New Jersey Administrative Code
Title 12 - LABOR AND WORKFORCE DEVELOPMENT
Chapter 235 - RULES OF THE DIVISION OF WORKERS' COMPENSATION
Subchapter 6 - COMMUTATION OF AWARD
Section 12:235-6.2 - Application form for commutation

Universal Citation: NJ Admin Code 12:235-6.2

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

(a) The application for commutation shall be made on a form prescribed by the Division which shall include:

1. The applicant's name, address, and social security number;

2. The name and address of the employer;

3. The name, address, and file number of the employer's insurance carrier;

4. The date of award;

5. The Judge of Compensation and the place wherein the award was rendered;

6. The amount of the award;

7. The amount of balance due on the award;

8. The amount requested for commutation; applicant's marital, employment, and economic status;

9. The purpose(s) for which commutation is being requested; and

10. Such other information as prescribed by the Director.

(b) The application for commutation shall be under oath or affirmation of the applicant.

(c) The application for commutation shall include, or have attached thereto, all documents upon which the applicant is relying in the application.

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