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

Filling out the State Of New Jersey Department Of Labor And Workforce Development Division of Workers' Compensation form can be straightforward with the right guidance. This guide provides clear instructions to help you successfully complete the necessary sections and fields of the form online.

Follow the steps to effectively complete the online form.

1. Click ‘Get Form’ button to access the form and open it in your online interface.
2. Begin by entering the ‘vicinage’ information, which refers to the jurisdiction where the case is being filed.
3. Input the ‘Social Security Number’ in the designated field.
4. Fill in the details for the ‘Petitioner’ including their ‘name,’ ‘date of birth,’ and address, ensuring you include the county.
5. Indicate whether the petitioner is ‘Medicare eligible’ by selecting 'Yes' or 'No'.
6. Provide the ‘Federal Employer Number’ and ‘NJ Registration Number’ as required.
7. Enter the name and address of the respondent, along with their ‘insurance carrier’ details.
8. Complete the case number section, ensuring all case numbers are accurately transcribed.
9. Document the ‘claim number’ along with the ‘date of accident or occupational exposure’ and describe the incident briefly.
10. Input information about the weekly wages, ensuring accuracy in recorded amounts.
11. If the petition is re-opened, indicate the date of the last award and fill in the amounts for permanent and temporary benefits.
12. Review all entries for correctness and completeness.
13. Once all sections are filled out, you can choose to save changes, download the form, print it, or share it as needed.

Complete your documents online today for a smoother filing experience.