justicedao/ipfs_state_laws huggingface dataset:
836-043-0087 Producer Changes and Compensation (1) The servicing carrier must pay a fee to the licensed agency on all new and renewal policies after the policy is issued. The servicing carrier shall pay the producer as premium is collected. The servicing carrier must process and mail fee payments within 30 days after the date the policy is issued or 30 days after the receipt of premium. The carrier may withhold payments until an accumulative total of $25 per agency is reached. However, the servicing carrier must pay the agency their fees upon request regardless of the amount or if the withholding time period exceeds six months. The fee payment also may be applied to return fees that the agency may owe to the servicing carrier from other assigned risk policies for that agency. The servicing carrier may not pay a producer fee on premium not actually collected. (2) The producer fee paid by the servicing carrier shall be in accordance with the producer fee percentage scales and shall be paid at the rate filed by the Plan Administrator with the Director. (3) It is the responsibility of the servicing carrier to determine whether the producer is properly licensed in the appropriate jurisdictions for payment of producer fees. If the producer listed on the application is not properly licensed, or if the employer designates a representative other than a licensed producer, the servicing carrier shall accept the assignment but the producer fee will not be paid. For all other purposes, the producer shall be treated as the producer of record. (4) The employer may request a change to the licensed producer. The employer shall provide written notice to the servicing carrier, generally in the form of a “producer of record” letter. The request must be made prior to the date of renewal, or with the consent of the servicing carrier at another agreed upon time. Statutory/Other Authority: ORS 656.427, 656.730 & 731.244 Statutes/Other Implemented: ORS 656.427, 656.730 & 737.265 History: ID 18-2008, f. 12-9-08, cert. ef. 1-1-09
836-043-0089 Confidentiality of Information The servicing carrier shall keep in confidence and must not, except as directed by the insured or the producer of record, or as otherwise may be required by law or the Insurance Commissioner, disclose to any third party, or use for the benefit of itself or any third party, such detailed information as it may obtain by virtue of its position as the servicing carrier. Such information may be used solely for the evaluation, underwriting, and insuring of coverage under this Plan and not for any other purpose. The servicing carrier may not use any information the servicing carrier obtains in its capacity as the servicing carrier to request, encourage, or solicit employers it insures under this Plan to use the services of any specific insurance producer, agency, insurer or group of insurers, including but not limited to direct writers affiliated with the servicing carrier, for purposes of providing voluntary workers’ compensation insurance or other lines of insurance to such employer. Statutory/Other Authority: ORS 656.427, 656.730 & 731.244 Statutes/Other Implemented: ORS 656.427, 656.730 & 737.265 History: ID 18-2008, f. 12-9-08, cert. ef. 1-1-09 ID 10-1996, f. 6-27-96, cert. ef. 7-1-96
836-043-0091 Self-Funded Plan It is essential for maintaining the viability of the Plan to establish and maintain rates at a level that will permit the Plan to operate with no more than a reasonable subsidy required from voluntary insured employers. The NCCI shall maintain necessary ratemaking data in order to permit the actuarial determination of rates and rating plans appropriate for the business insured through the Plan. Each servicing carrier shall report its experience on business written under the Plan to the NCCI in a format prescribed by the NCCI. It is the responsibility of the NCCI to monitor both rate adequacy and Plan results. The NCCI shall notify the Insurance Commissioner if excessive losses are indicated to enable the Insurance Commissioner to take corrective action. Statutory/Other Authority: ORS 656.427, 656.730 & 731.244 Statutes/Other Implemented: ORS 656.427, 656.730 & 737.265 History: ID 10-1996, f. 6-27-96, cert. ef. 7-1-96, Renumbered from 836-043-0080 ID 4-1994, f. & cert. ef. 4-19-94
