Free NJ Department of Labor - New Jersey

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NJ Department of Labor and Workforce Development Division of Workers' Compensation

Application Package for Secure Internet Access to the Division's database and Electronic Filing

P.O. Box 381 Trenton, New Jersey 08625-0381 For more information about COURTS on-line, please contact: (609) 984-2555 (609) 292-3758 FAX [email protected] http://lwd.dol.state.nj.us/labor/wc/egov/egov_index.html

State of New Jersey Department of Labor and Workforce Development Division of Workers' Compensation PO Box 381, Trenton, NJ 08625-0381

Thank you for your interest in the Division of Workers' Compensation's Internet database, COURTS on-line. Access to COURTS on-line is available to law firms, insurance carriers and Self Insurers through a unique password/login ID. In addition to proving information on all your firm's cases, COURTS on-line gives law firms the ability to electronically file and receive legal pleadings and insurance carriers the ability to electronically receive legal documents and to electronically forward those documents to their counsel for response. For more information about e-filing, please visit http://lwd.dol.state.nj.us/labor/wc/egov/efiling/courts_efile_index.html The minimum technical requirements for participation in COURTS on-line are the following: subscriber must have a unique e-mail address belonging solely to him/her; subscriber must routinely check his/her e-mail to receive important notices from the Division. Please note that email filters used by some Internet Service Providers may classify messages from the COURTS on-line staff as Bulk Mail or Junk Mail, while others may completely prevent the delivery of our messages to you. To ensure that messages are delivered correctly to your Inbox, please add the following domain names to your address book: "dol.state.nj.us" and "oit.state.nj.us" the Internet browser on the subscriber's computer must be either Microsoft Internet Explorer (version 6.0.2) or Firefox version 2.0 or higher. Netscape Navigator (version 4.7 or higher) is acceptable but not recommended; Adobe Acrobat Reader (the latest version) must be installed if subscriber is interested in e-filing subscriber must be able to download files through the Internet Before we can process the individual applications, we will need for your firm to designate a contact person, an individual with a managerial title. This can be done by completing application #1. It will be the contact person's responsibility to approve the list of users for your firm, advise us on the electronic filing access level for every subscriber, notify us whenever there is a change to this list and receive notices from the Division regarding technology issues. The individual subscriber application (application #2) needs to be completed and signed by each applicant as well as the contact person. Please note that if the contact person wishes to receive their own logon credentials, he or she will also have to complete a subscriber application (application #2). You can mail or fax the completed applications to the Division of Workers' Compensation at the address noted above, attn: Donna Conway, fax (609) 292-3758. If you have any questions, you can e-mail us at [email protected] or call us at (609) 984-2555. Within 2 weeks after you submit your applications to the Division, each applicant will be mailed a pin number and instructions on how to create their online profile, userID and password. Once the subscriber has created their profile successfully, they will then be able to log on to COURTS on-line. We look forward to hearing from you and thank you for your continued support of the COURTS project. Sincerely,

Shravani Kosnik COURTS Project Team
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NJ Division of Workers' Compensation - COURTS on-line program Designation of a Contact Person ­ Application 1

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Access to COURTS on-line is only available to authorized employees of law firms/insurance carriers/self insurers registered with the Division. Please keep in mind that the minimum requirements for participation in this program are the following: each individual applicant must have his or her own personal computer with a unique e-mail address belonging solely to that applicant; the Internet browser on the participant's computer must be either Microsoft Internet Explorer (version 6.0.2) or Firefox version 2.0 or higher. Netscape Navigator (version 4.7 or higher) is acceptable but not recommended; Adobe Acrobat Reader software (the latest version) for viewing and downloading documents; the applicant must be designated as an authorized participant by their employer. In order for us to process the applications filed by employees of your company/firm, we will need to know the identity of a key contact person in your company. The individual designated should be an officer of the company, a partner or have a managerial title. If your firm has multiple locations, the designated contact person should be located at the address that is registered with the Division of Worker's Compensation. It will be the contact person's responsibility to approve the list of users for your firm, advise us of their electronic filing status, notify us whenever there is a change to this list and receive notices from the Division regarding COURTS on-line issues. Please note that as long as one subscriber from your firm is designated as an electronic filer, your firm will be considered an "Electronic Filing" firm and will receive notices of electronically filed legal pleadings solely through the COURTS on-line system. I. Contact Person ­ Information
Your Name Title Firm Name Street Address City, State, ZIP Telephone # E-Mail Address: Fax #:
(complete all fields)

II.

Electronic Filing
My firm is interested in participating in the electronic filing program. By opting for this feature, I understand that as long as one subscriber from my firm is designated an electronic filer, my firm will be considered an "Electronic Filing" firm and will receive notices of electronically filed legal pleadings solely through the COURTS on-line system. My firm is not interested in electronic filing at this time.

III.

Contact Person Signature

I understand that it will be my responsibility to approve the list of users for the above referenced firm/company and to notify the Division in writing whenever an individual, participating in the COURTS on-line program is no longer employed with us or if his/her authorization to inspect records on behalf of this firm has been withdrawn. Date:
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Signature:

NJ Division of Workers' Compensation - COURTS on-line program

Subscriber Application ­ Application #2

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The minimum requirements for participation in this program are the following: each individual applicant must have his or her own unique e-mail address belonging solely to that applicant; the Internet browser on the participant's computer must be either Microsoft Internet Explorer (version 6.0.2) or Firefox version 2.0 or higher. Netscape Navigator (version 4.7 or higher) is acceptable but not recommended; Adobe Acrobat Reader software (the latest version) for viewing and downloading documents; the applicant must be designated as an authorized participant by their employer. Please complete sections I and II of this application, provide your signature in the requested areas and forward it to your employer for approval and their signature in sections III and IV. Within 2 weeks after you submit your applications to the Division, you will be mailed a pin number and instructions on how to create your online profile, userID and password. Once you have registered successfully, you will then be able to log on to COURTS on-line.

