction of workers' contributions and payment of workers' and employer's contributions, as required by 43:21-7, with respect to wages paid for employment subsequent to the effective date of withdrawal or revocation of the certificate of approval, unless the Division has approved another private plan to become effective on the day immediately following.
(b) Form DP-22, Notice of Withdrawal of Approval of Private Plan, shall be conspicuously posted for a period of not less than 30 days at or in the employer's factory, establishment or other premises at which the workers, who were covered under the private plan, are employed, as evidence of the termination of that plan.
New Jersey Administrative Code › Title 12 - LABOR AND WORKFORCE DEVELOPMENT › Chapter 18 - TEMPORARY DISABILITY BENEFITS › Subchapter 2 - PRIVATE PLANS › Section 12:18-2.22 - Insurer liability

Current through Register Vol. 56, No. 14, July 15, 2024
(a) A policy of insurance providing for the payment of benefits under a private plan shall provide that the insurer shall remain liable for the payment of benefits to any employee covered by the policy and the private plan for any period of disability commencing, during the continuance of the private plan, after the policy became effective and prior to the termination of the policy.
(b) At least 60 days' notice shall be given to the Division by the insurer or the policyholder before termination of the policy becomes effective, except that, if the policy is being terminated by reason of a change of insurer, this requirement may be waived.
(c) If a policy is being terminated for nonpayment of premium, at least 15 days' written notice shall be given to the Division before termination of the policy becomes effective.
New Jersey Administrative Code › Title 12 - LABOR AND WORKFORCE DEVELOPMENT › Chapter 18 - TEMPORARY DISABILITY BENEFITS › Subchapter 2 - PRIVATE PLANS › Section 12:18-2.23 - Mandatory provision

Current through Register Vol. 56, No. 14, July 15, 2024
Each contract of insurance providing for the payment of benefits under a private plan shall contain a clause or clauses guaranteeing that the benefits meet the requirements of 12:18-2.9, Minimum plan requirements.
New Jersey Administrative Code › Title 12 - LABOR AND WORKFORCE DEVELOPMENT › Chapter 18 - TEMPORARY DISABILITY BENEFITS › Subchapter 2 - PRIVATE PLANS › Section 12:18-2.24 - Security required

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The security required by the Division from an employer whose private plan does not provide for the assumption of the liability to pay benefits by an insurer, duly authorized and admitted to do business in this State, shall be in the form of a cash deposit, a bond of an admitted surety insurer conditioned on the payment of obligations under the plan, or bearer bonds issued or guaranteed by the United States of America or issued by this State, the amount to be determined by the Division upon the basis of the size of the payroll, the class or classes of risks contemplated, the financial standing of the employer and any additional factors which the Division may deem proper.
(b) The amount shall not be less than one-half of the contributions which would have been paid by the employees to be covered by the private plan during the previous year, or one-half of the estimated contributions of such employees for the ensuing year, whichever is greater.
New Jersey Administrative Code › Title 12 - LABOR AND WORKFORCE DEVELOPMENT › Chapter 18 - TEMPORARY DISABILITY BENEFITS › Subchapter 2 - PRIVATE PLANS › Section 12:18-2.25 - Security exemption

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Exemption from the requirement of 12:18-2.2 4, Security required, shall be granted to any employer who:
1. Is exempt from insuring the employer's workers' compensation liability, as provided by law; or
2. Satisfies the Division as to the employer's financial responsibility to pay the benefits provided by the employer's plan by furnishing a complete, current financial statement and such other proof as may be acceptable to the Division. An annual review of the financial responsibility will be made.
New Jersey Administrative Code › Title 12 - LABOR AND WORKFORCE DEVELOPMENT › Chapter 18 - TEMPORARY DISABILITY BENEFITS › Subchapter 2 - PRIVATE PLANS › Section 12:18-2.26 - Disposition of security upon termination

