Form 16 NJ A is the one-page workplace notice that every insured New Jersey employer must post to tell employees which company carries the business’s workers’ compensation coverage and when that coverage runs. It is not a claim form or a medical report. You complete three fields, print it on heavy card stock, file a duplicate copy with the state, and hang it where your employees will see it.
Where to Get the Form
Form 16 NJ A is maintained by the New Jersey Compensation Rating and Inspection Bureau (NJCRIB), and the New Jersey Department of Labor and Workforce Development links to it on its Forms and Publications page under “Employer Notice of Workers’ Compensation Insurance Coverage.”1New Jersey Department of Labor and Workforce Development. Workers’ Compensation Forms and Publications Many insurance carriers send a pre-filled copy when they issue or renew a policy. If yours doesn’t, download the blank form from the NJCRIB website and complete it yourself.2New Jersey Compensation Rating and Inspection Bureau. Form 16 NJ A – Posting Notice
How to Fill It In
The notice has only three fields to complete:2New Jersey Compensation Rating and Inspection Bureau. Form 16 NJ A – Posting Notice
- Insurance company. Use the full legal name of the carrier insuring your workers’ compensation liability, exactly as it appears on your policy declarations page. Don’t substitute a parent company name or an abbreviation.
- Coverage period. Enter the start and end dates of the current policy term.
- Employer. Write your business name as it appears on the policy.
The required legal language notifying employees that you have secured payment of compensation under Title 34, Chapter 15, Article 5 of the New Jersey Revised Statutes is already printed on the form. Don’t add anything, and don’t rearrange the layout — the content and arrangement must stay consistent with the prescribed form.
Printing Specifications
Form 16 NJ A must be clearly printed on a minimum of 90# index card stock, sized 8½ by 11 inches.2New Jersey Compensation Rating and Inspection Bureau. Form 16 NJ A – Posting Notice Standard printer paper does not meet the specification. The heavy stock requirement exists so the notice holds up in a workplace. If you’re printing it yourself, buy 90-pound index card stock before you print.
File the Duplicate Before You Post
Before the notice goes up on the wall, you must file a duplicate copy with the state. The form itself references this under regulation 3:2-1: “a duplicate filing must be made before the form is placed in use.”2New Jersey Compensation Rating and Inspection Bureau. Form 16 NJ A – Posting Notice If your carrier prepared the form for you, ask whether they also handle the duplicate filing. Some do. The compliance obligation stays with you either way.
Where to Post It
N.J.S.A. 34:15-80 requires you to post and maintain the notice “in a conspicuous place or places in and about” your place of business.3New Jersey Department of Labor and Workforce Development. Workers’ Compensation Law – Section 34:15-80 In practice, that means somewhere employees will actually look: a break room, near a time clock, by a main entrance, or on the bulletin board where you already post other required labor law notices. If your business operates at more than one location, each site needs its own posted copy.
When to Replace the Notice
The posted notice has to match your current coverage. When your policy renews, you need a fresh Form 16 NJ A reflecting the new carrier name (if it changed) and the new coverage dates. File a new duplicate with the state, then swap out the old notice. Leave the notice up for the full coverage period and only take it down to replace it.
Self-Insured Employers
If you’ve qualified before the Commissioner of Banking and Insurance to carry your own liability, you use a different version of the notice stating that fact rather than naming an outside carrier.3New Jersey Department of Labor and Workforce Development. Workers’ Compensation Law – Section 34:15-80 The posting obligation itself still applies.
Spanish-Language Version
Form 17 NJ is the Spanish-language equivalent of Form 16 NJ A, available from the same NJCRIB source and subject to the same printing and layout requirements.2New Jersey Compensation Rating and Inspection Bureau. Form 16 NJ A – Posting Notice If a significant share of your workforce speaks Spanish, posting Form 17 NJ next to the English version helps make sure every employee can read the coverage information.
If You’re an Employee Reading the Notice
Form 16 NJ A is how you identify the insurance company responsible for workers’ compensation claims at your workplace. If you’re injured on the job, the carrier named on the posting is the one handling your claim. If no Form 16 NJ A is posted and your employer can’t produce proof of coverage, that is a serious warning sign that the employer may be operating without the insurance New Jersey law requires.
Form 16 NJ A is a posting, not a claim form. To file a formal workers’ compensation claim, you use the Employee’s Claim Petition (form WC-365) from the New Jersey Division of Workers’ Compensation.1New Jersey Department of Labor and Workforce Development. Workers’ Compensation Forms and Publications