reglab/statecodes huggingface dataset:
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 43 - WORKERS'COMPENSATION INSURANCE RATING SYSTEM AND AUDIT PROCEDURES › Section 836-043-0024 - Right to Apply

Current through Register Vol. 63, No. 7, July 1, 2024
(1) An employer
			 who is eligible for workers' compensation insurance as set forth in this rule
			 may apply to the Plan Administrator for workers' compensation insurance under
			 the Plan as provided in this rule if the employer is unable to obtain a
			 reasonable offer of voluntary coverage. The employer must apply on the forms
			 and according to the directions prescribed in
Exhibits 1
,
2
, and
3
to this rule.
(2) For purposes of section (1) of this rule,
			 the offer of a rating plan approved by the Insurance Commissioner is considered
			 an offer of voluntary coverage or insurance. Any dispute arising from the
			 application or interpretation of this rule is subject to the dispute resolution
			 procedure provided in OAR 836-043-0070. As used in this section, "reasonable
			 rating plan" means any rating program approved for use in a state by the
			 regulatory authority.
(3) An
			 employer seeking coverage under the Plan or a representative of the employer
			 must:
(a) Within 60 days before applying for
			 coverage under the Plan, apply for workers' compensation insurance and receive
			 a declination from at least one insurer licensed to write and actively writing
			 workers' compensation insurance in Oregon. The declination must be from the
			 insurer providing workers' compensation insurance to the employer at the time
			 of application, if any. Proof of cancellation or nonrenewal from the insurer
			 shall be considered to be the required declination.
(b) Maintain a record of all insurer
			 declinations for the policy period in force. The employer must provide this
			 information to the Plan Administrator or servicing carrier upon request. The
			 information must include:
(A) Insurer
			 name;
(B) Person contacted at
			 insurer;
(C) Mailing address and
			 phone number of insurer contact; and
(D) Date of declination.
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 43 - WORKERS'COMPENSATION INSURANCE RATING SYSTEM AND AUDIT PROCEDURES › Section 836-043-0028 - Application by Electronic Transmission or Telephone

Current through Register Vol. 63, No. 7, July 1, 2024
(1) An application made by electronic
			 transmission or telephone must be completed in full and must be signed. The
			 signature may be submitted by facsimile transmission. The effective date of
			 coverage shall be determined in accordance with OAR 836-043-0044.
(2) An employer or the representative of an
			 employer may apply for assigned risk coverage electronically by accessing
			 NCCI's online application service. Upon receipt of an application submitted
			 electronically, the Plan Administrator shall review the information to
			 determine whether the employer is eligible. If the employer is eligible and the
			 application is complete and accurate, the Plan Administrator shall calculate
			 electronically the initial or deposit premium amount and request the employer
			 to submit the amount to continue the application process. The amount of the
			 initial or deposit premium shall be determined in accordance with rules set
			 forth in Exhibit 3 to OAR 836-043-0024.
(3) The employer or its agent must submit the
			 total required initial premium to the Plan Administrator by credit card or
			 electronic funds transfer. A portion of the deposit premium may be satisfied
			 with an authorized surety's financial guaranty bond as provided in OAR
			 836-043-0034.
(4)
(a) The employer or the representative of the
			 employer may contact the Plan Administrator by telephone to apply for assigned
			 risk coverage. If the information provided by telephone is complete, accurate,
			 and the employer is deemed eligible for coverage, the Plan Administrator shall:
(A) Advise the employer of the total
			 estimated annual premium and required initial or deposit premium required to
			 bind coverage; and
(B) Fax the
			 employer a copy of the completed applications as set forth in
Exhibits
			 1
and
2
of OAR 836-043-0024  for review and
			 signature.
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 43 - WORKERS'COMPENSATION INSURANCE RATING SYSTEM AND AUDIT PROCEDURES › Section 836-043-0032 - Nonelectronic Application

Current through Register Vol. 63, No. 7, July 1, 2024
(1) An
			 employer or the representative of an employer may submit a signed and completed
			 application as set forth in
Exhibits 1
and
2
of OAR
			 836-043-0024  by United States mail or a private overnight mail delivery
			 service. The application must be sent to the Plan Administrator and must
			 include the initial or deposit premium as calculated by the employer or its
			 agent. The application may include a requested date for the coverage to become
			 effective. A portion of the deposit premium may be satisfied with an authorized
			 surety's financial guaranty bond as provided in OAR 836-043-0034.
(2) The employer or its agent shall refer to
Exhibit 3
to OAR 836-043-0024  of the application for the
			 applicable deposit or initial premium rules.
Exhibits referenced are available from the
				  agency.
Stat. Auth.: ORS
				  656.427,
				  656.730 &
				  731.244
Stats. Implemented: ORS
				  656.427,
				  656.730 &
				  737.265
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 43 - WORKERS'COMPENSATION INSURANCE RATING SYSTEM AND AUDIT PROCEDURES › Section 836-043-0034 - Surety Bonds

