justicedao/ipfs_state_laws huggingface dataset:
836-043-0009 Participation by Insurers and Insurance Producers (1) All insurers authorized to transact workers' compensation insurance in Oregon are required to participate in the Plan and subscribe to the organizing principles for Oregon. (2) Failure of an insurer to comply with the Plan is grounds for revocation of the insurer's certificate of authority to transact workers' compensation insurance. (3) Each insurance producer who is authorized to transact the class of property and casualty insurance is authorized to transact workers' compensation insurance offered by the Plan. The Director of the Department of Consumer and Business Services may terminate a producer's authority under this section for cause. (4) An insurer may terminate participation in this Plan as of the close of the calendar year in which its authority to write workers’ compensation is terminated. With respect to all policies in force on the effective date of an insurer’s termination, the liability of the terminating insurer will cease on the succeeding anniversary date of each such policy. Termination of participation does not discharge or otherwise affect liabilities incurred prior to the anniversary date of such policies, and the insurer will be charged or credited in due course with the insurer’s proper share of all expenses, losses, and profits allocable thereof. (5) All insurers participating in the Plan through the Reinsurance Agreements provided for in the organizing principles shall share in the writings, expenses, servicing allowance and losses. Each insurer’s participation in the Plan shall: (a) Be in the proportion that the total net premiums of all members participating in the Plan in Oregon during the preceding calendar years bear to the aggregate direct premiums written in Oregon during the preceding calendar years by all insurers participating through the Reinsurance Agreements; (b) Except as provided in OAR 836-043-0017(2)(k), exclude that portion of the premiums attributable to the operation of the Plan; and (c) Be determined on the basis of the direct premiums as reported in the most recent annual reports filed with the regulatory authority. 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 8-2005, f. 5-18-05, cert. ef. 8-1-05 ID 10-1996, f. 6-27-96, cert. ef. 7-1-96, Renumbered from 836-043-0016 ID 4-1994, f. & cert. ef. 4-19-94
836-043-0028 Application by Electronic Transmission or Telephone (1) An application made by electronic transmission or telephone must be completed in full and must be signed. The signature may be submitted by facsimile transmission. The effective date of coverage shall be determined in accordance with OAR 836-043-0044. (2) An employer or the representative of an employer may apply for assigned risk coverage electronically by accessing NCCI’s online application service. Upon receipt of an application submitted electronically, the Plan Administrator shall review the information to determine whether the employer is eligible. If the employer is eligible and the application is complete and accurate, the Plan Administrator shall calculate electronically the initial or deposit premium amount and request the employer to submit the amount to continue the application process. The amount of the initial or deposit premium shall be determined in accordance with rules set forth in Exhibit 3 to OAR 836-043-0024. (3) The employer or its agent must submit the total required initial premium to the Plan Administrator by credit card or electronic funds transfer. A portion of the deposit premium may be satisfied with an authorized surety's financial guaranty bond as provided in OAR 836-043-0034. (4)(a) The employer or the representative of the employer may contact the Plan Administrator by telephone to apply for assigned risk coverage. If the information provided by telephone is complete, accurate, and the employer is deemed eligible for coverage, the Plan Administrator shall: (A) Advise the employer of the total estimated annual premium and required initial or deposit premium required to bind coverage; and (B) Fax the employer a copy of the completed applications as set forth in Exhibits 1 and 2 of OAR 836-043-0024 for review and signature. (b) For a application made by telephone, the employer or the representative of the employer shall submit the total required initial or deposit premium by electronic funds transfer in accordance with rules set forth in Exhibit 3 to OAR 836-0043-0028. [ED. NOTE: Exhibits referenced are available from the agency.] 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
836-043-0032 Nonelectronic Application (1) An employer or the representative of an employer may submit a signed and completed application as set forth in Exhibits 1 and 2 of OAR 836-043-0024 by United States mail or a private overnight mail delivery service. The application must be sent to the Plan Administrator and must include the initial or deposit premium as calculated by the employer or its agent. The application may include a requested date for the coverage to become effective. A portion of the deposit premium may be satisfied with an authorized surety's financial guaranty bond as provided in OAR 836-043-0034. (2) The employer or its agent shall refer to Exhibit 3 to OAR 836-043-0024 of the application for the applicable deposit or initial premium rules. [ED. NOTE: Exhibits referenced are available from the agency.] 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
