justicedao/ipfs_state_laws huggingface dataset:
836-042-0025 Workers’ Compensation Filings Standards for Unfair Discrimination (1) Except for revisions solely attributable to legislative enactments, changes in administrative rules or orders, or approved by the Director to prevent an impairment, or applying to state agencies, workers’ compensation insurance rates, rating plans, rating systems or provisions for claim payment are unfairly discriminatory if either: (a) Revision of a rate, rating plan or rating system is filed to become effective within six months of the effective date of a corresponding rate, rating plan or rating system previously established pursuant to OAR 836-042-0015 by the filing insurer; or (b) The rating system does not contain rules specifying that a revision of a rate, rating plan or system shall not apply to an insured until an anniversary rating date at least 11 months and 16 days subsequent to the earlier of the preceding anniversary rating date or the preceding policy effective date established for an insured unless approved by the Director to apply to all policies in force on a common date; or (c) Premium rates are based on provisions for claim payment filed by a licensed rating organization which are not the provisions most recently approved or premium rates are determined by multiplying superseded provisions by a factor; or (d) Provisions for claim payment to be used by an insurer as a basis for premium rates are revised to be effective on a date other than the date of a revision approved for a licensed rating organization. (2) Workers’ compensation insurance rating plans or rating systems are presumed to be unfairly discriminatory, unless demonstrated otherwise, if either: (a) A rating plan or rating system which produces only credit modifications to an insured’s premiums is offered at the option of the insurer; or (b) An insurer has filed two or more schedules of premium rates without providing a clear rule for deciding which schedule is to be applied to an insured. (3) Premiums are unfairly discriminatory if differentials between insureds fail to reasonably reflect the differences in expected losses and expenses to the insurer attributable to the insureds. Workers’ compensation insurance rates, rating plans or rating systems are not unfairly discriminatory when different premiums result or different rates apply to insureds if: (a) Differences in loss exposures, expense factors or investment income opportunity to an insurer can be attributed to the insureds; and (b) The differences are reasonably reflected by the rates, rating plan or rating system. Statutory/Other Authority: ORS 731.244 Statutes/Other Implemented: ORS 737.310 History: ID 3-2025, amend filed 06/25/2025, effective 07/01/2025 ID 15-1996, f. & cert. ef. 11-12-96 ID 15-1992, f. & cert. ef. 11-16-92 IC 14-1982, f. 12-17-82, ef. 12-29-82 IC 12-1982(Temp), f. 6-29-82, ef. 7-1-82 IC 4-1982, f. 1-27-82, ef. 7-1-82
836-042-0035 Workers’ Compensation Policy Forms Filings by Insurers Workers’ compensation insurance must be written using policy forms filed by the rating organization of which the insurer is a member except that if the insurer files a rating plan or rating system requiring a policy provision or endorsement for which the rating organization has made no usable filing then the insurer may file its own policy forms needed to implement its rating plans or systems. Such policy form filings are subject to ORS Chapter 742. Statutory/Other Authority: ORS 731 Statutes/Other Implemented: ORS 737.265(2) & ORS 737.320(3) History: ID 9-2017, amend filed 10/23/2017, effective 01/01/2018 IC 4-1982, f. 1-27-82, ef. 7-1-82
836-042-0040 Statutory Authority; Purpose and Effective Date Statutory Authority; Purpose and Effective Date (1) OAR 836-042-0040 through 836-042-0045 are adopted by the director pursuant to the requirements of ORS 737.225(4). (2) The purpose and applicability of these rules is to prescribe a uniform statistical plan for workers' compensation insurance statistics as required by ORS 737.225(4). (3) OAR 836-042-0040 through 836-042-0045 apply to all reporting of workers' compensation insurance statistics, as therein defined and prescribed provided that nothing contained herein shall restrict the reporting of statistical, financial, or accounting data necessary to fulfill the requirements of ORS Chapter 737. Statutory/Other Authority: ORS 731.244 & 737.225 Statutes/Other Implemented: ORS 737.225 History: ID 15-2012, f. 8-9-12, cert. ef. 1-1-13 IC 3-1982, f. 1-27-82, ef. 7-1-82
