Transcript New Jersey Department of Labor

New Jersey
Department
of
Labor and Workforce
Development
Division
of
Temporary Disability Insurance
Disability Coverage
Rhode Island
California
New Jersey
New York
Hawaii
Puerto Rico
New Jersey Program
Established in 1948
Modeled After California & Rhode Island
Compromise Between Business &
Labor
– Business – Private Coverage
– Labor – State Coverage
What is Temporary Disability
Insurance?
Temporary - Short Term Benefits
Disability
- Non-Work Related Illness or
Injury
Insurance - Protection
Who is Covered?
All Those Covered for Unemployement
Insurance With the Following Exceptions:
– Local Government (Optional)
– Federal Government
– Out-of-State Employment
The Division of Temporary Disability
Insurance Oversees Three Programs:
State Plan
Private Plan
Disability During Unemployment
Disabilities beginning more than 14 days after the
last date of work in covered employment
State Plan Operations
State Plan Eligibility
Covered Wages in Base
Year
– Base Week Requirement
2014 = $145*
– Alternative Earnings Test
2014 = $7,300*
Unable to Work
Medical Certification
Benefit Calculation
Benefit Calculation
– 2/3 of the Average Weekly
Wage
– Average Weekly Wage is
based on earnings in the 8
calendar weeks immediately
prior to start of disability
Weekly Benefit Rate
– 2014 = $595
Maximum Entitlement
– 2014 = $15,470
Claims Processing Goals
69% of claims determined within 14 days.
88% of claims determined within 28 days.
*To avoid processing delays, the application
form should be completed by the claimant,
the doctor, and the employer.
Benefit Limitations
Waiting Week
Criminal Acts
Gross Misconduct
Workers’ Compensation
Labor Disputes
Special Issues
Pregnancy
Drug Abuse
Alcohol Abuse
Protection of the Trust Fund
Independent Medical Examinations
Staff Physician
Cross-match With Unemployment
Insurance
Benefit Charges
– Are Determined by Most Recent Covered
Employer
Federal Tax Requirements
– Since 1982, TDI Third Party Pay
Taxable Under FIT & FICA
FICA Deducted From Benefits
Year End Statement Sent to Employer for (W2)
preparation
Not taxable for NJ State Income Tax
State Plan Funding
Based on Taxable Wages
2014 Taxable Wage Base
Employer Rates
= $31,500
Worker Rate
– Start-up Rate =
0.0050%
– .0036% on the first
$31,500
– Experience Rating
After Three Years =
0.10% to 0.75%
– 2014 Max. Employee
Contributions =
$119.70
– 2014 Contributions =
$31.50 to $236.25
Private Plan,
Disability During
Unemployment
&
Customer Services
Coverage Options
State Plan Coverage Is Automatic for
Most Workers
But
Workers May Be Covered by an
Employer’s Approved Private Plan
Instead.
Private Plan Coverage
Approximately 6,100 Private Plans
Covering Approximately 905,000 workers
State Plan oversees the administration of
all private plans
Supplemental Plans permitted on
voluntary basis
Third TDI Program
Disability During Unemployment
Disability Begins More Than 14 Days After
Last Day of Covered Employment.
Eligibility Same As U.I. (But Unable to Do
Any Work).
Federal Tax Requirements
Not Subject to FICA
Considered Income by IRS
New Jersey LWD Sends Form 1099G to
Claimant for Tax Year
Note:
Not taxable for NJ State Income Tax
Claims Processing
Claims come in through fax or mail and
are sorted and imaged into our system
Our mainframe system randomly assigns
the claim to an examiner, and when all 3
parts of the claim have been received, the
examiner processes that claim within 14
days and a determination of eligibility is
sent to the claimant
Claims Processing
If more information is needed, the
examiner will contact the claimant, doctor,
or employer via phone or mail to request
the information
Payments for eligible claims are made via
a Bank of America debit card which is
mailed to the claimant and is valid for all
UI, TDI, and FLI benefits paid for 4 years
Customer Service Section
609-292-7060
20 - 30 Agents who have the ability to view
claim images
Conversant System for inquiry
50,000 Conversant Calls Per Week
7,000 Agent Calls Per Week
Temporary Disability Insurance
Website
www.nj.gov/labor
Go to Temporary Disability
Provides general information on all three program areas
Ability to download claim form (DS-1)
Claimants can access State Plan claim information via Web
Services link
Ability to contact the Division via e-mail.
– Claim specific information not available via e-mail due to security issues
Ability to file an appeal via e-mail
We are creating a web based application expected to launch late
this year
Appeals
State Plan
Disability During Unemployment
Private Plan
Questions?
FAMILY LEAVE INSURANCE
Department of Labor and Workforce Development
Division of Temporary Disability Insurance
GENERAL INFORMATION