836-043-0034 Surety Bonds For all submission options under OAR 836-043-0028 or 836-043-0032, the employer submitting an application may satisfy a portion of the deposit premium with an authorized surety’s financial guaranty bond, but the cash portion of the deposit premium must be no less than either the minimum premium or 25 percent of the total estimated annual premium, whichever is greater. The employer may select any minimum deposit percentage listed in the NCCI Plan Oregon State Instructions page (Exhibit 3 to 836-042-0024) and post a bond for the premium difference between that percentage and the minimum deposit percentage otherwise applicable. 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
836-043-0041 Application Review (1) Upon receiving an application submitted under OAR 836-043-0028 or 836-043-0032, the Plan Administrator shall review the application for completeness and determine whether the employer is eligible for coverage under the Plan. (2) The Plan Administrator may request additional information to establish eligibility, to assign appropriate classification codes, to calculate applicable premiums and to otherwise appropriately process the application. The additional information may include: (a) Tax documentation; (b) Ownership information, including a request to complete and sign a change of ownership form; (c) Contracts, including worker leasing company arrangements, temporary employment agency contract or franchise agreements; (d) Supplemental worker leasing company applications; (e) Additional information regarding short-term policies requests, such as verification of annualized payroll; (f) Proof of declination of voluntary coverage; (g) Prior policy information including claims and audits, corporate charters, Dun & Bradstreet, Inc. reports, signed financial statements and signed letters of explanation; and (h) Any other information that the Plan Administrator considers necessary to process the application. (3) The employer or its agent shall provide information and documentation requested by the Plan Administrator or provide an acceptable explanation for failure to provide the requested items not later than the second business day after the request or upon the mutually agreed-upon date. (4) The Plan Administrator may return an incomplete application to the employer or its agent for completion or, with notice to the employer or its agent, the Plan Administrator may retain the application pending receipt of further information. The Plan Administrator may reject an application and the previously established effective date if the employer fails to comply in a timely manner with a request from the Plan Administrator. (5) An employer or a representative of an employer may resubmit a complete application to the Plan Administrator for an application review and establishment of a new effective date in accordance with 836-043-0044. 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
836-043-0046 Rates and Forms, Policy Term, Additional Coverages and Other Provisions (1) An insurer issuing a policy to an employer to which the Plan applies shall write the policy according to the classifications, forms including but not limited to policy endorsements, change of ownership forms, supplemental leasing forms, and rates and rating plans including retrospective rating plans authorized for use in the assigned risk market by the Plan Administrator and approved by the Insurance Commissioner as required in ORS 737.265(2). (2) The policy information page and all endorsements must be properly identified as a Plan or AR (Assigned Risk) policy, and policy information submitted on hard copy must show the Plan or AR indicator with the policy number on the Information Page. The Policy Information Page and all endorsements must be submitted to the Plan Administrator or its designee within the time frame and in the format established by the Plan Administrator. (3) The servicing carrier shall issue a policy and proof of coverage as required by ORS 656.419, for a term of at least one year, unless insurance for a shorter term has been requested. A short-term policy may be obtained only once within a 12-month period unless otherwise agreed by the servicing carrier. (4) The servicing carrier may make additional coverages described in the Supplement to the Plan available to an employer. Statutory/Other Authority: ORS 656.427, 656.730 & 731.244 Statutes/Other Implemented: ORS 656.419, 656.427, 656.730 & 737.265 History: ID 6-2009, f. & cert. ef. 8-14-09 ID 18-2008, f. 12-9-08, cert. ef. 1-1-09 ID 10-1996, f. 6-27-96, cert. ef. 7-1-96
836-043-0048 Additional States’ Coverage Except as shown on the binder or verification page, all assignments under the plan are to be made on an intrastate basis. An employer seeking insurance for operations in one or more states other than the state listed in the Policy Information Page may request its servicing carrier to furnish insurance in the additional states in accordance with OAR 836-043-0050 and the Interstate Assignments section of the Plan. A Plan policy that affords coverage on operations in more than one state shall clearly indicate the premium developed for each state separately. 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
