Free PDF - New Jersey


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Date: January 29, 2007
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State: New Jersey
Category: Workers Compensation
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http://lwd.dol.state.nj.us/labor/forms_pdfs/wc/pdf/scf-103.pdf

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For information on your ongoing Fund benefit payments or to advise us of changes in your status, please contact: New Jersey Department of Labor and
Workforce Development
Office of Special Compensation Funds
P.O. Box 399
Trenton, New Jersey 08625-0399
Telephone: (609) 292-2606
Fax: (609) 633-7783
E-mail: osef@dol.state.nj.us


BACKGROUND
The Second Injury Fund was created in 1923 to make benefit payments to to tally and permanently disabled workers in cases where the cause of disability was subsequent to a prior disability render ing the worker permanently and partially disabled. The concept behind the Fund is to encourage employers to hire disabled workers by limiting, in the case of further injury; their liability for compensation pay ments to amounts applicable to the latest injury. The Fund assumes liability for any remaining continuing benefits.

BEFORE FUND BENEFITS BEGIN
Before receiving Fund benefits, while you are receiving benefits from your em ployer or your employer's insurance carrier, you must advise this office of any changes in your address or telephone number. Notice of changes of address or telephone number must be in writing and contain your Social Security number and your signature. One or two months prior to your sched uled date to begin receiving benefits, you will receive a letter (regular and certified mail) along with an Initial Certification. You must answer all the questions on the form and return the form along with a clear, recent (no older that six months) photo of yourself. Please note that your signa ture must be notarized and all materials must be returned to the Office of Special Compensation Funds in the supplied pre addressed envelope. Failure to do so will result in the delay of your benefits.

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AWARD OF BENEFITS
At the conclusion of your hearings, when Fund benefits are awarded, the Judge of Compensation signs an Order for Total Disability with Second Injury Fund. A copy of these documents should be given to you by your attorney. Put these papers in a safe place in case you need them in the future.
New Jersey Department of Labor and
Workforce Development is an equal
opportunity employer with equal opportunity
programs. Auxiliary aids
and services are available upon request
to individuals with disabilities.


CERTIFICATION OF DISABILITY
Six months before the end of the first 450 weeks of permanent and total disabil ity, your case will be referred to the New Jersey Division of Vocational Rehabilita tion Services. They will send you a form, which you must complete and return with a doctors' certification that you remain 100% totally and permanently disabled and cannot work. Failure to comply with this certification will result in your Fund benefits being withheld until such time as you have complied.

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Jon S. Corzine Governor David]. Sowlow Commissioner

If you need this document in braille
or large print, call (609) 292-2606.
TTY users can contact this office
through New Jersey Relay: 7-1-1.


Payments from the Fund commence at the conclusion of payments by the em ployer or the employer's insurance carrier and continue until the death of the worker, as long as the worker remains totally and permanently disabled. The commencement date of Fund benefits is found on the last page of the Decision of Eligibility.

SCF-103 (7/06)

FUND BENEFITS
Upon receipt of the completed Initial Certification form and associated materials, your claim will be processed and the initial payment set for the closest pay period to the date you are to begin receiving benefits from the Fund. A separate check will be is sued for any days you are due benefits prior to the first pay period. Fund benefits are issued every other week and are generally mailed every other Thursday, the day prior to payments being due. Depending on where you live, checks may arrive as early as the following day or as late as the following Tuesday. Because of factors that affect postal delivery, we ask that you wait until at least the follow ing Friday before contacting the Office of Special Compensation Funds concerning a non-received check. Direct deposit is available for individuals with a bank account in the United States. A Petitioner Data Change form will be mailed to you with your first Fund check, and may be used to apply for direct deposit. Along with the completed form, you must provide a voided check or a copy of the portion of your bank sta tement showing your account number and the bank's identification (rout ing) number. This service takes from eight to twelve weeks to begin, and you will be notified one week prior to your first direct deposit check. Please note that Fund benefit checks are not forwarded by the Postal Service. They are returned to the Office of Special Compensation Funds. If a check is returned or the direct deposit of benefits is rejected, future benefits will be withheld until you

provide the correct address or bank infor mation. Once you begin receiving Fund benefits, you will receive an Annual Recertification form by mail each year during the month that you began receiving Fund benefits. You must complete this form, have it notarized, and return it to us. Every five years, a cur rent photo of yourself will be requested to be returned with the form. If you live in New jersey, you will also be notified of a location near you where you may receive assistance in completing the form. Fund benefits will be withheld until the com pleted form is received.

receive in the event that an overpayment occurs.

or receiving those benefits will be subject to both civil and criminal action to recover those benefits.

EMPLOYMENT
Wages from employment after the first 450 weeks of benefits for total and perma nent disability are used to reduce Fund benefits. You must notify this office imme diately if you begin to receive wages from employment. Failure to do so will result in suspension of Fund benefits.

INCOME VERIFICATION LETTER
A petitioner who requests income verifi cation must do so in writing. If any other in dividual is requesting income verification, the petitioner must sign a release, which must accompany the request. You may fax the request to (609) 633-7783. You must mail the original request to: New jersey Department of Labor and Workforce De velopment, Second Injury Fund, P.O. Box 399, Trenton, Nj 08625-0399. The request will be processed within three business days from the date we receive it.

OTHER SETTLEMENTS
The statute provides that any recovery that you may realize from a third-party ac tion, based on your total and permanent disability, will act as credit against pay ments otherwise due from your employer, the employer's insurance carrier, ancIJor the Fund. If you receive any such recovery, you must notify this office immediately. Failure to make this notification may result in suspension of benefits from the Fund and other parties.

MEDICAL BENEFITS
The Second Injury Fund makes no pay ment for medical expenses. If you need treatment for your compensable condition while receiving Fund benefits, you must notify your employer's compensation insur ance carrier.

FURTHER INFORMATION
Questions about your workers' com pensation claim or the Order for Total Disability with Second Injury Fund should be directed to your attorney. The Office of Special Compensation Funds cannot pro vide you with legal advice.

SOCIAL SECURITY BENEFITS
If you are awarded benefits from Social Security after the Order for Total Disability with Second Injury Fund is signed by the judge of Compensation and you are under the age of 62, you must advise this office immediately. There is a possibility that your weekly Fund benefits may be reduced pursuant to N.].S.A 34:15-95.5. Failure to notify this office will result in suspension of Fund benefits if an overpayment occurs. You are also advised to retain any retroac tive Social Security check that you may

PERIOD OF BENEFITS
Subject to reduction as mentioned above, Fund benefits are payable for the life of the beneficiary and cease upon the occa sion of his or her death. No death benefits are payable from the Fund and dependents accrue no rights to such benefits. In the event that we are not notified of the death of the beneficiary and checks are cashed or electronically deposited after his or her death, the individual cashing those checks