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NJ-2440                                       State of New Jersey
 10-03, R-6
                                              DIVISION OF TAXATION
                                                    PO BOX 019
                                         TRENTON, NEW JERSEY 08695-0019

                   STATEMENT IN SUPPORT OF EXCLUSION FOR AMOUNTS RECEIVED
                         UNDER ACCIDENT AND HEALTH INSURANCE PLAN
                              FOR PERSONAL INJURIES OR SICKNESS



                                                    YEAR __________

EMPLOYEE: ______________________________________________ SOC. SEC. NO. ___________________________

EMPLOYER: ______________________________________________ I.D. NO. _________________________________




                                                PERIODS OF SICKNESS
                      NUMBER
                       PAID                   INITIAL        ALLOWABLE               DAILY RATE
 FROM         TO       DAYS       MINUS       PERIOD          SICK DAYS       X        OF PAY          =    SICK PAY

                                     -                                        X                        =

                                     -                                        X                        =

                                     -                                        X                        =

                                     -                                        X                        =

                                     -                                        X                        =

                                     -                                        X                        =

                                     -                                        X                        =

                                     -                                        X                        =

                                     -                                        X                        =

                                                                            TOTAL SICK PAY FOR YEAR




This is to certify that the payment(s) set forth above meet all three criteria in N.J.A.C. 18:35-2.3

                                                  __________________________________________________
                                                  Authorized Signature of Employer

                                                  __________________________________________________
                                                  Title                                                    Date
Gross Income Tax
                                     Employee Accident or Health Insurance Exclusion
                                                                N.J.A.C. 18:35-2.3

18:35-2.3      Employee accident or health insurance                          2. Temporary disability benefit payments required to be made to
               exclusion from taxable gross income                               employees under a company’s private plan established pursuant
                                                                                 to New Jersey law in lieu of the State Plan described in (f)1 above
     (a) Amounts received by an employee through an accident or
                                                                                 and which has been approved by the Bureau of Private Plan
health insurance plan for personal injuries or sickness are not subject
                                                                                 Disability Benefits, Division of Unemployment Insurance and
to tax under the New Jersey Gross Income Tax Act.
                                                                                 Disability Insurance; and
      (b) Amounts received by an employee on account of personal
                                                                              3. Payments made to employees for personal injuries or sickness
injury or sickness qualify for exclusion from taxable gross income when
                                                                                 under a health or accident insurance policy by a commercial
received under the provisions of an employee accident or health insur-
                                                                                 insurance company.
ance plan which satisfies the following requirements:
                                                                                   (g) All taxpayers will be required to file with their annual New
 1. The payments must be compensation for wage loss which results
                                                                             Jersey Gross Income Tax Return a claim form furnished by the direc-
    from absence due to injury or sickness of the employee; and
                                                                             tor for the exclusion of any amounts received by them as an employee
 2. The payments must have a requisite certainty under an enforce-           through an accident or health insurance plan for personal injuries or
    able contractual obligation under the plan (see N.J.A.C. 18:35-2.3       sickness which meet all the conditions for exclusion from taxable gross
    (e)); and                                                                income under (f) 1, 2 and 3 above.
 3. The payments must not relate to sick leave wage continuation, the
                                                                             EXAMPLES:
    taking of which is largely discretionary and the payments are
    made regardless of the reason for absence from work.                        i. An employee of Company X is allowed 12 vacation days and 15
                                                                             sick days for the year 1982. The employee uses 12 vacation days and
     (c) The exclusion from taxable gross income applies to payments
                                                                             10 sick days in 1982 for which he receives his regular wage payment,
to employees under a health or accident insurance plan regardless of
                                                                             regardless of the cause for his absence. The amounts received by the
