43:21-45.2 Implementation of disability insurance goals for timely determination and prompt payment.

21. a. The division shall implement disability insurance goals for the timely determination and prompt 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 40 percent of the original benefit determinations shall be completed within seven days after the commencement of the disability, or the receipt of the benefit claims by the division, whichever is later;

(b) not less than 75 percent of the original benefit determinations shall be completed within 14 days after the commencement of the disability, or the receipt of the benefit claims by the division, whichever is later;

(c) not less than 85 percent of the original benefit determinations shall be completed within 21 days after the commencement of the disability, or the receipt of the benefit claims by the division, whichever is later; and

(d) not less than 90 percent of the original benefit determinations shall be completed within 28 days after the commencement of the disability, or the receipt of the benefit claims by the division, whichever is later; and

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

(a) not less than 80 percent of the original benefit determinations shall be completed within seven days after the commencement of the period of family temporary disability leave, or the receipt of the benefit claims by the division, whichever is later;

(b) not less than 85 percent of the original benefit determinations shall be completed within 14 days after the commencement of the period of family temporary disability leave, or the receipt of the benefit claims by the division, whichever is later;

(c) not less than 90 percent of the original benefit determinations shall be completed within 21 days after the commencement of the period of family temporary disability leave, or the receipt of the benefit claims by the division, whichever is later; and

(d) not less than 95 percent of the original benefit determinations shall be completed within 28 days after the commencement of the period of family temporary disability leave, or the receipt of the benefit claims by the division, whichever is later.

b. The commissioner shall, not later than September 30 of 2019 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 or the commencement of disability or family temporary disability, whichever is later: 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 or the commencement of disability or family temporary disability 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 employer failure 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 subsection 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 family temporary disability benefit claims, the number processing other temporary disability 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, or it is determined that there are other significant problems in the administration of the disability insurance system, 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 and make benefit payments expeditiously and accurately;

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

(c) any measures needed to inform employers and employees of their responsibilities to facilitate the timely provision of benefits; (d) any improvements needed in data processing, telephone and other communications technology, staff training, and other administrative services and equipment;

(e) any measures needed to improve service to claimants and beneficiaries, including implementing easy-to-use, user-friendly application processes, facilitating rapid response times to inquiries and applications, and providing easy access to assistance; and

(f) any other measures appropriate for a full modernization of the administration of all aspects of the disability insurance system.

The plan shall specify any added costs entailed in implementing the plan, which shall be regarded as costs of administration of family temporary disability benefits, and shall specify the amount of any resulting increase in the estimate made pursuant to R.S.43:21-7(d)(1)(G)(i), and (ii), of the amount needed to provide 100 percent of the cost of administration of 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 exceeding 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 fiscal year commencing on or after July 1, 2019, allocate not less than $1,200,000 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 annual allocation, not less than $600,000 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 the 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 2020 and September 30 of 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 by the division and by 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.

L.2019, c.37, s.21.