justicedao/ipfs_state_laws huggingface dataset:
836-005-0112 Persons Represented by Authorized Representative (1) A party or limited party participating in a contested case hearing in which an insured appears under ORS 737.505 may be represented by authorized representative of the party or limited party. (2) On or before the first appearance in a contested case by an authorized representative, the authorized representative must provide the presiding officer a letter from the party or limited party that authorizes the representative to appear on behalf of the party or limited party. (3) The presiding officer may limit an authorized representative’s presentation of evidence, examination and cross-examination of witnesses or presentation of factual arguments to ensure the orderly and timely development of the hearing record. The presiding officer may not allow an authorized representative to present any legal argument. (4) As used in this rule: (a) Authorized representative means a member of a partnership that is a party or limited party in the contested case, an authorized officer or regular employee of a corporation, association or organized group that is a party or limited party in the contested case, or an authorized officer or employee of a governmental authority other than a state agency, that is a party or limited party in the contested case; (b) Legal argument includes any argument on: (A) The jurisdiction of the Department to hear the contested case; (B) The constitutionality of a statute or rule or the application of a constitutional requirements; or (C) The application of court precedent to the facts of the contested case. (c) Legal argument does not include any argument on: (A) The application of the facts to the statutes or rules that directly apply to the issues in the contested case; (B) Comparison of prior actions of the Department; (C) The literal meaning of the statutes or rules that directly apply to the issues in the contested case; or (D) The admissibility of evidence or the correctness of procedures being followed. (5) When an authorized representative represents a party of limited party in a hearing, the presiding officer shall advise the representative of the manner in which objections may be made and the manner in which matters may be preserved for appeal. The advice is of a procedural nature and does not change applicable law on waiver or applicable law on the duty to make timely objection. When an objection may involve a legal argument, the presiding officer shall provide reasonable opportunity for the authorized for the authorized representative to consult legal counsel and shall permit the legal counsel to file written legal argument within a reasonable time after conclusion of the hearing. Statutory/Other Authority: ORS 821 Statutes/Other Implemented: ORS 183.457(1)(d) & 183.457(2)(b) History: IC 6-1988, f. & cert. ef. 3-30-88
836-005-0400 Annual Complaint Report The Director shall publish an annual statistical report on complaints against insurers as required under ORS 731.264, according to the method established in this rule. Each report shall contain the number, percentage, type and disposition of complaints against each insurer that were closed by the Department of Consumer and Business Services during the reporting period. The report shall be based on the records of the Department of Consumer and Business Services. The report shall be structured as a cross tabulation of complaints closed during the reporting period, by complaint type and disposition, against each insurer with respect to whom one or more complaints were closed during the period for which the report is made. Statutory/Other Authority: ORS 731 Statutes/Other Implemented: ORS 731.264(3) History: ID 19-2006, f. & cert. ef. 9-26-06 ID 11-1989, f. & cert. ef. 11-20-89 ID 3-1989(Temp), f. & cert. ef. 2-28-89
836-006-0010 Payment of Transition and Retaliatory Taxes (1) An insurer shall pay to the Director on April 1 of each year the amount of retaliatory tax due and payable under ORS 731.854, on the basis of the corporate excise tax obligation of the insurer that is owed or is estimated to be owed by the insurer for the preceding year ending December 31. (2) If a foreign insurer is unable to determine the full amount of the tax that is due and payable under ORS 731.854 for the preceding year ending December 31 when the tax is due on April 1, the insurer shall pay to the Director on April 1 the amount it estimates to be due and payable under ORS 731.854. A foreign insurer shall pay the amount owing or estimated to be owing regardless of whether its domiciliary state has granted an extension or delay for filing or paying the taxes owing in the domiciliary state. (3) When