whether insurance coverage is with a commercial insurance company
                                                                             employee in 1982 for the 12 vacation days and 10 sick days are sub-
to which premiums are paid by both employees and employer or sole-
                                                                             ject to tax as wage and salary income to the employee and the employ-
ly by the employer; or whether insurance coverage is provided by an
                                                                             er must also withhold gross income tax on such payments.
employer’s self-insured plan for which no insurance premiums are paid
by the employees.                                                              ii. Company Y has a self-insured disability plan for its employees
                                                                             who are absent from work because of accident or sickness. The plan
      (d) The exclusion from taxable gross income applies to payments
                                                                             is fully funded by the employer company and the employees make no
required to be made to employees under the State mandated tempo-
                                                                             contribution to the plan. Payment for the full amount of wages is made
rary disability benefit plan pursuant to the New Jersey Temporary
                                                                             to disabled employees absent from work, on the eighth calendar day.
Disability Law (N.J.S.A. 43:21-25, et seq.). Payments which are
                                                                             Payment for the initial seven days to the covered employee is discre-
excludable from taxable gross income include temporary disability ben-
                                                                             tionary with the company employer under the plan. The amount
efit payments required to be made under the State Plan which is
                                                                             received by the absent employee because of his disability is exclud-
administered by the Bureau of State Plan Disability Benefits under the
                                                                             able from taxable gross income as health or accident insurance after
New Jersey Disability Law. Exclusion from taxable gross income also
                                                                             the initial seven days of absence but is subject to withholding tax. Any
includes payments required to be made to employees under a compa-
                                                                             amount received by the employee as payment for the seven initial days
ny’s private plan established pursuant to New Jersey law in lieu of the
                                                                             is subject to tax as wage and salary income to the employee and is
State Plan described in the preceding sentence and which has been
                                                                             also subject to withholding tax.
approved by the Bureau of Private Plan Disability Benefits, Division of
Unemployment Insurance and Disability Insurance.                              iii. Employee C receives a payment in 1982 from the New Jersey
                                                                             Disability Benefit Fund during an absence from work because of tem-
      (e) Where payment to employees under the health or accident
                                                                             porary disability resulting from illness. Both the employee and employ-
insurance plan is largely discretionary with the employer, such as dur-
                                                                             er have contributed to the disability benefit fund. The total amount
ing the initial period (for example, first seven days), the exclusion from
                                                                             received by the employee from the New Jersey Disability Benefit Fund
taxable gross income does not apply. Such payments to the employ-
                                                                             is excludable from taxable gross income as a payment for health or
ee are subject to tax as wages and salaries. In order for a wage loss
                                                                             accident insurance and is not subject to withholding tax.
payment made under an accident or health insurance plan to be
excludable from taxable gross income, the payment to the employee              iv. Employee D is absent from work in 1982 because of illness and
must have a requisite certainty under an enforceable contractual oblig-      receives from the X Insurance Company the full amount of his wages
ation.                                                                       during the period of his absence from work. The payment was made
                                                                             from a health or accident insurance policy to which only the employer
     (f) Effective June 1, 1982, withholding of the gross income tax
                                                                             has contributed. The amounts received by the employee are exclud-
shall be required on all payments of wages and salaries made to an
                                                                             able from taxable gross income as health or accident insurance and
employee by an employer. The withholding or the tax is required even
                                                                             are not subject to withholding tax.
though such payments meet all the conditions for exclusion from tax-
able gross income as made through an accident or health insurance
plan for personal injuries or sickness under this section. The only
exceptions for the withholding of tax shall be for the following:
 1. Temporary disability benefit payments required to be made under
    the State Plan which is administered by the Bureau of State Plan
    Disability Benefits under the New Jersey Disability Law;

