reglab/statecodes huggingface dataset:
New Jersey Administrative Code › Title 12 - LABOR AND WORKFORCE DEVELOPMENT › Chapter 18 - TEMPORARY DISABILITY BENEFITS › Subchapter 3 - STATE PLAN › Section 12:18-3.4 - Reduction of benefits

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The amount of benefits otherwise payable to a claimant under the State plan for any week of disability, or part thereof, shall be reduced by the amount paid concurrently under any governmental or private retirement, pension or permanent disability benefit or allowance program to which his or her most recent employing unit contributed on his or her behalf. If such latter benefits are being paid on a monthly basis, the amount thereof to be deducted for each day of disability shall be determined as 1/30 of such monthly amount, multiplied by seven, and the amount (disregarding any fractional part of a dollar) shall be subtracted from the weekly benefit rate. If such latter benefits are being paid on a weekly basis, the amount thereof to be deducted for each day of disability shall be determined as 1/7 of the weekly amount multiplied by the number of days of disability during that week and that amount (disregarding any fractional part of a dollar) shall be subtracted from the weekly benefit rate.
(b) The amount of benefits payable to a claimant under the State plan for any week of disability, or part thereof, shall not be reduced by the amount of benefits payable under any program as mentioned above, unless one or more payments thereunder have been received by the claimant prior to the date on which the check in payment of benefits under the State plan is issued.
New Jersey Administrative Code › Title 12 - LABOR AND WORKFORCE DEVELOPMENT › Chapter 18 - TEMPORARY DISABILITY BENEFITS › Subchapter 3 - STATE PLAN › Section 12:18-3.5 - Concurrent coverage

Current through Register Vol. 56, No. 14, July 15, 2024
(a) A covered individual is deemed to be in "concurrent employment" if he or she is in employment with two or more employers the last calendar day of employment preceding the commencement of a period of disability. The term "concurrent employers" means the covered employers with whom the individual was employed on such last day of employment.
(b) The concurrent employers contributing to the State Disability Benefits Fund on behalf of a covered individual in concurrent employment shall be deemed to be his or her "most recent covered employer" for the purpose of computing his or her average weekly wage as defined in the Temporary Disability Benefits Law (43:21-27(j). An individual shall have his or her weekly benefit amount under the State plan computed on the basis of his or her total wages with all such employers during the base weeks in the eight calendar weeks immediately preceding the calendar week in which the disability commenced.
(c) State plan benefits paid to a covered individual in concurrent employment shall be charged to the accounts of the individual's concurrent employers in the same proportion that the individual earned wages from his or her concurrent employers during the 52 calendar weeks immediately preceding the week in which the disability commenced.
New Jersey Administrative Code › Title 12 - LABOR AND WORKFORCE DEVELOPMENT › Chapter 18 - TEMPORARY DISABILITY BENEFITS › Subchapter 3 - STATE PLAN › Section 12:18-3.6 - Notice to claimant and employer

Current through Register Vol. 56, No. 14, July 15, 2024
(a) A claimant shall be given written notice of any decision on his or her claim and of the reason for any denial of his or her claim.
(b) If the "Employer's Statement" on Form DS-1 has not been completed by an employer or his or her representative, a request for information shall be mailed or delivered to the employer or employers by whom the claimant was employed at the commencement of the disability or by whom he or she was last employed if out of employment less than two weeks.
(c) A copy of the decision of eligibility of the claimant stating his or her weekly benefit rate and the probable duration for which benefits will be paid, shall be mailed or delivered to the employer or employers by whom such claimant was employed at the commencement of the disability or by whom he or she was last employed if out of employment less than two weeks. A notice of each payment of benefits shall be given to such employer or employers.
New Jersey Administrative Code › Title 12 - LABOR AND WORKFORCE DEVELOPMENT › Chapter 18 - TEMPORARY DISABILITY BENEFITS › Subchapter 3 - STATE PLAN › Section 12:18-3.7 - Notice required from employers