a foreign insurer files with its domiciliary state a final return that determines the amount of taxes owing to that state for a particular year, the insurer shall also file with the Director an amended return showing the amount of taxes owing to the State of Oregon or due as a credit to the insurer. The foreign insurer shall pay any additional tax shown to be due on the final return together with interest as required by the Insurance Code on the taxes owing to the State of Oregon. (4) If a foreign insurer amends its return filed with its domiciliary state or files an amended Oregon excise tax return so as to change the amount of the tax due and payable under ORS 731.854, the insurer shall pay any additional tax owing to this state or shall be credited with any excess previously paid. (5) An insurer shall pay taxes and other amounts due under this rule in accordance with forms prescribed by the Director. (6) For purposes of this rule, "foreign insurer" also includes any alien insurer, and "state" includes a country other than the United States. Statutory/Other Authority: ORS 731.244 Statutes/Other Implemented: ORS 731.854 & Ch. 786(2) & OL 1995 History: ID 19-2006, f. & cert. ef. 9-26-06 ID 13-1997, f. & cert. ef. 10-14-97
836-006-0021 Allocation of Consolidated Excise Tax for Purpose of Offsetting Retaliatory Taxes (1) When the excise tax owing by a consolidated group pursuant to ORS 317.710 and 317.715 is determined, the share of the excise tax attributable to the member domestic insurer shall be established as provided in this rule for the purpose of allocating shares of the tax to member foreign insurers in order to calculate retaliatory taxes owing under 731.854. (2) The consolidated group excise tax shall be allocated to the domestic insurer in the proportion that the domestic insurer’s Oregon direct premiums written, wages and commissions, and real estate income bear to the total Oregon direct premiums written, wages and commissions, and real estate income for the consolidated group. Statutory/Other Authority: ORS 731.244 & 731.854 Statutes/Other Implemented: ORS 731.854 & 731.859 History: ID 15-1998, f. & cert. ef. 9-25-98
836-007-0001 Actions by Director for Restitution or Other Equitable Relief (1) As used in this rule: (a) “Actual damages” means reasonably foreseeable losses. (b) “Consumer” means an insured under a policy that is the subject of the enforcement action. (c) “Equitable relief” means injunctive relief, specific performance of a contract provision or specific performance of a provision of the Insurance Code or rules implementing the Insurance Code or applicable federal law. (2) The Director of the Department of Consumer and Business Services: (a) May seek restitution of actual damages or other equitable relief on a consumer’s behalf only when the director takes an action against an insurer under ORS 731.256(1). (b) Will not seek relief under subsection (a) of this section for any consumer who is entitled to a remedy under ORS Chapter 656; and (c) May reduce actual damages upon a showing that the consumer has failed to reasonably mitigate damages. Statutory/Other Authority: ORS 731.244 Statutes/Other Implemented: ORS 731.256 History: ID 10-2014, f. & cert. ef. 6-20-14 ID 8-2013(Temp), f. & cert. ef. 12-31-13 thru 6-20-14
836-009-0001 Purpose The purpose of rules in OAR chapter 836, division 9 is to establish assessments, fees and charges for administering the regulatory program of the Division of Financial Regulation, Department of Consumer and Business Services. Statutory/Other Authority: ORS 183.335, 293.445 & 731.804 Statutes/Other Implemented: ORS 183.335(7) & 731.804(1)-(2) History: ID 9-2024, minor correction filed 07/22/2024, effective 07/22/2024 ID 7-1993, f. & cert. ef. 9-3-93 IC 4-1983, f. 6-27-83, ef. 7-1-83
836-009-0008 Mailing List Fee The fee for inclusion of each entry on the Division of Financial Regulation mailing list established under ORS 183.335 for giving notice of rulemaking is $35. The fee shall be paid annually. The fee established under this rule does not apply to any federal, state or local governmental entity. Statutory/Other Authority: ORS 183 & 731 Statutes/Other Implemented: ORS 183.335(7) & 731.804(2) History: ID 10-2024, minor correction filed 07/22/2024, effective 07/22/2024 ID 21-1990, f. & cert. ef. 12-18-90