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Statement in Support of Exclusion for Amounts Received Under Accident and Health Insurance Plan For Personal Injuries or Sickness

  • 1. NJ-2440 State of New Jersey 10-03, R-6 DIVISION OF TAXATION PO BOX 019 TRENTON, NEW JERSEY 08695-0019 STATEMENT IN SUPPORT OF EXCLUSION FOR AMOUNTS RECEIVED UNDER ACCIDENT AND HEALTH INSURANCE PLAN FOR PERSONAL INJURIES OR SICKNESS YEAR __________ EMPLOYEE: ______________________________________________ SOC. SEC. NO. ___________________________ EMPLOYER: ______________________________________________ I.D. NO. _________________________________ PERIODS OF SICKNESS NUMBER PAID INITIAL ALLOWABLE DAILY RATE FROM TO DAYS MINUS PERIOD SICK DAYS X OF PAY = SICK PAY - X = - X = - X = - X = - X = - X = - X = - X = - X = TOTAL SICK PAY FOR YEAR This is to certify that the payment(s) set forth above meet all three criteria in N.J.A.C. 18:35-2.3 __________________________________________________ Authorized Signature of Employer __________________________________________________ Title Date
  • 2. Gross Income Tax Employee Accident or Health Insurance Exclusion N.J.A.C. 18:35-2.3 18:35-2.3 Employee accident or health insurance 2. Temporary disability benefit payments required to be made to exclusion from taxable gross income employees under a company’s private plan established pursuant to New Jersey law in lieu of the State Plan described in (f)1 above (a) Amounts received by an employee through an accident or and which has been approved by the Bureau of Private Plan health insurance plan for personal injuries or sickness are not subject Disability Benefits, Division of Unemployment Insurance and to tax under the New Jersey Gross Income Tax Act. Disability Insurance; and (b) Amounts received by an employee on account of personal 3. Payments made to employees for personal injuries or sickness injury or sickness qualify for exclusion from taxable gross income when under a health or accident insurance policy by a commercial received under the provisions of an employee accident or health insur- insurance company. ance plan which satisfies the following requirements: (g) All taxpayers will be required to file with their annual New 1. The payments must be compensation for wage loss which results Jersey Gross Income Tax Return a claim form furnished by the direc- from absence due to injury or sickness of the employee; and tor for the exclusion of any amounts received by them as an employee 2. The payments must have a requisite certainty under an enforce- through an accident or health insurance plan for personal injuries or able contractual obligation under the plan (see N.J.A.C. 18:35-2.3 sickness which meet all the conditions for exclusion from taxable gross (e)); and income under (f) 1, 2 and 3 above. 3. The payments must not relate to sick leave wage continuation, the EXAMPLES: taking of which is largely discretionary and the payments are made regardless of the reason for absence from work. i. An employee of Company X is allowed 12 vacation days and 15 sick days for the year 1982. The employee uses 12 vacation days and (c) The exclusion from taxable gross income applies to payments 10 sick days in 1982 for which he receives his regular wage payment, to employees under a health or accident insurance plan regardless of regardless of the cause for his absence. The amounts received by the whether insurance coverage is with a commercial insurance company employee in 1982 for the 12 vacation days and 10 sick days are sub- to which premiums are paid by both employees and employer or sole- ject to tax as wage and salary income to the employee and the employ- ly by the employer; or whether insurance coverage is provided by an er must also withhold gross income tax on such payments. employer’s self-insured plan for which no insurance premiums are paid by the employees. ii. Company Y has a self-insured disability plan for its employees who are absent from work because of accident or sickness. The plan (d) The exclusion from taxable gross income applies to payments is fully funded by the employer company and the employees make no required to be made to employees under the State mandated tempo- contribution to the plan. Payment for the full amount of wages is made rary disability benefit plan pursuant to the New Jersey Temporary to disabled employees absent from work, on the eighth calendar day. Disability Law (N.J.S.A. 43:21-25, et seq.). Payments which are Payment for the initial seven days to the covered employee is discre- excludable from taxable gross income include temporary disability ben- tionary with the company employer under the plan. The amount efit payments required to be made under the State Plan which is received by the absent employee because of his disability is exclud- administered by the Bureau of State Plan Disability Benefits under the able from taxable gross income as health or accident insurance after New Jersey Disability Law. Exclusion from taxable gross income also the initial seven days of absence but is subject to withholding tax. Any includes payments required to be made to employees under a compa- amount received by the employee as payment for the seven initial days ny’s private plan established pursuant to New Jersey law in lieu of the is subject to tax as wage and salary income to the employee and is State Plan described in the preceding sentence and which has been also subject to withholding tax. approved by the Bureau of Private Plan Disability Benefits, Division of Unemployment Insurance and Disability Insurance. iii. Employee C receives a payment in 1982 from the New Jersey Disability Benefit Fund during an absence from work because of tem- (e) Where payment to employees under the health or accident porary disability resulting from illness. Both the employee and employ- insurance plan is largely discretionary with the employer, such as dur- er have contributed to the disability benefit fund. The total amount ing the initial period (for example, first seven days), the exclusion from received by the employee from the New Jersey Disability Benefit Fund taxable gross income does not apply. Such payments to the employ- is excludable from taxable gross income as a payment for health or ee are subject to tax as wages and salaries. In order for a wage loss accident insurance and is not subject to withholding tax. payment made under an accident or health insurance plan to be excludable from taxable gross income, the payment to the employee iv. Employee D is absent from work in 1982 because of illness and must have a requisite certainty under an enforceable contractual oblig- receives from the X Insurance Company the full amount of his wages ation. during the period of his absence from work. The payment was made from a health or accident insurance policy to which only the employer (f) Effective June 1, 1982, withholding of the gross income tax has contributed. The amounts received by the employee are exclud- shall be required on all payments of wages and salaries made to an able from taxable gross income as health or accident insurance and employee by an employer. The withholding or the tax is required even are not subject to withholding tax. though such payments meet all the conditions for exclusion from tax- able gross income as made through an accident or health insurance plan for personal injuries or sickness under this section. The only exceptions for the withholding of tax shall be for the following: 1. Temporary disability benefit payments required to be made under the State Plan which is administered by the Bureau of State Plan Disability Benefits under the New Jersey Disability Law;