justicedao/ipfs_state_laws huggingface dataset:
836-011-0224 Internal Audit Function Requirements (1) An insurer is exempt from these requirements if: (a) The insurer has annual direct written and unaffiliated assumed premium, including international direct and assumed premium but excluding premiums reinsured with the Federal Crop Insurance Corporation and Federal Flood Program, less than $500,000,000; and (b) If the insurer is a member of a group of insurers, the group has annual direct written and unaffiliated assumed premium including international direct and assumed premium, but excluding premiums reinsured with the Federal Crop Insurance Corporation and Federal Flood Program, less than $1,000,000,000. (2) The insurer or group of insurers shall establish an Internal audit function providing independent, objective and reasonable assurance to the Audit committee and insurer management regarding the insurer’s governance, risk management and internal controls. This assurance shall be provided by performing general and specific audits, reviews and tests and by employing other techniques deemed necessary to protect assets, evaluate control effectiveness and efficiency, and evaluate compliance with policies and regulations. (3) In order to ensure that internal auditors remain objective, the Internal audit function must be organizationally independent. Specifically, the Internal audit function will not defer ultimate judgment on audit matters to others, and shall appoint an individual to head the Internal audit function who will have direct and unrestricted access to the board of directors. Organizational independence does not preclude dual-reporting relationships. (4) The head of the Internal audit function shall report to the Audit committee regularly, but no less than annually, on the periodic audit plan, factors that may adversely impact the Internal audit function’s independence or effectiveness, material findings from completed audits and the appropriateness of corrective actions implemented by management as a result of audit findings. (5) If an insurer is a member of an insurance holding company system or included in a group of insurers, the insurer may satisfy the Internal audit function requirements set forth in this rule at the ultimate controlling parent level, an intermediate holding company level or the individual legal entity level. Statutory/Other Authority: ORS 731.244 & ORS 731.488 Statutes/Other Implemented: ORS 731.488 History: ID 14-2017, adopt filed 12/20/2017, effective 12/20/2017
836-011-0225 Conduct of Insurer in Connection with the Preparation of Required Reports and Documents (1) A director or officer of an insurer may not directly or indirectly: (a) Make or cause to be made a materially false or misleading statement to an accountant in connection with any audit, review or communication required under OAR 836-011-0100 to 836-011-0230; or (b) Omit to state, or cause another person to omit to state, any material fact necessary in order to make statements made, in light of the circumstances under which the statements were made, not misleading to an accountant in connection with any audit, review or communication required under OAR 836-011-0100 to 836-011-0230. (2) An officer or director of an insurer, or any other person acting under the direction thereof, may not directly or indirectly take any action to coerce, manipulate, mislead or fraudulently influence any accountant engaged in the performance of an audit pursuant to OAR 836-011-0100 to 836-011-0230 if that person knew or should have known that the action, if successful, could result in rendering the insurer’s financial statements materially misleading. (3) For purposes of section (2) of this rule, actions that, “if successful, could result in rendering the insurer’s financial statements materially misleading” include, but are not limited to, actions taken at any time with respect to the professional engagement period to coerce, manipulate, mislead or fraudulently influence an accountant: (a) To issue or reissue a report on an insurer’s financial statements that is not warranted in the circumstances, due to material violations of statutory accounting principles prescribed by the Director, generally accepted auditing standards, or other professional or regulatory standards; (b) Not to perform audit, review or other procedures required by generally accepted auditing standards or other professional standards; (c) Not to withdraw an issued report; or (d) Not to communicate matters to an insurer’s audit committee. Statutory/Other Authority: ORS 731.244 & 731.488 Statutes/Other Implemented: ORS 731.488 History: ID 11-2008, f. & cert. ef. 7-29-08 ID 9-2008, f. 6-30-08, cert. ef. 7-1-08
836-011-0230 Canadian and British Companies In the case of Canadian and British insurers, the annual audited financial report is the annual statement of total business on the form filed by such companies with their domiciliary supervision authority and audited by an independent chartered accountant. For such insurers, the letter required under OAR 836-011-0150 shall state that the accountant is aware of the requirements relating to the annual audited statement filed with the Director under OAR 836-011-0120 and shall affirm that the opinion expressed conforms to those requirements. Statutory/Other Authority: ORS 731.244 & 731.488 Statutes/Other Implemented: ORS 731.488(2)(b) - 731.488(2)(c) History: ID 22-2002, f. & cert. ef. 11-27-02 ID 4-1992, f. & cert. ef. 3-26-92