836-009-0015 Refunds Except as provided by rule for fees and assessments under ORS 731.804, when the Director determines that the Department has received moneys in excess of the amount legally due and payable to the Department under the Insurance Code or that the Department in carrying out its functions under the Insurance Code has received moneys to which it has no legal interest, if the amount of the refund owed by the Department is less than $10, the Department shall pay the refund only upon receipt of a written request from the person who paid the money or the legal representative thereof. The written request must be received by the Department not later than three years from the date the moneys were paid to the Department. Statutory/Other Authority: ORS 293 & 731 Statutes/Other Implemented: ORS 293.445(4) History: ID 8-1989, f. & cert. ef. 8-11-89
836-010-0000 Statutory Authority and Implementation (1) OAR 836-010-0000, 836-010-0011 and 836-010-0021 are adopted under the authority of ORS 731.244 and 731.296, to aid in giving effect to provisions of ORS Chapters 737, 742 and 743 relating to the filing of rates and policy forms with the Director. The requirements of OAR 836-010-0000, 836-010-0011 and 836-010-0021 are in addition to any other requirements established by statute or by rule or bulletin of the Department. (2) OAR 836-010-0000, 836-010-0011, and 836-010-0021 apply to all filings submitted or resubmitted to the Director on or after May 1, 2002. Statutory/Other Authority: ORS 731.244 Statutes/Other Implemented: ORS 731.296, 737.205, 737.207, 742.001, 743.015 & 743.018 History: ID 20-2011, f. 12-16-11, cert. ef. 1-1-12 ID 8-2010, f. 3-31-10, cert. ef. 4-1-10 ID 20-2002, f. 10-11-02, cert. ef. 10-12-02 ID 11-2002(Temp), f. & cert. ef. 4-18-02 thru 10-11-02 ID 11-1998, f. & cert. ef. 8-10-98 Reverted to ID 9-1994, f. 7-1-94, cert. ef. 7-15-94 ID 20-1997(Temp), f. 12-29-97, cert. ef. 12-30-97 thru 6-11-98 ID 9-1994, f. 7-1-94, cert. ef. 7-15-94
836-010-0013 Additional Filing Requirements for Transitional Health Benefit Plans (1) Under section 5, chapter 80, Oregon Laws 2014, a transitional health benefit plan must comply with the Insurance Code as of December 31, 2013. (2) In addition to the requirements of OAR 836-010-0000, 836-010-0011, and 836-010-0021 when submitting a filing for a rate change to a transitional health benefit plan, the insurer shall comply with the guidance for the applicable plan year as provided in Exhibits 1, 2 and 3 of this rule. (3) The additional filing requirements set forth in this section apply only to 2015, 2016 and 2017 transitional plans. [ED. NOTE: Exhibits referenced are available from the agency] Statutory/Other Authority: ORS 731.244 & 743.018 Statutes/Other Implemented: 2014 OL Ch. 80 & Sec. 5 (Enrolled SB 1582) History: Reverted to ID 4-2016, f. & cert. ef. 4-8-16 ID 6-2016(Temp), f. & cert. ef. 4-28-16 thru 9-30-16 ID 4-2016, f. & cert. ef. 4-8-16 ID 17-2014, f. & cert. ef. 10-6-14 ID 8-2014(Temp), f. & cert. ef. 4-24-14 thru 10-20-14
836-010-0014 Notice and Procedural Requirements for Expanded Transitional Health Benefit Plans Text in ORMS History: Suspended by ID 12-2015, f. & cert. ef. 10-16-15 ID 11-2015(Temp), f. & cert. ef. 10-12-15 thru 3-18-16 ID 10-2015(Temp), f. & cert. ef. 9-23-15 thru 3-18-16 Reverted to Suspended by ID 12-2015, f. & cert. ef. 10-16-15 Sunset on 09-28-2017
836-010-0021 Required Actuarial Data (1) An insurer shall file with the Director, on or before March 15 of each year, geographic average rates for small employer, portability and individual health benefit plans for a rating period. The supporting actuarial data must be submitted with the certificate of compliance. The geographic average rates must demonstrate compliance with the applicable provisions of: (a) ORS 743.737, governing small employer premium rates; (b) ORS 743.760, governing portability premiums rates; and (c) ORS 743.767, governing individual premium rates. (2) Except as provided in this section, supporting actuarial data shall accompany every filing of property or casualty insurance rates submitted on a file and use basis under ORS 737.205 and prior approved rates under ORS 737.207. The data shall be in sufficient detail to justify the rate level change and shall demonstrate compliance with ORS 737.310 governing the making of rates. This section does not apply to: (a) Title insurance filings; (b) Workers’ compensation insurance filings; (c) Surety filings; (d) Home protection insurance filings; (e) Filings for mortgage insurance, which is the insurance against financial loss by reason of nonpayment of sums agreed to be paid, as defined in ORS 731.178, rather than a life insurance product offering payment of a mortgage in the event of death or disability; and (f) Purchasing group insurance filings. (3) A rate filing for commercial liability insurance received by the Department that is subject to ORS 737.207 and does not comply with the requirement of section (2) of this rule is in noncompliance with the requirements and standards of ORS Chapter 737. Statutory/Other Authority: ORS 731.244 Statutes/Other Implemented: ORS 731.296, 737.205, 737.207, 743.015 & 743.018 History: ID 20-2002, f. 10-11-02, cert. ef. 10-12-02 ID 11-2002(Temp), f. & cert. ef. 4-18-02 thru 10-11-02 ID 13-2000(Temp), f. & cert. ef. 12-21-00 thru 6-9-01 ID 12-2000, f. 11-14-00, cert. ef. 1-1-01 ID 11-1998, f. & cert. ef. 8-10-98 ID 20-1997(Temp), f. 12-29-97, cert. ef. 12-30-97 thru 6-11-98 ID 9-1994, f. 7-1-94, cert. ef. 7-15-94