Current through Register Vol. 63, No. 7, July 1, 2024
For all submission options under OAR 836-043-0028  or
				836-043-0032, the employer submitting an application may satisfy a portion of
				the deposit premium with an authorized surety's financial guaranty bond, but
				the cash portion of the deposit premium must be no less than either the minimum
				premium or 25 percent of the total estimated annual premium, whichever is
				greater. The employer may select any minimum deposit percentage listed in the
				NCCI Plan Oregon State Instructions page (Exhibit 3 to OAR 836-042-0024) and
				post a bond for the premium difference between that percentage and the minimum
				deposit percentage otherwise applicable.
Stat. Auth.: ORS
				  656.427,
				  656.730 &
				  731.244
Stats. Implemented: ORS
				  656.427,
				  656.730 &
				  737.265
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 43 - WORKERS'COMPENSATION INSURANCE RATING SYSTEM AND AUDIT PROCEDURES › Section 836-043-0041 - Application Review

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Upon
			 receiving an application submitted under OAR 836-043-0028  or 836-043-0032, the
			 Plan Administrator shall review the application for completeness and determine
			 whether the employer is eligible for coverage under the Plan.
(2) The Plan Administrator may request
			 additional information to establish eligibility, to assign appropriate
			 classification codes, to calculate applicable premiums and to otherwise
			 appropriately process the application. The additional information may include:
(a) Tax documentation;
(b) Ownership information, including a
			 request to complete and sign a change of ownership form;
(c) Contracts, including worker leasing
			 company arrangements, temporary employment agency contract or franchise
			 agreements;
(d) Supplemental worker
			 leasing company applications;
(e)
			 Additional information regarding short-term policies requests, such as
			 verification of annualized payroll;
(f) Proof of declination of voluntary
			 coverage;
(g) Prior policy
			 information including claims and audits, corporate charters, Dun &
			 Bradstreet, Inc. reports, signed financial statements and signed letters of
			 explanation; and
(h) Any other
			 information that the Plan Administrator considers necessary to process the
			 application.
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 43 - WORKERS'COMPENSATION INSURANCE RATING SYSTEM AND AUDIT PROCEDURES › Section 836-043-0044 - Binding Coverage

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The
			 Plan Administrator may issue binders to eligible employers in accordance with
			 the provisions of this Plan. The servicing carrier shall provide coverage under
			 any binder issued by the Plan Administrator, subject to the provisions of the
			 Plan, any applicable policy terms or conditions, and any applicable laws,
			 rules, or regulations. The Plan Administrator shall send copies of the binder
			 to the employer's representative, if any, the servicing carrier to which the
			 Plan Administrator assigned the employer and the Director of the Department of
			 Consumer and Business Services.
(2)
			 The Plan Administrator shall issue a binder for an employer when the Plan
			 Administrator determines all of the following occur:
(a) The employer is eligible for
			 coverage;
(b) The Plan
			 Administrator has received an application that is complete and signed by an
			 officer, owner or other designee with power of attorney and includes any
			 additional information within the established time frame; and
(c) The Plan Administrator has received the
			 total initial premium or deposit premium within the established time
			 frame.
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 43 - WORKERS'COMPENSATION INSURANCE RATING SYSTEM AND AUDIT PROCEDURES › Section 836-043-0046 - Rates and Forms, Policy Term, Additional Coverages and Other Provisions

Current through Register Vol. 63, No. 7, July 1, 2024
(1) An insurer
			 issuing a policy to an employer to which the Plan applies shall write the
			 policy according to the classifications, forms including but not limited to
			 policy endorsements, change of ownership forms, supplemental leasing forms, and
			 rates and rating plans including retrospective rating plans authorized for use
			 in the assigned risk market by the Plan Administrator and approved by the
			 Insurance Commissioner as required in ORS
			 737.265(2).
(2) The policy information page and all
			 endorsements must be properly identified as a Plan or AR (Assigned Risk)
			 policy, and policy information submitted on hard copy must show the Plan or AR
			 indicator with the policy number on the Information Page. The Policy
			 Information Page and all endorsements must be submitted to the Plan
			 Administrator or its designee within the time frame and in the format
			 established by the Plan Administrator.
(3) The servicing carrier shall issue a
			 policy and proof of coverage as required by ORS
			 656.419, for a term of at least
			 one year, unless insurance for a shorter term has been requested. A short-term
			 policy may be obtained only once within a 12-month period unless otherwise
			 agreed by the servicing carrier.
(4) The servicing carrier may make additional
			 coverages described in the Supplement to the Plan available to an
			 employer.
Stat. Auth.: ORS
				  656.427,
				  656.730 &
				  731.244
Stats. Implemented: ORS
				  656.419,
				  656.427,
				  656.730 &
				  737.265
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 43 - WORKERS'COMPENSATION INSURANCE RATING SYSTEM AND AUDIT PROCEDURES › Section 836-043-0048 - Additional States' Coverage

