Form 2 "Courts on-Line Program Subscriber Application" - New Jersey

What Is Form 2?

This is a legal form that was released by the New Jersey Department of Labor & Workforce Development - a government authority operating within New Jersey. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on September 5, 2012;
  • The latest edition provided by the New Jersey Department of Labor & Workforce Development;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form 2 by clicking the link below or browse more documents and templates provided by the New Jersey Department of Labor & Workforce Development.

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Download Form 2 "Courts on-Line Program Subscriber Application" - New Jersey

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Division of Workers’ Compensation - COURTS on-line program
NJ
Subscriber Application – Application #2
courts_online_app090512_i
The minimum requirements for participation in this program are the following: each individual applicant must have 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 7) or Firefox (latest version). 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
COURTS on-line Contact Person for their approval and 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
(complete all fields)
Your Name:
Firm Name:
Street Address:
City, State & ZIP:
Telephone:
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 34:15-128 printed on page 3 of this form.
I, the undersigned, am aware that I am responsible for preserving the security of my password, UserID and the COURTS User
PIN 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 logon ID, without the express permission of the Division.
Signature
Date:
III.
Electronic Filing Access Level
(to be completed by your COURTS on-line Contact Person)
Subscribers will not be able to electronically receive or submit legal pleadings on behalf of the firm.
Select the Electronic Filing Access Level (if no selection is made, access will default to the BASIC level):
Law Firms only - Subscribers will be able to receive notices of e-filed legal pleadings, data enter and save
BASIC
information into pre-formatted templates but they will not be able to e-file any legal documents.
LIMITED
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, e-file informal applications and to designate
FULL
respondent counsel electronically.
** If Limited or Full Access is selected for at least one employee of a company, that company 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 website on behalf of the firm/company has been withdrawn.
Date
Signature
Page 2 of 3
Contact Person Name and Title
Division of Workers’ Compensation - COURTS on-line program
NJ
Subscriber Application – Application #2
courts_online_app090512_i
The minimum requirements for participation in this program are the following: each individual applicant must have 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 7) or Firefox (latest version). 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
COURTS on-line Contact Person for their approval and 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
(complete all fields)
Your Name:
Firm Name:
Street Address:
City, State & ZIP:
Telephone:
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 34:15-128 printed on page 3 of this form.
I, the undersigned, am aware that I am responsible for preserving the security of my password, UserID and the COURTS User
PIN 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 logon ID, without the express permission of the Division.
Signature
Date:
III.
Electronic Filing Access Level
(to be completed by your COURTS on-line Contact Person)
Subscribers will not be able to electronically receive or submit legal pleadings on behalf of the firm.
Select the Electronic Filing Access Level (if no selection is made, access will default to the BASIC level):
Law Firms only - Subscribers will be able to receive notices of e-filed legal pleadings, data enter and save
BASIC
information into pre-formatted templates but they will not be able to e-file any legal documents.
LIMITED
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, e-file informal applications and to designate
FULL
respondent counsel electronically.
** If Limited or Full Access is selected for at least one employee of a company, that company 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 website on behalf of the firm/company has been withdrawn.
Date
Signature
Page 2 of 3
Contact Person Name and Title
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 work-injury 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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