836-010-0026 Prohibition on the Use of Discretionary Clauses (1)(a) As used in this rule, “discretionary clause” means a policy provision that purports to bind the claimant, or to grant deference to the insurer, in proceedings subsequent to the insurer’s decision, denial or interpretation of terms, coverage or eligibility for benefits. “Discretionary clause” includes a policy provision that provides any of the following: (A) An insured or other claimant may not appeal a denial of a claim; (B) The insurer's decision to deny coverage is binding upon a policyholder or other claimant or is otherwise entitled to deference upon appeal or review; (C) On appeal or review the insurer's decision-making power as to coverage is binding or otherwise entitled to deference; (D) The insurer's interpretation of the terms of a policy is binding upon a policyholder or other claimant or is otherwise entitled to deference; (E) On appeal the insurer's interpretation of the terms of a policy is binding or is otherwise entitled to deference; (F) A legal standard of review on appeal that gives deference to the original claim decision, or gives rise to such legal standard of review; or (G) The insurer has sole discretion to determine whether a claim is compensable or its interpretation of the provisions of the policy is entitled to deference in a subsequent proceeding. (b) Nothing in this section prohibits a carrier from including a provision in a contract that informs an insured that as part of its routine operations the carrier applies the terms of its contracts for making decisions, including making determination regarding eligibility, receipt of benefits and claims or explaining its policies, procedures and processes. (2) A policy, contract or agreement offered or issued in this state by an insurer to provide, deliver, arrange for, pay for or reimburse claim costs may not contain a discretionary clause or other language purporting to reserve discretion to the insurer to interpret the terms of the contract, or to provide standards of interpretation or review that are inconsistent with the laws of this state. (3) This rule does not prevent a policy provision that addresses alternative dispute resolution as allowed by law. (4) This rule is self-executing. The rule applies to policies, contracts and agreements issued or renewed on or after the date the rule is adopted. If a policy, contract or agreement is renewed and contains a provision rendered void and unenforceable by this rule, the parties to the policy, contract or agreement and the courts shall treat that provision as void and unenforceable. Statutory/Other Authority: ORS 731.244 Statutes/Other Implemented: ORS 731.008, 742.003 & 742.005 History: ID 2-2015, f. & cert. ef. 3-12-15
836-010-0051 Requirements for Electronic Reporting or Response (1) As used in this rule: (a) “Administrator” means the individual responsible for a person’s electronic account activation and maintenance. (b) “Contact” means the individual responsible for electronic account administration, an electronic report or electronic response. (c) “Contact Information” means: (A) Name; (B) Title; (C) Direct telephone number; (D) Electronic mail address; and (E) Mailing address. (d) “Maintenance” means ensuring accurate and current company and contact information, providing and updating user access and performing other activities necessary for user submission of reports or responses and timely communication with the Division of Financial Regulation. (e) “User” means an individual with rights to access the person’s electronic account. (2) This rule establishes requirements for submitting information or responses through the reporting system of the Division of Financial Regulation according to the instructions set forth on the website of the Division of Financial Regulation of the Department of Consumer and Business Services at dfr.oregon.gov. (3) A person required to submit information to the Division of Financial Regulation or to respond electronically to a request from the Division of Financial Regulation must activate and maintain an account through the reporting system of the Division of Financial Regulation. (4) A person subject to section (3) of this rule must: (a) Designate at least one administrator; (b) Designate at least one contact for account administration and for each electronic report or response; and (c) Provide current, accurate contact information for the administrator, company and each contact. Statutory/Other Authority: ORS 731.244 Statutes/Other Implemented: ORS 731.296 History: ID 5-2023, minor correction filed 05/19/2023, effective 05/19/2023 ID 12-2013, f. 12-31-13, cert. ef. 1-1-14
