Official Site of The State of New JerseyModels and Publications
Browse Workers’ Ausgleich forms and publications below.
|
BROCHURES ADDITIONALLY PUBLICATIONS |
Doc # |
Word |
|
Type |
|
Workers' Compensation Statute |
|
3/23 |
||
|
Workers' Compensation Control |
|
1/18 |
||
|
A Workers' Guide to Workers' Compensation in Brand Jersey (legal size paper) |
wc(g)-338 |
|
6/22 |
|
|
Guia Interpretativa para el Trabajador A louisiana Ley de Compensacion al Trabajador en Nueva Football (legal size paper) |
wc(g)-338s |
|
1/16 |
|
|
Underinsured Employers Fund Pamphlet: provides the regulatory mitarbeiter with the Uninsured Employers Funded (legal size paper) |
scf-122 |
|
11/02 |
|
|
Second Damage Fund - A Beneficiary's Guide: provides necessary information up recipients of second injury fund benefits. (legal size paper) |
scf-103 |
|
1/11 |
|
|
Fondo De Segunda Incapacidad - Guia del Beneficiario |
scf-103s |
|
1/11 |
|
|
WC Research Manual - connect to the instructions page |
|
|
|
7/11 |
|
EMPLOYEE / WORKER FORMS |
Doc # |
Word |
|
Release |
|
Application for Relaxed Audition |
wc-66 |
|
6/06 |
|
|
Discrimination Complaint Form |
scf-4 |
|
7/04 |
|
|
Report of Non-Compliance (online): submit this create to create and uninsured employer |
|
|
|
8/22 |
|
MY / GUARANTEE CARRIER FORMS |
Doc # |
Word |
|
Version |
|
NJ Advantages Letter - Medical Only: document maintained at the Compensation Rating and Dresser (NJCRIB) website |
|
|
|
|
|
NJ Benefit Letter - Indemnity: document maintained at the Ausgleich User both Bureau (NJCRIB) website |
|
|
10/7/04 |
|
|
NJ Benefit Letter Custom Directions: document maintained at the Compensation Rating plus Bureau (NJCRIB) website |
|
|
10/7/04 |
|
|
Employer Notice of Workers' Remuneration Policy Coverage: this link will take you to the NJ Compensation Ranking & Inspection Bureau's website. |
|
|
||
|
|
|
3/23 | ||
|
|
|
3/23 |
|
FORMAL LITIGATION FORMS |
Doc # |
Word |
|
Version |
|
Petitioner Forms |
||||
|
Employee's Claim Petition (can subsist used for Amended CP) |
wc-365 |
|
8/26/15 |
|
|
Employee's Claim Petition Supplemental Page |
wc-365.1 |
|
5/7/15 |
|
|
Application for Review button Changes to Formal Award (can be employed for Amended ReOpener) Reopener Complement Show |
wc-368
wc-368_Supp |
|
8/26/15 |
|
|
Dependency Claim Petition (can be used for Amended DCP) DCP Supplemental Page |
wc-366 DWCsupp |
|
8/26/15 |
|
|
Dependency Claim Entreat To Convert Voluntary Tender to Formal Judgment |
wc-956 |
|
12/19 |
|
|
Notice of Motion for Temporary and/or Medical Benefits (fillable) |
wc-101_i |
3/07 |
||
|
Standard petitioner's occupational fragend form |
wc-22 |
|
|
|
|
Second Injury Fund Verified Submit (fillable) |
scf-161_i |
|
3/22 |
|
|
Social Security Offset Calculation |
scf-16 |
|
5/95 |
|
|
Medical Provider Application for Payment or Reimbursement is Medical Payment |
wc-381 |
|
8/26/15 |
|
|
Unsured Employer's Fund Information Packet |
|
|
9/7/07 |
|
|
Motion for Emergent Medical Procedure |
wc-383 |
|
5/14 |
|
|
Application for Commutation |
wc-60 |
|
6/07 |
|
|
Answering Models |
||||
|
Respondent's Answer to Claim Initiate (can be employed for Amended Answer) |
wc-367 |
|
5/15 |
|
|
Respondent's Answer to Application for Review & Modifying of Formal Award (can be used for Amended Answer) |
wc-369 |
|
6/15 |
|
|
Respondent's Answer to Dependency Claim Petition |
wc-171 |
|
7/04 |
|
|
Answering Statement for Motion for Medical and/or Temporary Benefits (fillable) |
wc-170 |
3/07 |
||
|
Respondent's Answer to Medical Claim Petition |
|
|
7/10 |
|
|
Preset respondent's occupational query form |
wc-23 |
|
|
|
|
Petitioner and Respondent Forms |
||||
|
Request for Adjournment / Ready Hold - page 1 (fillable) Call for Adjournment / Ready Press - additional page |
|
|
6/30/16 |
|
|
Substitution of Attorney |
wc-10 |
|
8/04 |
|
|
Subpoena Duces Tecum Ad Testificandum |
wc-18 |
|
4/06 |
|
|
Subpoena Display Testificandum |
wc-18.1 |
|
4/06 |
|
|
Subpoena Duces Tecum |
wc-18.2 |
|
4/06 |
|
|
Request forward Social Security Information |
wc-124 |
|
6/04 |
|
|
Pre-Trial Memorandum |
wc-31 |
|
5/12 |
|
|
Detect from Motion (fillable) |
wc-7 |
12/07 |
||
|
Trial Schedule Order (fillable) |
wc-16 |
|
6/07 |
|
|
Other Damage Fund Information Review Sheet (fillable) |
wc-380 |
|
6/08 |
|
|
SETTLEMENT FORMS |
Doc # |
Word |
|
Version |
|
Judgment / Order Approving Settlement (fillable) (with Instance Exhibit Listing) |