Current through Register Vol. 63, No. 7, July 1, 2024
Except as shown on the binder or verification page, all
				assignments under the plan are to be made on an intrastate basis. An employer
				seeking insurance for operations in one or more states other than the state
				listed in the Policy Information Page may request its servicing carrier to
				furnish insurance in the additional states in accordance with OAR 836-043-0050 and the Interstate Assignments section of the Plan. A Plan policy that affords
				coverage on operations in more than one state shall clearly indicate the
				premium developed for each state separately.
Stat. Auth.: ORS
				  656.427,
				  656.730 &
				  731.244
Stats. Implemented: ORS
				  656.427,
				  656.730 &
				  737.265
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 43 - WORKERS'COMPENSATION INSURANCE RATING SYSTEM AND AUDIT PROCEDURES › Section 836-043-0050 - Interstate Assignments

Current through Register Vol. 63, No. 7, July 1, 2024
(1) Any
			 employer assigned under this Plan and desiring workers' compensation insurance
			 for operations for physical locations in states other than that covered by the
			 Plan may request its servicing carrier to furnish such insurance in such
			 additional states. If the servicing carrier is licensed in those additional
			 states and will write workers' compensation insurance on a voluntary basis, the
			 servicing carrier must do so on a voluntary basis and in accordance with the
			 law, rates, rules, classifications, and regulations applicable to the voluntary
			 workers' compensation market in those states.
(2) If the servicing carrier does not wish to
			 provide the insurance on a voluntary basis, the servicing carrier may provide
			 assigned risk coverage in such additional states subject to the following:
(a) Workers' compensation insurance may be
			 provided only in accordance with OAR 836-043-0001  to 836-043-0091  in those
			 states that have a Workers' Compensation Insurance Plan that is similar to this
			 Plan and that allows employers applying for coverage under those Plans to
			 obtain coverage for operations in Oregon;
(b) A servicing carrier providing such
			 insurance shall collect all premiums due based on the exposure for the physical
			 operations in those other states. The effective date of such insurance in such
			 additional states shall be the day after premium is received; however, in the
			 event coverage in such additional states is on an "if any" basis, the effective
			 date of such coverage shall be the day following receipt of an acceptable
			 request for such insurance by the servicing carrier. A copy of the policy
			 Information Page and all endorsements, properly identified as a Plan or AR
			 (Assigned Risk) policy, shall be submitted to the appropriate Plan
			 Administrator having jurisdiction in the state where the coverage is
			 effected;
(c) The rates, rating
			 plans, classifications, and policy forms used to provide coverage in such
			 additional states shall be those that are:
(A)
			 Applicable to the assigned risk market;
(B) On file and have been approved by the
			 regulators in those additional states; and
(C) Authorized for use in the assigned risk
			 market by the Plan Administrator;
(d) The servicing carrier must be a signatory
			 to an agreement providing reinsurance for workers' compensation insurance
			 policies issued to assigned risk market employers under the organizing
			 principles in each state where the coverage shall be provided; and
(e) A servicing carrier unwilling or unable
			 to provide insurance for an employer in additional states shall refer the
			 employer to the Plan Administrator or appropriate administrative organization
			 for the states where coverage is needed for instructions and
			 applications.
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 43 - WORKERS'COMPENSATION INSURANCE RATING SYSTEM AND AUDIT PROCEDURES › Section 836-043-0053 - Premium Obligations

Current through Register Vol. 63, No. 7, July 1, 2024
(1)
(a) The Plan Administrator shall not
			 knowingly make an assignment unless the employer has met all undisputed
			 workers' compensation premium obligations on any previous workers' compensation
			 insurance including but not limited to obligations to:
(A) Any servicing carrie;
(B) A direct assignment carrier; or
(C) A voluntary insurer.
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 43 - WORKERS'COMPENSATION INSURANCE RATING SYSTEM AND AUDIT PROCEDURES › Section 836-043-0056 - Insurer Cancellation and Nonrenewal of Workers' Compensation Insurance Policies or Surety Bonds

Current through Register Vol. 63, No. 7, July 1, 2024
The following provisions of this rule govern when an insurer
				cancels or fails to renew a workers' compensation insurance policy or surety
				bond:
(1) An insurer canceling
			 coverage under ORS 656.427 for an employer who has
			 an undisputed premium obligation not more than 30 days past due shall take the
			 following actions:
(a) At the time the
			 insurer gives notice of the cancellation, the insurer shall notify the employer
			 of the right to placement in the Plan if eligible under OAR
			 836-043-0043;
(b) Provide the
			 employer, not later than the tenth day after the employer's contact for Plan
			 coverage, an accurately filled-in "Request for Coverage" form, using the form
			 prescribed in Exhibits 1 and 2 to OAR 836-043-0024; and
(c) The insurer shall date stamp the request
			 for coverage identifying the insurer's name and forward the form to the Plan
			 administrator with payment, not later than the fifth day after receiving the
			 signed request form from the employer.
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 43 - WORKERS'COMPENSATION INSURANCE RATING SYSTEM AND AUDIT PROCEDURES › Section 836-043-0060 - Assignment Formula

