N.J. Admin. Code § 12:18-3.2

Current through Register Vol. 56, No. 21, November 4, 2024

Section 12:18-3.2 - Notice and proof of disability

(a) Within 30 days after the commencement of a period of disability, a written notice of disability, on which a claim for State plan benefits is based, shall be furnished to the Division by or on behalf of the person claiming benefits. 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 the claimant was too sick (or disabled) to work. The filing of Form DS-1 (Proof and Claim for Disability Benefits) shall constitute notice of disability.

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

3. The periods of disability 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 disability is known in advance: disability related to pregnancy or childbirth; disability related to scheduled medical procedures, treatments, or appointments for the individual; and disability related to scheduled ongoing care of the individual.

(b) Proof of disability on which a claim for benefits under the State plan is based shall be furnished by any claimant who expects to be or has been totally unable to perform the duties of his or her employment for a period of eight or more consecutive days and is under the care of a licensed medical practitioner. A claimant's authorized representative may furnish the proof of disability and file a claim for benefits on behalf of the claimant. The proof and claim accompanied by a certification of the attending licensed medical practitioner, shall be furnished to the Division, on Form DS-1 (Proof and Claim for Disability Benefits) not later than 30 days after the commencement of the period of disability for which benefits are claimed. A continued claim form on which the claimant must provide additional medical information in order to continue receiving benefits shall be filed as proof of continued disability when requested by the Division.

(c) A "period of disability" is payable from the first day of disability if the claimant receives medical care by a licensed medical practitioner within 10 days of the first day of disability. If the claimant fails to furnish such proof, benefits shall be payable from the first day of medical care.

(d) The failure to furnish a written notice or proof of disability 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 disability.

(e) 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.

N.J. Admin. Code § 12:18-3.2

Amended by R.1994 d.241, effective 5/16/1994.
See: 26 New Jersey Register 1326(a), 26 New Jersey Register 2131(a).
Amended by R.1997 d.143, effective 3/17/1997.
See: 29 New Jersey Register 91(a), 29 New Jersey Register 898(a).
Added (d).
Amended by R.1998 d.157, effective 4/6/1998.
See: 30 New Jersey Register 12(a), 30 New Jersey Register 1288(a).
Rewrote (a) and (b); inserted a new (c); recodified former (c) as (d), and rewrote the last sentence; and recodified former (d) as (e).

Amended by 55 N.J.R. 306(a), effective 2/21/2023