836-011-0235 Effective Dates (1) The requirements of OAR 836-011-0160(4) as amended effective July 1, 2008 apply to audits of the year beginning January 1, 2010 and thereafter. (2) The requirements of OAR 836-011-0223 first apply beginning January 1, 2010. An insurer or group of insurers that is not required to have independent audit committee members or only a majority of independent audit committee members, as opposed to a supermajority, because the total written and assumed premium is below the threshold and subsequently becomes subject to one of the independence requirements due to changes in premium has one year following the year the threshold is exceeded, but not earlier than January 1, 2010, to comply with the independence requirements. Likewise, an insurer that becomes subject to one of the independence requirements as a result of a business combination shall have one calendar year following the date of acquisition or combination to comply with the independence requirements. (3) The requirements of OAR 836-011-0100 to 836-011-0230 as amended effective July 1, 2008, except for 836-011-0223, are effective beginning with the reporting period ending December 31, 2010 and each year thereafter. An insurer or group of insurers that is not required to file a report because the total written premium is below the threshold and subsequently becomes subject to the reporting requirements shall have two years following the year the threshold is exceeded, but not earlier than December 31, 2010, to file a report. Likewise, an insurer acquired in a business combination shall have two calendar years following the date of acquisition or combination to comply with the reporting requirements. Statutory/Other Authority: ORS 731.244 & 731.488 Statutes/Other Implemented: ORS 731.488 History: ID 11-2008, f. & cert. ef. 7-29-08 ID 9-2008, f. 6-30-08, cert. ef. 7-1-08
836-011-0250 Authority; Purpose; Scope (1) OAR 836-011-0250 to 836-011-0260 are adopted by the Director of the Department of Consumer and Business Services pursuant to ORS 731.244. The purpose of OAR 836-011-0250 to 836-011-0260 is to improve the Director's ability to determine whether a self-insurance program satisfies the financial requirements of ORS 30.282 and 731.036 to be exempt from the Insurance Code and to clarify the components of the annual financial statement required under ORS 30.282 and 731.036, including the timeline for providing the annual financial statement to the program participants and to the director. (2) OAR 836-011-0250 to 836-011-0260 apply to every public body that establishes a self-insurance program that is exempt from the Insurance Code under ORS 30.282 and 731.036. (3) OAR 836-011-0250 to 836-011-0260 do not limit the Director's authority to order, conduct or perform examinations of self insurance programs to determine whether the program complies with applicable criteria for exemption from the Insurance Code. Statutory/Other Authority: ORS 731.244 Statutes/Other Implemented: ORS 30.282 & 731.036 History: ID 1-2011, f. & cert. ef. 2-4-11
836-011-0253 Definitions As used in OAR 836-011-0250 to 836-011-0260: (1) “Annual contributions” means total contributions paid by program participants less any premium collected from participants to procure insurance of any kind. (2) “Annual financial statement” means the financial report required under ORS 731.036 or the annual independently audited financial statement provided to program participants under ORS 30.282. The report described in this rule must comply with all applicable Government Accounting Standards Board requirements. Statutory/Other Authority: ORS 731.244 Statutes/Other Implemented: ORS 30.282 & 731.036 History: ID 1-2011, f. & cert. ef. 2-4-11
836-011-0255 Reserve Adequacy In order to demonstrate that a self-insurance program complies with the reserve adequacy provisions contained in ORS 30.282(6)(d) or 731.036(4), (5) or (6), the demonstration of compliance must be accompanied and supported by the written actuarial report issued by a qualified actuary. As used in this rule, “qualified actuary” means: (1) For property or casualty insurance, a person who is either: (a) A member in good standing of the Casualty Actuarial Society; or (b) A member in good standing of the American Academy of Actuaries who has been approved as qualified for signing casualty loss reserve opinions by the Casualty Practice Council of the American Academy of Actuaries. (2) For health insurance, a person who is a member in good standing of the American Academy of Actuaries, or a person recognized by the American Academy of Actuaries as qualified for such actuarial valuation. Statutory/Other Authority: ORS 731.244 Statutes/Other Implemented: ORS 30.282 & 731.036 History: ID 13-2011, f. & cert. ef. 9-21-11 ID 1-2011, f. & cert. ef. 2-4-11
836-011-0258 Unallocated Reserve Account In order to demonstrate compliance with the requirement to maintain an unallocated reserve account as set forth in ORS 30.282(6)(e)in which total assets exceed total liabilities by the greater of 25 percent of annual contributions or $250,000, total liabilities must include all liabilities identified by a qualified actuary including but not necessarily limited to the items listed in ORS 30.282(6)(d). Statutory/Other Authority: ORS 731.244 Statutes/Other Implemented: ORS 30.282 & 731.036 History: ID 1-2011, f. & cert. ef. 2-4-11
836-011-0260 Distribution of Annual Financial Statement A public body or the administrator of a self-insurance program must make the annual financial statement available to program participants and to the director not later than six months after the close of the program’s fiscal year. Statutory/Other Authority: ORS 731.244 Statutes/Other Implemented: ORS 30.282 & 731.036 History: ID 1-2011, f. & cert. ef. 2-4-11