836-043-0053 Premium Obligations (1)(a) The Plan Administrator shall not knowingly make an assignment unless the employer has met all undisputed workers' compensation premium obligations on any previous workers’ compensation insurance including but not limited to obligations to: (A) Any servicing carrie; (B) A direct assignment carrier; or (C) A voluntary insurer. (b) After policy issuance, if an employer does not meet all undisputed workers' compensation insurance premium obligations under the current policy or previous assigned risk or voluntary policies, the employer's present servicing carrier retains the right to cancel a policy currently in force under the plan in accordance with ORS 656.427. (2) When an employer with a prior undisputed workers' compensation premium obligation is a client of a worker leasing company as established in ORS 656.850 that is insured by the Plan, the servicing carrier may instruct the worker leasing company to issue a client cancellation notice to the Director of the Department of Consumer and Business Services with a copy to the client and a copy to the servicing carrier. Such a cancellation is effective on the 30th day after receipt of notice by the Director of the Department of Consumer and Business Services unless the client pays the prior premium debt or obtains coverage in the voluntary insurance market before the 30th day. When a worker leasing company fails to issue the requested client cancellation notice within 20 days of the request, the servicing carrier may cancel the worker leasing company policy. 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
836-043-0056 Insurer Cancellation and Nonrenewal of Workers’ Compensation Insurance Policies or Surety Bonds The following provisions of this rule govern when an insurer cancels or fails to renew a workers’ compensation insurance policy or surety bond: (1) An insurer canceling coverage under ORS 656.427 for an employer who has an undisputed premium obligation not more than 30 days past due shall take the following actions: (a) At the time the insurer gives notice of the cancellation, the insurer shall notify the employer of the right to placement in the Plan if eligible under OAR 836-043-0043; (b) Provide the employer, not later than the tenth day after the employer's contact for Plan coverage, an accurately filled-in "Request for Coverage" form, using the form prescribed in Exhibits 1 and 2 to OAR 836-043-0024; and (c) The insurer shall date stamp the request for coverage identifying the insurer's name and forward the form to the Plan administrator with payment, not later than the fifth day after receiving the signed request form from the employer. (2) An employer or its agent desiring Plan coverage, whose coverage is being cancelled or nonrenewed under ORS 656.427 and who does not have an undisputed premium obligation more than 30 days past due, shall: (a) Give notice to the canceling or nonrenewing insurer, prior to the termination of coverage, that the employer intends to become an insured employer under the Plan; and (b) Verify coverage elections and other information provided in the Request for Coverage form (Exhibits 1 and 2 to OAR 836-043-0024), and sign the request form and return the form with the deposit premium check to the canceling or nonrenewing insurer before the end of coverage or not later than the tenth day after the insurer issues the Request for Coverage form, if later. (3) The Plan Administrator shall process the Request for Coverage form received with a deposit premium prior to the coverage ending date in the manner provided for a Plan application, except that the Plan Administrator shall bind coverage under the Plan for Request for Coverage upon the date of receipt of the form (Exhibits 1 and 2 to OAR 836-043-0024) by the canceling or nonrenewing insurer in accordance with this rule or the ending date of previous coverage, if later. [ED. NOTE: Exhibits referenced are available from the agency.] Statutory/Other Authority: ORS 656.427, 656.730 & 731.244 Statutes/Other Implemented: ORS 656.419, 656.427, 656.730 & 737.265 History: ID 6-2009, f. & cert. ef. 8-14-09 ID 10-1996, f. 6-27-96, cert. ef. 7-1-96
836-043-0062 Issuance and Continuation of Policy (1) A policy must be issued, renewed or reinstated without a lapse in coverage when premium, including an interim premium audit or installment payment, is received by the carrier or postmarked by the United States Postal Service prior to the policy effective date or cancellation date. (2) The following table establishes reinstatement provisions for a policy that is cancelled or renewed: [Table not included. See ED. NOTE.] (3) A servicing carrier may impose additional requirements if necessary to effect the reinstatement of a policy. Effective or reinstatement dates for a lapse in coverage shall be determined in the same manner provided in OAR 836-043-0044. [ED. NOTE: Tables referenced are available from the agency.] 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
