A4924

An Act concerning the timely provision of temporary disability benefits and amending and supplementing P.L.1948, c.110.

Be It Enacted by the Senate and General Assembly of the State of New Jersey:

1. Section 31 of P.L.1948, c.110 (C.43:21-55) is amended to read as follows:

31. Penalties. (a) Whoever makes a false statement or representation knowing it to be false or knowingly fails to disclose a material fact, and each such false statement or representation or failure to disclose a material fact shall constitute a separate offense, to obtain or increase any disability benefit under the State plan or an approved private plan, or for a disability during unemployment, including any benefit during a period of family temporary disability leave, either for himself or for any other person, shall be liable for a fine of $250 to be paid to the division. Upon refusal to pay such fine, the same shall be recovered in a civil action by the division in the name of the State of New Jersey. If in any case liability for the payment of a fine as aforesaid shall be determined, any person who shall have received any benefits hereunder by reason of the making of such false statements or representations or failure to disclose a material fact, shall not be entitled to any benefits under this act for any disability occurring prior to the time he shall have discharged his liability hereunder to pay such fine.

(b) Any employer or any officer or agent of any employer or any other person who makes a false statement or representation knowing it to be false or knowingly fails to disclose a material fact, to prevent or reduce the benefits to any person entitled thereto, or to avoid becoming or remaining subject hereto or to avoid or reduce any contribution or other payment required from an employer under this act, or who willfully fails or refuses to make any such contributions or other payment or to furnish any reports required hereunder or to produce or permit the inspection or copying of records as required hereunder, or who fails to provide any notification or disclosure to the division or the employee required by subsection (a) of section 25 of P.L.1948, c.110 (C.43:21-49) or subsections f. or g. of section 10 of P.L.2008, c.17 (C.43:21-39.1) at the time and in the manner required by those sections, including disclosure of the information the division requires for the processing of a claim, shall be liable for a fine of $250 to be paid to the division, and, if a failure of an employer to provide the notification or disclosure to the division or the employee results in a delay in the payment of benefits, the employer shall also be liable for an added amount, to be paid to the claimant, equal to the benefits due from the time that the employer was required to provide the notification or disclosure until the time that the benefit payments commenced. Upon refusal to pay such fine or added payments to a claimant, the same shall be recovered in a civil action by the division in the name of the State of New Jersey.

(c) Any person who shall willfully violate any provision hereof or any rule or regulation made hereunder, for which a fine is neither prescribed herein nor provided by any other applicable statute, shall be liable to a fine of $500 to be paid to the division. Upon the refusal to pay such fine, the same shall be recovered in a civil action by the division in the name of the State of New Jersey.

(d) Any person, employing unit, employer or entity violating any of the provisions of the above subsections with intent to defraud the division shall in addition to the penalties hereinbefore described, be liable for each offense upon conviction before the Superior Court or any municipal court for a fine not to exceed $1,000 or by imprisonment for a term not to exceed ninety days, or both, at the discretion of the court. The fine upon conviction shall be payable to the State disability benefits fund of the division. Any penalties imposed by this subsection shall be in addition to those otherwise prescribed in this chapter (R.S.43:21-1 et seq.).

(e) Any sum collected as a fine or penalty pursuant to this section shall be deposited in the administration account of the State disability benefits fund and applied toward enforcement and other administrative costs of the division.

(cf:P.L.2008, c.17, s.8)

2. (New section) a. The division shall implement disability insurance goals for the timely payment of temporary disability benefits and family temporary disability benefits under the State plan, as follows:

(1) for temporary disability benefits, in each calendar year:

(a) not less than 25 percent of the original benefit determinations shall be completed within seven days after the receipt of the benefit claims by the division;

(b) not less than 65 percent of the original benefit determinations shall be completed within 14 days after the receipt of the benefit claims by the division;

(c) not less than 75 percent of the original benefit determinations shall be completed within 21 days after the receipt of the benefit claims by the division; and

(d) not less than 85 percent of the original benefit determinations shall be completed within 28 days after the receipt of the benefit claims by the division; and

(2) for family temporary disability benefits, in each calendar year:

(a) not less than 50 percent of the original benefit determinations shall be completed within seven days after the receipt of the benefit claims by the division;

(b) not less than 75 percent of the original benefit determinations shall be completed within 14 days after the receipt of the benefit claims by the division;

(c) not less than 85 percent of the original benefit determinations shall be completed within 21 days after the receipt of the benefit claims by the division; and