836-011-0300 Statutory Authority; Statutes Implemented (1) OAR 836-011-0300 to 836-011-0390 apply to insurers that are subject to the capital and surplus requirements of ORS 731.554 and insurers that are subject to the capital and surplus requirements of 731.566. (2) OAR 836-011-0300 to 836-011-0390 are adopted pursuant to the authority of ORS 731.244, 731.554, 731.574 and 733.210 for the purpose of implementing 731.554 and 731.574. Statutory/Other Authority: ORS 731.244, ORS 731.554 & ORS 733.210 Statutes/Other Implemented: ORS 731.554 & ORS 731.574 History: ID 14-2011, f. & cert. ef. 10-31-11 ID 7-1995, f. & cert. ef. 11-15-95
836-011-0310 RBC Reports (1) Each domestic insurer shall, on or prior to each March 1 (the "filing date"), prepare and submit to the Director a report of its RBC levels as of the end of the calendar year just ended, in a form and containing such information as is required by the RBC instructions. In addition, each domestic insurer shall file its RBC report: (a) With the NAIC in accordance with the RBC instructions; and (b) With the insurance commissioner in any state in which the insurer is authorized to do business, if the insurance commissioner has notified the insurer of its request in writing, in which case the insurer shall file its RBC report not later than the later of: (A) 15 days from the receipt of notice to file its RBC report with that state; or (B) The filing date. (2) A life or health insurer's RBC shall be determined in accordance with the formula set forth in the RBC instructions. The formula shall take into account (and may adjust for the covariance between) the following, determined in each case by applying the factors in the manner set forth in the RBC instructions: (a) The risk with respect to the insurer's assets; (b) The risk of adverse insurance experience with respect to the insurer's liabilities and obligations; (c) The interest rate risk with respect to the insurer's business; and (d) All other business risks and such other relevant risks as are set forth in the RBC instructions. (3) A property and casualty insurer's RBC shall be determined in accordance with the formula set forth in the RBC instructions. The formula shall take into account (and may adjust for the covariance between) the following, determined in each case by applying the factors in the manner set forth in the RBC instructions: (a) Asset risk; (b) Credit risk; (c) Underwriting risk; and (d) All other business risks and such other relevant risks as are set forth in the RBC instructions. (4) An excess of capital over the amount produced by the risk-based capital requirements contained in OAR 836-011-0300 to 836-011-0390 and the formulas, schedules and instructions referenced in 836-011-0300 to 836-011-0390 is desirable in the business of insurance. Accordingly, insurers should seek to maintain capital above the RBC levels required by 836-011-0300 to 836-011-0390. additional capital is used and useful in the insurance business and helps to secure an insurer against various risks inherent in, or affecting, the business of insurance and not accounted for or only partially measured by the risk-based capital requirements contained in 836-011-0300 to 836-011-0390. (5) If a domestic insurer files an RBC report that in the judgment of the Director is inaccurate, the Director shall adjust the RBC report to correct the inaccuracy and shall notify the insurer of the adjustment. The notice shall contain a statement of the reason for the adjustment. An RBC report as so adjusted is an "adjusted RBC report" for purposes of OAR 836-011-0300 to 836-011-0390. Statutory/Other Authority: ORS 731.244, 731.554 & 733.210 Statutes/Other Implemented: ORS 731.554 & 731.574 History: ID 14-2011, f. & cert. ef. 10-31-11 ID 7-1995, f. & cert. ef. 11-15-95
836-011-0340 Authorized Control Level Event (1) “Authorized control level event” means any of the following events: (a) The filing of an RBC report by the insurer indicating that the insurer’s total adjusted capital is greater than or equal to its mandatory control level RBC but less than its authorized control level RBC; (b) Notification by the Director to the insurer of an adjusted RBC report indicating the event in subsection (a) of this section, if the insurer does not challenge the adjusted RBC report under OAR 836-011-0360; (c) If, pursuant to OAR 836-011-0360, the insurer challenges an adjusted RBC report that indicates the event in subsection (a) of this section, notification by the Director to the insurer that the Director has, after a hearing, rejected the insurer’s challenge; (d) The failure of the insurer to respond to a corrective order, in a manner satisfactory to the Director, if the insurer has not challenged the corrective order under OAR 836-011-0360; or (e) If the insurer has challenged a corrective order under OAR 836-011-0360 and the Director has, after a hearing, rejected the challenge or modified the corrective order, the failure of the insurer to respond to the corrective order in a manner satisfactory to the Director subsequent to rejection or modification by the Director. (2) In the event of an authorized control level event with respect to an insurer, the Director shall: (a) Take such actions as are required under OAR 836-011-0330 regarding an insurer with respect to which an regulatory action level event has occurred; or (b) If the Director determines it to be in the best interests of the policyholders and creditors of the insurer and of the public, take actions necessary to cause the insurer to be placed under regulatory control under ORS 734.059 to 734.440. If the Director takes such actions, the authorized control level event is sufficient grounds for the Director to take action under 734.150(1) or (4) or 734.170, and the Director shall have the rights, powers and duties with respect to the insurer as are set forth in 734.059 to 734.440. Statutory/Other Authority: 731.244, 731.554 & 733.210 Statutes/Other Implemented: ORS 731.554 & 731.574 History: ID 7-1995, f. & cert. ef. 11-15-95