836-042-0043 Definition As used in OAR 836-042-0040 through 836-042-0045, unless the context requires otherwise: "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 agreements between states. Statutory/Other Authority: ORS 731.244 & 737.225 Statutes/Other Implemented: ORS 737.225 History: ID 15-2012, f. 8-9-12, cert. ef. 1-1-13 IC 3-1982, f. 1-27-82, ef. 7-1-82
836-042-0045 Workers’ Compensation Statistical Plan (1) The Statistical Plan for Workers' Compensation and Employers' Liability Insurance, 2008 Edition, filed by the National Council on Compensation Insurance and approved by the director to become effective January 1, 2009, and revisions approved by the director to become effective on or before July 1, 2025, is prescribed as the statistical plan for workers' compensation and employers' liability insurance. (2) Manuals or guides referenced within the statistical plan designated in section (1) of this rule are not prescribed by this rule. Statutory/Other Authority: ORS 737.225 Statutes/Other Implemented: ORS 737.265 & 737.320 History: ID 3-2025, amend filed 06/25/2025, effective 07/01/2025 ID 50-2023, amend filed 10/20/2023, effective 11/01/2023 ID 5-2022, amend filed 08/29/2022, effective 09/01/2022 ID 7-2021, amend filed 12/07/2021, effective 12/14/2021 ID 5-2021, temporary amend filed 06/18/2021, effective 06/18/2021 through 12/14/2021 ID 7-2020, amend filed 10/23/2020, effective 10/24/2020 ID 6-2020, temporary amend filed 08/14/2020, effective 08/14/2020 through 10/24/2020 ID 4-2020, temporary amend filed 04/30/2020, effective 05/01/2020 through 10/24/2020 ID 9-2017, amend filed 10/23/2017, effective 01/01/2018 ID 16-2014, f. & cert. ef. 10-1-14 ID 15-2012, f. 8-9-12, cert. ef. 1-1-13 ID 20-2008, f. 12-30-08, cert. ef. 1-1-09 ID 13-2008(Temp), f. 8-14-08, cert. ef. 9-1-08 thru 1-1-09 ID 3-2008, f. & cert. ef. 4-7-08 ID 10-2006, f. & cert. ef. 6-9-06 ID 5-2005, f. & cert. ef. 4-7-05 ID 7-2003, f. 12-3-03 cert. ef. 1-1-04 ID 15-2001, f, 12-19-01, cert. ef. 1-1-02 ID 2-1998, f. & cert. ef. 2-6-98 IC 4-1984, f. 9-28-84, cert. ef. 10-1-84 IC 5-1983, f. 6-30-83, cert. ef. 7-1-83 IC 2-1983, f. 3-16-83, cert. ef. 4-1-83 IC 10-1982, f. 6-23-82, cert. ef. 7-1-82 IC 3-1982, f. 1-27-82, cert. ef. 7-1-82
836-042-0050 Statutory Authority; Purpose and Applicability (1) OAR 836-042-0050 to 836-042-0060 are adopted pursuant to the general rulemaking authority of the Director in ORS 731.244 and the specific authority of 737.310, which authorizes the Director to prescribe by rule the conditions under which a division of payroll between different classifications is permitted for purposes of calculating workers’ compensation insurance premiums. (2) The purpose and applicability of OAR 836-042-0050 to 836-042-0060 is to improve parity in the workers’ compensation insurance market by prescribing a uniform set of rules for division of a single employee’s payroll between assigned classifications and a necessary clarification of the definition of payroll to effectuate these rules. (3) OAR 836-042-0050 to 836-042-0060 apply to all workers’ compensation insurance policies written by any insurer. Statutory/Other Authority: ORS 731.244 Statutes/Other Implemented: ORS 737.310 History: ID 12-1998, f. & cert. ef. 9-14-98 ID 15-1996, f. & cert. ef. 11-12-96 IC 2-1982, f. & ef. 1-15-82 IC 1-1981(Temp), f. & ef. 11-2-81
836-042-0070 Statutory Authority and Purpose OAR 836-042-0070 to 836-042-0090 are adopted pursuant to the general rulemaking authority of the Director of the Department of Consumer and Business Services in ORS 731.244 to specify for insurers offering large deductible provisions of workers’ compensation insurance policies requirements for rates, rating plans, and rating systems which may be approved according to ORS Chapter 737. Statutory/Other Authority: ORS 731.244 Statutes/Other Implemented: ORS 737, 737.310 & 741.001 - 742.007 History: ID 4-1995, f. 7-21-95, cert. ef. 10-1-95
836-042-0075 Definitions As used in OAR 836-042-0070 to 836-042-0090: (a) “Insurer” means any insurer authorized to write workers’ compensation insurance and includes the State Accident Insurance Fund Corporation. (2) “Director” means the Director of the Department of Consumer and Business Services. (3) “Large Deductible” means a provision in a workers’ compensation policy, or added by endorsement thereto, which allows a policy holder to be financially responsible for claims incurred under the policy up to a percentage of premium, a stated amount per claim, or other limit specified in the provision in exchange for a prospective premium reduction. (4) “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 Chapters 654 and 656, similar laws of the United States, or agreements between states. Statutory/Other Authority: ORS 731.244 Statutes/Other Implemented: ORS 737, 737.310 & 741.001 - 742.007 History: ID 4-1995, f. 7-21-95, cert. ef. 10-1-95
