Get State Of New Jersey Department Of Labor And Workforce Development Division Of Workers '

The State Of New Jersey Department Of Labor And Workforce Development Division of Workers' Compensation requires specific information for the Order for Total Disability form. Filling it out accurately is essential to ensure your request is processed smoothly.

Follow the steps to complete the form effectively.

1. Click ‘Get Form’ button to obtain the form and open it for completion.
2. Enter the case number and vicinage at the top of the form. This information identifies your submission and ensures it is allocated to the correct jurisdiction.
3. Provide your name and date of birth. Ensure this information is accurate, as it will be used to verify your identity.
4. Indicate your Medicare eligibility by selecting 'Yes' or 'No.' This information may affect your benefits.
5. Fill in your address, including the county. Make sure this is your current residence to avoid delays.
6. Enter the respondent's details, including their name and address. This identifies the party involved in the case.
7. Detail the names of the attorneys representing both the respondent and petitioner, including their contact information, like telephone numbers.
8. Provide your Social Security number and any relevant insurance carrier information, including claim numbers and employer identification numbers.
9. Document the date of the accident or occupational exposure and provide a brief description of the incident.
10. Complete the sections regarding weekly wages and rates. This section assists in calculating the benefits you may be entitled to.
11. If applicable, indicate if this is a reopened petition and provide information regarding any previous awards.
12. Detail any medical bills incurred due to the incident, and indicate whether an application for Social Security Disability benefits is pending or has been filed.
13. Review all entered information for accuracy before proceeding. Once confirmed, you can save changes, download, print, or share the form as necessary.

Complete your form online to facilitate the workers' compensation process.