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Within 10 days after the mailing of a request for information with respect to a period of disability, an employer shall furnish the Division with any information requested or known to him or her which may bear upon the eligibility of the claimant.
(b) If any employer or employing unit fails to respond to the request for information within 10 days after the mailing of such request, the Division shall rely entirely on information from other sources, including an affidavit completed by the claimant to the best of his or her knowledge and belief with respect to his or her wages and time worked. If it is determined that any information in such affidavit is erroneous, no penalty shall be imposed on the claimant except in the event of fraud.
(c) Any employer failing to respond to a request for information within the prescribed time period shall be subject to the penalties provided under 43:21-55(b).
(d) The employer, within two working days after receipt of the decision of eligibility, shall furnish the Division with any information known to him or her bearing upon the eligibility of the claimant or duration of payments to be made.
(e) If after receipt of a decision of eligibility an employer acquires information which may render the claimant ineligible for benefits or reduce the rate or amount of benefits, such employer shall immediately forward the information to the Division.
(f) Whenever a decision of eligibility with respect to a period of disability is based upon information other than that supplied by an employer because such employer failed to respond to a request for information, such decision of eligibility and any subsequent determination thereunder shall be incontestable by the non-complying employer, as to any charges to his or her employer's account under 43:21-7(e)  for benefits paid prior to the close of the calendar week following the receipt of his or her reply. Such decision of eligibility shall be altered if necessary upon receipt of information from the employer, and any benefits paid or payable with respect to weeks or parts thereof occurring subsequent to the close of the calendar week following the receipt of the employer's reply shall be paid in accordance with such altered decision of eligibility.
New Jersey Administrative Code › Title 12 - LABOR AND WORKFORCE DEVELOPMENT › Chapter 18 - TEMPORARY DISABILITY BENEFITS › Subchapter 3 - STATE PLAN › Section 12:18-3.8 - Filing of appeals by claimants or employers

Current through Register Vol. 56, No. 14, July 15, 2024
Unless the claimant or the employer, within seven calendar days after the delivery of a determination or notification thereof, or within 10 calendar days after such notification was mailed to his or her last-known address, files an appeal from such determination, it shall be final and benefits shall be paid or denied in accordance therewith, except for such determinations as may be altered as provided in 12:18-3.7.
New Jersey Administrative Code › Title 12 - LABOR AND WORKFORCE DEVELOPMENT › Chapter 18 - TEMPORARY DISABILITY BENEFITS › Subchapter 3 - STATE PLAN › Section 12:18-3.9 - Rules on appeal

Current through Register Vol. 56, No. 14, July 15, 2024
The rules of the Board of Review shall govern appeals in disability benefit cases under the State plan. See appeal rules at N.J.A.C. 12:20.
New Jersey Administrative Code › Title 12 - LABOR AND WORKFORCE DEVELOPMENT › Chapter 18 - TEMPORARY DISABILITY BENEFITS › Subchapter 3 - STATE PLAN › Section 12:18-3.11 - Reduced work week

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Benefits shall be compensable under N.J.S.A. 43:21-29 for any period of disability "resulting in the individual's total inability to perform the duties of employment." Benefits shall also be compensable at a fractional part of the week as provided in N.J.S.A. 43:21-40 in such cases where the claimant was in employment with a full-time employer and a part-time employer immediately preceding the period of disability if the claimant is unable to perform the duties of his or her regular full-time employment, but he or she is able to perform totally different duties with his or her part-time employer.
(b) With respect to a period of disability of an individual who is otherwise eligible for benefits, but only able to return to work on a reduced basis while recovering from the disability, the individual, if permitted by the employer to return to work on a reduced basis, shall be paid an amount of benefits with respect to that week such that the sum of the wages and those benefits paid to the individual, rounded to the next lower multiple of $ 1.00, will equal the weekly benefit amount the individual would have been paid if unable to perform the duties of employment due to disability, provided that:
1. The individual must have been unable to perform the duties of employment due to disability and receiving full benefits for at least seven consecutive days prior to claiming partial benefits pursuant to this subsection;
2. The maximum duration of partial benefits paid pursuant to this subsection is eight weeks, unless the Division, after a review of medical documentation from a qualified healthcare provider, approves, in writing, an extension beyond eight weeks, but in no case shall the duration be extended more than 12 weeks; and
3. If the individual is able to return to work on a reduced basis, but the employer is unable or otherwise chooses not to permit the individual to do so, the individual will continue to be eligible for benefits until the individual is fully recovered from the disability and able to perform the duties of employment, but nothing in this subsection shall be construed to increase the total number of weeks of disability benefits for which the individual is eligible.
New Jersey Administrative Code › Title 12 - LABOR AND WORKFORCE DEVELOPMENT › Chapter 18 - TEMPORARY DISABILITY BENEFITS › Subchapter 3 - STATE PLAN › Section 12:18-3.12 - Exceptions to the seven-day waiting period