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The security provided for in this subchapter should be applied by the Division to the payment of any unpaid obligations under the private plan. Upon termination of a private plan, which does not provide for the assumption by an admitted insurer of the liability to pay benefits, or upon withdrawal of approval of such private plan, the Division shall retain the security deposited, for the purpose of securing the payment of the obligations of the private plan. Upon the expiration of all benefit claims outstanding after the lapse of five complete calendar quarters following the effective date of termination or withdrawal of approval, the Division shall make a final assessment of the charges against the employer as provided in the Act and these regulations.
(b) If the amount of such assessment is not paid within 30 days after the date of notice thereof, the Division may collect the amount of the assessment out of the security on deposit, or may call upon the surety insurer for payment. Any security thereafter remaining shall be returned to the employer or the employer's legal representative or assignee, or the surety insurer paying the amount of such assessment shall be discharged of its obligation under the bond.
(c) The Division may make a partial return of the security at an earlier date if it finds that such security is in excess of that required.
New Jersey Administrative Code › Title 12 - LABOR AND WORKFORCE DEVELOPMENT › Chapter 18 - TEMPORARY DISABILITY BENEFITS › Subchapter 2 - PRIVATE PLANS › Section 12:18-2.27 - Exchange of information

Current through Register Vol. 56, No. 14, July 15, 2024
(a) If an employee's weekly benefit amount, determined under the benefit provisions of an employer's private plan, with respect to any period of disability, is less than the maximum weekly benefit amount payable under the State plan, and such weekly benefit amount has been computed on a basis different from that provided for covered individuals under the State plan, the weekly benefit amount shall be recomputed in accordance with the provisions of the New Jersey Temporary Disability Benefit Law (N.J.S.A. 43:21-40) as amended.
(b) If such recomputed weekly benefit amount is less than the maximum weekly benefit amount payable under the State plan and the computation of the "average weekly wage" for such recomputation yields a result which is less than the individual's average weekly earnings in employment, with all covered employers, during the base weeks in such base year, then the insurer which has undertaken to pay the benefits provided by the plan shall request the Division to provide such payer with a statement of the weekly wages of the employee earned from all covered employers during the base weeks in the base year immediately preceding the calendar week in which the employee's disability commenced, or immediately preceding the calendar week in which the employee submitted a claim for benefits consistent with N.J.S.A. 43:21-49(a)(3).
(c) When requesting such information, such payer shall furnish the Division with the following information:
1. Name, address and Social Security number of the employee;
2. Date on which the disability commenced, or date on which the employee submitted a claim for benefits consistent with N.J.S.A. 43:21-49(a)(3);
3. The names and addresses of such other employers, from whom the employee alleges to have earned wages immediately preceding his or her disability, or immediately preceding the date on which the employee submitted a claim for benefits consistent with N.J.S.A. 43:21-49(a)(3), as may be necessary to determine all wages earned in the required base weeks in the base year.
4. The weekly earnings of the employee from the employer during each of the calendar weeks in the base year immediately preceding the disability, or immediately preceding the date on which the employee submitted a claim for benefits consistent with N.J.S.A. 43:21-49(a)(3), if any.
New Jersey Administrative Code › Title 12 - LABOR AND WORKFORCE DEVELOPMENT › Chapter 18 - TEMPORARY DISABILITY BENEFITS › Subchapter 2 - PRIVATE PLANS › Section 12:18-2.28 - Notice from employers

Current through Register Vol. 56, No. 14, July 15, 2024
Within 10 days after the mailing of a request for information with respect to a period of disability, each employer having a private plan shall furnish the Division with any information requested or known to the employer which may bear upon the eligibility of the claimant.
New Jersey Administrative Code › Title 12 - LABOR AND WORKFORCE DEVELOPMENT › Chapter 18 - TEMPORARY DISABILITY BENEFITS › Subchapter 2 - PRIVATE PLANS › Section 12:18-2.29 - Reports by self-insurers

