New Jersey Administrative Code
Title 12 - LABOR AND WORKFORCE DEVELOPMENT
Chapter 21 - FAMILY LEAVE INSURANCE BENEFITS
Subchapter 3 - STATE PLAN
Section 12:21-3.2 - Notice and proof of family leave

Universal Citation: NJ Admin Code 12:21-3.2

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

(a) Within 30 days after the commencement of a period of family leave, a written notice of family leave, on which a claim for State plan benefits is based, shall be furnished to the Division by the claimant. 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 claimant begins the period of family leave. The filing of Form FL-1 (Proof and claim for family leave insurance benefits) or Form FL-2 (Proof and claim for family leave insurance benefits for bonding immediately following a State plan claim for pregnancy disability) shall constitute notice of family leave.

1. If an individual knows in advance when an anticipated period of family leave will commence, the individual may notify the employer of the anticipated period of family leave and submit to the Division a claim for benefits for that period, which shall include a statement of when the leave 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 family leave 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 family leave, except that if the Division receives the claim less than 30 days before the commencement of the period of family leave, the Division shall make the payment not more than 30 days after the receipt of the claim.

3. The periods of family leave 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 leave is known in advance:
i. Periods of leave for care of a child of the individual after adoption or childbirth (including childbirth under a valid gestational carrier agreement);

ii. The placement of a child into foster care with the individual;

iii. Periods of leave for scheduled medical procedures, treatments, or appointments for a family member of the individual; and

iv. Periods of leave for scheduled ongoing care of a family member of the individual.

(b) Proof of the care recipient's serious health condition or of the birth of a child or of the placement for adoption of a child on which a claim for family leave insurance benefits under the State plan is based shall be furnished by the claimant. The proof and claim accompanied, for claims relating to care of a family member (as opposed to bonding claims), by a certification of the health care provider, shall be furnished to the Division, on Form FL-1 (Proof and claim for family leave insurance benefits) not later than 30 days after the commencement of the period of family leave for which family leave benefits are claimed.

(c) The health care provider certification contained within Form FL-1 shall state the following:

1. The date, if known, on which the serious health condition of the family member commenced;

2. The probable duration of the serious health condition of the family member;

3. The medical facts regarding the serious health condition of the family member, of which the health care provider has personal knowledge;

4. A statement that the serious health condition of the family member requires the participation of the covered individual in providing care to the family member;

5. An estimate of the amount of time, total time and frequency, that the services of the covered individual are required in order to participate in providing care to the family member;

6. The dates of treatment of the family member if the family leave is for planned medical treatment; and

7. Such other information as the Division may require.

(d) A continued claim form on which the claimant must provide additional medical information in order to continue receiving family leave insurance benefits shall be filed as proof of continued family leave when requested by the Division.

(e) The failure to furnish a written notice or proof of family leave within the time or manner required by the Act and this subchapter shall not invalidate or reduce any claim, if it shall be shown to the satisfaction of the Division not to have been reasonably possible to furnish notice or proof and that such notice or proof was furnished as soon as reasonably possible. If such notice or proof is not furnished, the claim shall be reduced and limited to the period commencing 30 days prior to the receipt of the notice or proof of family leave.

(f) The Division shall require each claimant to have a valid Social Security Number when filing a claim for benefits. The claimant, upon request of the Division, shall provide proper identification, including proof of a valid Social Security Number, verification of the Social Security Number if there is a discrepancy, and documentation showing his or her legal name and address.

1. If unable to present proof of a valid Social Security Number, proper verification, or other appropriate documentation, the individual shall be determined ineligible for benefits until such time that he or she is able to present the required identification.

2. Any person who refuses or fails to cooperate with the Division in any effort to verify the validity of a Social Security Number, may be held ineligible for benefits from the date of claim and liable to refund any benefits previously paid.

3. Upon a showing of good cause by the claimant, the Division may, on a claimant-by-claimant basis, waive the requirement that the claimant have a valid Social Security Number when filing a claim for benefits.

Disclaimer: These regulations may not be the most recent version. New Jersey may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.