(d) not less than 95 percent of the original benefit determinations shall be completed within 28 days after the receipt of the benefit claims by the division.

b. The commissioner shall, not later than September 30 of 2018 and each subsequent year, issue, provide to the Legislature, and make available to the public on the department’s webpage, a report regarding division efforts in the preceding calendar year to attain the disability insurance goals set pursuant to this section for temporary disability benefits, and a report regarding those efforts for family temporary disability benefits. Each report shall include:

(1) the total number of claims and the number and percentage of original determinations completed within each number of days specified in the goals set pursuant to this section, and the number and percentage of original determinations completed within the following number of days after the receipt of the benefit claims: 35 days, 42 days, 49 days and 56 days, and the number and percentage of original determinations completed more than 56 days after the receipt of the claims and the average number of days to make the determinations for the claims that took more than 56 days;

(2) the number and percentage of claims received with insufficient information, what portion of those claims were because of failure of claimants to provide sufficient information, what portion of those claims were because of failures of medical providers of claimants to provide sufficient information, and what portion of those claims were because of failures of employers to provide sufficient information;

(3) the number and percentage of claims for which determinations were delayed because of a failure of the employer to make the notifications or disclosures to employees and the division within the amount of time required by subsection (a) of section 25 of P.L.1948, c.110 (C.43:21-49) or subsections f. or g. of section 10 of P.L.2008, c.17 (C.43:21-39.1), the number of complaints received related to employer noncompliance with those requirements, and the number of employers which have been, because of the failures, required, pursuant to section 31 of P.L.1948, c.110 (C.43:21-55), to pay fines or penalties to the division or added amounts to claimants, the total amount of payments to the division, and the total amount of payments to claimants;

(4) the number of personnel in the division and the budgeted cost of salaries and benefits for those personnel; the number of personnel who are processing temporary disability benefit claims and the budgeted cost of salaries and benefits for those personnel; the number of personnel who are processing family temporary disability benefit claims and the budgeted cost of salaries and benefits for those personnel; what percentage of total division administrative costs is comprised of those categories of personnel costs; and a comparison of total division administrative costs to the maximum amount permitted to be expended for those division administrative costs pursuant to section 22 of P.L.1948, c.110 (C.43:21-46); and

(5) if any of the disability insurance goals set pursuant to this section were not attained during the year, the report shall provide an evaluation of the causes of the deficiencies and a plan to correct them and that plan shall include:

(a) any increase in personnel needed to process claims;

(b) any measures needed to enforce notification and reporting requirements;

(c) any measures needed to inform employees of their responsibilities to facilitate the timely provision of benefits; and

(d) any improvements needed in data processing and other administrative services and equipment.

The plan shall specify any added costs entailed in implementing the plan, which shall be regarded as costs of administration of temporary disability and family temporary disability benefits, and shall specify the amount of any resulting increase in the estimate made pursuant to subparagraphs (i) and (ii) of R.S.43:21-7(d)(G) of the amount needed to provide 100 percent of the cost of administration of temporary disability and family temporary disability benefits.

The commissioner shall use that increased estimate in setting the rate of contributions pursuant to those subsections, except that the increase may not result in the total amount credited to those administrative costs to exceed the maximum amount permitted pursuant to subsection (a) of section 22 of P.L.1948, c.110 (C.43:21-46).

c. (1) The division shall, during each calendar year, allocate not less than $500,000 or more than $2,000,000 to disseminate information about the rights and responsibilities of employers and employees regarding temporary disability benefits and family temporary disability benefits by means of programs of educational outreach in communities and workplaces. Of that allocation, not less than $300,000 or more than $1,200,000 shall be used by the division to enter into contracts with community-based organizations to disseminate information to workers regarding temporary disability benefits and family temporary disability benefits. That allocation shall be regarded as a cost of administration of temporary disability and family temporary disability benefits and be charged to the administration account of State disability benefit fund. Of the costs charged to the administration account of the State disability benefit fund pursuant to this subsection, the percentage which is charged to the Family Temporary Disability Leave Account shall be equal to the percentage that family temporary disability benefits represents of all temporary disability benefits paid from the State disability benefits fund during the preceding calendar year. The allocation made pursuant to this subsection, including any adjustments in the allocation specified in the plan provided pursuant to paragraph (2) of this subsection, shall not result in the total amount credited to administrative costs exceeding the maximum amount permitted pursuant to subsection (a) of section 22 of P.L.1948, c.110 (C.43:21-46).