Current through Register Vol. 56, No. 14, July 15, 2024
(a) For the six month periods ending June 30 and December 31 of each calendar year during which a self-insured private plan is in effect, each employer shall, on a form prescribed by the Division, file a statement, on or before the 30th day following the end of the respective six month period, showing:
1. The number of claims received during the six month period;
2. The number of claims accepted during the six month period;
3. The amount of benefits paid during the six month period;
4. Such other information as the Division may require with respect to the financial ability of the self-insurer to meet the self-insured's obligations under the plan.
New Jersey Administrative Code › Title 12 - LABOR AND WORKFORCE DEVELOPMENT › Chapter 18 - TEMPORARY DISABILITY BENEFITS › Subchapter 2 - PRIVATE PLANS › Section 12:18-2.30 - Reports by unions and other benefit payers

Current through Register Vol. 56, No. 14, July 15, 2024
(a) For the six month periods ending June 30 and December 31 of each calendar year, each union, association of employees, nominee, trustee or organization which has assumed the liability to pay the disability benefits required under one or more private plans (which benefits are not guaranteed by a contract of insurance of an insurer duly authorized and admitted to do business in this State) shall, on a form prescribed by the Division, file a statement, on or before the 30th day following the end of the respective six month period, showing:
1. The number of claims received during the six month period;
2. The number of claims accepted during the six month period;
3. The amount of benefits paid during the six month period;
4. Such other information as the Division may require with respect to the financial ability of the union, association or employees, nominee, trustee or organization to meet their obligations under the plan.
New Jersey Administrative Code › Title 12 - LABOR AND WORKFORCE DEVELOPMENT › Chapter 18 - TEMPORARY DISABILITY BENEFITS › Subchapter 2 - PRIVATE PLANS › Section 12:18-2.31 - Reports by insurance companies

Current through Register Vol. 56, No. 14, July 15, 2024
(a) For the six month periods ending June 30 and December 31 of each calendar year, each insurance company which has assumed the liability to pay the disability benefits required under one or more private plans shall, on a form prescribed by the Division, file a report, on or before the 30th day following the end of the respective six month period, showing:
1. The number of claims received during the six month period;
2. The number of claims accepted during the six month period;
3. The amount of disability benefits paid during the six month period;
New Jersey Administrative Code › Title 12 - LABOR AND WORKFORCE DEVELOPMENT › Chapter 18 - TEMPORARY DISABILITY BENEFITS › Subchapter 2 - PRIVATE PLANS › Section 12:18-2.32 - Reports by employers having two or more plans

Current through Register Vol. 56, No. 14, July 15, 2024
On or before the 30th day following the close of each calendar half-year, each employer having two or more approved private plans in effect during such calendar half-year or any portion thereof shall, on a form prescribed by the Division, file a report showing the amount of taxable wages paid during such calendar half-year to employees while covered under each such private plan.
New Jersey Administrative Code › Title 12 - LABOR AND WORKFORCE DEVELOPMENT › Chapter 18 - TEMPORARY DISABILITY BENEFITS › Subchapter 2 - PRIVATE PLANS › Section 12:18-2.33 - Unemployment disability account deficit

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The term "unemployment disability account deficit" means any negative balance between the credits and debits of the account as determined by the Act.
(b) If the accumulated deficit at the end of any calendar year after interest and other earnings have been credited in accordance with the Act exceeds $ 200,000, such deficit shall be assessed and shall be collected under the provisions of 43:21-14, except that interest shall not accrue on any such assessment until 30 days after the date of notice of such assessment.
New Jersey Administrative Code › Title 12 - LABOR AND WORKFORCE DEVELOPMENT › Chapter 18 - TEMPORARY DISABILITY BENEFITS › Subchapter 2 - PRIVATE PLANS › Section 12:18-2.34 - Assessment of costs of administration

