Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 43 - WORKERS'COMPENSATION INSURANCE RATING SYSTEM AND AUDIT PROCEDURES › Section 836-043-0145 - Disposition of Test Audits

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The
			 bureau shall submit individual results of each test audit to the office or
			 offices designated by the insurer as soon as the bureau audit is
			 completed.
(2) For those audits
			 that do not result in a significant difference, defined as in excess of $500 in
			 premium or in excess of two percent of the total standard premium, whichever is
			 greater, the bureau must notify the insurer by letter of the name of the
			 insured, the policy number and the fact that the test audit was closed without
			 change from the original audit.
(3)
			 For those audits that do develop a significant premium difference, the bureau
			 must provide the insurer with a report explaining the difference and the effect
			 of such difference upon the total premium. An example of this report template
			 is located on the Department of Consumer and Business Services, Insurance
			 Division website at
www.insurance.oregon.gov
.
(4) Results of test audits of individual
			 insurers shall be confidential data under ORS
			 731.264.
(5) Immediately upon receipt of the bureau's
			 report, the insurer shall determine whether it agrees with the bureau's
			 findings, auditing the insured if necessary. If the insurer agrees with the
			 bureau's findings, the insurer shall file the corrected information on the
			 original or, if necessary, on a revised unit statistical report. When the net
			 premium difference is not sufficient to qualify as an "error" but a single
			 difference is sufficiently large to qualify as an error prior to any offsetting
			 premium amounts, the insurer shall be advised of such differences by an
			 "advisory" notice. Also, when individual claims have been assigned to an
			 incorrect classification an "advisory" notice shall also be submitted to the
			 insurer. Upon receipt of the "advisory" notice, the insurer shall report such
			 payrolls or losses on the initial or, if necessary, a "C" (corrected) Unit
			 Statistical Report. All test audit differences must be closed within sixty days
			 of notification unless the insurer requests an extension and the request is
			 approved by the bureau.
(6) When
			 classifications utilized by the insurer are found to be in error, the bureau
			 shall take the normal appropriate action to secure compliance.
(7) Findings resulting from test audits shall
			 not be utilized in any action by an insurer to enforce premium
			 collections.
(8) If there is
			 disagreement with the bureau's findings, the insurer shall communicate with the
			 designated contact at the National Council on Compensation Insurance office to
			 resolve areas of contention.
(9)
			 When an insurer is unable to resolve test audit differences with the bureau
			 staff, the insurer may present an appeal to the committee.
(10) When an insurer is unable to resolve
			 test audit differences with the committee, the insurer may present an appeal to
			 the director for final determination.
Exhibits referenced are available from the
				  agency.
Statutory/Other Authority: ORS
				  731.244 & 737.318
Statutes/Other Implemented: ORS
				  737.318