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New JerseyNew JerseyDepartmentDepartment
ofofLabor and Workforce Labor and Workforce
DevelopmentDevelopment
DivisionDivision
ofof
Temporary Disability InsuranceTemporary Disability Insurance
Disability CoverageDisability Coverage
Rhode IslandRhode Island
CaliforniaCalifornia
New JerseyNew Jersey
New YorkNew York
HawaiiHawaii
Puerto RicoPuerto Rico
New Jersey ProgramNew Jersey Program
Established in 1948Established in 1948
Modeled After California & Rhode IslandModeled After California & Rhode Island
Compromise Between Business & Compromise Between Business & LaborLabor– Business – Private CoverageBusiness – Private Coverage– Labor – State CoverageLabor – State Coverage
What is Temporary Disability What is Temporary Disability Insurance?Insurance?
Temporary - Short Term BenefitsTemporary - Short Term Benefits
Disability - Disability - Non-Work Related Illness or Non-Work Related Illness or
InjuryInjury
Insurance - ProtectionInsurance - Protection
Who is Covered?Who is Covered?
All Those Covered for Unemployement All Those Covered for Unemployement Insurance With the Following Exceptions:Insurance With the Following Exceptions:
– Local Government (Optional)Local Government (Optional)
– Federal GovernmentFederal Government
– Out-of-State EmploymentOut-of-State Employment
The Division of Temporary Disability The Division of Temporary Disability Insurance Oversees Three Programs:Insurance Oversees Three Programs:
State PlanState Plan
Private PlanPrivate Plan
Disability During UnemploymentDisability During UnemploymentDisabilities beginning more than 14 days after the Disabilities beginning more than 14 days after the last date of work in covered employmentlast date of work in covered employment
State Plan OperationsState Plan Operations
State Plan EligibilityState Plan Eligibility
Covered Wages in Base Covered Wages in Base YearYear– Base Week RequirementBase Week Requirement
2014 = $145*2014 = $145*
– Alternative Earnings TestAlternative Earnings Test2014 = $7,300*2014 = $7,300*
Unable to WorkUnable to Work
Medical CertificationMedical Certification
Benefit CalculationBenefit Calculation
Benefit CalculationBenefit Calculation– 2/3 of the Average Weekly 2/3 of the Average Weekly
WageWage
– Average Weekly Wage is Average Weekly Wage is based on earnings in the 8 based on earnings in the 8 calendar weeks immediately calendar weeks immediately prior to start of disabilityprior to start of disability
Weekly Benefit RateWeekly Benefit Rate– 2014 = $5952014 = $595
Maximum EntitlementMaximum Entitlement– 2014 = $15,4702014 = $15,470
Claims Processing GoalsClaims Processing Goals
69% of claims determined within 14 days.69% of claims determined within 14 days.
88% of claims determined within 28 days.88% of claims determined within 28 days.
*To avoid processing delays, the application *To avoid processing delays, the application form should be completed by the claimant, form should be completed by the claimant, the doctor, and the employer.the doctor, and the employer.
Benefit LimitationsBenefit Limitations
Waiting WeekWaiting Week
Criminal ActsCriminal Acts
Gross MisconductGross Misconduct
Workers’ CompensationWorkers’ Compensation
Labor DisputesLabor Disputes
Special IssuesSpecial Issues
PregnancyPregnancy
Drug AbuseDrug Abuse
Alcohol AbuseAlcohol Abuse
Protection of the Trust FundProtection of the Trust Fund
Independent Medical ExaminationsIndependent Medical Examinations
Staff PhysicianStaff Physician
Cross-match With Unemployment Cross-match With Unemployment InsuranceInsurance
Benefit ChargesBenefit Charges– Are Determined by Most Recent Covered Are Determined by Most Recent Covered
EmployerEmployer
Federal Tax RequirementsFederal Tax Requirements– Since 1982, TDI Third Party PaySince 1982, TDI Third Party Pay
Taxable Under FIT & FICATaxable Under FIT & FICAFICA Deducted From BenefitsFICA Deducted From BenefitsYear End Statement Sent to Employer for (W2) Year End Statement Sent to Employer for (W2) preparationpreparation
Not taxable for NJ State Income TaxNot taxable for NJ State Income Tax
State Plan FundingState Plan Funding
Employer RatesEmployer Rates– Start-up Rate = Start-up Rate =
0.0050%0.0050%
– Experience Rating Experience Rating After Three Years = After Three Years =
0.10% to 0.75%0.10% to 0.75%
– 2014 Contributions = 2014 Contributions = $31.50 to $236.25$31.50 to $236.25
Worker RateWorker Rate– .0036% on the first .0036% on the first
$31,500$31,500
– 2014 Max. Employee 2014 Max. Employee Contributions = Contributions = $119.70$119.70
Based on Taxable Wages
2014 Taxable Wage Base = $31,500
Private Plan,Private Plan,Disability During Disability During UnemploymentUnemployment
&&Customer ServicesCustomer Services
Coverage OptionsCoverage Options
State Plan Coverage Is Automatic for Most Workers
But
Workers May Be Covered by an Employer’s Approved Private Plan Instead.