Current through Register Vol. 56, No. 14, July 15, 2024
Any assessment under the provisions of 43:21-48 shall be collected under the provisions of 43:21-14, except that interest shall not accrue on any such assessment until 30 days after the date of notice of such assessment.
New Jersey Administrative Code › Title 12 - LABOR AND WORKFORCE DEVELOPMENT › Chapter 18 - TEMPORARY DISABILITY BENEFITS › Subchapter 2 - PRIVATE PLANS › Section 12:18-2.35 - Assessment of amount of refund of workers' contributions applicable to private plans

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The portion of the aggregate amount of refunds to workers during any calendar year pursuant to 43:21-7(d)(3)  to be assessed against private plans shall be determined by multiplying the aggregate amount of such refunds by the ratio of taxable wages involved in such refunds and paid by employers to employees covered under private plans to the total taxable wages involved in such refunds and paid by all employers.
(b) Such amount shall be prorated among the applicable private plans in the proportion that the wages covered by each plan bears to the total private plan wages in such refunds.
(c) The amount so prorated to a private plan shall be assessed against the employer, or the insurer if the insurer has indemnified the employer with respect thereto, and shall be collected under the provisions of 43:21-14 except that interest shall not accrue on such assessment until 30 days after the date of notice of such assessment.
(d) The amounts so recovered by the Division shall be paid into the State Disability Benefits Fund. (See N.J.A.C. 12:16-15, Application for workers' refunds.)
New Jersey Administrative Code › Title 12 - LABOR AND WORKFORCE DEVELOPMENT › Chapter 18 - TEMPORARY DISABILITY BENEFITS › Subchapter 2 - PRIVATE PLANS › Section 12:18-2.36 - Liability of successor employer

Current through Register Vol. 56, No. 14, July 15, 2024
Any employer who acquires the organization, trade, assets or business, in whole or in part, whether by merger, consolidation, sale, transfer, descent or otherwise, from an employer liable for any assessment made under 43:21-7(d)(3), 43:21-46 and 43:21-48 shall likewise be liable for such assessment.
New Jersey Administrative Code › Title 12 - LABOR AND WORKFORCE DEVELOPMENT › Chapter 18 - TEMPORARY DISABILITY BENEFITS › Subchapter 2 - PRIVATE PLANS › Section 12:18-2.37 - Continuation of plan on successor employer

Current through Register Vol. 56, No. 14, July 15, 2024
(a) If there is a change in the employer and the successor employer assumes the obligations and liability of the predecessor under the plan, the plan shall be transferred to the successor, if:
1. The workers to be covered by the plan immediately after the succession are not required to contribute to the cost of the plan; or
2. The class or classes of workers covered by the plan immediately prior to the succession constitute a majority of the workers in the same class or classes employed by the successor immediately after the succession; or
3. A majority of the workers in the class or classes covered by the plan in the employ of the successor immediately after the succession give their written consent to the plan; or
4. The plan is limited to the separate unit, plant, department or establishment operated by the predecessor and the provisions of paragraphs 1, 2 or 3 of this Section are met with respect to such separate unit, plant, department or establishment.
New Jersey Administrative Code › Title 12 - LABOR AND WORKFORCE DEVELOPMENT › Chapter 18 - TEMPORARY DISABILITY BENEFITS › Subchapter 2 - PRIVATE PLANS › Section 12:18-2.38 - Notice to covered employees

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Notice, in a form approved by the Director, of the benefits provided by the private plan shall be furnished to the covered employees by the employer by a conspicuous posting at the place of employment and by personal notice to each employee at the time of the establishment of the private plan, at any subsequent time of hire, and within three business days of when the employer knows, or should know, that the employee may have a need for disability benefits.
(b) The notice at (a) above shall reflect current rates, eligibility requirements, benefit entitlements, and rights of the employees under a private plan pursuant to the Temporary Disability Benefits Law, N.J.S.A. 43:21-25 et seq., including appeal rights, and shall include contact information for the private plan and instructions as to how to file for benefits with the private plan.
(c) In the event that an employer has an internet site or intranet site for exclusive use by its employees and to which all employees have access, posting of the notice at (a) above on the employer's internet or intranet site shall satisfy the conspicuous posting requirement set forth at (a) above.
(d) Providing to an employee through email the notice at (a) above shall satisfy the requirement at (a) above, that the employer provide each employee personal notice at the time of the establishment of the private plan, at any subsequent time of hire, and within three business days of when the employer knows or should know that the employee may have a need for disability benefits.
New Jersey Administrative Code › Title 12 - LABOR AND WORKFORCE DEVELOPMENT › Chapter 18 - TEMPORARY DISABILITY BENEFITS › Subchapter 3 - STATE PLAN › Section 12:18-3.1 - Extent of coverage

