Get New Jersey Workers Comp Claim

Filing a New Jersey Workers Comp Claim can seem daunting, but with the right guidance, it can be manageable. This guide provides step-by-step instructions to help users navigate the online form accurately and efficiently.

Follow the steps to complete your New Jersey Workers Comp Claim form online.

1. Click the ‘Get Form’ button to access the New Jersey Workers Comp Claim form and open it in your browser.
2. Identify the employer information section. Begin by entering the employer's name and address, including the ZIP code. Make sure to provide accurate details as this information is crucial for the claim.
3. Next, fill in the carrier or administrator claim number, jurisdiction, and report purpose code. This section helps the state identify the claim's context.
4. Provide the insured report number and the employer's location address if it differs from the main address. Also, include the Standard Industrial Classification (SIC) code.
5. Enter the employer's Federal Employer Identification Number (FEIN) and phone number to ensure proper contact.
6. If applicable, check the box for self-insurance and provide the corresponding FEIN and policy numbers.
7. Now, move on to the employee section. Input the employee's name (last, first, middle), date of birth, social security number, and date hired.
8. Complete the employee's address details, including ZIP code, sex, employment status, marital status, and phone number.
9. Indicate the state of hire, number of dependents, and the employee's occupation or job title.
10. Document the employee's wage information, including rate per day, month, week, or hour, and average weekly wages.
11. Fill in the occurrence/treatment section by noting the time the employee began work, date of injury or illness, last work date, and other relevant occurrence details.
12. Describe the type of injury or illness and part of the body affected, including specific circumstances leading to the incident.
13. In the section regarding safety equipment and treatment, indicate if safety measures were provided and used, and the initial treatment received.
14. Finally, ensure all sections are filled out completely before saving your changes. You have the option to download, print, or share the completed form as needed.

Complete your New Jersey Workers Comp Claim online today for a smooth filing experience.