836-043-0101 Statutory Authority; Purpose; Applicability (1) OAR 836-043-0101 to 836-043-0170 are adopted by the Director of the Department of Consumer and Business Services pursuant to the requirements of ORS 737.318. (2) OAR 836-043-0101 to 836-043-0170 establish a premium audit program system for workers' compensation insurance for the following purposes: (a) Achieving equitable premium charges to insureds and collecting credible ratemaking data; (b) Prescribing minimum standards for an efficient premium audit program that ensures an adequate proportion of an insurer's earned premium is audited and focuses on operations where accurate reporting may be difficult or where misreportings are more likely; (c) Educating insureds about the audit reporting function of the rating system; (d) Establishing a continuing test audit program of all insurers; (e) Providing an appeal process pursuant to ORS 737.318(3)(d) and 737.505(4) to (5) for insureds to request a hearing to dispute the results of an audit, as described in a final premium audit billing issued by an insurer to an insured. (3) OAR 836-043-0101 to 836-043-0170 apply to all authorized workers' compensation insurers, the State Accident Insurance Fund Corporation, Oregon insureds, and the National Council on Compensation Insurance. Statutory/Other Authority: ORS 731.244, 737.310 & 737.318 Statutes/Other Implemented: ORS 737.235, 737.318 & 737.505 History: ID 13-2012, f. 7-16-12, cert. ef. 1-1-13 ID 1-1988, f. & cert. ef. 1-20-88
836-043-0120 Minimum Standards of Insured Education Program (1) At or before policy issuance, an insurer shall make available to the insured information covering the matters identified in this section. This information may be delivered via electronic means, as provided for under ORS Chapter 84. (a) Which workers are subject to the Workers' Compensation Law for whom premiums must be paid; (b) What remuneration is subject to premium charges; (c) How to divide payroll between assigned classifications, as established in OAR 836-042-0060; (d) The requirements for verifiable records, as established in OAR 836-042-0060; (e) The existence and nature of premium audits and the appeal process afforded insureds by ORS 737.505; (f) The insured’s responsibility to notify the insurer of changes in the business structure and operations; and (g) The classification notice requirements prescribed by OAR 836-043-0175 to 836-043-0185. (2) When the insurer becomes aware of changes in the insured’s business that affect the reporting of payroll or other exposure basis, the insurer shall provide additional appropriate instruction to the insured. (3) When changes in statute, rules or rating system occur that affect reporting of payroll or other exposure basis, the insurer shall provide notification of such changes to insureds as soon as reasonably possible. Statutory/Other Authority: ORS 731.244, 737.310 & 737.318 Statutes/Other Implemented: ORS 737.318 History: ID 13-2012, f. 7-16-12, cert. ef. 1-1-13 ID 1-1999, f. & cert. ef. 2-19-99 ID 1-1988, f. & cert. ef. 1-20-88
836-043-0125 Purpose A Test Audit Program shall be conducted by the bureau to carry out ORS 737.318. To perform this function, the bureau shall maintain the test audit staff for examining pertinent records of a number of Oregon insureds and insurers established according to the schedule in Exhibit 1 of OAR 836-043-0130, or another appropriate audit level, as determined by the director. The purposes of the test audit program are as follows: (1) To check the accuracy and reliability of each insurer's audits, verify the classifications assigned, and assure that the premiums charged are based upon filed rates, rating plans and rating systems on file with and approved by the director; (2) To establish minimum auditing standards and to develop a program for monitoring insurer performance toward the achievement of established standards; and (3) To improve audit proficiency through the evaluation of insurer auditing practices. Statutory/Other Authority: ORS 731.244 & ORS 737.318 Statutes/Other Implemented: ORS 737.318 History: ID 5-2019, amend filed 04/19/2019, effective 07/01/2019 ID 13-2012, f. 7-16-12, cert. ef. 1-1-13 ID 18-1997, f. 11-25-97, cert. ef. 11-26-97 ID 7-1997(Temp), f. & cert. ef. 5-30-97 ID 1-1988, f. & cert. ef. 1-20-88