Signed into law May 2, 2008
Claim filing began July 1, 2009
–
–
care of a seriously ill family member
bonding with a newborn or newly adopted child.
GENERAL INFORMATION

2nd State to implement Family Leave Insurance
– California (2004)
– Washington (delayed 2015)

FLI is a benefit entitlement program not a leave
entitlement program

No employment protection provision to hold
job. Employees may have rights under other
laws including NJFLA and FMLA
COVERAGE


Workers covered under the New Jersey Unemployment
Compensation Law, including government entities
All businesses, regardless of the size

Employees may be covered under:
– the State Plan or an approved Private Plan
– Family Leave During Unemployment (leave
begins more than 14 days after the last day of
work)

Information regarding the type of coverage provided by
an employer must be posted at the worksite
PROGRAM FUNDING

100% funded by employee contributions through payroll
deductions

No employer contributions

New tax rate for 2014 is 0.001% of taxable wage base. Varies
annually based on fund balance, claim activity and
administrative costs.

The taxable wage base changes each year. In 2014 the taxable
wage base is $31,500. The maximum contribution in 2014 is
$31.50
CARE OF A FAMILY MEMBER

Benefits are payable for care of a family member with a
serious health condition supported by a certification provided
by a health care provider

Family Member
–
–
–
–

child (biological, adopted, foster, stepchild, legal ward of a
covered individual, child of a domestic/civil union partner who
is less than 19 years or age or over 19 and incapable of self
care)
spouse
domestic/civil union partner
parent (biological, foster, adoptive, stepparent or legal
guardian)
Claims may be filed for 6 consecutive weeks, Intermittent
weeks or 42 intermittent days
BONDING

Benefits are payable for bonding with a newborn or
newly adopted child during the first 12 months after the
birth or adoption

Claim must be for:
– Continuous period greater than seven days
– Non consecutive periods greater than seven days if
permitted by the employer
FAMILY LEAVE INSURANCE FACTS



An employer can require an employee to use up to two
weeks of paid time off (State of NJ requires)
The maximum allowance may be reduced by up to two
weeks of any paid time off if the employer requests the
reduction
Claimant must give the employer notice of family leave
– care of family member
 reasonable and practicable notice unless time of
leave is unexpected or unforeseeable.
 15 days for leave on an intermittent basis
– bonding
 30 days notice
FAMILY LEAVE INSURANCE FACTS

A formal appeal can be filed by an employee
or employer who disagrees with a
determination

The maximum payable is 6 weeks of benefits
in a 12 month period. The 12 month period
is the 365 consecutive days beginning with
the first day a claim is established
STATE PLAN COVERAGE
STATE PLAN ELIGIBILITY

Covered Wages in Base Year
– Base Week Requirement
2014 – 20 weeks with earnings of $145
or more
– Alternative Earnings Test
2014 - $7,300 during the base year period.

Base Year is the 52 weeks immediately prior to the
week in which the family leave claim begins
BENEFIT DURATION

6 Weeks during a 12 month period (365
consecutive days beginning with the first day
of a valid first claim)

First Claim is the claim for Family Leave
Insurance benefits initially filed. It begins the
running of the 12 month period
BENEFIT CALCULATION

Weekly Benefit Rate
–
–
–

2/3 of the Average Weekly Wage up to the maximum weekly
benefit rate. The maximum WBR for 2014 is $595
Average Weekly Wage is based on earnings in the 8 calendar
weeks immediately prior to start of family leave
Weekly Benefits Rate will be the same as for State Plan
temporary disability claim if family leave claim is filed
immediately after the State Plan temporary disability claim
Daily Rate
–
1/7 of the weekly benefit rate
Benefit Limitations

