New Jersey Department of Labor and Workforce Development

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 – 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 Deducted From Benefits Year End Statement Sent to Employer for (W 2) 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 1099 G 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 l l 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 l 2 nd State to implement Family Leave Insurance – California (2004) – Washington (delayed 2015) l FLI is a benefit entitlement program not a leave entitlement program l No employment protection provision to hold job. Employees may have rights under other laws including NJFLA and FMLA

COVERAGE l l 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 l 100% funded by employee contributions through payroll deductions l No employer contributions l New tax rate for 2014 is 0. 001% of taxable wage base. Varies annually based on fund balance, claim activity and administrative costs. l 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 l Benefits are payable for care of a family member with a serious health condition supported by a certification provided by a health care provider l Family Member – – l 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 l Benefits are payable for bonding with a newborn or newly adopted child during the first 12 months after the birth or adoption l 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 l l l 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 l reasonable and practicable notice unless time of leave is unexpected or unforeseeable. l 15 days for leave on an intermittent basis – bonding l 30 days notice

FAMILY LEAVE INSURANCE FACTS l A formal appeal can be filed by an employee or employer who disagrees with a determination l 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 l 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. l Base Year is the 52 weeks immediately prior to the week in which the family leave claim begins

BENEFIT DURATION l 6 Weeks during a 12 month period (365 consecutive days beginning with the first day of a valid first claim) l First Claim is the claim for Family Leave Insurance benefits initially filed. It begins the running of the 12 month period

BENEFIT CALCULATION l Weekly Benefit Rate – – – l 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 l Waiting Week (no waiting week if the State Plan Family Leave Insurance Claim is immediately after the State Plan temporary disability insurance claim) l Pensions reduce entitlement, dollar for dollar, if the most recent employer contributed to the pension benefit

OTHER BENEFIT PROVISIONS l 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 l 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 l Subject to Federal Income Tax – l Not Subject To: – – l Claimant can request that 10% of weekly benefits rate be withheld FICA State Income Tax 1099 G mailed to claimant by Division

Program statistics l 211, 560 eligible claims since 7 -1 -2009 l 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 l l l

Program statistics l l Volume running below original OLS estimates 22% of bonding claims processed through web center automation

Program challenges l l l l 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 l l Intermittent bonding Invalid relationships School employees during school wide recess Typical reasons (insufficient wages, failure to provide information, etc. )

APPLYING FOR BENEFITS l 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 l Claimants who receive State Plan temporary disability benefits will receive instructions after giving birth for filing a transitional bonding claim l Applications should not be filed until the family leave period begins

CUSTOMER SERVICE l Conversant System for general topics and claim specific information is now available l Agent Assistance – during business hours 609 -292 -7060 l 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?