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Under the following circumstances, the seven-day waiting period for payment of benefits shall not apply, and, therefore, benefits shall be payable with respect to the first seven days of the period of disability:
1. If the benefits are payable for a period of disability that is the result of the donation of any organ or bone marrow by the covered individual; or
2. If the benefits are payable for a period of disability, where in the event of a state of emergency declared by the Governor, or when indicated to be needed by the Commissioner of Health or other public health authority, the disability is an illness caused by an epidemic of a communicable disease, a known or suspected exposure to the communicable disease, or efforts to prevent spread of the communicable disease, which requires in-home care or treatment of the employee due to:
i. The issuance by a healthcare provider, the Commissioner of Health, or other public health authority of a determination that the presence in the community of the employee may jeopardize the health of others; and
ii. The recommendation, direction, or order of the provider or authority that the employee be isolated or quarantined as a result of suspected exposure to a communicable disease.
New Jersey Administrative Code › Title 12 - LABOR AND WORKFORCE DEVELOPMENT › Chapter 19 - DEFINITIONS USED BY EMPLOYMENT SECURITY AGENCY AND SPECIAL EMPLOYMENT RELATIONSHIPS › Subchapter 1 - GENERAL PROVISIONS › Section 12:19-1.1 - Purpose

Current through Register Vol. 56, No. 14, July 15, 2024
The purpose of this chapter is to set forth the definitions to be used throughout N.J.A.C. 12:16 through 12:19, and to provide examples illustrating the definitions and, in some instances, exceptions to the definitions.
New Jersey Administrative Code › Title 12 - LABOR AND WORKFORCE DEVELOPMENT › Chapter 19 - DEFINITIONS USED BY EMPLOYMENT SECURITY AGENCY AND SPECIAL EMPLOYMENT RELATIONSHIPS › Subchapter 1 - GENERAL PROVISIONS › Section 12:19-1.3 - Partnerships

Current through Register Vol. 56, No. 14, July 15, 2024
(a) A separate registration number and experience rating shall be assigned to each partnership that is composed of identical partners with identical interests, if all of the following conditions are met:
1. Each separate partnership joins in such a request to the Controller or the Controller's designee or the Controller or the Controller's designee determines that individual reporting is appropriate;
2. A separate written partnership agreement exists for each partnership;
3. The accounting records for each partnership are separately maintained; and
4. There is no commingling of the employment of the two or more partnerships.
New Jersey Administrative Code › Title 12 - LABOR AND WORKFORCE DEVELOPMENT › Chapter 19 - DEFINITIONS USED BY EMPLOYMENT SECURITY AGENCY AND SPECIAL EMPLOYMENT RELATIONSHIPS › Subchapter 1 - GENERAL PROVISIONS › Section 12:19-1.4 - Special employers

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The following situations outline special employment relationships which exist for tax purposes:
1. A crew leader shall be considered the employer of the crew which the crew leader has provided to the agricultural entity if:
i. The agreement between the farmer and the crew leader complies with all Federal and State laws and regulations, including the payment of applicable employment taxes and minimum wage;
ii. The crew leader has completed and submitted Department of Labor and Workforce Development Form UC-1CL, "Status Report of Crew Leader Employing Unit"; and
iii. The crew leader has met all the requirements of the Federal Migrant and Seasonal Agricultural Worker Protection Act, 29 U.S.C. §§
												1801 et seq., and the New Jersey Crew Leader Registration Act, 34:8A-7 et seq.
New Jersey Administrative Code › Title 12 - LABOR AND WORKFORCE DEVELOPMENT › Chapter 20 - BOARD OF REVIEW › Subchapter 1 - ORGANIZATION OF BOARD OF REVIEW › Section 12:20-1.1 - Membership

