Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 54 - INSURANCE POLICIES › Section 836-054-0210 - Required Content of Large Deductible Provisions

Current through Register Vol. 63, No. 7, July 1, 2024
An insurer which issues a workers' compensation insurance
				policy with a large deductible provision must file such provision with the
				Director for approval as required by ORS
				742.003. The provision must
				satisfy the following requirements:
(1) A large deductible provision must clearly
			 and prominently state that the insured employer must report all workers'
			 compensation insurance claims to the insurer and the insurer retains
			 responsibility to administer claims and to pay all costs and
			 expenses.
(2) A large deductible
			 provision must state that the insurer will delete the provision effective not
			 more than ten (10) days following discovery that an insured employer has on
			 three occasions within the policy period known of but not reported a workers'
			 compensation insurance claim to the insurer or has on any occasion within the
			 policy period made direct payment of claim costs. The provision may further
			 state that the insurer will cancel the policy with notice pursuant to ORS
			 656.427 or that the insurer will
			 delete the provision retroactively to the date of the offense with penalties
			 stated in the provision. When a large deductible provision is deleted, the
			 premium for any remaining portion of a policy term will be computed using the
			 rating plans applied by the insurer to the policy prior to deductible credits
			 except that any system of expense gradation applied by the insurer to similar
			 policies must be used.
(3) A large
			 deductible provision must specify that the basis for the Workers' Compensation
			 Premium Assessment will be premium earned prior to any premium credits or
			 modifications for the large deductible provision.
(4) A large deductible provision must specify
			 that the basis for any assessments by the Plan Administrator for the Workers'
			 Compensation Insurance Plan specified by OAR 836-043-0001  to 836-043-0090 will
			 be premium earned prior to any premium credits or modifications for the large
			 deductible provision.
(5) A large
			 deductible provision must define explicitly which expenses, if any, will be
			 billed to the employer in addition to direct claim costs and specify whether
			 such expenses are subject to the deductible limits together with direct claim
			 costs or will be billed in addition to deductible amounts.
(6) A large deductible provision must state
			 that the premium credit percentage and amount for the large deductible will be
			 recalculated after final premium audit based on actual premium or exposures and
			 after any retrospective premium adjustments for retrospectively rated
			 policies.
(7) A large deductible
			 provision shall contain an offer for the insurer to provide occupational safety
			 and health loss control consultative services as required by ORS
			 654.097.
(8) A large deductible provision shall
			 contain minimum eligibility requirements of not less than $500,000 estimated
			 country-wide annual premium prior to large deductible credits or premium
			 credits based on premium size. The minimum deductible limit per claim for each
			 injury or illness may not be less than $75,000. An aggregate limit for
			 deductible amounts for all claims may be specified but may not be less than the
			 deductible limit per claim.
Stat. Auth.: ORS
				  731.244
Stats. Implemented: ORS
				  742.001 -
				  742.007