I. Subscriber Information
Your Name: Street Address: City, State & ZIP: Telephone:

(complete all fields)

Firm Name:

Fax:

E-Mail:

II. Certification of Confidentiality and Subscriber Responsibilities (signature of participant required)
I, the undersigned, do hereby state under penalty of law, that I do not seek inspection of the records available on the Division of Workers' Compensation's COURTS on-line website for the purpose of selling or furnishing for a consideration to others and will not do so nor will I subsequently disclose any of the information to any person, organization, entity or governmental agency not entitled to receive the information from the Division of Workers' Compensation pursuant to R.S. 34:15-1 et seq. Please refer to NJSA 34:15128 printed on page 3 of this form. I, the undersigned, am aware that I am responsible for preserving the security of my password and the digital certificate issued to me in relation to this program. I understand that I am responsible for the actions of any unauthorized user gaining access into the database using my password and digital certificate, without the express permission of the Division. Date: Signature:

III.

Electronic Filing Access Level (to be completed by your COURTS on-line Contact Person)

Select the Electronic Filing Access Level (if no selection is made, access will default to the BASIC level): BASIC Subscribers will not be able to electronically receive or submit legal pleadings on behalf of the firm. LIMITED Law Firms only - Subscribers will be able to receive notices of electronically filed legal pleadings, data enter and save information into pre-formatted templates but they will not be able to electronically file any legal documents. FULL If Law Firm - this access level will give subscribers full rights to receive and file legal pleadings electronically. If Carriers ­ this access level will allow you to receive pleadings and to designate respondent counsel electronically. ** If Limited or Full Access is selected for at least one employee of a firm, that firm will receive notice of e-filed documents solely through the COURTS on-line website and not through US Mail.

IV.

Employer / Firm Approval (signature of your COURTS on-line Contact Person required)

The above individual has been approved to access workers' compensation cases on behalf of: ____________________________________________________ and has been assigned the above noted electronic filing access level.

I understand that it will be my responsibility to notify the Division, in a manner prescribed by the Division, immediately upon learning that this individual is no longer employed with us or that his/her authorization to inspect records on the COURTS on-line database Date: Signature:
Contact Person Name and Title

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34:15-128. Limited right to inspect or copy records. a. Notwithstanding any other provision of the chapter to which this act is a supplement [34:15-1 et seq.] or of any other law, no records maintained by the Division of Workers' Compensation or the Compensation Rating and Inspection Bureau shall be disclosed to any person who seeks disclosure of the records for the purpose of selling or furnishing for a consideration to others information from those records or reports or abstracts of workers' compensation records or workinjury records pertaining to any claimant. No information shall be disclosed from those records to any person not in the division, unless: (1) The information is provided in a manner which makes it impossible to identify any claimant; (2) The records are opened for the exclusive purpose of permitting a claimant, employer, insurance carrier or authorized agent of the claimant, employer or insurance carrier to conduct an investigation by or on behalf of the claimant, employer or insurance carrier in connection with any pending workers' compensation case to which the claimant, employer or insurance carrier is a party, and the party seeking access to the records certifies to the division that the information from the records will be used only for purposes directly related to the case; (3) The records are opened for the exclusive purpose of permitting a third party directly involved in a workers' compensation case, including any workers' compensation lienholders, or an authorized agent of the third party, to conduct an investigation by or on behalf of the third party in connection with the case, and the party seeking access to the records certifies to the division that the information from the records will be used only for purposes directly related to the case; (4) The records are subpoenaed by the Commissioner of Banking and Insurance pursuant to section 10 of P.L. 1983, c. 320 (C. 17:33A-10) or by a court of competent jurisdiction in a civil or criminal proceeding; (5) The division provides the information to another governmental agency pursuant to law, for a duly recognized purpose of that agency, which agency shall not subsequently disclose any of the information to any person, organization, entity or governmental agency not entitled to receive the information from the Compensation Rating and Inspection Bureau or the Division of Workers' Compensation pursuant to the workers' compensation law, R.S. 34:15-1 et seq.; or (6) The information is information about the claimant requested by the claimant, in which case the division shall disclose the information and the claimant shall not be charged fees in excess of the cost of providing copies of the information. b. Notwithstanding any other provision of law, no information from records maintained by the Compensation Rating and Inspection Bureau pertaining to any work injury or illness or workers' compensation claim shall be disclosed to any business or other member of the public unless the bureau discloses the information in a manner which makes it impossible to identify the claimant. c. Notwithstanding any other provision of law, no information provided by the Division to any other governmental agency pursuant to subsection a. of this section shall be disclosed by the agency to any business or other member of the public unless the information is disclosed to the business or other member of the public in a manner which makes it impossible to identify the claimant. d. Notwithstanding the restrictions on disclosure set forth under subsections a. through c. of this section, a claimant may authorize the release of records of the claimant to a specific person not otherwise authorized to receive the records, by submitting written authorization for the release to the division specifically directing the division to release workers' compensation records to that person. However, no such authorization directing disclosure of records to a prospective employer shall be valid, nor shall an authorization permitting disclosure of records in connection with assessing fitness or capability for employment be valid, and no disclosure of records shall be made with respect thereto, unless requested pursuant to and consistent with the federal "Americans with Disabilities Act of 1990," 42 U.S.C. § 12101 et seq. and the "Law Against Discrimination," P.L. 1945, c. 169 (C. 10:5-1 et seq.). It shall be unlawful for any person to consider for the purpose of assessing eligibility for a benefit, or as the basis for an employment-related action, an individual's failure to provide authorization under this subsection.

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