836-042-0080 Rate Filing Requirements and Standards An insurer that issues a policy for worker's compensation insurance including a large deductible provision must use a provision which satisfies requirements of OAR 836-054-0210 and has been approved by the Director and must file rating plans for determining premium credits or rating modifications with the Director according to ORS 737.320 and OAR 836-042-0001 to 836-042-0045 and which satisfy these additional requirements: (1) Such rating plans must be based on actuarial assumptions and methods similar to and not circumventing the design of retrospective rating plans approved by the Director. (2) A deductible credit or rating modification must be the final rating step so that the insurer may distinguish the amount of credit or modification premium and the policy premium prior to the credit or modification. An insurer may compute premium discounts based on premium amounts after deductible credits if the insurer can demonstrate that greater premium equity is achieved and that data distinguishing the various premium elements will be maintained. (3) Such rating plans may not contain provisions which cannot be approved under the unfair discrimination provisions of OAR 836-042-0025. (4) A deductible credit or rating modification must recognize expenses which vary with net earned premium after such credits or modifications (5) Prospective experience rating plans based on prior claims experience must use losses valued on a gross basis prior to deductible provisions. (6) Large deductible rating plans may not be applied to rating groups approved under OAR 836-042-0201 to 836-042-0225. (7) Minimum eligibility for a large deductible provision must be not less than $500,000 estimated country-wide annual premium prior to large deductible credits or premium credits based on premium size. The minimum deductible limit per claim for each injury or illness may not be less than $75,000. An aggregate limit for deductible amounts for all claims may be specified but may not be less than the deductible limit per claim. Statutory/Other Authority: ORS 731.244 Statutes/Other Implemented: ORS 737, 737.310 & 742.001 - 742.007 History: ID 11-2010, f. 5-4-10, cert. ef. 7-1-10 ID 4-1995, f. 7-21-95, cert. ef. 10-1-95
836-042-0085 Statistical Data Maintenance and Reporting Requirements An insurer that issues a policy for worker's compensation insurance including a large deductible provision must: (1) Maintain policy premium data distinguishing credit or modification premium for large deductible provisions; (2) Report policy unit statistical data with losses valued on a gross basis prior to deductible provisions; and (3) Separately report financial experience data to a licensed rating organization including premium prior to credits or modifications for large deductible provisions and loss valued on a gross basis prior to deductible provisions. Statutory/Other Authority: ORS 731.244 Statutes/Other Implemented: ORS 737, 737.310 & 741.001 - 742.007 History: ID 10-2009, f. & cert. ef. 11-13-09 ID 5-2005, f. & cert. ef. 4-7-05 ID 4-1995, f. 7-21-95, cert. ef. 10-1-95
836-042-0090 Trade Practices Found Injurious to the Insurance-Buying Public (1) Failure of an insurer to comply with OAR 836-042-0080, 836-042-0085 or 836-054-0210 constitutes an unfair trade practice under ORS 746.240. (2) Failure of an insurer to delete a large deductible provision following discovery that an insured employer has on three or more occasions during the policy period known of a workers’ compensation insurance claim for five (5) days or longer but has not reported the claim to the insurer or has on any occasion within the policy period made direct payment of claim costs constitutes an unfair trade practice under ORS 746.240. (3) Failure of an insurer to include amounts of premium credits or modifications for large deductible provisions in the base for the assessment imposed by the Director pursuant to ORS 656.612 and to pay the assessment on those amounts constitutes an unfair trade practice under ORS 746.240. Statutory/Other Authority: ORS 731.244 Statutes/Other Implemented: ORS 746.240 History: ID 4-1995, f. 7-21-95, cert. ef. 10-1-95
836-042-0100 Statutory Authority and Purpose OAR 836-042-0100 to 836-042-0115 are adopted under the Director’s authority in ORS 737.325(1) to modify filing requirements for insurers offering to classes of risks Large Risk Alternative Rating Plans which include workers’ compensation. Statutory/Other Authority: ORS 731.244 & 737.325(1) Statutes/Other Implemented: ORS 737, 737.310, 737.320 & 737.325(1) History: ID 11-2010, f. 5-4-10, cert. ef. 7-1-10
