New Jersey Administrative Code
Title 12 - LABOR AND WORKFORCE DEVELOPMENT
Chapter 235 - RULES OF THE DIVISION OF WORKERS' COMPENSATION
Subchapter 4 - INFORMAL HEARINGS
Section 12:235-4.3 - Contents of the application
Universal Citation: NJ Admin Code 12:235-4.3
Current through Register Vol. 56, No. 18, September 16, 2024
(a) The application for an informal hearing shall contain:
1. The worker's
name, address, age, and social security number;
2. The employer's name and address;
3. The name of the employer's insurance carrier,
if any;
4. The date of the
accident;
5. A brief description of how
the accident occurred;
6. A brief
description of the injury.
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