New Jersey Administrative Code
Title 12 - LABOR AND WORKFORCE DEVELOPMENT
Chapter 18 - TEMPORARY DISABILITY BENEFITS
Subchapter 1 - GENERAL PROVISIONS
Section 12:18-1.1 - Definitions

Universal Citation: NJ Admin Code 12:18-1.1

Current through Register Vol. 56, No. 18, September 16, 2024

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.).

"Base year" with respect to a period of disability means the first four of the last five completed calendar quarters immediately preceding the period of disability, except that, if the individual does not have sufficient qualifying weeks or wages in the individual's base year to qualify for benefits, the individual shall have the option of designating that the individual's base year shall be the "alternate base year," which means the last four completed calendar quarters immediately preceding the period of disability; and except that if the individual also does not have sufficient qualifying weeks or wages in the last four completed calendar quarters immediately preceding the period of disability, "alternate base year" means the last three completed calendar quarters immediately preceding the individual's benefit year and, of the calendar quarter in which the period of disability commences, the portion of the quarter which occurs before the commencing of the period of disability.

"Benefits" means the disability benefits provided by the Temporary Disability Benefits Law.

"Claimant" means an individual who has filed a claim for disability benefits or who has notified the Division or the employer, nominee, designee, trustee, union, association of employees, insurer or organization paying benefits under a private plan that he or she expects to file such a claim.

"Claimant's authorized representative" means an individual who represents or acts in behalf of a claimant who is incapable of fulfilling the requirements of filing claims for disability benefits, and who is so authorized by a power of attorney or other authorization satisfactory to the Division. Such authorized representative must file with the Division, on a form prescribed by the Director, a duly sworn affidavit that the claimant is incapable of making a claim for disability benefits and that he or she assumes the responsibility of acting in behalf of such claimant in accordance with the Act and this chapter. Such filing must be supported by medical documentation of incapacity by a licensed medical practitioner.

"Commissioner" means the Commissioner of Labor and Workforce Development.

"Director" means the Director of the Division of Temporary Disability Insurance in the Department of Labor and Workforce Development.

"Disability" or "disabled" means such disability as is compensable pursuant to N.J.S.A. 43:21-29.

1. Disability shall, 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, also includes an illness caused by an epidemic of a communicable disease, a known or suspected exposure to the communicable disease, or efforts to prevent the 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.

"Division" means the Division of Temporary Disability Insurance in the Department of Labor and Workforce Development.

"Employee" means a covered individual as defined in N.J.S.A. 43:21-27(b). With respect to any one employer the term shall mean such a covered individual who is in employment, as defined by the Unemployment Compensation Law and Regulations promulgated thereunder, for which he or she is entitled to remuneration from such employer or who has been out of such employment for less than two weeks and has not become employed by another employer, during such period.

"Employer" means a covered employer as defined in N.J.S.A. 43:21-27(a).

"Fund" means the State Disability Benefits Fund, as set forth in N.J.S.A. 43:21-46.

"Insurer" means any insurance company duly authorized to do business in the State of New Jersey, employer acting as a self-insurer, nominee, designee, trustee, union, association of employees or organization which has undertaken to pay benefits under a private plan.

"Licensed medical practitioner" means a legally licensed physician, dentist, optometrist, podiatrist, practicing psychologist, advanced practice nurse or chiropractor.

"Private plan" means a private plan approved by the Division as defined in N.J.S.A. 43:21-32.

"Proof and claim for disability benefits" means the proof of disability and claim for benefits initially filed with respect to a period of disability on a form prescribed by the Director.

"Supplemental proof and claim for disability benefits" means the proof and claim certifying to the continuance of disability on a form prescribed by the Director.

"Week" means a period of seven consecutive days starting with the day of disability.

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