Current through Register Vol. 56, No. 14, July 15, 2024
The Board of Review shall consist of three members appointed by the Assistant Commissioner who is responsible for the administration of the Unemployment Compensation Law and subject to the provisions of N.J.S.A., Title 11A, and the supplements and amendments thereto, from Civil Service Commission eligible lists.
New Jersey Administrative Code › Title 12 - LABOR AND WORKFORCE DEVELOPMENT › Chapter 20 - BOARD OF REVIEW › Subchapter 1 - ORGANIZATION OF BOARD OF REVIEW › Section 12:20-1.2 - Officers

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The Board of Review shall elect one of its members as chairperson and one as vice-chairperson to serve at the pleasure of the Board.
(b) The Board of Review may appoint a secretary to serve at the pleasure of the Board.
New Jersey Administrative Code › Title 12 - LABOR AND WORKFORCE DEVELOPMENT › Chapter 20 - BOARD OF REVIEW › Subchapter 1 - ORGANIZATION OF BOARD OF REVIEW › Section 12:20-1.3 - Duties

Current through Register Vol. 56, No. 14, July 15, 2024
(a) It shall be the duty of the members of the Board of Review to act as a final appeals board in hearing and deciding cases of benefit disputes, including appeals from determinations with respect to demands for refunds of benefits under 43:21-16(d)  of the Unemployment Compensation Law, to determine all matters of policy in the Board of Review, to supervise the work of appeal tribunals, and to issue rules and regulations governing the conduct of hearings and the presentation of appeals to the appeal tribunals and to the Board of Review.
(b) The chairperson of the Board of Review shall convoke and preside at all meetings of the Board of Review.
(c) The vice-chairperson shall perform the duties of the chairperson during any period of the latter's absence or incapacity.
(d) The executive secretary of the Board of Review shall keep a record of proceedings at meetings of the Board of Review and shall prepare minutes to record all actions of the Board at each meeting. Said minutes shall be presented to the Board of Review for approval at its next meeting.
(e) The executive secretary may, with the consent of the Board of Review, issue subpoenas and shall sign all orders and other official documents issued in the name of the Board of Review and shall certify its decisions. The executive secretary shall maintain the permanent file of the approved minutes of Board of Review meetings and shall be charged with the supervision of all administrative work of the Board of Review.
New Jersey Administrative Code › Title 12 - LABOR AND WORKFORCE DEVELOPMENT › Chapter 20 - BOARD OF REVIEW › Subchapter 1 - ORGANIZATION OF BOARD OF REVIEW › Section 12:20-1.4 - Quorum

Current through Register Vol. 56, No. 14, July 15, 2024
A quorum of the Board of Review shall consist of two members of the Board. No decision, determination, opinion or other official duty shall be rendered or taken by the Board of Review except with the approval of a majority thereof.
New Jersey Administrative Code › Title 12 - LABOR AND WORKFORCE DEVELOPMENT › Chapter 20 - BOARD OF REVIEW › Subchapter 2 - ORGANIZATION OF APPEAL TRIBUNALS › Section 12:20-2.1 - Membership

Current through Register Vol. 56, No. 14, July 15, 2024
Appeal tribunals shall consist of a single member who shall be a salaried examiner appointed by the Director subject to the provisions of N.J.S.A., Title 11A, and the supplements and amendments thereto, from Civil Service Commission lists.
New Jersey Administrative Code › Title 12 - LABOR AND WORKFORCE DEVELOPMENT › Chapter 20 - BOARD OF REVIEW › Subchapter 2 - ORGANIZATION OF APPEAL TRIBUNALS › Section 12:20-2.2 - Duties