836-042-0105 Definitions As used in OAR 836-042-0100 to 836-042-0115: (1) “Affiliate Insurer” means an insurer that directly or indirectly through one or more intermediaries, controls, or is controlled by, or is under common control with, the insurer specified where control is defined by ORS 732.548(2). (2) “Director” means the Director of the Department of Consumer and Business Services. (3) “Eligible Employer” means: (a) An employer defined by ORS 656.005(13) with: (A) An insurer estimated annual countrywide Workers’ Compensation standard premium in excess of $500,000; or (B) An insurer estimated annual countrywide premium in excess of $750,000 in combination with General Liability, Automobile Liability, Hospital Professional Liability, Crime and Glass, and Workers’ Compensation provided Workers’ Compensation countrywide standard premium is in excess of $500,000. (b) Eligible Employer does not include: (A) Rating groups approved under OAR 836-042-0201 to 836-042-0225; and (B) Employers obtaining Workers’ Compensation insurance from the Oregon Workers’ Compensation Insurance Plan under OAR 836-043-0001 to 836-043-0091. (4) “Insurer” means the State Accident Insurance Fund Corporation or an insurer authorized under ORS Chapter 731 to transact workers’ compensation insurance in this state. “Insurer” includes affiliate insurers for General Liability, Automobile Liability, Hospital Professional Liability, Crime and Glass. (5) “Large Risk Alternative Rating Plan” means optional retrospective or large deductible rating as mutually agreed upon by insurer and eligible employer. (6) “Rating Plan” means a rule or set of rules used by an insurer to calculate premium for an eligible employer. (7) “Workers’ Compensation Standard Premium” means premium determined by authorized rates including any experience rating modification, any applicable schedule rating, employer’s liability increased limits, waiver premium, claim and merit rating, supplemental disease, atomic energy exposure, nonratable catastrophe loadings, aircraft seat surcharge, loss constants and minimum premiums, but does not include premium discounts, coal mine disease charge, employee leasing client processing fees, expense constant, USL&H expense constant, terrorism premiums, catastrophe premiums, and large deductible credits. Statutory/Other Authority: ORS 731.244 & 737.325(1) Statutes/Other Implemented: ORS 737, 737.310, 737.320 & 737.325(1) History: ID 11-2010, f. 5-4-10, cert. ef. 7-1-10
836-042-0110 Rate Filing Requirements The Director may approve retrospective rating plans and large deductible rating plans as mutually agreed upon between insurer and eligible employer under the following conditions: (1) The rating plan is filed with director according to ORS 737.205, 737.310, and 737.320 containing rules indicating the manner in which the rate is promulgated and how the resultant premium is derived; (2) The rating plans which include large deductible options must comply with OAR 836-042-0070 to 836-042-0090 and 836-054-0201 to 836-054-0210; (3) The insurer demonstrates rating plan compliance with all workers’ compensation financial and statistical reporting as required by OAR 836-042-0040 to 836-042-0045; (4) The use of the Large Risk Alternative Rating Plans is an independent option and is not a substitute for, nor incompatible with, Manual Rating, Experience Rating, Loss Rating, rating under Loss Reimbursement or Deductible Plans, or any individual-risk rating rule permitted by Oregon law; and (5) The insurer maintains documentation supporting the eligible employer’s Large Risk Alternative Rating Plan sufficient for examination under ORS 737.235. Statutory/Other Authority: ORS 731.244 & 737.325(1) Statutes/Other Implemented: ORS 737, 737.205, 737.310, 737.320 & 737.325(1) History: ID 11-2010, f. 5-4-10, cert. ef. 7-1-10
836-042-0115 Trade Practices Found Injurious to the Insurance Buying Public Failure of an insurer to comply with OAR 836-042-0110 constitutes an unfair claims practice under ORS 746.240. Statutory/Other Authority: ORS 731.244 & 737.325(1) Statutes/Other Implemented: ORS 746.240 History: ID 11-2010, f. 5-4-10, cert. ef. 7-1-10
836-042-0201 Statutory Authority; Purpose; Effective Date (1) OAR 836-042-0201 to 836-042-0225 are adopted under the general rulemaking authority of the Insurance Commissioner in ORS 731.244 and the specific authority relating to workers’ compensation insurance rating groups in ORS 737.316. (2) The purpose of OAR 836-042-0201 to 836-042-0225 is to provide an orderly procedure for insurers to combine the workers’ compensation insurance experience of a group of employers for rating purposes. (3) OAR 836-042-0201 to 836-042-0225 become effective October 14, 1983. Statutory/Other Authority: ORS 731.244 & 737.316 Statutes/Other Implemented: ORS 737.316 History: ID 15-1996, f. & cert. ef. 11-12-96 ID 10-1993, f. 10-1-93, cert. ef. 10-2-93 Reverted to IC 2-1984, f. 1-18-84, ef. 2-1-84 Suspended by ID 2-1993(Temp), f. & cert. ef. 4-1-93 ID 18-1992(Temp), f. 12-21-92, cert. ef. 1-2-93 IC 2-1984, f. 1-18-84, ef. 2-1-84
