N.J. Admin. Code § 12:18-2.27

Current through Register Vol. 56, No. 24, December 18, 2024

Section 12:18-2.27 - Exchange of information

(a) If an employee's weekly benefit amount, determined under the benefit provisions of an employer's private plan, with respect to any period of disability, is less than the maximum weekly benefit amount payable under the State plan, and such weekly benefit amount has been computed on a basis different from that provided for covered individuals under the State plan, the weekly benefit amount shall be recomputed in accordance with the provisions of the New Jersey Temporary Disability Benefit Law (N.J.S.A. 43:21-40) as amended.

(b) If such recomputed weekly benefit amount is less than the maximum weekly benefit amount payable under the State plan and the computation of the "average weekly wage" for such recomputation yields a result which is less than the individual's average weekly earnings in employment, with all covered employers, during the base weeks in such base year, then the insurer which has undertaken to pay the benefits provided by the plan shall request the Division to provide such payer with a statement of the weekly wages of the employee earned from all covered employers during the base weeks in the base year immediately preceding the calendar week in which the employee's disability commenced, or immediately preceding the calendar week in which the employee submitted a claim for benefits consistent with N.J.S.A. 43:21-49(a)(3).

(c) When requesting such information, such payer shall furnish the Division with the following information:

1. Name, address and Social Security number of the employee;

2. Date on which the disability commenced, or date on which the employee submitted a claim for benefits consistent with N.J.S.A. 43:21-49(a)(3);

3. The names and addresses of such other employers, from whom the employee alleges to have earned wages immediately preceding his or her disability, or immediately preceding the date on which the employee submitted a claim for benefits consistent with N.J.S.A. 43:21-49(a)(3), as may be necessary to determine all wages earned in the required base weeks in the base year.

4. The weekly earnings of the employee from the employer during each of the calendar weeks in the base year immediately preceding the disability, or immediately preceding the date on which the employee submitted a claim for benefits consistent with N.J.S.A. 43:21-49(a)(3), if any.

(d) If the private plan of an employer provides as a condition of eligibility for benefits with respect to a period of disability, that an otherwise eligible employee shall have established at least 20 or a lesser number of base weeks within the base year preceding the week in which his or her period of disability commenced, or immediately preceding the date on which the employee submitted a claim for benefits consistent with N.J.S.A. 43:21-49(a)(3), and the employee has not established such base weeks from his or her employment with the employer, then the insurer which has undertaken to pay the benefits provided by the plan shall request the Division to provide such payer with a statement of the number of base weeks in the employee's base year. When requesting such information, such payer shall furnish the Division with the following information:

1. Name, address and Social Security number of the employee;

2. Date on which the disability commenced, or date on which the employee submitted a claim for benefits consistent with N.J.S.A. 43:21-49(a)(3);

3. The names and addresses of such other employers, from whom the employee alleges to have earned wages in the base year immediately preceding his or her disability, or immediately preceding the date on which the employee submitted a claim for benefits consistent with N.J.S.A. 43:21-49(a) (3), as may be necessary to determine the required number of base weeks; and

4. The number of calendar weeks in the base year immediately preceding the calendar week in which the period of disability commenced, or immediately preceding the date on which the employee submitted a claim for benefits consistent with N.J.S.A. 43:21-49(a)(3), during which the employee earned not less than the minimum base week requirement as defined at N.J.S.A. 43:21-27(i)(4) from the employer.

(e) If the private plan of an employer provides, with respect to periods of disability commencing on or after January 1, 1968, that the maximum total benefits payable to any eligible employee may be computed as an amount equal to 26 times the weekly benefit rate or 1/3 of his or her total wages in his or her base year, whichever is lesser, and it appears that such provision will be applicable with respect to any period of disability because wages earned with prior employers in the base year are lacking, then the insurer shall be request the Division to provide a statement of the total wages in the employee's base year. When requesting such information, such insurer shall furnish the Division with the following information:

1. Name, address and Social Security number of the employee;

2. Date on which the disability commenced, or date on which the employee submitted a claim for benefits consistent with N.J.S.A. 43:21-49(a)(3);

3. Names and addresses of other employers in the base year prior to the week in which the disability commenced, or the week in which the employee submitted a claim for benefits consistent with N.J.S.A. 43:21-49(a)(3);

4. Total amount of wages earned by claimant with the most recent employer.

N.J. Admin. Code § 12:18-2.27

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.1998 d.157, effective 4/6/1998.
See: 30 New Jersey Register 12(a), 30 New Jersey Register 1288(a).
In (a), deleted "Section 16 of" following "provisions of" ; in (d), deleted "commencing on or after January 1, 1953" following "disability" in the first sentence; deleted a former (e); and recodified former (f) as (e).
Amended by R.2001 d.298, effective 8/20/2001.
See: 33 New Jersey Register 1849(a), 33 New Jersey Register 2814(b).
Rewrote (d)3 and 4.
Amended by R.2003 d.214, effective 5/19/2003.
See: 35 New Jersey Register 1039(a), 35 New Jersey Register 2226(a).
In (d), rewrote 3 and 4.

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