Waiting Week (no waiting week if the State
Plan Family Leave Insurance Claim is
immediately after the State Plan temporary
disability insurance claim)

Pensions reduce entitlement, dollar for
dollar, if the most recent employer
contributed to the pension benefit
OTHER BENEFIT PROVISIONS

No benefits are payable if:
–
Receiving Temporary Disability Benefits
–
Receiving Workers’ Compensation Benefits
–
Receiving benefits from a disability or cash
sickness program or similar law of any state or the
federal government.
–
Receiving Unemployment Benefits
–
Receiving Full Paid Time Off
–
Working
OTHER BENEFIT PROVISIONS

No benefits are payable if:
–
not in covered employer within 14 days of the last day
worked
–
–
not under the care of a health care provider
involved in a Labor Dispute
–
discharged for Gross Misconduct
–
employee of an educational institution and benefits
are claimed between academic year or terms or
during a school-wide recess when claimant has a
reasonable assurance of returning to work
Tax Information

Subject to Federal Income Tax
–

Not Subject To:
–
–

Claimant can request that 10% of weekly benefits
rate be withheld
FICA
State Income Tax
1099G mailed to claimant by Division
Program statistics

211,560 eligible claims since 7-1-2009

Bonding claims 81%
Care claims 19%
7.5% claimants work for State of NJ
21% of claims PTO reduction
77% claims determined in 14 days or less
91% approval rate





Program statistics


Volume running below original OLS
estimates
22% of bonding claims processed through
web center automation
Program challenges







Intermittent FLI care & bonding claims
Confusion with FMLA & NJ FLA
Early claim submission
Paid Time Off reduction
Integration with Private Plan TDI carriers
Adoption & custody issues
Claims from employees of educational
institutions
Ineligible claims




Intermittent bonding
Invalid relationships
School employees during school wide
recess
Typical reasons (insufficient wages, failure
to provide information, etc.)
APPLYING FOR BENEFITS

Application can be obtained:
– by writing to the Division of Temporary Disability Insurance, PO
Box 387, Trenton, NJ 08625-0387
–
telephoning Customer Service Section
609-292-7060
–
website – www.nj.gov/labor

Claimants who receive State Plan temporary disability benefits will
receive instructions after giving birth for filing a transitional
bonding claim

Applications should not be filed until the family leave period
begins
CUSTOMER SERVICE

Conversant System for general topics and claim specific
information is now available

Agent Assistance – during business hours
609-292-7060

Website
–
–
–
www.nj.gov/labor
Contains general program information
Applications and informational pamphlets can be downloaded
Claimants can view State Plan claim details or file a transitional
bonding claim via the Web Services link.
Questions?
WHAT DOES ALL OF THIS
MEAN FOR THE SAFE ACT?
The SAFE ACT
• provides an unpaid leave of absence, for a period not
to exceed 20 days in a 12-month period, to address
circumstances resulting from domestic violence or a
sexually violent offense
• the employee must have worked at least 1,000 hours
during the immediately preceding 12-month period
• the employee must have worked for an employer in
the State that employs 25 or more employees
Leave may be taken by an employee
who is a victim of domestic violence, or
a victim of a sexually violent offense.
Leave may also be taken by an
employee whose child, parent, spouse,
domestic partner, or civil union partner
is a victim of domestic violence or a
sexually violent offense.
The SAFE Act is a leave
entitlement program. TDI and FLI
are benefit entitlement programs.
Just like a period of FMLA-covered
unpaid leave, you must qualify for
TDI or FLI benefits during this
period.
Eligibility Requirements
1
• Covered Wages
2
• Unable to work (TDI), or
caring for someone with a
serious medical
condition(FLI)
3
• Medical Certification
Issues to Watch for TDI/FLI Claims
• No intermittent days allowed for TDI
• Must provide medical certification
• The waiting week is only triggered when
you have been out of work for 22 days.
• Must meet wage requirements
• This is replacement for lost wages- so if
your employer pays you, we won’t
Questions?