Current through Register Vol. 63, No. 7, July 1, 2024
(1) This rule
			 describes the mechanism used to provide for the random and equitable
			 distribution of employers under the Plan to servicing carriers. The Plan
			 Administrator may override the random assignment process to ensure the
			 availability of requested Plan coverages to the employer.
(2)
(a) A
			 servicing carrier is responsible for providing services on behalf of those
			 insurers that have elected to meet their Plan participation requirements by
			 subscribing to the organizing principles. The Plan Administrator shall
			 determine the allocable percentage of the servicing carrier through an
			 objective selection process. However, the combined allocable percentages for
			 all servicing carriers must be equal to the combined net voluntary premiums
			 written for all signatories to the organizing principles as compared to the
			 total net premiums of all insurers participating in the Plan in Oregon. An
			 approved servicing carrier may receive assignments for any risk eligible for
			 coverage under the Plan.
(b) When
			 assigning an employer to an insurer, the Plan Administrator shall consider the
			 employer's prior Plan coverage, special requirements, including but not limited
			 to additional states or federal coverage, and premium size.
(c) Any carrier authorized by the U.S.
			 Department of Labor to provide coverage under the U.S. Longshore and Harbor
			 Workers' Compensation Act (USL&HW) and extension acts is eligible to
			 receive assignments requesting the same coverage in the assigned risk market. A
			 carrier with USL&HW authorization is also eligible for assignments
			 requesting Maritime, Program I or II. The Plan Administrator shall determine
			 request for assignments under the USL&HW Act, Maritime, or extension acts
			 coverage in accordance with the assignment methodology established by the Plan
			 Administrator.
(d) A servicing
			 carrier that has previously reported voluntary or assigned risk premium writing
			 in any state, that is subject to the Federal Coal Mine Health and Safety Act or
			 that has previously accepted assignments in any state for operations that are
			 subject to the Federal Coal Mine Health and Safety Act, will receive
			 assignments requesting such coverage in accordance with the assignment
			 methodology established by the Plan Administrator.
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 43 - WORKERS'COMPENSATION INSURANCE RATING SYSTEM AND AUDIT PROCEDURES › Section 836-043-0062 - Issuance and Continuation of Policy

Current through Register Vol. 63, No. 7, July 1, 2024
(1) A policy must be issued, renewed or
			 reinstated without a lapse in coverage when premium, including an interim
			 premium audit or installment payment, is received by the carrier or postmarked
			 by the United States Postal Service prior to the policy effective date or
			 cancellation date.
(2) The
			 following table establishes reinstatement provisions for a policy that is
			 cancelled or renewed: [Table not included. See ED. NOTE.]
(3) A servicing carrier may impose additional
			 requirements if necessary to effect the reinstatement of a policy. Effective or
			 reinstatement dates for a lapse in coverage shall be determined in the same
			 manner provided in OAR 836-043-0044.
Tables referenced are available from the
				  agency.
Stat. Auth.: ORS
				  656.427,
				  656.730 &
				  731.244
Stats. Implemented: ORS
				  656.427,
				  656.730 &
				  737.265
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 43 - WORKERS'COMPENSATION INSURANCE RATING SYSTEM AND AUDIT PROCEDURES › Section 836-043-0064 - Renewal, Nonrenewal

Current through Register Vol. 63, No. 7, July 1, 2024
(1) A
			 servicing carrier shall send a renewal or nonrenewal notice of impending
			 expiration of coverage to the insured, the representative of the insured and
			 the Plan Administrator at least 45 days before the expiration date of
			 insurance. Upon receipt of the required premium, the servicing carrier shall
			 issue the policy in accordance with Oregon statutes and rules and furnish a
			 copy of such policy and all endorsements, properly identified as a Plan or AR
			 (Assigned Risk) policy, to the Plan Administrator or its designee within the
			 time and in the format established by the Plan Administrator.
(2) The servicing carrier shall apply the
			 deposit premium paid by an employer in the Plan against the deposit required
			 for a renewal policy, if any. If the servicing carrier assigned the renewal
			 policy is different from the previous servicing carrier, then the previous
			 servicing carrier shall promptly bill the employer for the final billing
			 period, including any audit adjustments. If the final billing is not paid on or
			 before the 30th day after the billing, the renewal servicing carrier may
			 immediately issue a cancellation notice.
(3) A servicing carrier may refuse to renew a
			 policy if the servicing carrier is unable to supply a required type of
			 coverage, including but not limited to longshore, coal mine, maritime or
			 additional state exposures.
Stat. Auth.: ORS
				  656.427,
				  656.730 &
				  731.244
Stats. Implemented: ORS
				  656.427,
				  656.730 &
				  737.265
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 43 - WORKERS'COMPENSATION INSURANCE RATING SYSTEM AND AUDIT PROCEDURES › Section 836-043-0066 - Reassignment

