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 online can seem daunting. This guide will provide you with step-by-step instructions to simplify the process and ensure you complete the form accurately and efficiently.

Follow the steps to complete your form successfully.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the petitioner’s information in the designated fields, including the name, address, and telephone number. Ensure that all details are accurate to avoid any delays.
3. Next, input the details of the respondent, including their name and address, in the respective sections.
4. Fill in the case specifics, including the case number, claim number, and the date of the accident or occupational exposure.
5. Indicate if the petitioner is Medicare eligible by selecting 'Yes' or 'No'.
6. Detail the weekly wages and rates in the appropriate sections. Provide full disclosure to ensure correct compensation calculations.
7. If applicable, enter information about any re-opened petitions, indicating the date of the last award and any payments made.
8. In the permanent disability section, describe the percentage of disability along with the nature and extent of the injury.
9. Complete the medical bills section by listing the names of doctors or institutions involved, and any miscellaneous information relevant to the case.
10. Finally, review all entered information for accuracy. Once complete, you can save changes, download, print, or share the form as needed.

Start completing your document online today for a smooth and straightforward process.