Current through Register Vol. 56, No. 14, July 15, 2024
It shall be the duty of the appeal tribunals to hear and decide disputed benefit claims, including appeals from determinations with respect to demands for refunds of benefits under 43:21-16(d)  of the Unemployment Compensation Law of New Jersey and determinations with respect to requests by employers for relief from benefit charges pursuant to N.J.A.C. 12:17-21.
New Jersey Administrative Code › Title 12 - LABOR AND WORKFORCE DEVELOPMENT › Chapter 20 - BOARD OF REVIEW › Subchapter 3 - APPEALS TO APPEAL TRIBUNALS › Section 12:20-3.2 - Appeal process

Current through Register Vol. 56, No. 14, July 15, 2024
The appeal procedures for cases before the appeal tribunals can be found at N.J.A.C. 1:12.
New Jersey Administrative Code › Title 12 - LABOR AND WORKFORCE DEVELOPMENT › Chapter 20 - BOARD OF REVIEW › Subchapter 4 - APPEALS TO BOARD OF REVIEW › Section 12:20-4.1 - Presentation of appeals

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Notice of appeal shall be filed within 10 calendar days after the date of notification or mailing of the decision which is being appealed. Any written statement, including a facsimile, electronic mail or other electronic transmission, filed within the time for appeals allowed by law, which sets forth the fact that a party to a decision made by an appeal tribunal is aggrieved thereby or dissatisfied therewith, shall be deemed to be an appeal. A copy of the Appeal Tribunal decision being appealed shall be included whenever possible.
(b) In computing any period of time the day of the act or event after which the designated period begins to run is not to be included. The last day of the period so computed is to be included, unless it is a Saturday, Sunday or legal holiday, in which event the period runs until the end of the next day which is neither a Saturday, Sunday, nor a legal holiday.
(c) The date on which an appeal is filed is the date of the postmark, or in the event that the postmark is missing, the date of receipt by an office or employee of the Department of Labor and Workforce Development authorized to accept appeals.
(d) A party appealing from a decision of an appeal tribunal may also file at the office where the claim was filed or with the Board of Review a notice of appeal to the Board of Review, or at an office or with an employee authorized to accept such appeals, setting forth the information required thereby.
(e) Notice of appeal filed at an office authorized to accept such appeals shall be transmitted immediately to the Executive Secretary of the Board of Review. If, after an appeal has been filed, it is found that the matter may be adjusted to the satisfaction of the parties without further hearing, a request for dismissal of the appeal will be entertained and acted upon by the Board of Review.
(f) Receipt by any party of notice of hearing on an appeal shall be deemed to constitute notice that an appeal has been filed. Any party, other than the appellant, shall be supplied with a copy of the appeal if request is made therefor before the date of the scheduled hearing.
(g) An appeal shall be considered on its merits if it is filed within 10 days of notification or mailing. Notification of a decision means actual receipt of a decision by the claimant or any interested party to the appeal.
(h) 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 20 - BOARD OF REVIEW › Subchapter 4 - APPEALS TO BOARD OF REVIEW › Section 12:20-4.2 - Appeal process

Current through Register Vol. 56, No. 14, July 15, 2024
The appeal procedures for cases before the Board of Review are found at N.J.A.C. 1:12.
New Jersey Administrative Code › Title 12 - LABOR AND WORKFORCE DEVELOPMENT › Chapter 20 - BOARD OF REVIEW › Subchapter 4 - APPEALS TO BOARD OF REVIEW › Section 12:20-4.3 - Temporary appointment to Board of Review

Current through Register Vol. 56, No. 14, July 15, 2024
The Executive Secretary to the Board of Review shall serve in the place of any member of the Board who is temporarily absent or unavailable.
New Jersey Administrative Code › Title 12 - LABOR AND WORKFORCE DEVELOPMENT › Chapter 20 - BOARD OF REVIEW › Subchapter 5 - GENERAL RULES FOR BOTH APPEAL STAGES › Section 12:20-5.1 - Inspection of decisions