836-043-0064 Renewal, Nonrenewal (1) A servicing carrier shall send a renewal or nonrenewal notice of impending expiration of coverage to the insured, the representative of the insured and the Plan Administrator at least 45 days before the expiration date of insurance. Upon receipt of the required premium, the servicing carrier shall issue the policy in accordance with Oregon statutes and rules and furnish a copy of such policy and all endorsements, properly identified as a Plan or AR (Assigned Risk) policy, to the Plan Administrator or its designee within the time and in the format established by the Plan Administrator. (2) The servicing carrier shall apply the deposit premium paid by an employer in the Plan against the deposit required for a renewal policy, if any. If the servicing carrier assigned the renewal policy is different from the previous servicing carrier, then the previous servicing carrier shall promptly bill the employer for the final billing period, including any audit adjustments. If the final billing is not paid on or before the 30th day after the billing, the renewal servicing carrier may immediately issue a cancellation notice. (3) A servicing carrier may refuse to renew a policy if the servicing carrier is unable to supply a required type of coverage, including but not limited to longshore, coal mine, maritime or additional state exposures. 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
836-043-0066 Reassignment (1) An employer may submit to the Plan Administrator a written request for reassignment to a different carrier, if available. The employer must submit the request in writing to the Plan Administrator not later than the 30th day and not earlier than the 60th day prior to the expiration of the current policy unless the Plan Administrator approves another request period or at the request of the regulatory authority. The employer must provide the Plan Administrator with an acceptable reason for the request with appropriate documentation. Acceptable reasons for an employer to request reassignment include: (a) Documented poor servicing carrier service such as failure to provide timely issuance of statements, policies, and endorsements, or services not provided under the policy; (b) Documented refusal of or inability of a servicing carrier to supply a required type of coverage including but not limited to longshore, coal mine, maritime or additional state exposures; (c) Documented failure of a servicing carrier to return premium due to the insured, where there is no valid bona fide premium dispute; (d) Based on the servicing carrier’s A.M. Best Rating or financial size category, if appropriate documentation is provided to and approved by the Plan Administrator; or (e) Any other substantial documented reason subject to approval of the Plan Administrator (2) The request for reassignment is subject to approval by the Plan Administrator. If the Plan Administrator approves the reassignment request, the employer shall submit a new application as provided in OAR 836-043-0028 or 836-043-0032 along with the appropriate initial or deposit premium to the Plan Administrator and must be otherwise eligible for continued coverage through the Plan. The reassignment shall be made on a random basis. 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
836-043-0072 Voluntary Coverage Notwithstanding OAR 836-043-0089, an insurer that wishes to insure an employer as voluntary business may do so at any time. If a servicing carrier wishes to insure voluntarily one of its plan accounts, the servicing carrier must provide written notice to both the Plan Administrator and the agent of the employer of its intent at least 30 days in advance of the effective date of the servicing carrier’s voluntary coverage. If the insurer is not the servicing carrier, the servicing carrier shall cancel its policy pro rata and the assignment shall automatically terminate as of the later of the effective date of the voluntary insurer’s policy or the date the voluntary insurer provides written notice to the servicing carrier of its coverage. 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
836-043-0079 Notification of Outstanding Premium A servicing carrier or its representative shall furnish information regarding outstanding assigned risk and voluntary workers' compensation insurance premium or other workers' compensation monetary policy obligations identified by the servicing carrier or its representative to the Plan Administrator or its designee in accordance with the appropriate Assigned Carrier Performance Standards or other state market conduct or regulatory requirements. A servicing carrier shall report to the Plan Administrator within five business days of the servicing carrier’s determination all instances of noncompliance and of any compliance by the 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
836-043-0082 Policyholder Services A servicing carrier shall provide all of the following to each policyholder or a representative of the insured and its producer: (1) Access to audit, loss control and safety services. (2) Prompt, professional handling of claims, including investigation, resolution and communication. (3) Fair and prompt responses to complaints and disputes. (4) Access to appropriate information regarding the classification of the business and the factors influencing the policy premium. 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