Current through Register Vol. 63, No. 7, July 1, 2024
(1) An employer may
			 submit to the Plan Administrator a written request for reassignment to a
			 different carrier, if available. The employer must submit the request in
			 writing to the Plan Administrator not later than the 30th day and not earlier
			 than the 60th day prior to the expiration of the current policy unless the Plan
			 Administrator approves another request period or at the request of the
			 regulatory authority. The employer must provide the Plan Administrator with an
			 acceptable reason for the request with appropriate documentation. Acceptable
			 reasons for an employer to request reassignment include:
(a) Documented poor servicing carrier service
			 such as failure to provide timely issuance of statements, policies, and
			 endorsements, or services not provided under the policy;
(b) Documented refusal of or inability of a
			 servicing carrier to supply a required type of coverage including but not
			 limited to longshore, coal mine, maritime or additional state
			 exposures;
(c) Documented failure
			 of a servicing carrier to return premium due to the insured, where there is no
			 valid bona fide premium dispute;
(d) Based on the servicing carrier's A.M.
			 Best Rating or financial size category, if appropriate documentation is
			 provided to and approved by the Plan Administrator; or
(e) Any other substantial documented reason
			 subject to approval of the Plan Administrator
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 43 - WORKERS'COMPENSATION INSURANCE RATING SYSTEM AND AUDIT PROCEDURES › Section 836-043-0068 - Cancellation

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The servicing
			 carrier may cancel a policy after its issuance, with the approval of the
			 Insurance Commissioner, for any of the reasons stated in this section. The
			 servicing carrier must first provide an opportunity for cure and must file the
			 reasons for cancellation with the Insurance Commissioner for necessary approval
			 before issuance of the cancellation notice and inform the Plan Administrator of
			 the reason for the cancellation. A proposed cancellation shall be deemed
			 approved unless disapproved by the Insurance Commissioner on or before the 15th
			 day after the servicing carrier filed the reasons for cancellation. A servicing
			 carrier may initiate cancellation when the employer:
(a) Has failed to comply with reasonable
			 health, safety or audit requirements;
(b) Has violated any of the terms and
			 conditions under which the insurance was issued;
(c) Is not eligible for workers' compensation
			 insurance under the Plan;
(d)
			 Refuses to allow the servicing carrier or NCCI reasonable access to its
			 facilities or its files and records for audit or inspection;
(e) Refuses to disclose to the servicing
			 carrier the full nature and scope of the employer's exposure;
(f) Has had the employer's worker leasing
			 company license denied, revoked or suspended; or
(g) The employer does not properly report
			 changes in ownership.
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 43 - WORKERS'COMPENSATION INSURANCE RATING SYSTEM AND AUDIT PROCEDURES › Section 836-043-0071 - Dispute Resolution Procedures

Current through Register Vol. 63, No. 7, July 1, 2024
(1)
(a) A
			 bona fide premium dispute is established when the employer or its
			 representative provides:
(A) Written notice
			 to the Plan Administrator that includes all of the following:
(i) All documentation relevant to the
			 dispute, including written notice to the insurer or the servicing carrier
			 detailing the specific areas of dispute;
(ii) Description of the attempts to reconcile
			 the differences; and
(iii) A
			 specific request for a review of all documentation, appropriate action to
			 resolve the areas of dispute and if necessary, a hearing before the appropriate
			 administrative or regulatory body having jurisdiction over assigned risk
			 related appeals.
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 43 - WORKERS'COMPENSATION INSURANCE RATING SYSTEM AND AUDIT PROCEDURES › Section 836-043-0072 - Voluntary Coverage

Current through Register Vol. 63, No. 7, July 1, 2024
Notwithstanding OAR 836-043-0089, an insurer that wishes to
				insure an employer as voluntary business may do so at any time. If a servicing
				carrier wishes to insure voluntarily one of its plan accounts, the servicing
				carrier must provide written notice to both the Plan Administrator and the
				agent of the employer of its intent at least 30 days in advance of the
				effective date of the servicing carrier's voluntary coverage. If the insurer is
				not the servicing carrier, the servicing carrier shall cancel its policy pro
				rata and the assignment shall automatically terminate as of the later of the
				effective date of the voluntary insurer's policy or the date the voluntary
				insurer provides written notice to the servicing carrier of its
				coverage.
Stat. Auth.: ORS
				  656.427, ORS
				  656.730 & ORS
				  731.244
Stats. Implemented: ORS
				  656.427, ORS
				  656.730 & ORS
				  737.265
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 43 - WORKERS'COMPENSATION INSURANCE RATING SYSTEM AND AUDIT PROCEDURES › Section 836-043-0076 - Takeout Credit