Current through Register Vol. 56, No. 14, July 15, 2024
Copies of all decisions of the appeal tribunals and the Board of Review shall be kept on file at the offices of the Board of Review and of the appeal tribunals at Trenton. Such decisions shall be open for inspection but not in any manner revealing the names of any of the parties or witnesses involved.
New Jersey Administrative Code › Title 12 - LABOR AND WORKFORCE DEVELOPMENT › Chapter 21 - FAMILY LEAVE INSURANCE BENEFITS › Subchapter 1 - GENERAL PROVISIONS › Section 12:21-1.1 - Purpose and scope

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The purpose of this chapter is to implement P.L. 2008, c. 17, which amends 43:21-25 et seq., the Temporary Disability Benefits Law.
(b)
									P.L. 2008, c. 17 extends the temporary disability benefits program, so as to provide to covered individuals family leave insurance benefits, a monetary benefit (not a leave entitlement), which protects the covered individual against wage loss suffered because of the need of the covered individual to participate in providing care for a family member who has a serious health condition or to bond with a newborn or newly adopted child.
(c) Neither P.L. 2008, c. 17, nor this chapter, establishes the right of a covered individual to take leave from work to participate in providing care for a family member who has a serious health condition or to bond with a newborn or newly adopted child; that is, neither P.L. 2008, c. 17, nor this chapter, establishes the right of a covered individual to be restored to employment following a period of leave from work to participate in providing care for a family member who has a serious health condition or to bond with a newborn or newly adopted child.
(d) Any reference within P.L. 2008, c. 17, or within this chapter, to "family leave" or "family temporary disability leave" does not create a new type of leave, but rather, pertains solely to the manner, pursuant to P.L. 2008, c. 17, in which an otherwise established type of leave must be taken by an individual in order for the individual to avoid consequences under P.L. 2008, c. 17, which may include ineligibility for or a reduction of the individual's family leave insurance benefits.
(e) Any reference within P.L. 2008, c. 17, or within this chapter, to pre-conditions related to leave (for example, the requirement under P.L. 2008, c. 17, §12, with regard to family leave to bond with a newborn or newly adopted child that a covered individual must provide the employer with prior notice of the leave not less than 30 days before the leave commences) are solely referring to pre-conditions to the payment of full family leave insurance benefits (a monetary benefit). The potential consequence to a covered individual for failure to satisfy these pre-conditions related to leave would be limited solely to those sanctions that are expressly set forth within P.L. 2008, c. 17 and this chapter, which sanctions affect entitlement to family leave insurance benefits. Those sanctions should in no way affect entitlement to leave under the New Jersey Family Leave Act, 34:11B-1 et seq., the Federal Family and Medical Leave Act, 29 U.S.C. §§
										2601 et seq., any other statutory leave program, a collective bargaining agreement or an individual employer policy.
New Jersey Administrative Code › Title 12 - LABOR AND WORKFORCE DEVELOPMENT › Chapter 21 - FAMILY LEAVE INSURANCE BENEFITS › Subchapter 1 - GENERAL PROVISIONS › Section 12:21-1.3 - Service of papers

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Any and all written communications issued by the Division may be served personally or by registered or certified mail. A copy of the notice may be left at the principal office or place of business in New Jersey of the person required to be served.
(b) Such service shall constitute due notice.
(c) The verification by the individual who served the notice or the return post office receipt of the registered or certified mail shall be proof that notice was served.
New Jersey Administrative Code › Title 12 - LABOR AND WORKFORCE DEVELOPMENT › Chapter 21 - FAMILY LEAVE INSURANCE BENEFITS › Subchapter 1 - GENERAL PROVISIONS › Section 12:21-1.4 - Reimbursement of funds