836-043-0135 Test Audits (1) An analysis of test audit results shall be completed on each test audit. (2) The test auditor shall interview the insured or an authorized representative of the insured in order to solicit the insured's cooperation and also to obtain all factual data necessary for proper completion of the test audit. (3) If a current inspection is in the file, the test auditor shall verify data contained in that report. (4) Each test audit may be performed on site or as a virtual audit and shall contain the following: (a) A reconciliation of payroll subject to premium charge, which must be made with the independent control records of the State Unemployment Insurance quarterly reports and FICA quarterly report; (b) A review of the cash disbursements journal to develop the remuneration paid to contract labor and casual labor; (c) A detailed review of at least one pay period to verify proper classification; (d) A review of time cards to verify proper treatment of overtime remuneration; (e) A review of original entry records to verify proper application of the "division of single employee's payroll" rules (OAR 836-042-0050 to 836-042-0060); (f) A list of the name, duties, and earnings of all persons assigned to the "standard exceptions" classifications. When size of the risk makes the listing impractical, spot checks must be made; (g) A list of the name, title, duties, and earnings of all covered executive officers, partners or individuals; (h) A summary, by classification, of all chargeable payrolls; (i) A summary of the differences between the test audit and the insurer audit. (5) Examples of the templates and forms described in this rule are located on the Department of Consumer and Business Services, Division of Financial Regulation website at dfr.oregon.gov. Statutory/Other Authority: ORS 731.244 & ORS 737.318 Statutes/Other Implemented: ORS 737.318 History: ID 5-2019, amend filed 04/19/2019, effective 07/01/2019 ID 13-2012, f. 7-16-12, cert. ef. 1-1-13 ID 1-1988, f. & cert. ef. 1-20-88
836-043-0145 Disposition of Test Audits (1) The bureau shall submit individual results of each test audit to the office or offices designated by the insurer as soon as the bureau audit is completed. (2) For audits that do not result in a significant premium difference, defined as in excess of $500 in premium or in excess of two percent of the total standard premium, whichever is greater, the bureau shall provide the insurer with the policy numbers and the named insureds for all test audits closed without change. (3) For audits that result in a significant premium difference, the bureau shall provide the insurer with a report explaining the difference and the effect of such difference upon the total premium. An example of this report template is located on the Department of Consumer and Business Services, Division of Financial Regulation website at dfr.oregon.gov. (4) Results of test audits of individual insurers shall be confidential data under ORS 731.312. (5) Immediately upon receipt of the bureau's report, the insurer shall determine whether it agrees with the bureau's findings, auditing the insured if necessary. If the insurer agrees with the bureau's findings, the insurer shall file the corrected information on the original or, if necessary, on a revised unit statistical report. When the net premium difference is not sufficient to qualify as an "error" but a single difference is sufficiently large to qualify as an error prior to any offsetting premium amounts, the insurer shall be advised of such differences by an "advisory" notice. Also, when individual claims have been assigned to an incorrect classification an "advisory" notice shall also be submitted to the insurer. Upon receipt of the "advisory" notice, the insurer shall report such payrolls or losses on the initial or, if necessary, a "C" (corrected) Unit Statistical Report. All test audit differences must be closed within sixty days of notification unless the insurer requests an extension and the request is approved by the bureau. (6) When classifications utilized by the insurer are found to be in error, the bureau shall take the normal appropriate action to secure compliance. (7) Findings resulting from test audits shall not be utilized in any action by an insurer to enforce premium collections. (8) If there is disagreement with the bureau's findings, the insurer shall communicate with the designated contact at the National Council on Compensation Insurance office to resolve areas of contention. (9) When an insurer is unable to resolve test audit differences with the bureau staff, the insurer may present an appeal to the committee. (10) When an insurer is unable to resolve test audit differences with the committee, the insurer may present an appeal to the director for final determination. Statutory/Other Authority: ORS 731.244 & ORS 737.318 Statutes/Other Implemented: ORS 737.318 History: ID 5-2019, amend filed 04/19/2019, effective 07/01/2019 ID 13-2012, f. 7-16-12, cert. ef. 1-1-13 ID 11-1994, f. 12-19-94, cert. ef. 1-1-95 ID 1-1988, f. & cert. ef. 1-20-88
