436-050-0290 Commencement/Termination/Cancellation of Employers with a Self-Insured Employer Group; Effect on Net Worth; Extension of Coverage; Change in Entity; Change of Address; Recordkeeping (1) Addition of new members. Prospective new members of a self-insured employer group must submit an application to the board of trustees, or its administrator. The administrator of a group consisting of private employer members may not be a member of the group. The trustees, or administrator, may approve the application for membership under the bylaws of the self-insured employer group. Once approved, the administrator or board of trustees must submit to the director, within 30 days of the effective date of membership, a completed Form 1869, “Endorsement to Self-Insured Group Application” or a form approved by the director, which must be accompanied by: (a) A current financial statement of the employer applying; (b) Evidence of at least $150,000 individual net worth if the prospective new member is a private employer; (c) An agreement signed by the administrator of the self-insured employer group and the employer, making the employer jointly and severally liable for the payment of any compensation and moneys due to the director by the group or any member of the group; or, if a governmental subdivision self-insured employer group, a resolution by the governing body of each governmental subdivision binding it to be liable for the payment of any compensation and other amounts due to the director under ORS chapter 656 incurred by that governmental subdivision during the period of group self-insurance; (d) A statement showing the effect on the new combined net worth of the group; and (e) The employer’s payroll by class and description and loss information for the last four fiscal or calendar years. (2) Incomplete or incorrect submissions. Incomplete submissions or incorrectly completed endorsements to add new members received by the director will not be considered filed, and the employer will not be included in the self-insurance of the self-insured employer group. Failure to file a correct and complete endorsement with the required supporting documentation within 30 days of the effective date of membership may result in the assessment of civil penalties. (3) Termination or cancellation of membership. An individual employer member may elect to terminate its membership in a self-insured employer group or be subject to cancellation by the group under the bylaws of the group, subject to the following: (a) Groups consisting of private employer members must cancel the membership of any private employer member that fails to maintain the minimum individual net worth required under OAR 436-050-0260(15). Cancellation must occur within 30 days of the group’s receipt of the employer member’s most recent fiscal year end financial data demonstrating insufficient net worth. (b) No later than 10 days before the effective date of the member’s cancellation, or immediately following the date of the member’s termination, the self-insured employer group must submit the following information to the director: (A) A statement, without disclaimers or qualifying language as to the accuracy of the information provided: (i) Showing the effect of the employer member’s termination or cancellation on the remaining combined net worth of the group; and (ii) Certifying that the group continues to meet the combined net worth requirements in OAR 436-050-0260; (B) Evidence that the employer member requesting termination or being canceled has made alternate arrangements for coverage if the member continues to employ subject workers; (C) Evidence that the employer member requesting termination or being canceled has been provided a written reminder about its potential future liability as described in (1)(c) of this rule; and (D) The expected date of cancellation or termination. (c) If an employer member’s membership in a self-insured employer group is canceled, terminated, or ceases due to the cancellation or revocation of the group’s certification, the group must, upon the member’s request, provide the member with the most recent claim loss data for the member as reported to the director under OAR 436-050-0175(3)(a). The group must provide the claim loss data no later 30 days after receiving the member’s request. (4) Revocation of certification due to change in membership. If the director determines the cancellation or termination of an employer member adversely affects the self-insured employer group to the extent that the group no longer qualifies for self-insurance certification, the director may revoke the self-insured employer group’s certification under OAR 436-050-0340(1). (5) Change in entity. If there is a change in the entity of an employer member, the employer member must reapply for membership within the self-insured employer group under this rule. A change in entity includes, but is not limited to: (a) A partner joining or leaving a partnership; (b) A sole proprietorship, partnership, or corporation, changing to another of those ownership structures; or (c) An employer selling an existing business to another person, except in the case of a corporation. (6) Change in name or address. An employer member of a group must, within 10 days after there is a change of address or assumed business name, notify the board of trustees or administrator of the change. (a) A change of address includes, but is not limited to: (A) Establishment of a new or additional location; or (B) Termination of an existing location. (b) The administrator or board of trustees must, within 10 days, submit to the director an endorsement as notice of the change. The endorsement must state specifically which location is being deleted or which is being added and identify if address is the mailing, operating, or the principal place of business of the location. (7) Maintenance of coverage records. The self-insured employer group is responsible for maintaining coverage records relating to each employer member, to include: (a) The employer member’s application for membership in the self-insured employer group, with original signatures; (b) The employer member’s liability agreement under OAR 436-050-0270(1)(g), or resolution under OAR 436-050-0280(1)(g), with original signatures; (c) Cancellation or termination notices; (d) Reinstatement applications and notices; and (e) Records on the locations of employers that have been canceled or have terminated their participation in the group. Statutory/Other Authority: ORS 656.726(4) Statutes/Other Implemented: ORS 656.434 & ORS 656.440 History: WCD 7-2022, amend filed 11/07/2022, effective 01/01/2023 WCD 7-2017, amend filed 12/14/2017, effective 01/01/2018 WCD 5-2016, f. 11-28-16, cert. ef. 1-1-17 WCD 10-2014, f. 8-15-14, cert. ef. 9-15-14 WCD 6-2012, f. 10-4-12, cert. ef. 1-1-13 WCD 5-2001, f. 6-22-01, cert. ef. 7-1-01 WCD 7-1989, f. 12-22-89, cert. ef. 1-1-90 WCD 9-1985, f. 12-12-85, cert. ef. 1-1-86 WCD 5-1985, f. 12-10-85, cert. ef. 1-1-86, Renumbered from 436-051-0420 WCD 7-1983, f. 12-22-83, cert. ef. 12-27-83 WCD 4-1982, f. 2-10-82, cert. ef. 2-15-82