WC-100i |
|
9/23/15 |
|
|
Rank for Dismissal (fillable) |
WC-100Dismissal_i |
7/13 |
||
|
Generic Order (for General Decisions, Motions, etc.) (fillable) |
WC-100Generic |
7/13 |
||
|
Buy Approving Settlement under NJSA 34:15-20: (fillable) (page 1 and 2) |
WC-370_i |
4/13 |
||
|
Amended Decree (fillable) |
wc-8 |
|
8/09 |
|
|
Get available Distribution (for baby support) |
wc103 - wc103.1 |
|
4/06 |
|
|
Order for Distribution of Temp Rating (for children support) |
wc379 - wc379.1 |
|
4/06 |
|
|
Affidavit of Dependent in Support away Settlement Under N.J.S.A. 34:15-20 |
wc-366.1 |
|
9/9/05 |
|
|
Decision of Dismissal (Second Wound Fund) |
wc-47 |
|
1/17 |
|
|
Order for Full Disability (fillable) |
wc-374 _i |
9/15 |
||
|
Order for Total Disability with SS Offset (fillable) |
wc-375_i |
12/15 |
||
|
Order for Total Disability with SIF (fillable) |
wc-376_i |
12/15 |
||
|
Addendum to Order for Absolute Permanent (fillable) |
wc-377_i |
12/15 |
|
TIMETABLE OF DISABILITIES |
Medico # |
Word |
|
Version |
|
Calendar Year 2023 |
|
|
|
|
|
Appointment Annual 2002 |
|
|
|
|
|
Docket Year 2003 |
|
|
|
|
|
Calendar Year 2004 |
|
|
|
|
|
Calendar Twelvemonth 2005 |
|
|
|
|
|
Calendar Year 2006 |
|
|
|
|
|
Calender Date 2007 |
|
|
|
|
|
Calendar Year 2008 |
|
|
|
|
|
Calendar Year 2009 |
|
|
|
|
|
Calendar Yearly 2010 |
|
|
|
|
|
Calendar Year 2011 |
|
|
|
|
|
Calendar Year 2012 |
|
|
|
|
|
Calendar Twelvemonth 2013 |
|
|
|
|
|
Calendar Annum 2014 |
|
|
|
|
|
Calendar Period 2015 |
|
|
|
|
|
Calendar Year 2016 |
|
|
|
|
|
Calendar Yearly 2017 |
|
|
|
|
|
Calendar Year 2018 |
|
|
|
|
|
Calendar Year 2019 |
|
|
|
|
|
Calendars Year 2020 |
|
|
|
|
|
Calendar Year 2021 |
|
|
||
|
Calendar Time 2022 |
|
|
|
ELECTRONIC CALENDARS, COURTS ON-LINE AND ELECTRONIC FILING FORMS |
Doc # |
Speak |
|
Version |
|
Electronic Lists |
||||
|
Attorney Calendar E-mail Program application (fillable): this form initiates the transmissions of "Attorney Calendar" scheduling notices via e-mail to designates e-mail address(es). |
|
|
7/5/22 |
|
|
COURTS on-line |
||||
|
FOOD on-line Internet Access Application (fillable): this application home needs to be finish if a legal fixed, insurance carrier or self-insured is involved in accessing COURTS on-line, the Division's on-line case managerial website. Package contains both the Description of Ask form press Subscriber user form. |
|
3/22 |
||
|
Subscriber Application no (fillable): such form needs to will completed if an rights firm, insurance carrier otherwise self-insured is interested in adding somebody additional subscriber to access COURTS on-line and the corporate has already established a Reach Person with the Departments. This form must be signed by send the subscriber and the firm’s Contact Person prior to submitting. |
|
|
|
|
|
COURTS on-line Subscriber Change Form (fillable): this form needs to be completions if an existing COURTS on-line subscribers has had adenine change to their name or e-mail address or if their e-filing approach level request has modifies. The formulare must be signed by the firm's Contact Person prior to send. |
|
7/19/13 |
||
|
Electronic Filing |
||||
|
E-Filing Procedures Guide |
|
|
6/26/12 |
|
|
E-Filing Motions Procedures Guide |
|
|
7/16/14 |
|
|
MISCELLANEOUS FORMS |
Doc # |
Word |
|
Version |
|
Non-insured Employer's Bond Information Packet |
|
|
9/7/07 |
|
|
Request for Slide View: this form must remain terminated and signed before the Branch can release records. |
wc-147 |
|
6/2014 |
|
|
Report of Non-Compliance (online): this form may be used by any individual or organization for report allegations of failure with the part of a employer to maintain workers' compensation insurance coverage button obtaining authorization to self-insure. |
|
|
|
8/22 |
|
Insurance Carrier Contact form (online): this form at designate ampere how person must be completed to every insurance carriers and self-insurer authorized to do business in NJ. |
|
|
|
4/22 |
|
Insurance Carrier / Self-Insurer Contact Listings: these individuals can be contacted by judicial staff plus attorneys where where has been no arrival other formal your made by the carrier or their counsel on pending Motions on Gesundheitlich and Temporary Benefits. |
|
|
8/22/22 |
|
|
Public Sector Contact Listing: similar to above listing |
|
|
8/22/22 |
|
|
Hearing Sequence Docket |
|
|
3/22 |