(2) The commissioner shall, not later than September 30 of 2018 and each subsequent year, issue, provide to the Legislature, and make available to the public on the department’s webpage, a report regarding efforts made during the preceding calendar year of the division and of community-based organizations to disseminate information about the rights and responsibilities of employers and employees regarding temporary disability and family temporary disability benefits. Each report shall include, for that preceding calendar year:

(a) an accounting of all funds allocated pursuant to this subsection and all expenditures made from those funds by the division and each community-based organization entering into contracts with the division pursuant to this subsection, and estimates of the number of employers and the number of workers to which the information was disseminated;

(b) an estimate of the number of workers who were eligible for temporary disability and family temporary disability benefits and what percentage of those workers received those benefits, including an assessment of whatever progress was made to increase that percentage; and

(c) a plan to increase the percentage of workers who are aware of the benefits which specifies the amounts to be allocated to the division and community-based organizations for the purposes of this subsection during the subsequent calendar year, provided that the amounts specified shall not be less than or more than the minimum and maximum amounts indicated in paragraph (1) of this subsection.

3. This act shall take effect immediately.

STATEMENT

This bill implements measures to facilitate the timely payment of benefits under the temporary disability insurance (TDI) law, P.L.1948, c.110 (C.43:21-25 et al.), and the family leave insurance (FLI) law, P.L.2008, c.17 (C.43:21-39.1 et al.), and provides for increased dissemination of information about those benefits.

The bill applies existing penalties of the TDI law to employers who fail to provide the notifications and disclosures at the time and in the manner required by the TDI and FLI laws to employees, claimants, and program administrators. If a failure delays benefit payments, the employer is required to pay the claimant an added amount equal to the benefits due from the time that the notification or disclosure was required until the benefit payments commenced.

The bill also requires the division to implement goals for the timely payment of TDI and FLI benefits. For TDI benefit claims, the goals set minimum percentages of initial claims to be completed within specified time spans as follows: 25% within seven days, 65% within 14 days, 75% within 21 days, and 85% within 28 days. For FLI benefit claims, the goals specified by the bill set the minimum percentages at 50% within seven days, 75% within 14 days, 85% within 21 days, and 95% within 28 days.

The bill requires the Commissioner of Labor and Workforce Development to issue annual reports regarding efforts to attain those goals. Each report is required to include:

1. The total number of claims, and the number and percent of claims completed within each number of days specified in the goals, and the number and percent of original determinations completed within 35 days, 42 days, 49 days, 56 days, and more than 56 days.

2. The number and percent of claims received with insufficient information, what portions of those claims were due to failures to provide sufficient, timely information by each of the following groups: claimants, their medical providers, and employers.

3. The number and percent of claims delayed due to employer failure to make the required, timely notifications or disclosures, the number of related complaints, and the number of employers who, due to those failures, paid fines to the division or added amounts to claimants, and total payments to the division and claimants.

4. The number, and salary and benefit costs, of division personnel, and the portion of them processing TDI and FLI claims, with a comparison of those costs to the maximum administrative expenditures allowed by the TDI and FLI laws.

5. An evaluation of the causes of any failures to meet the goals, and a plan to correct them, which would include, as needed: increases in personnel; measures to enforce notification and reporting requirements; measures to inform employees of their responsibilities to facilitate the timely benefit provision; improvements in administrative services and equipment; and related increases in the TDI and FLI benefit administration expenditures.

The commissioner is required to use that increased estimate in setting the rate of TDI and FLI worker taxes, except that the increase may not result in the total amount credited to TDI and FLI administrative costs to exceed the maximum amount allowed by the TDI and FLI laws, which is 0.1% of wages subject to TDI taxes.

Finally, the bill directs the division to disseminate information about the rights and responsibilities of employers and employees regarding TDI and FLI benefits. Not less than $500,000 or more than $2,000,000 are allocated each year to the programs, of which not less than $300,000 or more than $1,200,000 are allocated to contracts with community-based organizations to disseminate benefit information to workers. The amount allocated, within those limits, will be based on a plan included in an annual report issued by the commissioner, which includes an accounting of the allocated funds and their expenditure by the division and community-based organizations, estimates of the number of employers and workers receiving the information, estimates of the number of workers eligible for benefits and the percent of them receiving the benefits, and the plan to increase worker awareness of the benefits.