836-011-0350 Mandatory Control Level Event (1) “Mandatory control level event” means any of the following events: (a) The filing of an RBC report indicating that the insurer’s total adjusted capital is less than its mandatory control level RBC; (b) Notification by the Director to the insurer of an adjusted RBC report that indicates the event in subsection (a) of this section, if the insurer does not challenge the adjusted RBC report under OAR 836-011-0360; or (c) If, pursuant to OAR 836-011-0360, the insurer challenges an adjusted RBC report that indicates the event in subsection (a) of this section, notification by the Director to the insurer that the Director has, after a hearing, rejected the insurer’s challenge. (2) In the event of a mandatory control level event: (a) With respect to an insurer transacting life insurance, the Director shall take actions necessary to place the insurer under regulatory control under ORS 734.059 to 734.440. In that event, the mandatory control level event is sufficient grounds for the Director to take action under 734.150(1) or (4) or 734.170, and the Director shall have the rights, powers and duties with respect to the insurer as are set forth in 734.059 to 734.440. Notwithstanding the provisions of this subsection, the Director may forego action for not more than 90 days after the mandatory control level event if the Director finds there is a reasonable expectation that the mandatory control level event may be eliminated within the 90-day period. (b) With respect to an insurer transacting property and casualty insurance, the Director shall take actions necessary to place the insurer under regulatory control under ORS 734.059 to 734.440, or, in the case of an insurer that is writing no business and that is running off its existing business, may allow the insurer to continue its run-off under the supervision of the Director. In either event, the mandatory control level event is sufficient grounds for the Director to take action under 734.150(1) or (4) or 734.170, and the Director shall have the rights, powers and duties with respect to the insurer as are set forth in 734.059 to 734.440. Notwithstanding the provisions of this subsection, the Director, may forego action for not more than 90 days after the mandatory control level event if the Director finds there is a reasonable expectation that the mandatory control level event may be eliminated within the 90 day period. Statutory/Other Authority: ORS 731.244, 731.554 & 733.210 Statutes/Other Implemented: ORS 731.554 & 731.574 History: ID 7-1995, f. & cert. ef. 11-15-95
836-011-0360 Hearings An insurer may request a hearing, as provided in ORS 731.240, for the purpose of challenging any determination or action by the Director in connection with any event described in this rule. The insurer shall notify the Director of its request for a hearing not later than the fifth day after notification by the Director under any of the events described in this rule. Upon receipt of the insurer’s request for a hearing, the Director shall set a date for the hearing. The date shall be not less than 10 nor more than 30 days after the date of the insurer’s request. The events to which the opportunity for a hearing under this rule relates are as follows: (1) Notification to an insurer by the Director of an adjusted RBC report; (2) Notification to an insurer by the Director that the insurer’s RBC plan or revised RBC plan is unsatisfactory, and such notification constitutes a regulatory action level event with respect to the insurer; (3) Notification to any insurer by the Director that the insurer has failed to adhere to its RBC plan or revised RBC plan and that the failure has a substantial adverse effect on the ability of the insurer to eliminate the company action level event with respect to the insurer in accordance with its RBC plan or revised RBC plan; or (4) Notification to an insurer by the Director of a corrective order with respect to the insurer. Statutory/Other Authority: ORS 731.244, 731.554 & 733.210 Statutes/Other Implemented: ORS 731.240, 731.554 & 731.574 History: ID 7-1995, f. & cert. ef. 11-15-95
836-011-0380 Supplemental Provisions; Exemption (1) 836-011-0300 to 836-011-0390 are supplemental to any other provisions of the laws of this state, and do not preclude or limit any other powers or duties of the Director under such laws, including, but not limited to, OAR 836-011-0100 to 836-011-0120. (2) OAR 836-011-0300 to 836-011-0390 do not apply to any domestic insurer transacting property and casualty insurance that: (a) Writes direct business only in this state; (b) Writes direct annual premiums of $2 million or less; and (c) Assumes no reinsurance in excess of five percent of direct premium written. Statutory/Other Authority: ORS 731.244, 731.554 & 733.210 Statutes/Other Implemented: ORS 731.554 & 731.574 History: ID 14-2011, f. & cert. ef. 10-31-11 ID 7-1995, f. & cert. ef. 11-15-95