Current through Register Vol. 56, No. 14, July 15, 2024
If benefits have been paid in error to a claimant by one program (either the State plan, family leave insurance benefits during unemployment, or a private plan) for a period of family leave and the claimant is correctly entitled to benefits under another program (either the State plan, family leave insurance benefits during unemployment, or a private plan) for that same period of family leave, the Division may arrange for a reimbursement of funds between the two programs. If it is determined that the benefits were received as a result of the claimant's making a false statement knowing it to be false or knowingly failing to disclose a material fact, the individual shall be subject to a fine and repayment of the overpaid amount under the provisions of 43:21-55(a).
New Jersey Administrative Code › Title 12 - LABOR AND WORKFORCE DEVELOPMENT › Chapter 21 - FAMILY LEAVE INSURANCE BENEFITS › Subchapter 1 - GENERAL PROVISIONS › Section 12:21-1.5 - Completion of medical certifications by health care provider or licensed medical practitioner

Current through Register Vol. 56, No. 14, July 15, 2024
No health care provider or licensed medical practitioner shall charge a claimant or care recipient a fee for services rendered in completing forms issued by the Division of Temporary Disability Insurance or by any insurer requesting medical information associated with the filing of any claim for payment of family leave insurance benefits.
New Jersey Administrative Code › Title 12 - LABOR AND WORKFORCE DEVELOPMENT › Chapter 21 - FAMILY LEAVE INSURANCE BENEFITS › Subchapter 1 - GENERAL PROVISIONS › Section 12:21-1.6 - Payment of benefits

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The Division (for State plan and family leave insurance benefits during unemployment) or the insurer (for private plan), shall make all family leave insurance 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; or
2. As prescribed under 43:21-42(c), relative to the payment of benefits due a minor.
New Jersey Administrative Code › Title 12 - LABOR AND WORKFORCE DEVELOPMENT › Chapter 21 - FAMILY LEAVE INSURANCE BENEFITS › Subchapter 1 - GENERAL PROVISIONS › Section 12:21-1.7 - Plan jurisdiction

Current through Register Vol. 56, No. 14, July 15, 2024
Whether the claimant for a particular claim is covered by the State plan or a private plan shall be determined based on the coverage (State plan or private plan) provided by the current employer at the time the first or reestablished claim is filed or, where the claimant has become unemployed within the 14 days immediately preceding the claim, his or her most recent previous employer at the time the first or reestablished claim is filed.
New Jersey Administrative Code › Title 12 - LABOR AND WORKFORCE DEVELOPMENT › Chapter 21 - FAMILY LEAVE INSURANCE BENEFITS › Subchapter 1 - GENERAL PROVISIONS › Section 12:21-1.8 - Notice to workers

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Each employer shall post in each of the employer's worksites, in a place or places accessible to all employees at the worksite, a printed notification of covered individuals' rights relative to the receipt of family leave insurance benefits under P.L. 2008, c. 17 and this chapter.
(b) Each employer shall provide each employee of the employer with a written copy of the notification referred to in (a) above under each of the following circumstances:
1. Not later than April 1, 2009;
2. At the time of the employee's hiring;
3. Whenever the employee provides notice to the employer under 12:21-3.7 or under the analogous provision within a private plan; and
4. At any time, upon the first request of the employee.
New Jersey Administrative Code › Title 12 - LABOR AND WORKFORCE DEVELOPMENT › Chapter 21 - FAMILY LEAVE INSURANCE BENEFITS › Subchapter 2 - PRIVATE PLANS › Section 12:21-2.1 - 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 subsection, 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, 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' 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 family leave insurance 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 by the State plan if the employer has State plan coverage. However, claims coming within the purview of 12:21-2.1 0 or 3.6 shall be governed thereby.
New Jersey Administrative Code › Title 12 - LABOR AND WORKFORCE DEVELOPMENT › Chapter 21 - FAMILY LEAVE INSURANCE BENEFITS › Subchapter 2 - PRIVATE PLANS › Section 12:21-2.2 - 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 family leave commencing while he or she is covered under a private plan.
(b) An employee shall not be paid any benefits for family leave insurance benefits during unemployment, 43:21-3 and 4, for any period of family leave commencing while he or she is a "covered individual" as defined in 43:21-27(b)(2).
(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 family leave insurance benefits 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 file a timely claim for benefits provided that:
1. The application to the State plan would have constituted a timely filed claim to the private plan if it had been then made; and
2. Proof of entitlement to family leave insurance benefits 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 under the private plan.
New Jersey Administrative Code › Title 12 - LABOR AND WORKFORCE DEVELOPMENT › Chapter 21 - FAMILY LEAVE INSURANCE BENEFITS › Subchapter 2 - PRIVATE PLANS › Section 12:21-2.3 - 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 written 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 12:21-2.6. 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 21 - FAMILY LEAVE INSURANCE BENEFITS › Subchapter 2 - PRIVATE PLANS › Section 12:21-2.4 - Choice of health care provider