Current through Register Vol. 63, No. 7, July 1, 2024
The Plan Administrator shall establish a take-out credit
				program. The take-out credit program shall operate in accordance with the
				following guidelines:
(1) Each insurer
			 participating in the Plan who removes an employer insured through the Plan is
			 eligible for a take-out credit application against the premium used to
			 calculate the Plan participation base of the enrolled insurer. An insurer shall
			 contact the take-out credit administrator to enroll in the program. Any insurer
			 licensed in Oregon and writing workers' compensation insurance coverage is
			 eligible to enroll in the take-out credit program.
(2) An insurer may not receive credit for any
			 policy removed from the Plan within one calendar year after the insurer or its
			 affiliate wrote the policy in the voluntary market. An insurer who does not
			 enroll in the program cannot receive take-out credit.
(3) An insurer, other than the last voluntary
			 insurer of record, may remove a policy without any restriction on the length of
			 time the policy resided in the assigned risk market.
(4) For the purpose of the take-out credit
			 program, the requirements of this rule apply to an insurer's affiliates as well
			 as to the insurer.
(5) The kind and
			 amount of coverage to be offered a voluntary employer shall not be less than
			 those afforded by the policy being replaced unless the kinds and amounts of
			 coverage are refused by the employer.
(6) The granting of credits is subject to the
			 following provisions:
(a) An insurer who
			 removes an employer from the assigned risk market is eligible for a take-out
			 credit application equal to the annual premium from the voluntary policy times
			 a credit factor from the following schedule: Total Premium -- $5,000 or Less --
			 Total Premium -- Greater than $5,000:
(A)
			 First Year -- 3:1 -- 1:1;
(B)
			 Second Year -- 3:1 -- 1:1;
(C)
			 Third Year -- 3:1 -- 1:1.
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 43 - WORKERS'COMPENSATION INSURANCE RATING SYSTEM AND AUDIT PROCEDURES › Section 836-043-0079 - Notification of Outstanding Premium

Current through Register Vol. 63, No. 7, July 1, 2024
A servicing carrier or its representative shall furnish
				information regarding outstanding assigned risk and voluntary workers'
				compensation insurance premium or other workers' compensation monetary policy
				obligations identified by the servicing carrier or its representative to the
				Plan Administrator or its designee in accordance with the appropriate Assigned
				Carrier Performance Standards or other state market conduct or regulatory
				requirements. A servicing carrier shall report to the Plan Administrator within
				five business days of the servicing carrier's determination all instances of
				noncompliance and of any compliance by the employer.
Stat. Auth.: ORS
				  656.427,
				  656.730 &
				  731.244
Stats. Implemented: ORS
				  656.427,
				  656.730 &
				  737.265
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 43 - WORKERS'COMPENSATION INSURANCE RATING SYSTEM AND AUDIT PROCEDURES › Section 836-043-0082 - Policyholder Services

Current through Register Vol. 63, No. 7, July 1, 2024
A servicing carrier shall provide all of the following to each
				policyholder or a representative of the insured and its producer:
(1) Access to audit, loss control and safety
			 services.
(2) Prompt, professional
			 handling of claims, including investigation, resolution and
			 communication.
(3) Fair and prompt
			 responses to complaints and disputes.
(4) Access to appropriate information
			 regarding the classification of the business and the factors influencing the
			 policy premium.
Stat. Auth.: ORS
				  656.427,
				  656.730 &
				  731.244
Stats. Implemented: ORS
				  656.427,
				  656.730 &
				  737.265
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 43 - WORKERS'COMPENSATION INSURANCE RATING SYSTEM AND AUDIT PROCEDURES › Section 836-043-0087 - Producer Changes and Compensation

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The servicing carrier must pay a fee to
			 the licensed agency on all new and renewal policies after the policy is issued.
			 The servicing carrier shall pay the producer as premium is collected. The
			 servicing carrier must process and mail fee payments within 30 days after the
			 date the policy is issued or 30 days after the receipt of premium. The carrier
			 may withhold payments until an accumulative total of $25 per agency is reached.
			 However, the servicing carrier must pay the agency their fees upon request
			 regardless of the amount or if the withholding time period exceeds six months.
			 The fee payment also may be applied to return fees that the agency may owe to
			 the servicing carrier from other assigned risk policies for that agency. The
			 servicing carrier may not pay a producer fee on premium not actually
			 collected.
(2) The producer fee
			 paid by the servicing carrier shall be in accordance with the producer fee
			 percentage scales and shall be paid at the rate filed by the Plan Administrator
			 with the Director.
(3) It is the
			 responsibility of the servicing carrier to determine whether the producer is
			 properly licensed in the appropriate jurisdictions for payment of producer
			 fees. If the producer listed on the application is not properly licensed, or if
			 the employer designates a representative other than a licensed producer, the
			 servicing carrier shall accept the assignment but the producer fee will not be
			 paid. For all other purposes, the producer shall be treated as the producer of
			 record.
(4) The employer may
			 request a change to the licensed producer. The employer shall provide written
			 notice to the servicing carrier, generally in the form of a "producer of
			 record" letter. The request must be made prior to the date of renewal, or with
			 the consent of the servicing carrier at another agreed upon time.
Stat. Auth.: ORS
				  656.427,
				  656.730 &
				  731.244
Stats. Implemented: ORS
				  656.427,
				  656.730 &
				  737.265
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 43 - WORKERS'COMPENSATION INSURANCE RATING SYSTEM AND AUDIT PROCEDURES › Section 836-043-0089 - Confidentiality of Information