836-043-0150 Summary of Test Audit Results (1) Test audit results shall be summarized quarterly for the individual insurer or insurer group, as well as for the industry as a whole. The summary must include all prior quarters up to but not exceeding a total of six quarters. The summary must reflect separately the results of field audits, desk audits, non-productive audits, and payroll reports. An example of this report template is located on the Department of Consumer and Business Services, Division of Financial Regulation website at dfr.oregon.gov. (2) The summary of test audit results must be reported quarterly to the insurer's home office to the attention of the designated contact. If the insurer’s home office is located outside Oregon, a copy of the summary results must also be forwarded to the Oregon branch or division office that reports directly to the home office. It shall be the insurer's responsibility to keep the bureau advised of the responsible contact to whom the summary results should be directed. (3) The bureau shall maintain sufficient records to permit accurate reporting to the insurer and the director. (4) Copies of all summary reports shall be made available to the director upon completion. Individual insurer reports shall be made available to the director upon request. Statutory/Other Authority: ORS 731.244 & ORS 737.318 Statutes/Other Implemented: ORS 737.318 History: ID 5-2019, amend filed 04/19/2019, effective 07/01/2019 ID 13-2012, f. 7-16-12, cert. ef. 1-1-13 ID 11-1994, f. 12-19-94, cert. ef. 1-1-95 ID 1-1988, f. & cert. ef. 1-20-88
836-043-0155 Test Audit Standards (1) An insurer meets the test audit performance standard when the number of premium differences for field audits and desk audits in excess of $500 or two percent of the insured's standard premium, whichever is greater, does not exceed the maximum allowable number of errors shown in the Test Audit Performance Standards in Exhibit 2. (2) An insurer that fails to meet the test audit performance standards for six consecutive quarters shall meet with the director or the director’s designated representative to provide a detailed explanation of the remedial measures the insurer is taking to restore overall audit proficiency to an acceptable level. (3) If an insurer fails to meet the test audit performance standards after implementing the remedial measures required in section (2) of this rule, the director may impose a penalty, including possible suspension of the insurer's certificate of authority. [ED. NOTE: To view attachments referenced in rule text, click here to view rule.] Statutory/Other Authority: ORS 731.244 & ORS 737.318 Statutes/Other Implemented: ORS 737.318 History: ID 5-2019, amend filed 04/19/2019, effective 07/01/2019 ID 13-2012, f. 7-16-12, cert. ef. 1-1-13 ID 18-1997, f. 11-25-97, cert. ef. 11-26-97 ID 7-1997(Temp), f. & cert. ef. 5-30-97 ID 11-1994, f. 12-19-94, cert. ef. 1-1-95 ID 1-1988, f. & cert. ef. 1-20-88
836-043-0165 Monitoring Audit Program System The director may examine every insurer for the purpose of determining its compliance with: (1) The statistical reporting requirements of OAR 836-042-0045; (2) The premium audit program requirements of OAR 836-043-0110 and 836-043-0115; and (3) The minimum standards of insured education programs of OAR 836-043-0120. Statutory/Other Authority: ORS 731.244 & ORS 737.318 Statutes/Other Implemented: ORS 737.318 & ORS 737.235 History: ID 5-2019, amend filed 04/19/2019, effective 07/01/2019 ID 13-2012, f. 7-16-12, cert. ef. 1-1-13 ID 1-1988, f. & cert. ef. 1-20-88
836-043-0175 Statutory Authority; Purpose; Applicability (1) OAR 836-043-0175 to 836-043-0185 are adopted by the Director of the Department of Consumer and Business Services pursuant to the provisions of ORS 737.310. (2) The purpose of these rules is to prescribe minimum standards for notice by insurers to insureds regarding approved rate classifications. (3) These rules apply to all authorized workers' compensation insurers and the State Accident Insurance Fund Corporation. Statutory/Other Authority: ORS 731.244 & 737.310 Statutes/Other Implemented: ORS 737.310 History: ID 13-2012, f. 7-16-12, cert. ef. 1-1-13 ID 2-1992, f. 2-6-92, cert. ef. 2-15-92 ID 2-1988, f. & cert. ef. 1-20-88
