New Jersey Administrative Code

Notes N.J. Admin. Code § 12:20-4.6 Repealed by R.1994 d.408, effective 8/1/1994. See: 26 New Jersey Register 2196(a), 26 New Jersey Register 3179(a). Section was "Hearing appeals on cases removed from appeal tribunal to Board of Review."

Notes N.J. Admin. Code § 12:20-4.7 Repealed by R.1994 d.408, effective 8/1/1994. See: 26 New Jersey Register 2196(a), 26 New Jersey Register 3179(a). Section was "Decisions of Board of Review."

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 …

Notes N.J. Admin. Code § 12:20-5.2 Repealed by R.1994 d.408, effective 8/1/1994. See: 26 New Jersey Register 2196(a), 26 New Jersey Register 3179(a). Section was "Witness fees."

Notes N.J. Admin. Code § 12:20-5.3 Repealed by R.1994 d.408, effective 8/1/1994. See: 26 New Jersey Register 2196(a), 26 New Jersey Register 3179(a). Section was "Orders for supplying information from division records."

Notes N.J. Admin. Code § 12:20-5.4 Amended by R.1978 d.116, effective 3/31/1978. See: 10 New Jersey Register 117(a), 10 New Jersey Register 202(a). Amended by R.1989 d.473, effective 9/5/1989. See: 21 New Jersey Register 1496(a), 21 New Jersey Register 2797(a). Representation pro…

(a) The purpose of this chapter is to implement P.L. 2008, c. 17, which amends N.J.S.A. 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 …

The following words and terms, when used in this chapter, shall have the following meanings, unless the context clearly indicates otherwise: "Act" means the Temporary Disability Benefits Law, N.J.S.A. 43:21-25 et seq., as amended by P.L. 2008, c. 17, which extends the temporary d…

(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 const…

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…

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 …

(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 N.J.S.A. 43:…

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 beco…

(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 cha…

(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 establis…

(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 …

(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 …

(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 w…

(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 th…

(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; 2. That the security for such payment is insufficient; 3. That there has been a fai…

Upon receipt by the Division of a petition to terminate a private plan, signed by not less than 10 percent 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 of…

(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 Di…

(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 …

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. Notes N.J. Admin. Code § 12:21-2.18

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. Notes N.J. Admin. Code § 12:21-2.19

(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, N.J.S…

(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 discon…

(a) The employer shall be liable for the deduction of workers' contributions and payment of workers' contributions, as required by N.J.S.A. 43:21-7, with respect to wages paid for employment subsequent to the effective date of withdrawal or revocation of the certificate of approv…

(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 family leave commencing, during the con…

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 N.J.A.C. 12:21-2.9, Minimum plan requirements. Notes N.J. Admin. Code § 12:21-2.23

(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 admitt…

(a) Exemption from the requirement of N.J.A.C. 12:21-2.2 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 responsib…

(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 benefit…

(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 family leave, is less than the maximum weekly benefit amount payable under the State plan, and such weekly benefit amount has been comp…

Within 10 days after the mailing of a request for information with respect to a period of family leave, 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. Not…

(a) For the one-year period ending 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 one-year period, showing the…

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 pla…

(a) For the one-year period ending December 31 of each calendar year, each union, association of employees, nominee, trustee or organization, which has assumed the liability to pay the family leave insurance benefits required under one or more private plans (which benefits are no…

(a) For the one-year period ending December 31 of each calendar year, each insurance company, which has assumed the liability to pay the family leave insurance benefits required under one or more private plans shall, on a form prescribed by the Division, file a statement, on or b…

On or before the 30th day following the close of each calendar year, each employer having two or more approved private plans in effect during such calendar year or any portion thereof shall, on a form prescribed by the Division, file a report showing the amount of taxable wages p…

(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 requi…

(a) Employee contributions to a private plan shall be deposited in a trust fund account and shall not be part of an employer's assets. (b) Trust fund assets deposited by an employer as required under (a) above shall be used only for the administration and payment of family leave …

(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 practit…

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. Notes N.J. Admin. Code § 12:21-2.5

(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 de…

(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 Divis…

(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 l…

(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 N.J.S.A. 43:21-37 to N.J.S.A. 43:21-42 inclusive, by assuring that: 1. The private plan shall cover all employees, except as pr…

(a) A claimant 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) A claimant shall not be paid any benefits under N.J.S.A. 43:21-3 and 4 for any period of family leave comm…

(a) A covered individual shall be eligible for family leave insurance benefits where the covered individual seeks to take intermittent family leave for the purpose of bonding with a newborn or newly adopted child, including a child who becomes the child of a parent pursuant to a …