Current through Register Vol. 63, No. 7, July 1, 2024
The servicing carrier shall keep in confidence and must not,
				except as directed by the insured or the producer of record, or as otherwise
				may be required by law or the Insurance Commissioner, disclose to any third
				party, or use for the benefit of itself or any third party, such detailed
				information as it may obtain by virtue of its position as the servicing
				carrier. Such information may be used solely for the evaluation, underwriting,
				and insuring of coverage under this Plan and not for any other purpose. The
				servicing carrier may not use any information the servicing carrier obtains in
				its capacity as the servicing carrier to request, encourage, or solicit
				employers it insures under this Plan to use the services of any specific
				insurance producer, agency, insurer or group of insurers, including but not
				limited to direct writers affiliated with the servicing carrier, for purposes
				of providing voluntary workers' compensation insurance or other lines of
				insurance to such employer.
Stat. Auth.: ORS
				  656.427,
				  656.730 &
				  731.244
Stats. Implemented: ORS
				  656.427,
				  656.730 &
				  737.265
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 43 - WORKERS'COMPENSATION INSURANCE RATING SYSTEM AND AUDIT PROCEDURES › Section 836-043-0091 - Self-Funded Plan

Current through Register Vol. 63, No. 7, July 1, 2024
It is essential for maintaining the viability of the Plan to
				establish and maintain rates at a level that will permit the Plan to operate
				with no more than a reasonable subsidy required from voluntary insured
				employers. The NCCI shall maintain necessary ratemaking data in order to permit
				the actuarial determination of rates and rating plans appropriate for the
				business insured through the Plan. Each servicing carrier shall report its
				experience on business written under the Plan to the NCCI in a format
				prescribed by the NCCI. It is the responsibility of the NCCI to monitor both
				rate adequacy and Plan results. The NCCI shall notify the Insurance
				Commissioner if excessive losses are indicated to enable the Insurance
				Commissioner to take corrective action.
Stat. Auth.: ORS
				  656.427, ORS
				  656.730 & ORS
				  731.244
Stats. Implemented: ORS
				  656.427, ORS
				  656.730 & ORS
				  737.265
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 43 - WORKERS'COMPENSATION INSURANCE RATING SYSTEM AND AUDIT PROCEDURES › Section 836-043-0101 - Statutory Authority; Purpose; Applicability

Current through Register Vol. 63, No. 7, July 1, 2024
(1) OAR 836-043-0101  to 836-043-0170  are
			 adopted by the Director of the Department of Consumer and Business Services
			 pursuant to the requirements of ORS
			 737.318.
(2) OAR 836-043-0101  to 836-043-0170  establish a premium audit program system for workers' compensation insurance
			 for the following purposes:
(a) Achieving
			 equitable premium charges to insureds and collecting credible ratemaking
			 data;
(b) Prescribing minimum
			 standards for an efficient premium audit program that ensures an adequate
			 proportion of an insurer's earned premium is audited and focuses on operations
			 where accurate reporting may be difficult or where misreportings are more
			 likely;
(c) Educating insureds
			 about the audit reporting function of the rating system;
(d) Establishing a continuing test audit
			 program of all insurers;
(e)
			 Providing an appeal process pursuant to ORS
			 737.318(3)(d)
			 and 737.505(4) to
			 (5) for insureds to request a hearing to
			 dispute the results of an audit, as described in a final premium audit billing
			 issued by an insurer to an insured.
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 43 - WORKERS'COMPENSATION INSURANCE RATING SYSTEM AND AUDIT PROCEDURES › Section 836-043-0105 - Definitions

Current through Register Vol. 63, No. 7, July 1, 2024
As used in OAR 836-043-0101  to 836-043-0170, unless the context
				requires otherwise:
(1) "Audit" means
			 a process of verification of information used to determine the premium for a
			 workers' compensation insurance policy that is performed in one of the
			 following formats:
(a) "Desk audit" means an
			 audit performed by an insurer at a site, other than the insured's principal
			 place of business, mutually agreed to by the insurer and the insured. A desk
			 audit does not consist of an examination of a payroll report submitted by the
			 insured to the insurer in lieu of an audit.
(b) "Field audit" means an audit performed by
			 an insurer at the insured's principal place of business, work site, or other
			 site mutually agreed to by the insurer and the insured.
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 43 - WORKERS'COMPENSATION INSURANCE RATING SYSTEM AND AUDIT PROCEDURES › Section 836-043-0115 - Insurer Audit Procedure Guide