836-043-0180 Definitions As used in OAR 836-043-0175 to 836-043-0185 unless the context requires otherwise: (1) "Bureau" means the licensed rating organization of this state for workers' compensation insurance. (2) "Classification" means a grouping of insurance risks according to a classification system used by an insurer. (3) "Classification System" means a schedule of classifications and a rule or set of rules used by an insurer for determining the classifications applicable to an insured. (4) "Insurer" means any insurer authorized to transact workers' compensation insurance or the State Accident Insurance Fund Corporation. (5) "Reclassification" means an addition or removal of a classification by an insurer to a policy for an insured when the previous classification is improper or inadequate. (6) "Workers' Compensation Insurance" means insurance providing coverage for the obligations of an employer arising from illness or injury to workers whether such obligation is imposed by ORS Chapter 656, similar laws of the United States or agreement between states. Statutory/Other Authority: ORS 731.244 & 737.310 Statutes/Other Implemented: ORS 737.310 History: ID 13-2012, f. 7-16-12, cert. ef. 1-1-13 ID 2-1992, f. 2-6-92, cert. ef. 2-15-92 ID 2-1988, f. & cert. ef. 1-20-88
836-043-0185 Insurer Classification Notice (1) When an insurer issues a workers' compensation insurance policy to an insured for the first time, an insurer shall provide each insured a written rate classification notice describing the work activities of each classification assigned. This information may be delivered via electronic means, as provided for under ORS Chapter 84. (2) The rate classification notice shall include the following information: (a) The complete description for each classification assigned as contained in the insurers' classification system filed with and approved by the director; (b) An adequate description of work activities for such classification as reviewed by the director; (c) One or more publications that include basic ratemaking and classification information and necessary records and reporting procedures for the division of payroll of an individual employee among classifications assigned as provided for under OAR 836-042-0060; (d) An amendatory endorsement to the policy for reclassification assignments during the policy year as provided for under ORS 737.310(13). (3) When an insurer provides the written rate classification notice required under ORS 737.310 (12) and (13), the notice must be given in the manner prescribed by section (2) of this rule. [ED. NOTE: Exhibits referenced are available from the agency.] Statutory/Other Authority: ORS 731.244, 737.310(12) & 737.310(13) Statutes/Other Implemented: ORS 737.310(12) History: ID 13-2012, f. 7-16-12, cert. ef. 1-1-13 ID 2-1992, f. 2-6-92, cert. ef. 2-15-92 ID 2-1988, f. & cert. ef. 1-20-88
836-043-0200 Statutory Authority; Purpose; Applicability (1) OAR 836-043-0200 to 836-043-0240 are adopted by the Director pursuant to 731.244, 737.310(13) and 737.526(1) to aid in the effectuation of insurer filings under 737.205, the review of workers’ compensation insurance filings under 737.320 and the hearing process under 737.505 for persons aggrieved by the application of the rating system. (2) The purpose of these rules is to establish an Oregon Workers’ Compensation Rating System Review and Advisory Committee by which the authorized workers’ compensation rating organization for this state may: (a) Exchange information and experience data with its members and the Director; (b) Consult and cooperate with its members and the Director with respect to National Council on Compensation Insurance filings and to application of workers’ compensation rating system; and (c) Hear insured grievances regarding the application of its rating system. (3) These rules apply to all authorized workers’ compensation insurers, the State Accident Insurance Fund Corporation and the National Council on Compensation Insurance. Statutory/Other Authority: ORS 731.244, 737.310(13) & 737.526(1) Statutes/Other Implemented: ORS 737.310(13) & 737.526 History: ID 11-1992, f. 6-9-92, cert. ef. 6-15-92
836-043-0240 Committee Activities The subject matter jurisdiction of the Committee shall include but not be limited to the following: (1) Any insured or insurer grievance regarding the application of any part of the NCCI rating system adopted by the insurer, including but not limited to: (a) A classification; (b) Classification system; (c) Experience rating system or component thereof; or (d) Rating plans including the retrospective rating plans, component parts and tables. (2) Except for voluntary market advisory loss cost and assigned risk plan advisory rate filings, proposed filings of the NCCI for subsequent submission to Director. (3) The calling for an analysis of any special or ordinary statistical data reports from the NCCI or its members. (4) Special surveys or projects dealing with the rating system as may be initiated by the Director. Statutory/Other Authority: ORS 731.244, 737.310(13) & 737.526(1) Statutes/Other Implemented: ORS 737.310(13) & 737.526 History: ID 11-1992, f. 6-9-92, cert. ef. 6-15-92