N.J. Admin. Code § 12:235-4.3

Current through Register Vol. 56, No. 11, June 3, 2024

Section 12:235-4.3 - Contents of the application

(a) The application for an informal hearing shall contain:

1. The worker's name, address, age, and social security number;

2. The employer's name and address;

3. The name of the employer's insurance carrier, if any;

4. The date of the accident;

5. A brief description of how the accident occurred;

6. A brief description of the injury.

N.J. Admin. Code § 12:235-4.3

Recodified from N.J.A.C. 12:235-6.3 by R.2002 d.340, effective 10/21/2002.
See: 34 New Jersey Register 2257(a), 34 New Jersey Register 2549(a), 34 New Jersey Register 3641(d).
Former N.J.A.C. 12:235-4.3, Personnel functions, recodified to N.J.A.C. 12:235-9.3.