836-042-0205 Definitions As used in OAR 836-042-0201 to 836-042-0225 unless the context requires otherwise: (1) “Anniversary Rating Date” means the month and day that a rating plan is initially applied to a policy and each annual anniversary thereafter, unless a different date is established by the rating organization to which the insurer belongs. (2) “Combined Experience” means the sum of workers’ compensation insurance premium, claims, and payroll or other exposure measures used by an insurer to rate individual members of a group of employers. Data from all members of the group are included in the sum without further modification or adjustment. (3) “Experience Rating” means any prospective modification of workers’ compensation insurance premium based on previous workers’ compensation experience data for an individual employer or a group of employers. (4) “Group Anniversary Rating Date” means the month and day the combined experience of a group of employers is initially used to rate individual members of the group and each annual anniversary thereafter, unless a different date is established with the approval of the Insurance Commissioner. (5) “Insurer” means any person authorized to write workers’ compensation insurance in this state and includes the State Accident Insurance Fund Corporation. (6) “Modification Factor” means the numerical result of an experience rating calculation. Insurance premiums are multiplied by this number to adjust for past experience of an employer or a group of employers. (7) “Premium” means the contractual amount charged to an insured for insurance for a specific period of time, regardless of the timing of actual charges. (8) “Premium Discounting” means the modification of workers’ compensation insurance premium according to a rating plan used by an insurer based solely upon a gradation of expense provisions according to the amount of premium. (9) “Rating Plan” means any set of rules and values filed with the Insurance Commissioner and used by an insurer to calculate premiums. (10) “Retrospective Rating” means adjustment of workers’ compensation insurance premium for the policies of a group of employers after the policies have expired using the combined experience from those policies according to the insurer’s rating plan. (11) “Workers’ Compensation Insurance” means insurance covering the obligations of an employer arising from workers’ illness or injury, whether an obligation is imposed by ORS Chapter 656, similar laws of the United States, or agreements between states. Statutory/Other Authority: ORS 731.244 & 737.316 Statutes/Other Implemented: ORS 737.316 History: ID 10-1993, f. 10-1-93, cert. ef. 10-2-93 Reverted to IC 2-1984, f. 1-18-84, ef. 2-1-84 ID 18-1992(Temp), f. 12-21-92, cert. ef. 1-2-93 IC 2-1984, f. 1-18-84, ef. 2-1-84
836-042-0215 Consent to Group Rating Required Before Policy Issuance; Provision Required in Consent Form; Contents of Consent Form (1) An insurer intending to combine the experience of a group of employers for rating purposes may not issue a policy to a member of the group unless it has secured a signed consent to group rating from each group member. (2) The form used by the insurer to secure consent to group rating must be approved by the Director. The form must include the following wording, or substantially equivalent wording approved by the Director: “The premium you must pay for this insurance will be determined in part by the consolidated experience of all members of the group in which you participate." (3) The consent to group rating form must include the following: (a) Name and address of the group member; (b) Name, title and signature of the person giving consent; (c) Name and nature of the organization to which employers in the group belong; (d) Specific description of how the combined experience of the group will be used for rating the group member; and (e) The period covered by policies to be used for deriving the combined experience of group members. Statutory/Other Authority: ORS 731.244 & 737.316 Statutes/Other Implemented: ORS 737.316 History: ID 3-1999, f. & cert. ef. 3-25-99 ID 10-1993, f. 10-1-93, cert. ef. 10-2-93 Reverted to IC 2-1984, f. 1-18-84, ef. 2-1-84 Suspended by ID 2-1993(Temp), f. & cert. ef. 4-1-93 ID 18-1992(Temp), f. 12-21-92, cert. ef. 1-2-93 IC 2-1984, f. 1-18-84, ef. 2-1-84