Current through Register Vol. 56, No. 14, July 15, 2024
(a) A claimant shall not be entitled to any benefits from the Fund with respect to any period of disability commencing while he or she is covered under a private plan.
(b) A claimant shall not be paid any benefits under 43:21-3 and 43:21-4 for any period of disability commencing while he or she is a "covered individual" as defined in 43:21-27(b).
(c) An individual who is covered by a private plan or is separated from his or her employment for a period of two weeks or more immediately prior to the disability shall not be entitled to any benefits under the State plan.
(d) If application for benefits is made under a private plan or for disability during unemployment (43:21-4 ) and it is determined that the claim should have been made under the State plan, a claimant shall not be deprived of benefits under the State plan for failure to give timely notice and proof of disability provided that:
1. The application to the private plan or for disability during unemployment (43:21-4 ) would have been timely noticed to the State plan if it had been then made; and
2. Proof of disability is made under the State plan not later than the time prescribed by the Act.
New Jersey Administrative Code › Title 12 - LABOR AND WORKFORCE DEVELOPMENT › Chapter 18 - TEMPORARY DISABILITY BENEFITS › Subchapter 3 - STATE PLAN › Section 12:18-3.2 - Notice and proof of disability

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Within 30 days after the commencement of a period of disability, a written notice of disability, on which a claim for State plan benefits is based, shall be furnished to the Division by or on behalf of the person claiming benefits. The notice need not be on any prescribed form but shall state the claimant's full name, address, and valid social security number, as well as the date on which the claimant was too sick (or disabled) to work. The filing of Form DS-1 (Proof and Claim for Disability Benefits) shall constitute notice of disability.
1. If an individual knows in advance when the period of disability will commence, the individual may notify the employer of the anticipated period of disability and submit to the Division a claim for benefits for that period, which shall include a statement of when the period of disability will commence and any certification requested by the Division, prior to, but not more than 60 days prior to, the date on which the period of disability will commence.
2. The Division shall process the claim at (a)1 above, immediately and, upon a finding that the claim is valid, shall pay the benefit upon the commencement of the period of disability or after any applicable one week waiting period, except that if the Division receives the claim less than 30 days before the commencement of the period of disability, the Division shall make the payment not more than 30 days after the receipt of the claim.
3. The periods of disability to which the provisions at (a)1 and 2 above apply shall include, but not be limited to, any of the following if the commencement date of the period of disability is known in advance: disability related to pregnancy or childbirth; disability related to scheduled medical procedures, treatments, or appointments for the individual; and disability related to scheduled ongoing care of the individual.
New Jersey Administrative Code › Title 12 - LABOR AND WORKFORCE DEVELOPMENT › Chapter 18 - TEMPORARY DISABILITY BENEFITS › Subchapter 3 - STATE PLAN › Section 12:18-3.3 - Filing of claims for benefits

Current through Register Vol. 56, No. 14, July 15, 2024
(a) All claims and other required documents relating thereto may be filed by mail except in those cases where the claimant is notified by the Division that a personal appearance or examination will be required. Filing by mail shall be deemed complete based on the postmark date, or in its absence, the date received by the Division.
(b) Disability benefits shall be payable to any claimant while outside of this State, provided he or she complies with the Act and this Subchapter. In such case, the attending medical practitioner shall be licensed under the laws applicable to the place where the claimant is receiving treatment.