Current through Register Vol. 63, No. 7, July 1, 2024
Each insurer shall develop audit procedures that include all of
				the features described in this rule or, in place thereof, more comprehensive
				alternative procedures that will consistently achieve minimum standards as
				measured by the Oregon Test Audit Program under OAR 836-043-0125. The features
				are as follows:
(1) The auditor shall
			 perform a pre-audit review to ensure that the insurer provided or made
			 available to the auditor all relevant information and materials, as listed in
			 this section.
(a) The bureau Basic
			 Manual;
(b) Bureau bulletins,
			 "Scopes Manual" on classifications or similar classifications and committee
			 minutes pertinent to classifications and auditing procedures;
(c) Policy information that provides a
			 description of operations and a summary of payrolls by
			 classification;
(d) Bureau
			 Inspection & Classification Reports that provide a description of
			 operations and summary of employees by classification;
(e) Bureau Experience Rating Modification
			 Worksheets that provide payroll classifications and claims allocation
			 history;
(f) Claims data in
			 sufficient detail to verify classification assignments;
(g) Pertinent correspondence;
(h) Prior year's audit file if renewed, or
			 copies of interim payroll reports, if on an interim reporting basis.
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 43 - WORKERS'COMPENSATION INSURANCE RATING SYSTEM AND AUDIT PROCEDURES › Section 836-043-0120 - Minimum Standards of Insured Education Program

Current through Register Vol. 63, No. 7, July 1, 2024
(1) At or before policy issuance, an insurer
			 shall make available to the insured information covering the matters identified
			 in this section. This information may be delivered via electronic means, as
			 provided for under ORS Chapter 84.
(a) Which
			 workers are subject to the Workers' Compensation Law for whom premiums must be
			 paid;
(b) What remuneration is
			 subject to premium charges;
(c) How
			 to divide payroll between assigned classifications, as established in OAR
			 836-042-0060;
(d) The requirements
			 for verifiable records, as established in OAR 836-042-0060;
(e) The existence and nature of premium
			 audits and the appeal process afforded insureds by ORS
			 737.505;
(f) The insured's responsibility to notify
			 the insurer of changes in the business structure and operations; and
(g) The classification notice requirements
			 prescribed by OAR 836-043-0175  to 836-043-0185.
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 43 - WORKERS'COMPENSATION INSURANCE RATING SYSTEM AND AUDIT PROCEDURES › Section 836-043-0125 - Purpose

Current through Register Vol. 63, No. 7, July 1, 2024
A Test Audit Program shall be conducted by the bureau to carry
				out ORS
				737.318.
				To perform this function, the bureau shall maintain the test audit staff for
				examining pertinent records of a number of Oregon insureds and insurers
				established according to the schedule in Exhibit 1 of OAR 836-043-0130, or
				other appropriately credible audit levels as determined by the director. The
				purposes of the test audit program are as follows:
(1) To check the accuracy and reliability of
			 each insurer's audits, verify the classifications assigned, and assure that the
			 premiums charged are based upon filed rates, rating plans and rating systems on
			 file with and approved by the director;
(2) To establish minimum auditing standards
			 and to develop a program for monitoring insurer performance toward the
			 achievement of established standards; and
(3) To improve audit proficiency through the
			 evaluation of insurer auditing practices.
Exhibits referenced are available from the
				  agency.
Statutory/Other Authority: ORS
				  731.244 & 737.318
Statutes/Other Implemented: ORS
				  737.318
Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 43 - WORKERS'COMPENSATION INSURANCE RATING SYSTEM AND AUDIT PROCEDURES › Section 836-043-0130 - Selection of Risks for Test Audit

Current through Register Vol. 63, No. 7, July 1, 2024
(1) All insurers or insurer groups shall be
			 test audited on a continuous basis. Each quarter, the bureau shall send a list
			 of policies selected for test audit to each insurer's Oregon policy issuing
			 office or other office designated by the insurer.
(2) The number of policies to be selected for
			 each insurer shall be determined based on Exhibit 1, using the insurer's
			 current policy premium distribution and the error ratio from the insurer's
			 previous test audits. The policy premium distribution shall be based on
			 estimated annual standard premium reported by the insurer for policies subject
			 to selection. For each insurer, the error ratio shall be the number of policies
			 found to have audit errors divided by the total number of policies test audited
			 during the latest six quarters. The error ratio shall be assigned a credibility
			 weight, as described in Exhibit 1, and the complement weight shall be assigned
			 to the statewide error ratio of all insurers for the latest six quarters. The
			 credibility weighted error ratio for the insurer shall be used to determine the
			 policy sample rates in Exhibit 1.
(3) The quarterly list of policies selected
			 for test audit shall be randomly drawn from an insurer 'entire book of workers'
			 compensation business, subject to the requirements of section (2) of this rule.
			 Additional policies may be added at the request of the director. The list shall
			 indicate, for each insurer or insurer group, the insured, the policy number,
			 the issuing office (if available) and the policy dates. This list shall only
			 include policies with expiration dates not less than 90 days prior to the date
			 of selection. Unless otherwise requested by the director, this list shall
			 exclude:
(a) Wrap-up policies approved under
			 ORS
			 737.602 or Sections 1 and 2, Chapter 336, Oregon Laws 1995;
(b) Policies for risks that have been test
			 audited within the four-year period prior to the date of selection;
			 and
(c) Policies canceled by either
			 the insured or the insurer prior to the expiration date of the
			 policy.