836-010-0130 Statutory Authority; Purpose; Applicability (1) OAR 836-010-0130 to 836-010-0145 are adopted pursuant to the general rulemaking authority of the Commissioner in ORS 731.244 to aid in the effectuation and enforcement of 731.438. (2) The purpose of OAR 836-010-0130 to 836-010-0145 is to prescribe title plant standards for title insurers. (3) OAR 836-010-0130 to 836-010-0145 applies to all authorized title insurers. Statutory/Other Authority: ORS 731 Statutes/Other Implemented: ORS 731.438 History: IC 1-1978, f. 3-27-78, ef. 4-1-78
836-010-0140 Title Plant Standards (1) The title plant shall maintain "adequate maps" as defined in OAR 836-010-0135, that will enable a person working the title plant to locate a tract of land which is the subject of a title search with reference to the government survey system. (2) The title plant shall maintain a "general index," as defined in OAR 836-010-0135, in either alphabetical or phonetical order, so that any record pertaining to any person by name may be readily located. (3) The title plant shall maintain a "currently posted" "tract or geographic index" and “general index” as defined in OAR 836-010-0135. Statutory/Other Authority: ORS 731 Statutes/Other Implemented: ORS 731.438 History: ID 12-2016, f. 12-29-16, cert. ef. 1-9-17 IC 1-1978, f. 3-27-78, ef. 4-1-78
836-010-0150 Marriage of Same-Gender Couple Validly Performed (1) This rule is adopted under the general rulemaking authority of the Director of the Department of Consumer and Business Services in ORS 731.244 to comply with the United States Supreme Court decision in United States v. Windsor, 570 U.S. 12 (2013) and Geiger v. Kitzhaber, No. 6: 13-cv-01834-MC (D. Or. May 19, 2014). (2) Any person or entity subject to regulation by the Department of Consumer and Business Services under the Insurance Code, must consider the marriage of a same-sex couple validly performed the same as the person or entity considers any other marriage validly performed. (3) This rule applies to any action or activity related to the transaction of insurance in Oregon. (4) Any privilege, immunity, right or benefit granted under the Insurance Code to an individual because the individual is or was married to an individual of the opposite sex, is granted on equivalent terms, substantive and procedural, to an individual who is or was a partner in a marriage of a same-sex couple validly performed. Statutory/Other Authority: SCOTUS Decision in United States v. Windsor, 570 U.S. 12 (2013); Letter of Advice from Oregon Attorney General dated October 16, 2013; Geiger v. Kitzhaber, No. 6: 13-cv-01834-MC (D. Or. May 19, 2014). & ORS 731.244 Statutes/Other Implemented: ORS 731.008, 731.016 & 731.236 History: ID 11-2014, f. & cert. ef. 7-17-14
836-010-0155 Gender Specific Contract Language (1) As used in this rule, “provider” includes but is not limited to: (a) A physician as defined in ORS 677.010. (b) A physician group, independent practice association, physician-controlled organization, hospital organization or other provider organization that contracts with a provider for the purpose of facilitating the provider’s participation in a provider network contract. (c) A person licensed or certified by the laws of this state to administer medical services or mental health services in the ordinary course of business or practice of a profession. A person grandfathered under the provisions of Section 3, chapter 674, Oregon Laws 2015 (Enrolled Senate Bill 696) shall be considered licensed or certified under this section. (2) An individual’s attending provider determines whether a sex-specific recommended preventive service that is required to be covered without cost sharing under section 2713 of the Public Health Service Act and its implementing regulations is medically appropriate for a particular individual. When an attending provider determines that a recommended service is medically appropriate for an individual and the individual satisfies the criteria for the service or treatment, the insurer must provide coverage for the recommended service regardless of sex assigned at birth, gender identity, or gender of the individual otherwise recorded by the insurer. Statutory/Other Authority: ORS 731.244 Statutes/Other Implemented: ORS 743A.066, 743A.080, 743A.100, 743A.104, 743A.105, 743A.108 & 743A.110 and 743A.120 History: ID 5-2016, f. & cert. ef. 4-26-16