Private Plan CoveragePrivate Plan Coverage
Approximately 6,100 Private PlansApproximately 6,100 Private Plans
Covering Approximately 905,000 workersCovering Approximately 905,000 workers
State Plan oversees the administration of State Plan oversees the administration of all private plansall private plans
Supplemental Plans permitted on Supplemental Plans permitted on voluntary basisvoluntary basis
Third TDI Program Third TDI Program Disability During UnemploymentDisability During Unemployment
Disability Begins More Than 14 Days After Disability Begins More Than 14 Days After Last Day of Covered Employment.Last Day of Covered Employment.
Eligibility Same As U.I. (But Unable to Do Eligibility Same As U.I. (But Unable to Do Any Work).Any Work).
Federal Tax RequirementsFederal Tax Requirements
Not Subject to FICANot Subject to FICA
Considered Income by IRSConsidered Income by IRS
New Jersey LWD Sends Form 1099G to New Jersey LWD Sends Form 1099G to Claimant for Tax YearClaimant for Tax Year
Note:Note:Not taxable for NJ State Income TaxNot taxable for NJ State Income Tax
Claims ProcessingClaims Processing
Claims come in through fax or mail and Claims come in through fax or mail and are sorted and imaged into our systemare sorted and imaged into our system
Our mainframe system randomly assigns Our mainframe system randomly assigns the claim to an examiner, and when all 3 the claim to an examiner, and when all 3 parts of the claim have been received, the parts of the claim have been received, the examiner processes that claim within 14 examiner processes that claim within 14 days and a determination of eligibility is days and a determination of eligibility is sent to the claimantsent to the claimant
Claims ProcessingClaims Processing
If more information is needed, the If more information is needed, the examiner will contact the claimant, doctor, examiner will contact the claimant, doctor, or employer via phone or mail to request or employer via phone or mail to request the informationthe information
Payments for eligible claims are made via Payments for eligible claims are made via a Bank of America debit card which is a Bank of America debit card which is mailed to the claimant and is valid for all mailed to the claimant and is valid for all UI, TDI, and FLI benefits paid for 4 yearsUI, TDI, and FLI benefits paid for 4 years
Customer Service SectionCustomer Service Section609-292-7060609-292-7060
20 - 30 Agents who have the ability to view 20 - 30 Agents who have the ability to view claim imagesclaim images
Conversant System for inquiryConversant System for inquiry
50,000 Conversant Calls Per Week50,000 Conversant Calls Per Week
7,000 Agent Calls Per Week7,000 Agent Calls Per Week
Temporary Disability InsuranceTemporary Disability InsuranceWebsiteWebsitewww.nj.gov/laborwww.nj.gov/labor
Go to Temporary DisabilityGo to Temporary Disability
Provides general information on all three program areasProvides general information on all three program areas
Ability to download claim form (DS-1)Ability to download claim form (DS-1)
Claimants can access State Plan claim information via Web Claimants can access State Plan claim information via Web Services linkServices link
Ability to contact the Division via e-mail.Ability to contact the Division via e-mail.– Claim specific information not available via e-mail due to security issuesClaim specific information not available via e-mail due to security issues
Ability to file an appeal via e-mailAbility to file an appeal via e-mail
We are creating a web based application expected to launch late We are creating a web based application expected to launch late this year this year
AppealsAppeals
State PlanState Plan
Disability During UnemploymentDisability During Unemployment
Private PlanPrivate Plan
Questions?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 $145or more
– Alternative Earnings Test2014 - $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– Claimant can request that 10% of weekly benefits
rate be withheld
Not Subject To:– 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 hours609-292-7060
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
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?