Current through Register Vol. 56, No. 14, July 15, 2024
(a) A care recipient whose care giver is covered under a private plan shall have the right to choose his or her own health care provider. The care giver shall, if requested by the private plan insurer, have the care recipient submit to an examination by a licensed medical practitioner designated by the private plan insurer. The examinations shall not be more frequent than once a week, shall be made without cost to the care giver or care recipient and shall be held at a reasonable time and place. Refusal by the care recipient to submit to an examination shall disqualify the care giver from all benefits for the period of family leave in question, except from benefits already paid.
(b) Where a care recipient has utilized a health care provider, and that health care provider has examined the care recipient and has diagnosed him or her with a serious health condition, the insurer paying benefits may only deny benefits to the care giver during that period so certified where:
1. The insurer paying benefits has contacted the care recipient's health care provider and has reached a mutual agreement therewith as to a change in the period of either the care recipient's serious health condition or care required by the care giver;
2. A licensed medical practitioner designated by the insurer paying benefits has examined the care recipient and has determined that the care recipient either no longer has a serious health condition or requires care by the care giver. Where such a determination has been made, benefits shall not be paid beyond the date of the examination;
3. A care recipient refuses to submit to or fails to attend an examination conducted by a licensed medical practitioner designated by the insurer paying benefits, in which case the care giver shall be disqualified from receiving all benefits for the period of family leave in question, except as to benefits already paid; or
4. The insurer paying benefits has obtained credible factual evidence showing that the care recipient is performing activities that demonstrate a serious health condition does not exist. 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 21 - FAMILY LEAVE INSURANCE BENEFITS › Subchapter 2 - PRIVATE PLANS › Section 12:21-2.5 - 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 21 - FAMILY LEAVE INSURANCE BENEFITS › Subchapter 2 - PRIVATE PLANS › Section 12:21-2.6 - Appeals

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The appeal procedures for private plan family leave insurance cases are found at N.J.A.C. 1:12A and at the N.J.A.C. 12:18 Appendix.
(b) If a claimant covered under a private plan is denied benefits by the insurer for any period of family leave 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 claimant 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 that could not have been reasonably foreseen or prevented.
New Jersey Administrative Code › Title 12 - LABOR AND WORKFORCE DEVELOPMENT › Chapter 21 - FAMILY LEAVE INSURANCE BENEFITS › Subchapter 2 - PRIVATE PLANS › Section 12:21-2.7 - 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 21 - FAMILY LEAVE INSURANCE BENEFITS › Subchapter 2 - PRIVATE PLANS › Section 12:21-2.8 - 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 family leave insurance 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 family leave insurance 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 the 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 21 - FAMILY LEAVE INSURANCE BENEFITS › Subchapter 2 - PRIVATE PLANS › Section 12:21-2.9 - 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 benefits during any family leave commencing while the plan is in effect;
2. Eligibility requirements for family leave insurance benefits shall be no more restrictive than those requirements for benefits payable under the State plan; and
3. Except as provided for in 12:21-2.1 0, the family leave insurance 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 21 - FAMILY LEAVE INSURANCE BENEFITS › Subchapter 2 - PRIVATE PLANS › Section 12:21-2.10 - 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 family leave. 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 family leave 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 family leave. 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 21 - FAMILY LEAVE INSURANCE BENEFITS › Subchapter 2 - PRIVATE PLANS › Section 12:21-2.11 - 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 21 - FAMILY LEAVE INSURANCE BENEFITS › Subchapter 2 - PRIVATE PLANS › Section 12:21-2.12 - 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. 12:21-2.11, 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 verifying the employees' 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.