Oregon Administrative Rules › Chapter 436 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, WORKERS' COMPENSATION DIVISION › Division 50 - EMPLOYER/INSURER COVERAGE RESPONSIBILITY › Section 436-050-0160 - Applying for Certification as a Self-Insured Employer

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Required
			 information. An employer applying for certification as a self-insured employer
			 must submit:
(a) A completed Form 1868,
			 "Application for Self-Insurance;"
(b) Proof of an adequate staff qualified to
			 process the employer's claims under OAR
			 436-050-0150(2);
(c) The employer's audited financial
			 statements or audited annual reports for the last three fiscal or calendar
			 years, subject to the following:
(A) If the
			 audited financial statements of a parent company are provided in place of
			 statements for the employer, the director will not authorize the individual
			 employer to be self-insured under its own program, unless a parental company
			 guarantee can be obtained. Otherwise, it will be necessary for the parent
			 company to be the self-insured employer or to separately insure the employer.
			 In the context of this section, a parent company is a legal entity that owns a
			 majority interest in the employer, or owns a majority interest in another
			 entity or succession of entities that own a majority interest in the employer;
			 or
(B) If audited financial
			 statements are not available at the time of application, the employer may
			 submit certified financial statements in place of audited financial statements
			 or annual reports. However, if the certified financial statements submitted are
			 insufficient to evaluate the employer's financial ability, the director may
			 require the employer to submit audited financial statements;
(d) The employer's most recent
			 experience rating modification worksheet and supporting documentation.
			 Applicants with prior Oregon experience who do not submit this data will be
			 assigned a 1.50 experience rating modification pending receipt of the data. All
			 those without prior Oregon experience will be assigned a 1.00 experience rating
			 modification;
(e) The type,
			 retention, and limitation levels of excess workers' compensation insurance the
			 employer is planning to obtain as required by OAR
			 436-050-0170;
(f) If applicable, a service agreement
			 between the employer and service company that has been signed by both parties
			 that meets the requirements of OAR
			 436-050-0210. The agreement
			 must:
(A) Be submitted at least 14 days
			 before the desired date of certification, and be approved by the director
			 before the service company begins processing claims, regardless of the
			 effective date established in the agreement; and
(B) The agreement must also contain the
			 location, mailing address, telephone number, and any other contact information
			 of the service company;
(g) Proof of the employer's ability to
			 provide an acceptable security deposit, including either:
(A) Evidence from a surety bond company
			 admitted to do surety business in this state that they will issue a surety bond
			 for the employer, as Principal, and the Oregon Department of Consumer and
			 Business Services, Workers' Compensation Division, as Obligee; or
(B) Evidence from a qualified bank that they
			 will issue an irrevocable standby letter of credit for the employer with the
			 Oregon Department of Consumer and Business Services as the
			 beneficiary;
(h) Evidence
			 of an occupational safety and health loss control program in accordance with
			 OAR 437-001 as required by ORS
			 656.430(10);
			 and
(i) Evidence of:
(A) The employer's authorization to do
			 business in this state under ORS chapters 58, 60, 62, 63, 65, 67, 70, and 648,
			 as applicable; or
(B) The
			 employer's status as a municipal or public corporation as defined in ORS
			 297.405.