N.J. Admin. Code § 12:235-3.2

Current through Register Vol. 56, No. 24, December 18, 2024

Section 12:235-3.2 - General motions for temporary disability and/or medical benefits

(a) In all motions by the petitioner for temporary disability or medical benefits, the original notice of motion shall be filed with the district office to which the case is assigned and a copy of the notice of motion and claim petition served by certified mail or personal service on the attorneys of record. If the attorney of record is unknown, then service shall be made by certified mail on the respondent(s) and its carrier(s). If it is a new claim petition and it is a claim petition filed on paper, then the notice of motion shall also be filed with the central office. Motions for temporary disability and/or medical benefits shall evidence that petitioner is currently temporarily totally disabled and/or in need of current medical treatment. Where only past periods of temporary total disability and/or medical expenses are claimed by petitioner, such issues should be presented at pretrial for resolution or trial and not by motion under this section.

(b) The notice of motion for temporary disability or medical benefits shall be on a form prescribed by the Division and shall contain:

1. A detailed account of compensable lost time claimed by the petitioner, indicating any period paid by the respondent;

2. Affidavits or certifications made in personal knowledge by the petitioner or the petitioner's attorney, as well as the report(s) of a physician(s) stating the medical diagnosis and the specific type of diagnostic study, referral to specialist, or treatment being sought, and, if available, an itemized bill and report of the treating physicians or institutions or both for which services past, present and future, petitioner is seeking payment and such other evidence as shall relate to the petitioner's claim for temporary disability and/or medical treatment; and

3. If the petitioner, having received treatment, cannot secure a report of the medical provider authorized by the respondent, it shall be set forth in the affidavit in lieu of the physician's report.

(c) If an attorney for the petitioner knowingly files an incomplete, inaccurate or misleading notice of motion for temporary disability and/or medical benefits, or an attorney for the respondent files an untimely, incomplete, inaccurate or misleading answer, the attorney may be assessed a penalty in accordance with N.J.A.C. 12:235-3.1 4.

(d) Except for good cause shown, respondent(s) shall file an answer within 21 days of service of the motion or within 30 days after service of claim petition whichever is later.

(e) When the Division has received a notice of motion for temporary disability and/or medical benefits filed in accordance with (a), (b) and (c) above, it shall list the motion for a hearing before a Judge of Compensation peremptorily within 30 days of the filing of the motion. Motions for medical and/or temporary benefits shall commence and continue in a timely manner subject to the scheduling constraints of the Division. Said scheduling may be accelerated as ordered by the Director, the Supervising Judge of the vicinage, or the Judge of Compensation to whom the case is assigned.

(f) Affidavits, certifications and medical reports submitted in accordance with (b) above in support of the motion may constitute a prima facie case and may be sufficient basis for the issuance of an order compelling the respondent to provide the relief sought unless respondent files supporting affidavits or certifications to oppose said motion on a legal or factual basis, or files medical reports if there is a medical basis to oppose said motion. No order shall be issued until 30 days after service of the claim petition.

(g) Examination, if required by respondent, shall be completed within 30 days of receipt of the motion and the report issued in not more than 35 days from receipt of the motion and shall not delay the start of the hearing of the motion except for good cause shown.

(h) For motions where it appears the only issue involved is which carrier or employer is liable to petitioner for the benefits sought, a judge of compensation may order one carrier or employer to pay benefits without prejudice and subject to an order of reimbursement if another party is later held liable for such benefits.

(i) On conclusion of the hearing on the motion for temporary and/or medical benefits, the Judge of Compensation shall, within 15 days, render a final decision on the motion and notify the respective counsel of the decision. In computing the 15 days' time, the 15 days shall be from the last day of hearing or from the date of filing of briefs as ordered by the Judge, whichever is later. Under no circumstances shall briefs be filed later than 15 days after the hearing.

N.J. Admin. Code § 12:235-3.2

Amended by R.1991 d.466, effective 9/3/1991.
See: 23 N.J.R. 1759(a), 23 N.J.R. 2642(a).
Penalty assessment increased from $ 50 to $ 200; Physician's reports allowed; scheduling requirements added at (d).
Amended by R.1997 d.110, effective 3/3/1997.
See: 28 N.J.R. 4067(a), 29 N.J.R. 799(a).
In (a), provided that service of notice and be made to the attorneys of record rather than on parties and be made by certified mail or personal service; inserted (b)3; in (c), inserted reference to filing of untimely, incomplete, inaccurate or misleading answer and amended the penalty reference; inserted new (d) and (f); deleted (e) and recodified former (d), (f), and (g) as (e), (g), and (h); and in (g), provided for issuance of report and inserted "except for good cause shown".
Amended by R.2002 d.340, effective 10/21/2002.
See: 34 N.J.R. 2257(a), 34 N.J.R. 2549(a), 34 N.J.R. 3641(d).
Rewrote (a); in (c), amended the N.J.A.C. reference.
Amended by R.2004 d.263, effective 7/6/2004.
See: 36 N.J.R. 1350(a), 36 N.J.R. 3294(a).
Added a new (h); recodified former (h) as (i); added (j).
Amended by R.2006 d.91, effective 2/21/2006.
See: 37 N.J.R. 4175(a), 38 N.J.R. 1192(a).
In (b)2, substituted "or the" for "," following petitioner; substituted ", as well as the" for "and following attorney"; and added "diagnostic study, referral to specialist, or".
Amended by R.2009 d.299, effective 10/5/2009.
See: 41 N.J.R. 1935(a), 41 N.J.R. 3807(a).
Section was "Motions for temporary disability and/or medical benefits". Deleted (j).